Patients reported outcome: “There Will Be Blood”
It was said that ability of the mind to re-evaluate existing convictions upon acquiring new information is the sign of intellect. In other words a human being has to always strive to doubt existing authoritative opinions, push the envelope, and get outside the box to be on the winning team of progress.
Unfortunately, the physical implication of this approach is not always cut and dry and often people, accustomed to the black and white mindset, instead of going out of the box attempt to break it.
In one of the online discussion I came across an opinion that doubted the good old scientifically and clinically proven fact, that massage increases arterial blood flow supply to the tissue. Having raised an objection to defend the view that I go by in my daily practice, I offered a scientific explanation on why the studies supporting the idea that “massage therapy disturbing blood supply” are incompetent and why using such study as a reference is invalid.
Oh boy, I was accused of being retrograde, was drowned with buzz words and pepper sprayed with rhapsody of “out of the box” thinking.
This incident brought to mind a recent case of a patient with severe pain in the left side of lower back. The patient was a young female, who experienced severe pain at the left side lower back in sitting position or while standing up.
She was referred to our clinic by a physician who was Board Certified in Physical Medicine, and who had been invited to consult the patient when she was hospitalized. Her physician informed me that all necessary tests, including CT and MRI, had found no significant spinal abnormalities.
Yet she endured quite an Odyssey of pain. She couldn’t work and her day-today life was greatly affected. The patient became depressed, anxious, and mentally exhausted.
In a desperate attempt to help, her primary care physician referred her to the Multidiscipline Pain Management Center in hope of addressing her condition with a combination of acupuncture, chiropractic adjustments and physical therapy. This approach failed and her pain and disability increased. The pain became so intolerable that she was hospitalized.
After an intense flair up her pain management physician recommended surgery of electrodes insertion in the spinal cord to prevent pain stimuli reaching the brain. However, the Pain Management center’s psychiatrist insisted that such treatment should be postponed and antipsychotic medications, as well as psychotherapy, should be attempted first.
Patient was practically disabled for four months prior to her visit to our clinic.
These symptoms could have been the result of many different abnormalities, including spinal disorders, muscular syndromes, and abdominal disorders accompanied by adhesions. By having lower back MRI Drs. excluded spinal disorders and various blood tests excluded significant inner organ disorders that could produce this type of symptoms.
Thinking over her case, because of absence of trigger point in lower back region, I suspected that her problem lies in the abdomen area and decided to start with abdominal massage in order to accelerate venous blood and lymph drainage. These techniques are gentle and always feel pleasant. After a few minutes of applying the drainage techniques she began to cry. My first thought was that my therapy had increased intensity of pain. As I asked her about it, she replied, “No, it didn’t increase my pain.” At this moment, it was obvious to me that she had released psychological tension and suppressed emotions. This is very common in patients who suffer from intense chronic pain, and such a reaction ignited hope for a successful rehabilitation.
After application of abdominal drainage techniques she reported a significant decrease of pain intensity in lower back region. I asked her to sit up. Since for many months, prior to this treatment, she couldn’t sit for 10 minutes experiencing excruciating pain, it was to our great surprise, the pain didn’t come back as she sat still for more than 10 minutes. At this moment, my suspicion that her severe back pain was the result of significant venous stasis and lymphedema in the abdominal cavity grew into assurance. Acceleration of venous blood drainage means increase of arterial blood supply. If, God forbid, massage therapy disturbs blood supply, we would make people sick.
In the last 20 years evidence-based medicine was “redirected“ to draw its conclusions from research papers exclusively, disregarding clinical outcome as evidence-based proof. Therefore, ignoring critical evidence, my opponents supported the conclusion that ”massage therapy disturbs blood supply.”
Incidentally, this approach of evidence based medicine recently was denied by FDA. Today, in order for product to be approved, not only research paper is needed, but also patients reported outcome should be positive. Massage therapy is about results or clinical outcome. Any methodology, being it oriental massage therapy or conventional scientifically developed methods, has to be clinically tested as safe and effective. The essence of abdominal massage is to replace large amounts of venous blood in the abdomen area with the fresh arterial blood rich with nutrients and oxygen, thus letting the body to heal itself. Considering that 30 to 35% of all blood supply is delivered to abdominal cavity, it’s hard to imagine that massage somehow doesn’t increase the flow of arterial blood. In other words if it weren’t for massage than what did it?
When trying to get out of the box, one should remember that this is a considerable mental and spiritual effort, which cannot be undertaken by bluntly undermining everything that was done by the previous generations of exceptional human minds, who, perhaps, also stepped out of their boxes in attaining this knowledge.
