The role of biomedical science in the field of massage therapy
The recent article By Dr. Ross Turchaninov, MD “NEW SCIENTIFIC DATA TO REVISIT ACTIVE TRIGGER POINTS CONCEPT “inspired me to write this commentary.
The entire clinical medicine field was developed and based on biomedical science data. The science of Medical Massage is also based on biomedical science data. Researchers, who have developed more than 70 hands-on massage protocols started from observations, available data of anatomy, physiology pathophysiology, histological, radiological data and more, and then during the research worked hard, to develop most effective step by step massage techniques, allowed us successfully to achieve sustainable results.
When thousands of massage therapists decade after decade successfully reproduce sustainable results by implementing these protocols, should there be any doubts? Regrettably, about 10 years ago, the word “science” was literally abused. People created Movements of ”NEW science”, including” new neuroscience.” As far as I am concerned, I classify destructing minds of 1000s massage therapists, who have spent money and efforts, studying “NEW science” revelations as atrocity! In general, it’s not about money, and it’s not about pretending to be intellectuals, “understanding more than others.” It is about our patients who need our help.
Vigorous arguments were flamed by the “new” revelations such as ”TRIGGER POINT IS A FORMATION OF FIBROCONNECTIVE TISSUE IN MUSCLES.” Even the group of supposedly very educated people, proposed peer review, offering a “scientific” point of view stating that there is no such thing as trigger points.
Regrettably, it was a long time ago, and I don’t have the link to this peer review discussion. At the time I was posting my responses to the peer reviews as well as invited these groups of “well-educated” authors to respond to my arguments. There was no response as this peer review, done not by people who spent years in the treatment room, handling difficult skeletal muscular disorders, for which the inclusion of trigger point therapy is a must. Then I have offered my opinion on this particular peer review and, literally, crashed each argument stated in it.
In the article below, Dr. Ross Turchaninov, MD, in much detail, explains the science-based clinical necessity to include trigger point therapy.
Now I have to share with you a story.
Years ago, at the beginning of my career back in the Soviet Union, I had a patient, who suffered from the difficult case of sciatic nerve neuralgia. In the elite clinic where I worked, it was not an easy thing to get an appointment. People waited for three to four weeks for the first appointment and having missed that appointment, they had to start the waiting period all over.
Therefore, the first thing that patient did was ask me to schedule for him the next appointment in one week. When I asked him for the reason of this measure he told me that he just found out about a wonderful healer – an old gypsy who lived in a camp next to the city, and who have already helped many people in difficult cases similar to the one he had. He felt apprehensive allowing me to treat him, without first being treated by this old lady, and expressed the readiness to try the conventional methods of treatment only in the case her treatment won’t help him.
I understood this suffering person, appreciated his honesty, as well as did hear about miracles by this lady, from other people. We made a deal, that I would go with him, and would observe what she does. It is important to stress out, that she wasn’t educated at all and spoke broken Russian. She performed introductory massage, and I could see how slowly she increased pressure adjusting the threshold of pain. Then she performed some improvised kneading techniques. By pulling skin from side to side, it was clear she was achieving some fascia release, practically similar to how I am palpating trigger points. She palpated and performed ischemic compression for each trigger point she could discover for approximately 30 seconds. Prior to starting the compressions, she communicated with the patient clarifying the angle of the compression direction. Before my patient stood up, I knew she achieved results, I could see that the treatment, including trigger point therapy, was good. Indeed, he felt better after her treatment. Please try to convince this lady and this patient that she shouldn’t have included trigger point therapy.
In my opinion, not many of us have the degree of talent similar to the one this lady had. Saying this I’m neither discrediting the importance of science in general nor do I am diminishing the significance of the science of massage. As a massage clinician, I am the product of this science.
The role of biomedical science in fields of massage therapy is to clinically develop concepts and protocols that we will be able to study and successfully implement on people who are suffering from different dysfunctions. Wouldn’t she, provide equally important techniques I have described, she probably wouldn’t achieve results.
Many MDs practice trigger point injections only, without addressing muscular pathologies, the buildup of tension in the fascia, and more. Do they achieve sustainable results? Too often symptoms are coming back, while after a year, for example, repeated radiological examinations confirm the occurrence of additional degenerative changes, thus witnessing inadequacy of such treatment.
Would one sustain results if they neglect to address pathological muscular tension, including muscle energy techniques, release the buildup of tension in the fascia, apply appropriate ischemic compression for each trigger point? Never. It is clinically proven that one would never sustain results and with time all the symptoms will come back.
After the gypsy therapist finished her work, I have convinced the patient to continue his therapy with me. For sustainable results, in my opinion, he needed to receive treatments that included post isometric relaxation techniques /muscle energy techniques, and, considering the more neurological origin of trigger points, include in treatment much more adequate, prolonged kneading.
From the article ”Despite a mountain of studies, publications and countless CEU classes, hypertonic muscle abnormalities, especially active Trigger Points (TP), continue to affect patients’ lives, devastate communities with an opioid crisis while driving up the cost of medicine. 31 million Americans suffer from low back pain at any given time (N Engl J Med. 1994) while according to the CDC, only 15 million Americans suffer from COPD.”
