THE PLACEBO EFFECT AND ITS ROLE IN MASSAGE THERAPY. PART II
Sentiments and emotions in massage therapy field
|The degree of emotional reactions to everything is different. As we are different people, emotional reactions depend on our personal or philosophical views. At times, one can experience a significant emotional reaction without an apparent or explainable reason.|
|In my professional life, I experienced acute emotional reactions, when inspirations, whatever they can be, make me adjust my energy status. These positive changes always lead to the better outcome in treatment. As an educator, I am emotionally reacting when I scheduled to teach an educational session of an extremely effective rapidly changing health of people, topic, to teaching hands-on protocols that one could effectively incorporate in many other massage protocols, targeting different disorders.|
|Just to clarify, in my professional life I navigate from one excitement to another one, as I am always excited to share my knowledge, no matter what massage protocol I teach. For example, the protocol for sciatic nerve neuralgia. My goodness! It feels great to equip massage therapists with tools for numerous treatments, to be able significantly to reduce the intensity of nerve pain, improve functional activities, and, most importantly, at times to be able to prevent potential surgery! How could that not be highly emotional and spirited feeling when, statistically, 30% of the adult population suffers from lower back disorders and disproportional amounts of spinal surgeries performed daily?|
|Whoever don’t agree with my statement:” in the meantime, the post-concussion rehabilitation protocol, is practically the only available protocol in the entire healthcare field that directly addresses the causes of symptoms, and, most importantly, prevents the developments of brain dysfunction, thus saving the future of many people” please challenge me. It’s important for everyone to come to common terms on this issue.|
|However, prior to challenging me, make sure that the biomarker:” irregularity of autonomic activities” and “post-treatment (+/-) balance in autonomic activities” will be used as the clinical evidence of stabilization of patients/prevention of encephalopathies developments, as well as the end of hypometabolic stage, restoration of brain function, including the evidence of normal/sufficient blood perfusion.|
|Presently, I am very excited when I plan the Manchurian Acupressure for tension headache class at the World massage Festival in Las Vegas, which will happen next month. My excitement in teaching this workshop is due to significant multiple effective uses of this protocol in treatments of many disorders, in cases of all types of headaches; including tension and migraine headaches this method sometimes delivers miraculous results.|
|The difference between a migraine and tension headache is a separate issue. While demagoguery about the causes for migraines is a not stop the discussion, it always ends up with prescription medications, those that do not only stop working with time but can cause even more intense headaches.|
|On the other hand, the effectiveness of the Manchurian acupressure for tension headaches massage protocol is clinically proven. In my opinion, many chronic migraine headaches, in most cases are nothing else but secondary to muscular tensions developments, triggering brain vascular constriction or/and vasodilation. In any case, it’s not about theoretical talks or reading literature. It is all about helping people, and we are doing it.|
|Since Dr. Ross posted in FB:”|
|“As we know now there is no parasympathetic division of ANS in the lumbosacral area and ANS function there is under control of ONLy sympathetic division or more precisely by increase or decrease of sympathetic tone. From this perspective, all bodywork procedures including CTM must be re-adjusted. If we are talking about CTM as a means to decrease fascia pressure it can be used on local bases first, if other modalities are addressing skin, muscle and periosteum are used as well.”|
|As well as you and others, I was taught that the sympathetic nervous system arranged in segments along the entire spinal cord while the parasympathetic nervous system has two separate division cervical and lumbosacral. Thus, each organ and tissue in the human body has dual innervation from each division of the autonomic nervous system. In 2016 an absolutely incredible piece of science was published in ‘Science’ which the world prestigious scientific publication. This study confirmed without any doubts that there is NO parasympathetic division of the autonomic nervous system in the sacral area and functions of all organs in the lower abdominal and pelvic areas are under control of ONLY sympathetic division or more precisely by increase or decrease of sympathetic tone. Many clinical observations are now got their explanation. For example, people under a lot of stress complain about chronic constipation since there is no balancing impact of parasympathetic division on the function of the large intestine. Similar way pathological changes in the function of the soft tissues are also can be explained. For example, the patients with carpal tunnel syndrome very rarely exhibit White Dermographism reaction while the patients with even mild irritation of the sciatic nerve will exhibit such reaction almost immediately as a sign of cutaneous reflex zones formation. This study has the great impact on bodywork in general since it requires of adjustments of modalities and/or techniques which therapist uses. For example, one of the critical components of craniosacral therapy is restoring balance, including lumbosacral area, between sympathetic and parasympathetic divisions of the autonomic nervous system or balance between cervical and lumbosacral parts of the parasympathetic division. If we now know that there is no parasympathetic division in the sacral area the entire theoretical concept and clinical effectiveness of craniosacral therapy become very questionable. Results of this study affect other modalities as well.|
|I have got very excited and posted the following:|
|”Ross. I believe in everything that you say. I got very excited because I personally know a group of 11 DPTwomen, who work exclusively with the cases of infertility, incontinence, and different smooth muscles dysfunctions of the pelvic floor, including cramps. An extremely busy urological and gynecological office refers patients with these disorders. Practically, what they do is the intervaginal massage. They even have different instruments that they employ during the time of these procedures. I am receiving referrals from them for abdominal visceral massage.