To review the full protocol for abdominal/visceral massage please click here.
Please click this link to get familiar with the scientific review of the studies that concluded that ”massage therapy disturbs blood supply”
“Prostitution VS. Massage therapy” Are we contributing to the confusion?
20+ years ago when I arrived to Los Angeles, I have obtained the only available at that time license of massage technician. Adding to my bewilderment was fact that my license was listed under adult entertainment category.
Neither of the stipulations made much sense. “How could such developed country lump this powerful health related methodology into the adult entertainment category?”
Little by little I started to understand that many so-called “massage“ places were nothing else, but illegal whore houses.
Having realized this, I still couldn’t comprehend in what way licensing massage therapists alongside prostitutes, helps to fight illegal activities or, in general, serve any constructive purpose.
From studying the US history I remembered how alcohol prohibition has shown that more Americans got addicted to alcohol, organized crime activities expanded to multi-million dollar operations, killing innocent people, etc.
With elimination of prohibition, things changed for the better: less alcoholics, more tax revenue and more education on why not to drink excessively.
Not that I am a proponent of legalized prostitution, but by this day I cannot understand why regulating prostitution was given such priority over massage therapy, bouncing it off to the road ditch of marginalization.
Why were these memories brought back to life? Because I came across the video that you can see embedded below.
Initially I thought this lady was a hooker. Then I realized she was an actress who did quite a talented humorous impression on “masseuse” whatever “masseuse” means. More than that. This video is a clever take of the stereotype that some general public has of massage: something that make you feel good, with some sexual implication, that although is not always explicit and is officially prohibited, yet nevertheless always present.
In itself the suspicion in sexual undertone is only half the problem. The bigger issue is that by perceiving massage as a cover up for sexual favors, such perception denies massage any treatment affect, reducing its healing power to a sort of voodoo.
Apparently, out of realization of utter unfairness of such perception for practitioners who put out great deal of honest physical and emotional effort in their work, lately there came a trend that attempts to elevate massage therapist from the abyss of prostitution and voodoo to a lofty heights of science. I am talking about the “evidence based” approach to massage. This approach goes into another extreme and denies all the methods of physical rehabilitation that are not supported by the latest scientific research, thus parting themselves from all hints of voodoo-ism and at the same time ricocheting at such methods as acupuncture, homeopathic medicine, Chinese cupping with all the concepts that go alone with it such as meridians, yin-yang, chi, etc. In its unchanged righteousness it also denies 9/10th of the Western massage protocols, scientifically developed in the previous centuries as long as it lies East of the Atlantic Time zone.
If my conjecture about the genesis of “evidence based” trend is true, I am startled by the great discontinuity between the popular believe and the proposed cure. In my view massage therapist should be placed more or less in between those extremes.
The country where I came from had many idiotic rules and regulations, but somehow in the field of massage therapy the globally planned economy worked well. Massage therapist over there was neither scientist nor a prostitute, but a medical professional. Like a construction worker who fulfills the orders of architect or structural engineer, a massage therapist worked with the medical doctor, and following his/her treatment plan, provided therapy to patients. Continuing this analogy, a good construction worker has to have a very specific set of skills. These skills are not the skills that allow him to calculate the sheer force or a momentum acting at the edge of a cantilever, or the knowledge of how the future building would fit in the overall city landscape, but nevertheless are highly specific set of skills allowing the construction worker to put the building together. In the same way, massage therapist doesn’t have to know the intricacies of biochemistry and cellular level or molecular biology, but there is a set of absolutely pertinent practical skills specific to massage that a therapist has to know extremely well. That is: How to perform step by step protocols that are developed by scientists for massage therapists.
Surely there were exceptions out of this rule. There were a number of brilliant researchers and medical doctors who at the same time possessed hands on massage skills. But as a general rule, the reverse wasn’t true.
I think that such approach would fit even better in the framework of highly compartmental American mentality, where a specialist knows his/her area very well, but feels quite helpless outside it.
That’s why I feel that making massage therapists to graduate Master and PhD programs, where they would be force fed by hours of anatomy, physiology and pathologies is going to be just as productive as offering PhD programs to construction workers. Therefore I feel that the group that pushes such program requirements does nothing else but promoting some special interests and, if being given a go, would hurt the entire massage field tremendously.
In my view the damaged image of massage practitioner should be cleaned up by the collective movement, medical and massage fields toward each other. Once American public stars commonly seeing massage therapist in the hospital setting, the video like the one I offered you above, would stop being done. The much larger involvement of massage therapist in the overall preventive efforts would make our nation much healthier and would free much of taxpayers’ money for bigger and better things.