I would like to stress that ”31 million Americans suffer from low back pain at any given time (N Engl J Med. 1994)” That is from the lower back only. What about the pain in the neck and upper back and pains in the extremities? The big question is: What is the role of active and, as a matter-of-fact, latent trigger point playing in this pandemics of painful skeletal muscular disorders? I described the chain of pathological developments, as well as their sequence, and technical approaches for adequate treatment and sustainable results achievement. To summarize I admire Dr. Ross’ work. I do.
In this article “NEW SCIENTIFIC DATA TO REVISIT ACTIVE TRIGGER POINTS CONCEPT” Dr. Ross provided interesting additional information. As a clinician, in the cases when massage therapists are reacting to new scientific data, I ask how will it change the way we provide trigger points therapy?
A little over ten years ago, a movement around fascia Congress was created, based on the new findings of connective tissue containing constricting fibers. As for these findings, I never saw the study that produced the same outcome, except for those presented at the fascia Congress. Let’s say that connective tissue indeed does contain constrictive fibers. I asked then, and asking now, how is this finding changing the techniques that we implement when addressing buildups of tension within fascia?
Please, don’t get me wrong, I carefully read the articles by Dr. Ross. The presented in this article scientific data is nothing like those theories presented at the fascia Congress. As in his other articles, these ones are truly educational, reinforcing the necessity to include trigger point methods in your therapy.
But because the appearance of the wordage “new scientific data” in the title of the article could make some people feel uneasy about its content, I wanted to reassure you that these articles are not only ok to read but a must-read.
These excellent articles gave us a great opportunity to discuss new evidence for clinically proven methods. As clinicians, we need scientific data, but this data should be clinically proven. Otherwise, it’s just a gimmick that can mislead you, distract, and lure us into spending money on that gimmick rather than on the real clinically oriented education. After all the more educated we are the more we can help our patents and It’s all said and done it’s all about the patients.
I highly recommend you read these articles carefully. This is real schooling. I mean it.
Detoxification and immune systems sufficiency
The material presented here is partially from my article, first was published at 42 MASSAGE & BODYWORK • JUNE/JULY 2006
I concluded my article Remembering the uniqueness of massage therapy with the following words
I am of the opinion that massage therapists must remember about the great uniqueness of massage therapy when treating any disorders/dysfunctions. Our methods are not similar to painkillers that block pain impulses from reaching the brain but address the real causes that producing pain, and other dysfunctions.
For those who didn’t have chance to read it, you’re welcome to click this link http://medicalmassage-edu.com/remembering-about-the-uniqueness-of-massage-therapy/
In the current article, I will present a clinically oriented material. Its purpose is to understand the causes of dysfunctions and offer ways to treat them by means of massage in order to achieve results.
Biological science, which is the study of living organisms, is the base for the entire healthcare system and the utilizations of its clinical methods, including the methods of medical-massage. One of the subdisciplines of biology is microbiology. Microbiology also contains many subdisciplines such as virology, bacteriology, etc. Clinical medical fields such as Immunology, infectiology, and rheumatology emerge from the studies of virology and bacteriology. Mainly mentioned above medical specialties developed testing means and medications that are capable of diagnosing and treating detected infections.
Science of massage is also a part of biomedical science, but the goals of the research are to develop specific massage protocols to address particular disorders. To understand physiology and pathophysiology is to understand the causes of particular dysfunctions and find ways to address them by means of massage in order to achieve results.
This link is to “boosting the immune system” blog http://medicalmassage-edu.com/boosting-the-immune-system-made-simple/Further in this article I will refer to this blog.
Especially, in massage therapy fields, we view the body and its dysfunction and disorders, holistically. That means that we cannot see any disorder, illness, dysfunctions, as an individual problem of organ or system. We view individually diagnosed disorders as an illness of the entire body. For example, stress leading to insufficient lymph drainage, excessive accumulation of toxic metabolic waste, decreasing immune power and much more. Of course, in turn, the immune system demonstrates insufficiency.
For example, people from the same age group and have the same health conditions, placed the same crowd, where many infected by a coronavirus. Some of them would get ill, some would die, while some other would experience insignificant symptoms and recover with ease, or maybe won’t have symptoms at all. In this case, all depend on the individual’s ability of the immune system to defend her/him from this and other viruses as well as from other infections. Functions of all organs and systems depend on the normal function of other organs and systems. Massage therapy has the potential to address, improve and to balance these functions. The bottom line is that in order to empower/balance the immune system we must balance the functions of all organs and systems. First of all to keep a relative activity balance between sympathetic and parasympathetic subdivisions of the autonomic nervous system.
At the very end of this blog, you will find the link to the physiological effect of massage and other materials that support and explain the statement made above.
I would like to finish my introduction by saying that massage therapy is not a remedy for all diseases, but it is an extremely powerful methodology of treatment. One must integrate it in treatments of most of the skeletal muscular disorders, migraines and tension headaches, sciatica, thoracic outlet syndrome, rehabilitation from concussions/prevention of encephalopathies, prevention and treatments of other degenerative brain diseases, and more.
