It's Time to Reward Yourself
An interesting study recently published in the Journal of the American Heart Association (JAHA) confirms what we all learned when we were children – and serves as food for thought as to how you can improve your practice and your personal life.
X-Ray: To Be or Not to Be - That Is the Question
For the past year, I have been asked by many practicing chiropractors, college presidents, faculty and others what my opinion is on the "Choosing Wisely" guidelines the American Chiropractic Association (ACA) recently adopted for its members.
Lead Patients to the Fountain (and Foundation) of Youth
We're all seeking the fountain of youth and marketers are capitalizing on it. (Global demand for anti-aging products, treatments and services was valued at 140.3 billion in 2015, according to Zion Market Research.)
Depression & The Secondary Vessels
As an acupuncturist I see many people suffering from depression. I often think depression is the major imbalance of our culture. I have a patient I've been working with for several years. Her major challenge is chronic stubborn depression.
Neck Pain: Activation Exercises
In observing patients and studying rehab, I have learned that tight muscles are weak muscles and that stretching is sometimes less effective than muscular activation. There is a delicate balance between joints that move too little and joints that are hypermobile.
The Science Behind the Efficacy of Cosmetic Acupuncture
The beauty industry continues to boom and grow constantly, from topical creams, lotions and potions all the way to cutting edge cosmetic surgeries.
More Access to Chiropractic Instead of Opioids: H.R. 5722
With the opioid epidemic both an ongoing public health crisis and a hot topic extending well beyond the health care industry, Congress continues stepping up to the plate.
Vaccine Injury? The Autism Debate (Part 2)
As suggested in my first article on this topic [August 2018],1 my impression is that the vaccine authoritarians and radicals have not helped to mold a proper social / political environment for addressing the issue of vaccine injury.
Working for Someone Else: Know the Rules of the Game
Many of us decide to become acupuncturists because we are healers at heart and want to focus on treating patients, not because we want to own and operate a business. So we work for someone else, which can have great advantages, especially as a new graduate.
An Update From the Acupuncture Now Foundation
Since launching the Acupuncture Now Foundation (ANF), our volunteer leadership has continued to work to achieve our vision of "Creating a World Where the Benefits of Acupuncture are Known and Available to All.
Bringing Acupuncture to Ohio
The jolt of seeing a woman conscious and talking during surgery left a lasting impression in 1971 when acupuncture was on the national news.
Multichannel Access: Software for a Better Customer Experience
It is no secret that today's consumer has high expectations when it comes to how and when they can contact a business. In fact, one of the reasons clinic management software has become so popular with acupuncture practitioners is they allows customers to book appointments and make payments online day or night.
The Importance of the Scapulohumeral Rhythm
The shoulder has the greatest range of motion of any joint in the body. What is often overlooked in shoulder mechanics is that motion in the shoulder is not purely at the glenohumeral joint.
"Don't Crack My Neck": What Do You Do Next?
It's Monday morning and your first new patient of the day, a 35-year-old female, presents with chronic headaches and neck pain. The patient was referred by her primary care provider for evaluation and management without the use of cervical manipulation.
A New NCCIH Director ... One That Backs Acupuncture
The third time is a charm—the National Center for Complementary and Integrative Health (NCCIH), a division of the National Institutes of Health (NIH), announced it's newest director, Dr. Helene Langevin.
The Origin of Blood
The Roman doctor, Galen, (2nd century AD) did pivotal work to prove that blood, which he thought was produced by the liver, and the cardio vascular system existed. He conceived that the arteries and veins were two separate networks.
Possession: Blocks to Healing
Before we can approach treatment of a patient's primary elemental imbalance (AKA "Causative Factor" or "CF"), a number of specific energetic blocks must be considered and, if present, removed in order for treatment to be effective. I cannot emphasize this enough.
Your First Impression Always Deserves a Second Chance
Doctor, have you ever had a patient you just couldn't "warm up to"? You know, the kind of patient who "irks" you, who has a hidden agenda to get something you haven't anticipated, perhaps causing you to want to hide in a closet when they come in for treatment.
