Out of scope of practice or just politics Part 3
History of the Soviet Medical and Sports Massage.
|As explained in Part 1 and Part 2 of this blog the science of Soviet Medical Massage was originally developed by Professor Anatoli Sherbak in the nineteen thirties as well as my Dr.Serazini, who was internationally recognized as a father of modern sports massage. In the nineteen fifties, these developments were expanded by German scientists Drs. Glezer and Dalicho. Later in the sixties and seventies, many scientists of the former Soviet bloc countries contributed to this development. They were, for instance, Soviet scientists like professor Dembo, professor Popilyansky, Dr.Chernich, professor Kremer, the Bulgarian scientist professor Ivanov, Prof Anichkin, Prof.Belaya, and many, many more. Yet, little or close to nothing of the Medical and sports Massage protocols, that was improving sports performances, was known in the West. Although the large research institutions were involved in the Medical and Sports Massage studies, their developments were kept in strict secrecy. The secrecy was guaranteed by KGB and was overseen personally by the influential member of the central Communist Committee comrade Suslov.
The reason for such secrecy was substantial. During the “Cold War,” Soviet propaganda always tried to portray the Soviet system and the Soviet way of life as superior to the one adopted by the West. It even came up with the myth of special new “Soviet Person”, the carrier of the advanced Soviet mentality, which allegedly was far superior to a mentality of a Western person.
In order to somehow substantiate this myth, the Soviet propaganda utilized any Olympic sports and the dominance of the Soviet bloc athletes, especially of the USSR and Eastern Germany during Olympic Games in the sixties, seventies and eighties.
It would be essential to note a much greater longevity of the Soviet bloc athletes compared to their Western counterparts. The vast majority of the Soviet bloc athletes were competitive for ten to fifteen years. The real secret of such longevity was the elaborate system of pre-event and post-event rehabilitative Sports massage and the proper warm up procedure; a sequence of special exercises including neuromuscular re-education that ensured that all the muscles of the responsible regions work in assembly and in the neurological sense. Such powerful scientifically based methods made verifies that joints are stable enough to withstand huge competitive loads and to perform to the maximum physiological potential of individual athletes.
All that changed during the time of Gorbachev’s “perestroika” – restructuring of the Soviet economy – and, subsequently, during the time when the Soviet system has fallen apart. The scientific institutions that for decades were supported financially by the Soviet Government, regardless of their actual profitability, were suddenly left without any funding and, thus, quickly disintegrated.
The impressive body of knowledge accumulated by decades of arduous work by talented scientists was literally abandoned. That’s why, paradoxically, the only people who could carry the torch of knowledge in the Russian Medical and Sports Massage were those who have emigrated from the Soviet Union at the time and prior to “perestroika.”
In the institution where I worked in 1963, a military faculty was organized, which was preparing military sports instructors, thus making it a military PO. Box. The research was conducted under a strict secrecy, and practitioners who were trained were obligated to keep this secrecy and knew that those protocols were a secret product of Communist party. Perhaps, for those who lived in the free world, the threat of KGB will be difficult to comprehend, but we all knew too well that messing around with KGB was a bad idea. It was too serious.
The Soviet government used to keep secrecy only for massage protocols that substantially improved athletic performances. The other medical massage research papers, including hands-on massage protocols, such as fibromyalgia and many other ones were available (see the link below)
As I know, today post-concussion rehabilitation protocols and some other were published. I remember very well how our bosses used to gloat regarding the fact that Medical Massage for visceral and skeletal muscular diseases in no case was of the interest in America as the US was under complete control of pharmaceutical industry. What was kept in strict secrecy, were post-event sports massage protocols like the one attempted to develop by the Western Experts below:
The possibility of speeding up the athlete’s recovery by massage captured the attention of Western European and American scientists working in the field of Sports Medicine. However, authors of numerous studies in different centers mostly concluded that massage does not have any significant impact on the process of recovery after maximal exercises (Drews, et al., 1990; Carfarelli, et al., 1990; Rodenberg, et al., 1994; Tiidus, et al., 1995; Gupta, et al., 1996, and more). All these studies were conducted by very responsible scientists and published in respected professional journals.