The immune system
The immune system is a collection of billions of immune cells that move through lymph /bloodstream24 /7. They are “military defense forces” containing different specialized units. When the immune system works well, it maintains our bodies healthy. They use different strategies defending the body against foreign bodies /antigens such as bacteria, viruses, and cancerous cells. It is in constant dynamics, moving in and out of organs, and when detecting antigens, quickly destroying them.
We are born with some immune defenses. It’s called “the innate immune system.” The rest is the acquired immune system, composed of specialized, systemic cells – “soldiers” that eliminate pathogens.
A more substantial defense comes from the acquired immune system or adaptive immune system. It develops antibodies, including and not limited to B cells and T cells which are memory/acquired immunity. White blood cells are known as lymphocytes B and T cells. B cells are activated into immunoglobulins, also known as antibodies. These acquired antibodies bind to the foreign antigens, killing them and not allowing the antigens to bind to the host cell.
The lymphatic system
Theoretical knowledge for a practical approach to successful hands-on procedures.
The main function of the lymphatic system is detoxification or disposal of toxic metabolic waste, but it also plays an important role in immunity, it’s part of the immune system. Lymph is an extracellular fluid that enters the lymphatic vessels and is mixed with cellular elements. The lymphatic system starts at the lymphatic sacs in the extracellular spaces. These sacs have pores, allowing the passage of large proteins and other metabolic waste products. When the lymphatic sacs are filled, lymph enters the lymphatic vessels. These vessels also have large pores and carry a small number of smooth muscles. The walls of lymphatic vessels contain valves, directing the flow of the lymph one way only (toward the heart). Along the path of the lymphatic vessels are lymphatic nodes. When the fluid reaches these nodes, infections, alien proteins, and other foreign materials are destroyed. The drained lymph then continues its flow. Most of the lymphatic fluid reenters the circulation via the thoracic duct (a common drainage duct). Through this duct, the lymph enters the brachiocephalic vein. The right lymphatic duct drains lymph only from the right upper extremity and half of the face and head.
The Nature of the Lymphatic Flow
During inspiration, the diaphragm muscle contracts, creating negative intrapleural pressure. This is when both the thoracic and right lymphatic ducts release the largest amount of lymph into the circulatory system. It’s important to remember these points, our techniques contributing to negative intrapleural pressure, and accelerating lymphatic drainage/detoxification/immune response.
• Gravity is the main opposition to lymph flow. Most of the lymphatic vessels are between skeletal muscles. When muscles contract (during movement), a pumping action is created, thereby pushing the lymph along.
• Pulsations of large blood vessels also help the lymph to flow. • The peristaltic contractions produced by the walls of lymphatic vessels, however weak, contribute somewhat to the flow of lymph (though not significantly).
Attn: When we perform manual acceleration of lymph drainage we use the knowledge of the nature of lymph drainage and apply special techniques to accelerate lymphatic drainage.
Step 1. The client lies on her back. Place your hands on the upper part of the rib cage (mainly on the sternum). Ask your client to inhale and exhale. In the next inhalation, resist the expansion of the rib cage with moderate pressure. Release the pressure upon exhalation. With a resistance of rib cage expansion, we cause the diaphragm muscles to work harder. The degree of the diaphragm muscle contractions projects the level of negativity of intrapleural pressure. The more negative intrapleural pressure we create, the bigger the volume of lymph drains into the circulatory system. Repeat the rib cage expansion 5–6 times.
Step 2. Ask your client to turn her head to the right. Place your hand on the junction area of the thoracic duct and the brachiocephalic vein. Apply pressure (pumping action) upon exhalation. Repeat these techniques 5–6 times.
Step 3. Ask your client to turn her head to the left. Place your hand on the junction area of the right lymphatic duct and the superior vena cava. Apply pressure (pumping action) upon exhalation. Repeat these techniques 5–6 times.
Step 4. Place your fist on the client’s navel area. When the client exhales, perform pumping techniques under moderate pressure. Given the fact that the biggest lymphatic vessels including the cisterna chyli are on this level, this pumping effort is extremely important for the acceleration of lymphatic fluid progression to the thoracic duct. Repeat this technique 5–6 times. Lymphatic nodes are mechanical and chemical filters. As you understand, we are directing lymph drainage through lymphatic nodes, very often connective tissue within them becomes tense, which in turn reduces their drainage and filtering capability. Very often, this tension is a significant contributor to insufficient drainage. Therefore, it is very important to massage all lymphatic nodes gently to release this connective tissue tensions. If you palpate any swellings, enlargements, or tenderness in the lymphatic nodes, do not massage those nodes. You should recommend the client to see her physician.
Occasionally lymph drainage procedures cause nausea, dizziness, muscle pain, and decreased energy. This is a result of the massive release of toxic products into the circulatory system. Please inform your client that this kind of reaction is possible and should be seen as a positive occurrence as evidence of detoxification. During the procedure, if your client reports headaches, nausea, or dizziness, stop the procedure. Invite your client for a repeat session after two days. Usually, the reactions mentioned above do not reoccur the second time, because the earlier session that prompted the reaction removed enough toxins. Statistics show that only 10 percent of clients get an adverse reaction to lymphatic drainage. However, 90 percent experience a boost of energy, better mood, etc., after the first session. All contraindications to massage therapy apply to the manual acceleration of lymph drainage. However, people with specific medical conditions need to consult their physicians. Doctors must be instructed that manual acceleration of lymph drainage is a very gentle procedure that causes massive acceleration of lymph drainage to the circulatory system. At the time of direct, gentle massage of lymphatic nodes, if you palpate any swellings, enlargements, or tenderness of the lymphatic nodes, do not massage them.