Support Patients With Multi-Channel Customer Service
It's no secret that today's consumers have high expectations when it comes to how and when they can contact a business. In fact, one of the reasons clinic management software has become so popular is that they allow patients to book appointments and make payments online day or night.
A Historic First for Chiropractic Assistants
The New Jersey State Board of Chiropractic Examiners will begin issuing licenses as early as Nov. 1, 2018 to chiropractic assistants who have undergone a 500-hour training course and passed a competency exam.
That's a Wrap: Compression Bands for Contemporary DCs
Over the past decade, compression bands have been increasingly utilized in trainer and manual therapy offices. I was first introduced to the compression band by Kelley Starrett, author of Becoming a Supple Leopard, and have since been using it as a teaching tool.
Time-Saving Tips for Your Practice & Life
Of all the finite resources we possess, perhaps the most valuable one is time. There never seems to be enough time to accomplish everything that must be done, and all too often we sacrifice things in our personal life to meet the demands of our practice.
Easy, Inexpensive Tools for a Successful Practice (I Promise)
Successful practitioners are the ones who know how to run a business, first and foremost. I became a licensed acupuncturist in 2006. After having worked in chiropractor's offices for nine years, I opened my own office in 2015: four treatment rooms, a back office and a waiting room.
Food for Thought: An Examination of Diet & Digestion
Even an acute poison can become an excellent drug if it is properly administered. On the other hand even a drug, if not properly administered, becomes an acute poison. — Charaka Samhita
The Benefits of Going Paperless
The benefits of going paperless in your practice are profound. If you haven't done it yet, here's why you should.
Chiropractic Management of Patellofemoral Arthralgia
Patient reports with pain in the front part of her right knee, especially during and after her weekly Zumba class. She states there has been no injury of which she is aware. No outward sign of injury is observed.
UHC Up to Its Old Tricks With Latest Headache Policy
A decade ago, UnitedHealthcare announced changes to its chiropractic services policy that declared manipulative therapy for headache unproven and ineligible for reimbursement.
The international standardization conference was held this year in Shanghai, China (June) - this was the ninth plenary session. Meetings for technical committees, or working groups also took place at the conference.
December, 2015, Vol. 15, Issue 12
Massage and the Stress Response
Making Sense of the Existing Literature
By Massage Therapy Foundation Contributor
Contributed by Beth Barberree, BA, RMT; April Neufeld, BS, LMT; and S. Pualani Gillespie LMT, MSN, RN, BCMTB
Massage has long been seen as a way for people to decrease their stress levels. With the growing number of people seeking massage therapy care in recent years, it becomes increasingly important to understand if it is effective in managing the negative health consequences of stress. In this month's article review, we explore work from a team of experienced researchers who provided a review of the existing literature in this area.
Albert Moraska, Robin Pollini, Karen Boulanger, Marissa Brooks, and Lesley Teitlebaum in their 2008 article, "Physiological Adjustments to Stress Following Massage Therapy: A Review of the Literature," provided a critical evaluation of peer-reviewed research that had investigated the relationship between massage therapy and physiological measures of stress. The authors emphasized that reviews like this one are important to understanding the effectiveness of massage therapy in the management of the health impacts of stress.
In this literature review, massage therapy was defined as "the manipulation of soft tissues for the purpose of producing physiological effects on the vascular, muscular or nervous systems of the body." Only studies where massage therapy was applied within the context of this definition were included, so any studies involving light touch modalities were excluded. The research group only included studies where the massage was provided by trained therapists, and those with adults as the participants. This process of deciding what studies will be included and excluded is called setting the inclusion criteria.
With these criteria in mind, the research team conducted a broad and extensive search of several electronic research databases, along with the researchers' own libraries, for articles that pertained to "stress" in combination with "massage," "bodywork," "physiotherapy," and "manual therapy." Articles were included when "presenting dependent variables of stress that included the hormones cortisol, epinephrine, norepinephrine, or physical measures of blood pressure (BP) and heart rate." Of the initial 1032 citations reviewed that met the search parameters, only "25 articles were found to meet all inclusion criteria."