For us, as massage therapists, non-parasympathetic innervation offers an additional idea of how to contribute to the outcome. What crossed my mind was to teach these ladies to incorporate the Manchurian acupressure techniques into an intervaginal massage. This additional protocol proves to suppress sympathetic activities. Many times I witnessed these results in clinical conditions when after 15 minutes of application usually 20-millimeter decrease in blood pressure. This is in case of high sympathetic tone. Therefore, the proven techniques affect the balance of autonomic activity.
Of course, when treating people with bronchial asthma, we try to suppress parasympathetic activities. However, in general, as I mentioned: “an inhibitory regime explains successful outcome and even if this is the case of “not parasympathetic innervation”. The main goal is to investigate clinically, how we can improve the outcome, based on the new data. I’m anxious to talk to this ladies and to do some clinical experiment by suppressing sympathetic tone. Will report.”
|This past Thursday I canceled all my plans and went to this PT office. By the way, the head ofthisDPT office is my student. 25 years ago, I was a staff trainer at the big PT Corporation that provided inpatients and outpatients PT services to, practically, all hospitals in greater Los Angeles. At that time, she graduated with an undergrad biology major and didn’t know what she wanted to do in regards to her future career.|
|Back then, she took many medical massage classes from me and successfully implemented them on patients. Until today, we were big friends
On Thursday, I have arrived at 8 AM. Of course, she expected me, we have communicated on the Fourth of July.
The general idea was to test clinically the effect of 15 minutes of Manchurian acupressure for tension headaches, and 15 minutes of lateral toes massage, and record the effect of these procedures on sympathetic activities. In addition, it was to listen to subjective patient reports. She selected six women, chronically suffering from lower abdominal/pelvic floor pains, and poorly responded to treatment.
To exclude the real pathology that could explain these pains physicians subjected all the patients to thorough testing including CTs. Of course, I suspected overactive sympathetic reactions fueled these pains, tensions and nonseptic inflammations. We used the Ambulatory Blood Pressure Monitoring device. Placed 30 minutes prior to my treatment, and removed 30 minutes after my treatments, following subjective patients’ report.
Interesting enough, this pilot study proved a significant suppression of sympathetic activities. All six ladies who received my treatment, being on the monitor for 30 minutes prior to my treatment, evidently demonstrated higher sympathetic activities, at the time of the treatment as well as 30 minutes after the treatment, blood pressure was dropped on average 25 mm. Most importantly, all six reported much less intensity of pain, some described the feeling like a better blood supply. Next Saturday I will provide staff training for this PT office.
I hope now I could explain my high emotions, prior to teaching Manchurian acupressure for tension headaches seminar at WMF, and in general.
THE PLACEBO EFFECT AND ITS ROLE IN MASSAGE
Be careful! Words can damage…
By Boris Prilutsky
Previously, I already wrote about my consulting work in the research settings. While I am performing a massage procedure, scientists use recording equipment, and lab tests and they are trying to develop medications, to replicate outcome of massage. The principal investigator, who is a neurologist, Ph.D., the professor of neurology at the local medical school in LA, is a very powerful person in scientific circles. Sometimes during conferences, I do not feel comfortable when he is asking my opinion. Seriously speaking, sometimes I even do not feel comfortable at all. I’m the only one who is a massage therapist in this assembly; the rest are scientists, PhDs or students working on their Ph.D. programs.
I’m not trying to show off. This is just to explain why when three weeks ago he called me and said:” if you don’t mind, approximately in 40 minutes I will bring a patient, who exhibits a very difficult case of migraine attack” I said, “Of course!”
In 40 minutes at the conference room, there were eight people, two representatives from each team. The principal investigator requested them to present at my initial evaluation. A few minutes later, he brought a 56 years old woman, a movie star. Obviously, she was suffering: she was very anxious and shaking. In such cases, I ask to briefly present a history and describe symptoms in details. Then I do palpations, assessments of a range of motion, etc. During the last 45 days, nonstop, she suffered from high-intensity pressure headaches and couldn’t sleep.
In the beginning, the prescribed medications could somehow control the intensity of pain even though temporarily. Then during the last week, the pain became unbearable. The primary care physician did all tests, including MRI. All of them turned out perfect. The neurologist performed EEG and other neurological tests. All were good. The neurologist diagnosed her, with a migraine, whatever it means. Because the prescribed medications stopped working, the primary care physician requested the second opinion from a topnotch neurologist.