You should recommend the client see her physician. There is no doubt that lymph drainage is a powerful method for lymphedema reduction.
Step 5. Place the tips of the fingers on the submandibular lymph nodes, and under moderate/light pressure, massage the nodes in a circular motion (5–6 times).
Step 6. Place the tips of the fingers on the submental lymph nodes, and under moderate pressure, massage the nodes in a circular motion (5–6 times).
Step 7. Place the tips of the fingers on the cervical lymph nodes, and under moderate/light pressure, massage the nodes in a circular motion (5–6 times).
Step 8. Place the tips of the fingers on the axillary lymph nodes, and under moderate/light pressure, massage the nodes in a circular motion (5–6 times).
Step 9. Place the tips of the fingers on the cubital lymph nodes, and under moderate/light pressure, massage the nodes in a circular motion (5–6 times).
Step 10. Place the tips of the fingers on the inguinal lymph nodes, and under moderate/light pressure, massage the nodes in a circular motion (5–6 times).
Step 11. Place the tips of the fingers on the popliteal lymph nodes, and under moderate/light pressure, massage the nodes in a circular motion (5–6 times).
Step 12. Place the tips of the fingers on the malleolar lymph nodes, and under moderate/light pressure, massage the nodes in a circular motion (5–6 times). As stated previously, the pores of lymphatic vessels are large. Therefore, the proposed steps of pumping and direction of lymphatic fluid to the lymphatic nodes must be performed gently and with a lot of sense. If kneading techniques are performed instead of pumping/increasing drainage and increase flow through lymph nodes, lymphatic fluid will be removed from the lymphatic vessels to the extracellular space instead of being directed to the nodes, thoracic duct, and right lymphatic duct.
Step 13. With both hands, perform pumping techniques on the lateral sides of the lower leg with a combination of light strokes directed toward the lymph nodes. Proceed with the same technique on the front thighs.
Step 14. With the client lying in an anatomical position, perform pumping techniques on the forearm and arm, accompanied by light strokes directed toward the lymph nodes.
Step 15. Ask your client to lie on her stomach. Perform pumping techniques on the lower leg and back thigh, accompanied by strokes directed toward the lymph nodes.
Step 16. Place both hands on the lumbar region. Move your strokes toward the lateral part of the lower back and proceed in the direction of the axillary lymph nodes. Repeat 5–6 times. The total time of the session is approximately 45 minutes. Usually, the proposed protocol on the anterior and posterior are completed in 20–25 minutes. Repeat the proposed protocol twice.
The large pores of lymphatic vessels, under pressure, allow the lymph to move back into the extracellular spaces instead of proceeding through the lymphatic vessels to the lymphatic nodes and ducts. Therefore when performing described above techniques, pushing lymphatic fluid towards nodes, apply light / moderate pressure.
Simplicity and contribution of lymphatic drainage to well-being puts its contribution to detoxification in a unique position of value. For example, a person receives vaccination against the particular flu that initiates antibody production in the body. The existence of flu antibodies (the immune system warriors) means that this person has acquired resistance to the flu virus. However, at the same time, this person still has a considerable accumulation of toxins in their body. This means that her acquired immune system is significantly suppressed/insufficient and that her body has a lowered ability to defend against infection.
Referring to you to my blog ”boosting the immune system” accumulation of the excessive amount of toxins is the result of insufficient drainage or decreased quantities drainage through lymphatic nodes. Remember, when bacteria/virus enters lymphatic nodes, antibodies destroy them. “This insufficient immune system function can easily be restored by detoxifying this person’s body. Lymphatic drainage discipline causes significant detoxification, which in turn boosts/balancing the function of the already acquired immune capabilities.
The major question then becomes: ”Is an excessive amount of metabolic waste causes insufficiency of the immune system only?”
The categorical answer is NO. It has a negative effect on the functions of all organs and systems, including the central nervous system. It causes intracranial accumulations of excessive amount CSF, leads to neurotoxicity, functional reversible encephalopathies, has an adverse effect on the quality of sleep, muscular twitching, and foggy brain. To some degree, it exacerbates memory loss and diminishes the ability to focus. Can we view this insufficiency of brain function, as a brain the only dysfunction? As I stated in my article, in massage therapy fields we must view our body and its dysfunction in a holistic way.
1. In 1963, the professor of medicine, at the second Leningrad medical school, Alexander Dembo MD Ph.D., who has developed post-concussion rehabilitation medical massage protocol, realized that the cerebrospinal fluid drains into the lymphatic system. The resistance of rib cage expansion, accelerating the drainage of CSF, but as well, it contributes to the increase of lymphatic drainage. In the 1970s another Soviet scientist Vladimir Chernich MD Ph.D., who has researched lymph drainage and proposed the full-body acceleration of lymph drainage techniques, was positive that the brain contains lymphatic vessels. Today modern technological developments allowed scientists to detect in the brain the unknown earlier before Glymphatic System.