The research team found that the 25 studies employed a diversity of experimental methods. There was large variability in session duration, "from 5 to 90 minutes, with over half (52%) of the studies having a session duration between 20 and 30 minutes." Commonly, 6 to 10 treatments were delivered, but data was most often collected following the first session. The researchers chose not to report on specific massage techniques used as the specific techniques used were reported in varying degrees of detail and those studies had varied results.
"Study populations were varied and included sexually abused women, patients with eating disorders, pain conditions, hypertension, HIV positive diagnosis, cancer, post-operative patients, critical care patients, healthy adult populations, and some specific disease states." Hormones that are markers for stress response were also noted by the researchers in this review.
Salivary cortisol is easy to collect from the mouth and non-invasive, so massage therapy studies frequently use this method for assessing cortisol levels. Of those studies that measured reductions in salivary cortisol it appears that the decrease, although significant, may be short term. There does not appear to be a cumulative reduction in salivary cortisol levels with multiple massage treatments. The subject populations in these studies were highly varied, "which suggests that many groups may experience an immediate benefit from massage therapy for this variable. . . However, most study participants were either healthy adults or experiencing chronic life stress."
Urinary cortisol has been used to assess changes following multiple massage treatments. The studies that assessed urinary cortisol did so at baseline and after 5 weeks of twice-weekly massage and found evidence of a cumulative reduction in urinary cortisol.
"Epinephrine (adrenaline) is produced mainly from the adrenal medulla and reflects the subject's sympathomedullar activity" [activity from this gland]. "Epinephrine output is mainly influenced by mental stress."
"Norepinephrine (noradrenaline) is considered an indicator of sympathoneuronal [sympathetic nervous system] activity as most of the circulating norepinephrine is released from sympathetic nerve endings. This hormonal defense reaction is aimed at routing energy from organs to muscles for the muscles" and "is more responsive to physical activity" than to mental stress. However, the authors state a decrease in either of these hormones "may indicate a physiological reduction in stress" routing circulation from organs to muscles.
Cardiovascular responses reported in 16 of the studies were blood pressure and heart rate. "Increases in blood pressure, respiration and heart rate are all physiological manifestations of the sympathetic nervous system's response to stressful events." There were mixed results in the studies reporting these responses, with the differences including what body parts were massaged, the massage techniques applied, overall health of the study participants, duration of the massage session, and single session versus multiple sessions. No studies reported an increase in blood pressure. Also the effect of massage on heart rate, although not sustainable, seemed to be repeatable as decreases following massage occurred one visit after the next.
It was noted by the research team that their review was based on the outlined inclusion criteria. The authors contrasted their review with a meta-analysis completed by Moyer et al. (2004). Results of the two reviews were not consistent. The two reports differed with respect to levels of salivary cortisol and blood pressure; the Moyer et al. (2004) report found no massage sessions that affected salivary cortisol and did find a change for blood pressure. The authors of the current review conclude that the difference in findings reveals more about the current state of massage therapy research than about the clinical effects of massage therapy on stress measures. Overall, "the studies reviewed showed a variety of methodological shortcomings."
Of significant interest to readers is the authors' conclusion that, "to date, the research on massage therapy and stress has not progressed to demonstrate efficacy in a trial of sufficient size or methodological rigor to make definitive statements about its efficacy in reducing stress as measured by physiological variables in any particular patient population." It is unfortunate that the evidence does not support making strong conclusions about the impact of massage therapy on physiological stress indicators. It is also unclear why there is no mention of heart rate and blood pressure in the key words listed as search criteria in the current review, even though these non-hormonal markers of stress were included in the review. This may lead to difficulty in having this review come up in other literature searches.
The authors identify opportunities for future studies to examine the effectiveness of massage therapy. Based on the diversity among the studies in the current review, the authors emphasized the need for research that employs methodological rigor including large sample sizes, detailed and reproducible treatment protocols, and reporting of clinical and statistical significance.
The Massage Therapy Foundation continues to support and promote research as seen in this month's review. The Foundation is currently accepting scientific submissions for our 2016 International Massage Therapy Research Conference (IMTRC) that will be held in Seattle, Washington, May 12-15. More information about the conference as well as the submission guidelines are now available on our website at www.massagetherapyfoundation.org.
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