After studying the above report in detail and many other similar to this one, I realized why there was such discrepancy in the results. The time of treatment here plays a crucial role. All Western articles, which reported about the failure of massage therapy to speed up the recovery process, had the same striking similarity. Despite a truly scientific approach to the evaluation of treatment and its duration, these studies neglected to follow the proper protocol: TIME OF THE TREATMENT and DURATION.
Cafarell, et al., 1990 immediately after exercise 4 min
Drews, 1990 immediately after exercise 30 min
Wenos, et. al., 1990 48 hours after exercise N/A
Rodenberg, et al., 1994,15 minutes after exercise 15 min
Tiidus, 1995 48 hours after exercise 10 min
Gupta, 1996 48 hours after exercise 10 min
After numerous experiments, the Soviet scientists concluded that massage has to be initiated no earlier than 2-2.5 hours after vigorous exercises. Further, in my further discussion I’ll be referring to this essential consideration.
Only one published article on this subject puts everything in the correct perspective. In this study, a group of North Carolina and Virginia authors (Smith, L.L et al., 1994) formulated a protocol based on that of Russian scientists, proving its value. Prof. Smith, L.L et al., 1994) even wrote, I followed recommendations of Soviet scientists and, evidently, discovered the importance of a rehabilitative massage.
It so happens that I personally know and know very well the Soviet scientist, who in 1993, secretly wrote research massage protocol for Prof. Smith on a piece of paper. Even at that time, Soviet citizens used to be afraid of a disclosure.
According to the Soviet protocol, authors examined the effect of massage on delayed onset of muscle soreness, and creatine kinase (an enzyme indicator of muscle damage) and neutrophil (an inflammatory white blood cell) count. It is noteworthy, the authors adjusted their experimental protocol according to the practical recommendations of the Russian scientist who was also a massage therapist. These authors considered that vigorous exercises damage muscular tissue with the development of aseptic (noninfectious) inflammation and interstitial edema. The body reacts to these events by mobilizing neutrophils to the affected area. Neutrophils enter tissues and start their cleaning job (i.e., phagocytosis) to remove the waste products produced by the muscular injury and inflammation. Their increased concentration also attracts other types of phagocytic cells, macrophages. In the process of phagocytosis, catabolic enzymes are released from neutrophils, additionally damaging already injured muscular fibers. Dr. Smith and associates, through their research, noticed that two major events indirectly support this theory: temporary reduction of neutrophil count and increased concentration of creatine kinase in local blood vessels, and their following migration into soft tissues as critical elements responsible for the long lasting muscle soreness after vigorous exercises. This study showed that this process precisely matches the 2-hour time limit after vigorous exercise.
This is what Smith, et al., had to say in their conclusion:
“During acute inflammation, blood flow slows as vessels dilate in an area of injury. When this occurs, the white blood cells, including neutrophils, are displaced from the central, axial zone of blood flow to the peripheral, plasmatic zone and subsequently marginate along the vessel walls. Since sports massage appears to increase blood flow through the vascular bed, we theorized that this increased flow rate in the area of microtrauma could prevent the typical outward displacement of neutrophils. In addition, we speculated that the mechanical action of sports massage could shear marginated cells from vessel walls and thus hinder emigration of cells from the circulation into tissues spaces. …control group exhibiting a more rapid and steeper increase CK (i.e. creatine kinase) values than the massage group. …sports massage rendered hours after termination of unaccustomed eccentric exercise reduces the intensity of delayed onset muscle soreness and reduces serum creatine kinase levels.”
Delayed onset muscle soreness might sound innocent. Yet phagocytosis actually injures healthy muscles, and when it happens repeatedly, it makes muscles weaker disabling them from performing at their maximum potential, as well as preconditions them for injury. As a part of the Soviet training regime, Olympians practiced until their heart rate would reach 205 to 220 times per minutes. Imagine what kind of physical athletes had to perform if their resting heart rate was 40 to 45 times per minutes.