All the systems mentioned above, practically serve the same goal, the disposal of metabolic waste. Therefore techniques that I am proposing today, are scientifically but most importantly clinically proven as an effective massage protocol for disposing of metabolic waste, improve the body functions, and prevent brain dysfunction.
2. There is a negative chain reaction caused by stress, including but not limited to the buildup of tension in muscles, the increased secretion of stress hormones, and more. As you understood from my article, constrictions of muscles create pumping and thus support lymphatic drainage. Tense muscles do not provide sufficient support for lymph drainage. The increase in stress hormones secretion decreases the immune power by lowering the number of lymphocytes. Again, referring to my blog ”boosting the immune system” in the included video, I am stressing the importance of combining stress management massage with lymph drainage acceleration techniques.
3. I have a patient, who nationwide is one of the leading oncologists, a researcher, who was and is involved in the research and development of immunotherapy for different types of cancer, which is the most effective and side effects free, cancer treatments. In one of my private discussions, we talked about the lymphatic system and stress management massage, I said: “who knows how many times our treatment exposes cancer cells to the immune system, and as a result, prevents people from terrible suffering and death.” He responded that by reading my materials, he could not deny the possibility that massage therapists do extremely important work in preventing cancer. His concluding comment was “malignant cells use mechanisms to outsmart the immune system.”
I asked him whether it would be correct to say that malignant cells outsmart mostly those, with an insufficient immune system. He responded that logically I was correct.
Going back to the research of Dr.Chernich, he was able to prove that this method boasting Cytotoxic T lymphocytes and NK cells, cells are capable of eliminating the malignant tumor. He also proved, that the increase in stress hormone secretion lowers the number of lymphocytes, and therefore after massive observation, he concluded that excessively stressed people are at higher risk to develop cancer.
4. I don’t believe, that we should, as well as can, help people who already develop difficult pneumonia secondary to coronavirus infection. These patients in this critical condition are in the intensive care units. At the same time, I can tell, that if prior to pandemics, these patients would undergo the treatment that I outlined in my article, their immune system would protect them from coronavirus and other infections.
5. ” Why do older people who suffer from preconditions such as cardiovascular diseases, diabetes, high blood pressure, and cancer are at the particularly high risk to contract coronavirus infection?”
Nowadays any instruction typically answers it in the following way: ”Their immune system is compromised.”However, this answer raises another question:“ Because of their life for many years, older people must have a very strong acquired immune system. Maybe the reason for their susceptibility is the buildup of additional metabolic waste secondary to the consumption of large amounts of medications suppresses their immune system. I believe so.
6. Much of the literature nowadays is devoted to boosting the immune system. I use this word too. Therefore, you could understand from this article that the methodology I describe is none else but the balancing of immune power.
It is impossible to overestimate the power of scientifically sounds, clinically proven massage therapy modalities I have presented in this article. In addition to all the presented theoretical concepts, I’m successfully practicing these modalities for many decades.
It took a while to write this article. Therefore I would appreciate the feedback. Everyone is welcome to share his or her thoughts about the subject matter discussed in this article.
I received the criticism, as well as friendly advice, not to include advertising of my video hands-on educational materials in my posts.
Sorry, I strongly disagree. Why I am writing all of this? For sure not to enrich your knowledge in biomedical science, pathology, anatomy, pathophysiology only. You don’t need me for this, and I don’t see my mission as merely searching the Internet to present generally available data.
My goal in this undertaking is to provide theoretical information applicable to the successful application of certain massage protocols. Articles give me an opportunity, but the limited opportunity to share my knowledge and clinical experiences. At the same time, on my DVDs, I explain many in-depth concepts and offer practical guidance at the time of performing massage. By repeatedly watching and implementing the learned material on real people, allow massage therapists to learn to the level of successful hands-on application and that’s why I make them available. In such a case I achieve my goal.
For curious minds…
The physiological effect of massage on the human body
Two factors define the physiological effect of massage on humans:
1. The local or mechanical factor is expressed by a mechanical acceleration of venous blood drainage, some degree of lymph drainage acceleration, passive exercise for soft tissues, breaking down deposits of calcium in soft tissue and stimulation of its removal from the body.
2. The main power of massage therapy is in reflexive therapy. By mobilizing skin, connective and muscular tissue, we deform the mechano-receptors, which in turn release action potentials/impulses. Through neurological pathways, these electrical impulses stimulate motor and vasomotor centers. As a reflex or involuntary reaction of organs and systems to original stimuli, the body responds by expressing positive changes such as muscular relaxation, vasodilation, reduction of blood pressure, reduction of stress hormones production, etc.
To ensure that we achieve the most profound physiological effect on the body of the client, massage should be performed as deep as possible. The deeper we massage, the more we stimulate the nervous centers, and the faster and to a greater degree the reflexive therapeutic effects occur, the greater would be awakened positive factors listed earlier.