During the 1st 10 years of practicing in America I was witnessed significant positive changes in regards of the general public as well as in evolution of medical societies’ views on therapies by means of massage. Thanks to the effort of some individuals, AMTA and ABMP, now we have California state massage therapy certification. It’s a very encouraging progress.
Using the opportunity would like to thank everyone who has contributed to this certifications. I was and am hopeful that little by little, we will get our desired place in the healthcare system. It was a significant move forward.
When pain, no gain
According to Wikepedia the origin of the expression “No pain, no gain” goes back as far as the second century A.C. At that time though it was referring to spiritual rather than physical activity – unless a person endures some spiritual search or suffering – he or she won’t achieve any spiritual gain.
In America this expression was revamped and became and exercise motto that promises greater value rewards for the price of hard and even painful work. Under this conception competitive athletes are required to endure pain and pressure to achieve professional excellence.
The motto expresses the belief that solid large muscle is the result of training hard and suffering sore muscles repeatedly, implying that those who avoid pain will never reach a professional level as athlete. Beneficial pain refers to that resulting from tearing microscopic muscle fibers, which will be rebuilt more densely, making a bigger muscle.
It came into prominence after 1982 when actress Jane Fonda began to produce a series of aerobic workout videos. In these videos, Fonda would use “No pain, no gain” catch phrases for the concept of working out past the point of experiencing muscle aches. This catch phrase is perfect for marketing because it encapsulate a simple concept and, enforced in memory, rolls off the tongue as a nursery rhyme.
As we all know everything genius is simple. Unfortunately the reverse is not always true. Pain in this case usually leads to serious re-strain and re-sprain traumas and, at times, could end athlete’s career. Pain is a signal of the body on the existence of injury, disorders or dysfunction. A phenomenon of skeletal muscular injuries disorders or dysfunctions always manifested as elevated resting tone of muscles, which then be transmitted to tendons, ligaments and other tissues. Described muscular conditions, should be viewed as a precondition to significant muscles or ligaments tears that, at times, require surgeries. Besides, when athletes suffer from pain and tension in muscles and, in some cases also in fascia, they cannot perform to the best of their physiological potential.
Because of this, or maybe because the words pain and gain that rhyme so well in English, and don’t rhyme in other languages, the motto perhaps didn’t stick in other countries. Well I can bravely say this for the Russian language where the word “pain” sounds like bol` and the word “gain” like priobretat`.
In any case coming from Russia the concept of “No pain, no gain,” when it was introduced to me, seemed quite foreign. This introduction has occurred in a quite peculiar way.
When I arrived to the US, I was hired by a physical therapy company as a staff trainer, to teach Russian Medical massage methodology. Since the primary goal of this methodology, from its inception, was treatment of patients, one of its major emphases was placed on avoiding traumas. Therefore medical massage always starts with very light pressure and in inhibitory regime.
This regime allows for gradual increase in pain threshold, which in turn permits gradual increase of pressure without activating of the pain analyzing system.
When a therapist continues to provide massage while pain analyzing system is activated, it is likely that not only a therapist is going to reach his/her treatment goal, but also would aggravate client’s condition. For detail please read the article Reaction vs. Aggravation.
If you ever be asked by healthcare professionals to explain scientific part of what you are doing you are welcome to give these references. They will be acceptable and scientifically sounds.
Most of the physical therapists, physical therapists assistant, and physical therapy aides, who have had worked for this company, had no problem with this approach. However, there were some who objected. Specifically I remember one heavy set, tall, muscular physical therapist who looked like a line-backer. At the moment my English was quite rusty but I remember him referring to Medical Massage approach something not manly. He was the first one who familiarized me with “No pain, no gain” motto and its application to massage therapy, promoting vigorous pressure. According to him Americans were tough people and were ready to endure pain to reach results. There were also other who insisted that pain sensation after treatment as a positive reaction.
Luckily this company used to employ more than 120 physical therapists, and most was following my teaching to avoid activating pain analyzing system and traumatizing clients. Faster and more sustained results were achieved almost in all cases. I am very happy to say that the “line-backer,” due to clinical outcome, changed his mind in regards “no pain, no gain“ and started following protocols everyone used successfully.
I remember how, while participating with fibromyalgia support group, I listened to one well known rheumatologist, who deeply doubted the effectiveness of deep tissue massage on human body. As a proof of his position he showed me the list of 200 of his patients, who incurred fibromyalgia after receiving deep tissue massage.