Not to be confused, the principal investigator was the 3rd opinion. He didn’t damage her and immediately decided that I have to see her. Straight from his office, he brought her to the research facility. I wasn’t there for the second opinion visit and didn’t know the content of the doctor-patient conversation. However, according to her, when she asked about the prognosis, the answer was that it was possible that she will have to live with these headaches all her life, including the possibility of ending up in coma and death.
She said:” Boris, the doctor believes that you will know the answer to when I will die.” I said:” Ma’am, I am a massage therapist, with me people talking about life and not death.” Everyone, including her, started laughing. As she was sitting, I examined the range of motion in her neck. It was terribly limited. Preliminary I could palpate significant tension in fascia and muscles, at the neck and upper back area. Examination/palpation of TMJ muscles/fascia suggested significant buildups of tension. When somebody suffers from severe headaches, very anxious etc., I always first perform Manchurian acupressure for tension headaches. In a direct translation from Chinese, it is head pressure headaches. We interpret it as tension headaches. No matter what is the cause of a headache, fifteen minutes seven positions acupressure session immediately reduces the intensity of a headache. For example, when I am treating fibromyalgia patients, who are also emotionally exhausted, I always start with Manchurian acupressure. It works miraculously. In such cases, the mechanism of placebo almost always gets activated, contributing to the energy boost and the sense of ” light at the end of the tunnel.” It has always been a game changer.
As I was expecting, it worked with this actress miraculously. After fifteen minutes of acupressure, I asked her to report if intensity or a headache changed and whether she’s experiencing a change in her condition. She offered us a bit drama play and said: “…my goodness Boris, I don’t feel a headache.” I responded: “Ma’am your reaction to the first acupressure procedure, is excellent and encouraging. We have a chance to help you to get rid of headaches, to stabilize your condition, and bring you back to life. Then I asked her to lay on the table, addressed tension within fascia and muscles, and trigger points. Spend time also to address TMJ musculature. It takes additional 30 minutes. Then I assessed her range of motion, and we all were pleasantly surprised witnessing significant ROM improvement, including at TMJ motion. In total, so far I have performed six treatment on her. Almost no episodes of high-intensity headaches, not less importantly, she is slipping in average seven hours each night. I am planning to provide additional 9 to 10 treatments, to sustain the results.
After the treatment was completed, the principal investigator said: “The results it is obvious. What do you think about this difficult phenomenon?” I answered:” It was the obvious case of tension headaches and not a migraine. The treatment addressed the buildups of tension. By addressing the causes of these headaches, we achieved results.”
When the lady left the facility, we talked a bit more. I asked whether the neurologist who provided the second opinion was the board certified idiot, or somehow things got complicated. The principal investigator told us, that second opinion neurologist, was a very knowledgeable and experienced physician, and that somehow things got out of control. One of the fellows, who is a neurologist, participating in a Ph.D. program, told me:”Boris, it was a great therapeutic joke, when you said”:’ Ma’am, I am a massage therapist, with me people talking about life; not about death.’ She laughed, and I got a good feeling about the further treatment he said.
I said:”Doctor it wasn’t a joke. I meant what I said.”
This Ph.D. student said:” you are a lucky person, sir, to believe so much in power of your occupation.“ He got my traditional answer:” In my opinion, there is a big difference between believing and knowing, Doctor. Thank God I know about the power of massage, as most of the massage therapists do.”
Currently, I am working on the article for Journal of Massage Science. Most likely, the title of this article will be “PLACEBO EFFECT AND ITS ROLE IN MASSAGE THERAPY.” In general, I will discuss the mechanisms of placebo as well as nocebo. In many ways, our approach and views on psychologically triggered placebo are different from the classic approach of the medical society. Today I presented the case when nocebo practically destroyed the patient. In fact, she could possibly die.
Thank God, it didn’t happen. One can say, “come on Boris, she wouldn’t die.” I disagree. There are enough documented cases when psychologically triggered nocebo led patients to death. But this is not the point. The even difficult case of nocebo, couldn’t sustain and resist powerful stimulation by massage.
- On August 8th, 2018, at world massage Festival in Las Vegas,
I will teach, Manchurian acupressure for tension headaches”
8 Credit Hours
Manchurian Acupressure for tension headaches is a modern name of this method. Direct translation sounds like “For head pressure reduction”. It is sequence compressions of different points on the face, head, neck, and rib cage. This class is primarily hands-on training. In most cases, after 15 minutes of appropriate applications, the intensity of headaches is rapidly reduced or eliminated. Very effective in cases of a tension headache, but also helping in different cases of headaches including migraine headaches.
For more details please click here http://worldmassagefestival.com/2018/prilutsky.html
Looking forward to seeing you in my class.
Twenty Years Later
This article was first published in Science of Massage Institute online Magazine