Note that deep tissue mobilization does not require excessive pressure. Pressure should be significant but shouldn’t activate the pain analyzing system, which could be recognized by two different factors:
1. Muscular protective spasm as a response to excessive pressure.
2. The client reports “too much pressure” even in absence of the protective muscular spasm.
Note: In order to achieve successful results in any type of massage, 50 percent of the procedure time should be spent on kneading.
Please watch this presentation on how stress debilitating on our health, for better understanding of the importance to provide full-body medical massage http://medicalmassage-edu.com/the-mechanism-of-stress-debilitation-of-human-health/
There might be personal benefits in sincere and active compassion
|Like most people, forced by courante for inactivity, I was racking my brain on ways to be productive and if possible help to other people in that difficult time. Browsing the net, I got engaged in a discussion about the tools that we as massage therapists can use to help people who contracted a coronavirus infection with two massage therapists who read this post.
I finished the post with these two sentences: I believe it is important to learn a step-by-step, full-body lymphatic drainage acceleration techniques. It’s always important and especially important today.
Now I’m thinking this is not enough. The subject of ”detoxification, and immune response” deserves a separate article written comprehensively, like we are saying, presenting a holistic view. Writing this article will keep me occupied and give an internal sense of peace and a sense of doing something right.
I’d like to encourage you to post your other requests, those covering the topic of ”detoxification, and immune response” or related to any other massage related topics, general or specifics.
As for myself… sitting at home, I decided to share my knowledge, to distract people, to help advance professional skills, etc. and while doing it I start realizing how beneficial it is for me, for my morals. I have tried to contribute and in the end, gained a piece of mind.
This sharing will keep our minds occupied, and push away heavy unproductive thoughts and, at the same time would allow us to concentrate on important subjects that otherwise remain marginalized in our busy everyday life.
In the meanwhile, I can say this. A massage therapist can help to a degree if a patient developed unusual difficult pneumonia. I will briefly discuss massage in cases of pneumonia and other respiratory diseases in that article. However, when someone has already been infected by a coronavirus we won’t be able to help, at least, at this point. The patients with cases of pneumonia secondary to coronavirus infection are in intensive care units.
When this pandemic dictated the entire nation to stay home, my management company asked what it might do for the massage community?
I recommended reducing the prices as much as possible on the educational materials. I was planning to write some educational commentaries, and we started working together.
As I stated, I don’t have a financial interest in all educational materials, and I thought it was very nice of them, to offer Vol. 5 for $10
or offer instructional DVD + set of silicone jars for $34.95
as well as post-concussion rehabilitation instructional DVD for $15
God willing, soon we will have our normal lives back: go to work, and be productive. Let’s try to advance ourselves in our ability to help other people, who are suffering.
Thank God for all
Remembering about the uniqueness of massage therapy
To me, the information presented in the article was a borderline distortion if not disinformation and I posted my considerations about it on his site.
Below I would like to share with you this what I have written there.
In my opinion, the aforementioned article was not written for massage therapists. In fact, it isn’t written for physical therapists or anybody who is applying physical methods of treatments.
As a massage therapist, I possess considerable clinical expertise and rich clinical experience in rehabilitation of post-concussions. The main goal of this rehabilitation is not the elimination of symptoms but the prevention of post-trauma brain dysfunction/encephalopathies. I would like to repeat not the elimination of symptoms only.
- “Neck musculature mass has been suggested as a biomechanical contributor to injury severity.” I hope we all agree that muscle mass cannot contribute to the severity. At least, this is not our professional language and approach.
- In my opinion, the sentence below represents the claim of health care professionals, who are radiologists, and who have never managed post-concussion rehabilitation: “Overall and individual muscle cross-sectional areas were correlated with symptom severity, neuropsychological testing, recovery time, and headache.”
- Can MRI cross-sectional examination determine the high resting tone (tension) in all suboccipital muscles? No, this examination cannot. When treating painful skeletal muscular disorders, because of pain sensation, neighboring muscles immediately elevate the muscular tone even those that do not share the same innervations. When treating muscular syndromes such as piriformis muscles/sciatica, all gluteal muscles increase muscular tone. In the case of the head trauma/concussions, all neck muscles, including suboccipital muscles, are in the state of a protective muscular spasm.
- As massage therapists, we must address all of the surrounding muscles, in order to reduce tension, and achieve results. In the case of the buildup of tension in the fascia, massage therapists must address it too. We can release this tension. At the same time, because of this article, one might address rectus capitis posterior only, and thus never will be able to achieve real results. Unlike painkillers that only block pain impulse to reach the brain, one of the greatest unique features of massage therapy is in addressing the real causes that produce pain and disorders/dysfunctions. The same is true to say in cases of post-concussion rehabilitation.
Below is my article Rehabilitation VS inhibition of symptoms
If you won’t have much patience to read it in its entirety, then please read at least the summary and conclusion. It will give you a quick overview of how and why we as massage therapists can prevent encephalopathies/brain dysfunction.
You’re welcome to challenge all that I stated in this post. Professional discussion can advance our level of professionalism.
1. I am of the opinion that massage therapists must remember about the great uniqueness of massage therapy when treating any disorders/dysfunctions. Our methods are not similar to painkillers that block pain impulses from reaching the brain but address the real causes that producing pain, and other dysfunctions.