I assured him that deep tissue massage has nothing to do with sudden application of vigorous pressure and told him about the value of introductory massage, gradual increase of pressure as application of the Gate control theory and four strategies for deep tissue massage. I also told him about massage therapists who neglected such careful and gradual approach, professing immediate vigorous pressure and who, most likely, inflicted trauma and caused incurring fibromyalgia in his patients. Subsequently, he referred me many fibromyalgia clients allowing me to help them managing their symptoms.
Contemplating about the differences in deep tissue massage approach, I am remembering one of my students. He was of Chinese nationality, immigrant from Vietnam, who came to my school, sharing with me his life story. He told me that he was considered a “black sheep” in his family for his inability to learn. He also shared with me his dream of healing people with his hands.
I accepted him to my school and noticed that despite being slightly uncoordinated, due to overexcitement, he had quite capable hands. In general, he was a very eager to learn student. After graduating he was accepted to one of the famous spas and started his quick rise to prominence. However, apparently not being satisfied with what he knew, he took some extra courses. He was taught, as he was explaining me, the version of deep tissue massage that emphasizes vigorous pressure as in “No pain, no gain.” Despite my objections, he insisted on this method that he thought was superior. Unfortunately this lead to many clients being traumatized and him being eventually fired from the spa and, of course, it is to no surprise of mine.
Vigorous pressure, persisted while pain analyzing system is activated causes development of myositis, tendinitis, microscopic tears of soft tissue, development of trigger points and many other pathologies.
In retrospect I can rephrase the “No pain, no gain” motto as “When pain, no gain.”
This blog contains a few links to the important information. For 40 years I’m practicing scientifically developed massage protocols and all offered information is based upon real scientific data, related to the science of massage.
I know, that there is new trend out there ”show me the references.” Many times people request these references, just for the sake of requesting for they don’t know what to do with them.
Most of my references are in Russian. However, below I’d like to offer some Western references in English from the books of Dr. Ross Turchaninov. While writing these books, he undertook a truly titanic work on collecting and verifying them. Both Dr. Turchaninov and I are trained and practice medical massage as it was proposed by Prof. Sherback, therefore references that he offered are applicable for articles I provided the links above. Again, I included only small portion of his references, those that I checked myself.
Thinking back though at my entire career, during the last 20 years at the US many times I have presented to medical doctors, physical therapists, doctors of chiropractic medicine. No one ever asked me for references. I guess the material I presented sounded scientifically enough.
As for me – references do not provide treatment. Our hands do.
And while we are on the topic of hands … If you visit out fan page at
http://www.facebook.com/FreeInstructionalandSelfMassageLessons you will find many free lessons, including almost 4 hours hands-on performances: ”Orthopedic massage physical therapy aide program Part1″
Unexpected usefulness of certain massage protocols
Several weeks ago, I received a 53 years old male client who was suffering from what was introduced to me as sciatic nerve neuralgia. He had reported all classical symptoms of this disorder, including pain in the buttocks with irradiating to the leg. This wasn’t his first episode; during the last five years the pain was on and off. The MRI examinations showed, 4mm disc bulging on the level of L4-L5, and 5 mm disc bulging on the level of L5-S1. When I asked him slightly to bent forward, he could do it without experiencing increase in pain intensity.
During these five years of suffering through the pain, he tried many different therapies including epidural injections with no real progress.
As usual in such cases I started palpating lower back area, buttocks, hamstring muscles, investigating for tension within muscles and fascia, discovering trigger points, etc.
There was much indication that Piriformis Muscle Syndrome could be responsible for all the difficult clinical picture. However when I have investigated gluteus muscles by slight compressions, especially area of sacrotuberous ligament, my client immediately complained on experiencing intense irradiating pain in penis and testicles. The pain was disappearing once I was stopping the compression.
I have immediately checked the tension in hamstring muscles. Their resting tone was noticeably high alone with the apparent limitation in range of motion and containment of numerous trigger points. I told him that these muscular syndromes, if addressed appropriately and in detail, would not only help him alleviate pain and limitation in the range of motion, but also can increase his erection during intercourse.
The client, who happened to be a urologist, immediately asked me about how I deduced him having the erectile dysfunction.
I explained him that the clinical symptoms he experienced often caused by chronic lower back disorders, which also cause hamstring muscles tension. Hamstring muscles tension, is transmitted to sacrotuberous ligament, resulting in irritation of pudendal nerve. Since pudendal nerve provides innervation to sex organs its irritation produces pain in penis and testicles, and diminishes one’s ability to maintain erection. Therefore my treatment that included releasing tensions in muscles and addressing trigger points could have improved his sexual potentials.