2. Just because the article is published at PubMED.gov, it doesn’t mean that this article is written for massage therapists and/or this is good and scientifically valid material. Some time ago PubMED.gov published this article
Please Google:” Massage Impairs Post-exercise Muscle Blood Flow and ‘‘Lactic Acid’’ Removal” and you will find many other “scientific publications” repeating the same nonsense, Massage Impairs Post-exercise Muscle Blood flow”??????
In truth, the mere fact of something being published in PubMED.gov doesn’t guarantee it is a reliable material and could, in fact, be absolute nonsense.
This is my principle approach to a discussion. When in a discussion, someone disagrees or categories a statement as “nonsensical”, they must explain why it’s nonsensical or must explain the base of the disagreement. In this post, I said: ”Please Google:” Massage Impairs Post-exercise Muscle Blood Flow and Lactic Acid Removal” and you will find many other “scientific publications” repeating the same nonsense, like “Massage Impairs Post-exercise Muscle Blood flow”
Here is a detailed explanation of why all these “research” “findings”, are nonsense big-time.
Even today, doctors practice suboccipital injections, be it Botox/toxin injection, or corticosteroids hormones injections. Can it inhibit pain? In some cases, it can. Does it address causes that lead to encephalopathies? Positively not.
”In mild traumatic brain injury, the rectus capitis posterior minor is the only suboccipital muscle whose cross-sectional area is associated with symptom severity and worse outcome. Given the unique connection of this muscle to the dura, this finding may suggest that pathology of the myodural bridge contributes to symptomatology and prognosis in mild traumatic brain injury.”
To make the aforementioned claim, by all scientific standards, the researchers should first assess autonomic activities, and only then administrate these injections.
One cannot do Botox/toxin or corticosteroid injections nonstop and then, after a minimum of four months of observation, do a test of autonomic activities again. The test must be run much more frequently especially in view of the fact that test equipment can assess the irregularity or normalizations of the autonomic system rather quickly. Only when the test would establish normalization of the autonomic activities, anyone can claim what they claimed in this article.
Besides, why use the injections? Injections that have side effects. When it comes to muscular tone, by means of massage, we can achieve sustainable results without side effects, and in a relatively short time.
Having said that, practically my entire career I’m participating in an integrative medicine approach, which is a diagnosis by MDs, and then many different health care disciplines and methods, including injections, but only in certain cases when needed. Sometimes, but not often, it is very difficult to inhibit sharp pains by means of massage only. Many factors contribute to the pain, including but not limited to the central sensitization of pain.
One of the conditions to sustain results in post-concussions rehabilitation/prevention of encephalopathies, during numerous treatment is an immediate decrease of intracranial pressure, which reduces the intensity of headache, etc.
Remember, it’s very difficult to positively contribute to the balance of autonomic activities when intense sharp pains present. In certain cases, suboccipital injections can be very helpful, but in no case, as you could understand from my article Rehabilitation VS inhibition of symptoms, should be viewed as the main effort to prevent brain dysfunction developments. Prevention of encephalopathies demanding much more.
Do you possess enough expertise and experience to break my fascia?
Below is my blog about this bizarre request “to break fascia.” In this blog, I am not only presenting this case, but also explaining fascia/muscles relations, pathophysiology, and much more. In addition, I am providing information about the historical developer of this methodology. It’s a fascinating story.
“Breaking fascia” is not the only special memory that I have about fascia misunderstandings. Several years ago, there was a lot of excitement around the fascia congress. Many of my friends and students attended. I have the graduates, a group of personal trainers, who attended my school and for many years, they combined personal training with practicing massage. Through them, I received a lot of information about fascia congress.
I asked one of the attendees: ”why no one at Congress mentioned the name of Elizabeth Dickle, who made known the importance of tension build-up in the connective tissue/fascia and its impact on chronic somatic and visceral abnormalities to the scientific community.
He answered that this Congress wasn’t for massage therapists. I asked was it for personal trainers? I didn’t get a clear answer. It’s okay.
In fact, this brief commentary, it is specifically FOR massage therapists
Five years ago or so, I received a call from a patient referred by MD. Her first question was: “Do you possess enough expertise and experience to break my fascia?”
Jokingly I answered: “I’m in the business of repairing, and not breaking.” Regrettably, she felt that my humor was not appropriate and angrily retorted: ”Boris, I have developed myofascial tissue problem. For two months, I was seeing “fascia chiropractor”, and little by little started feeling much worse. Now my pain us not only in the scapula, but traveling to my arm, and I cannot sleep at night because of pain. In the beginning, it wasn’t like this, I could sleep without pain. Of course, I asked what chiropractor did, the answer was:” he tried to break my fascia, but my case is difficult and he couldn’t succeed. My primary care physician believes you can do it.”
Thinking about terminology…
To tell you the truth I don’t know where the terminology “breaking fascia” and “myofascial tissue” come from. No book of histology will support the existence of myofascial tissue. We have fascia and muscle alliance, an anatomical unit that is working together. Yet, histologically speaking, these are different tissues. Fascia is a connective tissue, which means fibers of fascia have no potential to constrict while the function of muscles is to constrict. I have invited her for treatment, and using a very convincing tone of voice, told her: ”clinical picture as you described, can be the result of buildups of tension within fascia and muscles. I possess the expertise to detect these abnormalities and eliminate this tension, in which case you can feel much better.
More about the case…
It was a difficult mechanical pain case. In addition, the patient exhibited anterior scalene muscle syndrome that triggered a neurological picture, radiating pain to the upper extremity. During the first five treatments performing connective tissue massage/fascia release and mobilization techniques, trigger point therapy, and massage techniques addressing muscles I have achieved positive change in the clinical picture. The patient could sleep at night, experienced no radiating pain to the upper extremity, was free of pain movement of the neck and upper back.
Of course, I convinced her to continue treatments in order to increase the threshold of muscular irritability. She agreed, and I have provided seven more treatments. Since then, during all these years I treated her sciatic nerve neuralgia, and knee sprain/strain type of injury. Today she is doing well. Her neck and upper back symptoms have never come back.
Briefly “About muscles /fascia”
Fascia surrounds each muscle, hosts pathways for nerves and blood vessels, participates in a nutritional supply, provides support for muscles when they are under a significant load. For example, when a biceps constricts, flexes forearm, lifts weight, fascia supports biceps action by sharing the load. Still, it is connective tissue; fibers cannot constrict. The physiology of movement relies on a constriction of muscles. Flexion, extension, stabilizations are the results of muscular constrictions. At the time of the movement relaxation in muscles happening due to action of antagonism as muscles cannot relax by themselves.
Due to the negative effects of stress, physical activities, irritation of spinal nerves, etc., muscles can build tension, expressed in shortening of muscles. When muscles build up tension and especially pathological tension, massage techniques especially kneading, can stimulate the decrease of muscular tension while passive stretching can affect buildups of tension in muscles.
However, kneading and passive stretching have no effect on abnormally tense fascia. Being a connective tissue, fascia has no blood vessels anatomical structure. Of course, cells of connective tissue need blood supply like any other cell in our body. Blood vessels in neighboring muscles, release these supplies, and connective tissue cell membrane allowed to this supply in. This process is called diffusion.
Tension in muscles
When muscles build up tension, blood vessels also constrict, thus making insufficient blood supply, to the fascia. If the insufficient blood supply to the fascia lasts a long time, it leads to tension build up in fascia. This tension is not the result of fibers shortening (as fascia fibers have no potential to constrict) but is the result of wrinkle- like buildup of tension.
To successfully stretch fascia, one needs to pull tense fascia in different directions mechanically. Without releasing buildups of tension in the fascia, it is impossible to sustain normal resting tone in muscles, to prevent reactivation of trigger points, etc. In turn, it makes it impossible to help people who suffer from different painful skeletal muscular disorders.
The inhibition of pain doesn’t imply adequate rehabilitation and sustainable results. Failure to achieve sustainable results would lead to pathology, including faster developments of osteoarthritis, and other degenerative diseases such as tendinosis, developments of muscular syndromes, etc. Besides, even if the pain is inhibited, one shouldn’t expect that the patient will be free of pain, no flare-ups, and will be restored desirable functional abilities.
The history of connective tissue massage.
The works of Austrian physical therapist Elizabeth Dickle made known to the scientific community the importance of tension build-up in the connective tissue/fascia and its impact on chronic somatic and visceral abnormalities.
As with many important discoveries, Dickle’s discovery was an accidental find. For several years, she suffered a failure of arterial circulation in her lower extremities resulting from Thromboangiitis Obliterans. The disease had progressed to the stage when amputation became a real possibility. Dickle also experienced chronic, lower back pain caused by her limping. While rubbing her lower back and trying to relieve tension, she noticed sensations of warmth and weak pulsations in her feet. Intrigued by her finding, she started using various techniques on her lower back. She noticed that pulling the skin on her lower back triggered the most intense warm sensations in her feet. After several months of self-therapy, she was able to restore circulation through her lower extremities and prevented double amputation. Powerful stuff!
Dickle shared her findings with Prof. W. Kohlrausch. Their combined efforts, as well as the later works of Prof. N. Veil and Dr. Luebe in Austrian and German clinics, shaped a major method of somatic rehabilitation they called Bidegewebsmassage or connective tissue massage/fascia release and mobilization techniques as it is known by the rest of the world.
During the extensive research, they developed connective tissue massage/fascia release and mobilization hands-on protocols, including the stipulation regarding the direction of movement. This was presented in a straightforward way so that thousands of massage therapists could learn these techniques and, successfully, implement them on patients. Thousands were replicating their outcomes when treating back and limp disorders, internal organ diseases, etc.
Russian Medical Massage
The work of Prof. Sherback, which is a fundamental plateau for medical massage, is also a fundamental groundwork for any massage therapy. Today, the concepts that lay the foundation of his works were tested and massively utilized for many years, and thus proved their clinical viability.
to post questions, agreements, and disagreements.
You’re also welcome, to watch videos, where I demonstrate the utilization of silicone jars for fascia release and mobilizations. It is very powerful.