After six treatments all clinical symptoms of sciatic nerve neuralgia were almost gone, but I have continued providing massage treatment, including trigger point therapy to hamstring muscles, paying special attention to gluteus muscles, and area of sacrotuberous ligament.
With decreased pain, my client could report feelings of warm sensation in penis, and was amazed at how his erectile potential has improved.
Altogether I’ve provided this doctor with 14 treatments, on the basis of three-times a week. Treatment included, connective tissue massage/fascia release, muscular mobilization, trigger point therapy, as well as post-isometric relaxation techniques. This step by step protocol I present on my instructional DVD#1
In fact he was so impressed with the result that he referred to me three of his patients, who had suffered similar symptoms.
As of today my urologist client is discharged. We are staying in touch. He feels great, and happy and this is a source of great pride and joy for me. His patients – all three of them are improving, including improvement of their sexual potential. This is another example of how appropriately applied medical massage protocol makes a huge difference in difficult cases compromised health manifested by complex clinical symptoms.
Clinical incidences could be educational
Recently I had a rather stormy discussion in one of the user groups regarding my article “Body cells carry emotional memories.” This theory doesn’t have existing scientific explanation, only a working hypothesis. But this hypothesis has such a frequent support in everyday clinical experience that I felt it cannot be ignored. Turning around the discussion in my head I remembered the incident that perfectly fit as the supportive argument for this hypothesis.
This one lady (let’s call her Ann just to preserve her anonymity) was referred to me by her primary care physician. Eleven years prior to this referral took place, after giving birth to a beautiful baby girl, Ann developed clinical depression, frequent episodes of anxieties, muscular pains and aches and sleep disorders. As her health was declining she was diagnosed with postpartum depression. During all this years, she received clinical psychological and pharmacological treatments. Nothing was working and symptoms were getting worse.
The referring physician, requested to provide her with medical stress management massage. During the first session, as I was attempting to massage her right side upper back, shoulder area, and pectoralis muscles, she sprang out and with convulsive movement deflected my hand away from her. To my inquiry about the reason for such reaction she was quite vague. But having been familiar with similar behavior before in my practice and suspected an emotional trauma, similar to the one I described in my article “Body cells carry emotional memories.”
Because my touch didn’t cause her to sprang out and deflecting my hand when I was massaging the other parts of her body, I have convinced her to allow me to massage her right side upper back, shoulder area, and pectoralis muscles. Also I have advised to her to release any emotions, if she’d experience any at the time of massage, including crying if she’ll have felt like it. And so she did cry it out.
Eventually, after the fifth treatment, she told me what caused this anxiety. Actually, all these years she didn’t realize that it was poisoning her life. During the treatments, and the related emotional releases what was deeply plunged in her subconscious mind, somehow came out and became obvious.
The story went back to the incident that happened while she was in her early teens between her and her boyfriend who was two years her senior. It was what was supposes to be their first sexual encounter. In the moment of truth the boyfriend saw her thirteen year old breasts. The gentleman that he was, he sneered at them, pushed her against her chest, and told her that she needs to grow up before he would yield his manhood to her undeveloped femininity. When she start crying, he had pushed her few additional times, including area of right side upper back, shoulder area, and pectoralis muscles. Thus these regions became bookmarks of emotional scars. Surely, in the moment of tight dramatic tension, these were the chain of events that left a heavy emotional scar to all her life. Although Ann is quite a beautiful woman, happily married and looks spectacular for her age, somewhere in the depth of her subconscious mind the burn of this rejection haunted her all her life. She complained that during intimate moments with her husband, she always felt tormented, whenever the action was coming to her breast region.
I said and recommend to her since all this incident got conscious realization just to get rid of it. I also stated that her ex-boyfriend was not only rude and stupid, but most likely had some serious emotional problem himself. At that moment she started laughing as well, because as she explained the person, who used to be that boyfriend of hers, indeed today has some serious psychological problem.
We were laughing together for some time, especially Ann who seemingly couldn’t stop. I have no doubts in my mind that this laugh was her additional emotional release and a cure, because the next five times we’ve met she had no more problems with me massaging pectoralis and as she admitted, first time in all her life she fully enjoyed the intimate moment with her husband.
As many stories like this accumulated over my more than 40 year old practice, I can all but shrug when I hear how someone, with the righteousness of scientific purist, denies the connection between body regions somehow linked with emotional traumas. While purists like these wait another fifty years until such connection would be proven by the official Western science, many therapists could help very many suffering people armed with only working hypothesis and a bit of common sense.