The workouts of such intensity could produce a substantial damage to muscles unless two hours later athletes would undergo post-event rehabilitative sports massage. This treatment cannot be viewed as a shock absorber, for additional damages by phagocytosis, but as a preventive effort against additional injuries. Working with Olympian teams, I, as well as other therapists in our group, used to restore the local blood supply in muscles immediately, preventing the development of fascia tension, as well as restoring normal functions of organs and systems. Briefly, I’m talking about this in my article that, amusingly, were published in Massage Magazine.
Below I included the references to this article.
Smith, L.L., Keating, M.N., Holbert, D., Spratt, D.S., McCammon, M.R., Smith, S.S., Israel, R.G.: The Effect of Athletic Massage of Delayed Onset Muscle Soreness. Creatine Kinase and Neutrophil Count: Preliminary report. J. Orthp. Sports Phys. Ther., 19(2): 93-99, 1994.
Lucky for “Sports Recovery and Performance Enhancement” all there references to this work were by the Western Experts.
Working in the “Inhibitory Regime” (massaging while gradually increasing pressure), we awaken reflexes to the original stimuli. These are expressed in vasodilation (reduction of peripheral vascular resistance, reduction of left cardiac work, etc.) As a matter of fact, with Post-Event Sports-Massage, we also prevent the enlargement of the heart muscles (hypertrophy), balance the biomechanics that prevents sports-related injuries, as well as improve the performance of the athlete.
The above article uses proper protocols is what makes the difference between proper and improper utilization of Sports Massage. Scientifically-proven protocols are designed through extensive research and thorough analysis of data on efficacy and safety of any treatment. Post-Event Sports Massage contains important methods used to improve the performance of athletes, rehabilitate from exercise stress, eliminate side effects, and prevent sports-related injuries.
I hope I don’t end up sounding like a boaster. In reality, I am a very humble man. I just happen to be in the right place at the right time and, as a result, I was exposed to the amazing source of knowledge, which, by a freak of current, got abandoned and dried up.
All my life, I was trying to popularize this knowledge, make it available to everybody and especially at the place of my new motherland that was so good for me and my family. I did what I could, what was within my physical, mental and financial abilities and now I am not a young man. I made 22 DVDs describing protocols of Medical Massage. I hope this contribution of mine would be rightly understood despite my less than perfect English.
For a detailed discussion of all the protocols discussed above please follow the link below.
I also highly recommend to purchase medical massage texts by Dr.Ross Turchaninov
This is what I wrote about him and his works.
Out of scope of practice or just politics Part 2
By Boris Prilutsky
|As I explained in the previous blog, when massage Magazine removed my article, without allowing me to reply to those complaints, my partner wrote Karen Manahan editor in chief an emotional personal e-mail. The text is below.
As you know, I am Boris Prilutsky’s business partner, as well as providing technical support.
You might not know this, but among a multitude of bad things that has happened in the former Soviet Union, there were actually rare diamonds of good things. One of those diamonds was Medical and Sports Massage, to which the Soviet Machine devoted huge scientific efforts and human resources.
The reason for this was simple. The Soviet Union was, generally speaking, a closed society and the only change for its people to compare themselves against the West was through sport, Olympic Games, Bolshoi ballet etc. The Olympic gold was the way to show to all people inside the Soviet Union and outside it that the Soviet System is superior to the West and thus making the Soviet life superior as well.
Why was Medical and sports Massage making such a difference? Simple. Because the main problem with athletic performance is athlete’s susceptibility to injuries. In other words, an athlete could have huge potentials, but if s/he’s injured, s/he cannot compete. Side effects of vigorous exercise not only precondition athletes, for sports related injuries, but also wouldn’t allow performing to maximum potentials.
Still, people during those times heard the rumors about it, and the profession of massage therapists was very prestigious and required many years (7 years) of extensive medical studies. People who became such therapists always worked in the hospital environment among doctors or, like Boris, worked with Olympic teams.
You see, Boris learned all these protocols long times ago and although he learned them from scientists who invented and tested them, he is not a scientist himself.
For example, the concussion protocol was invented in 1963 by Professor Alexander Dembo, when one of the most famous Soviet boxers, had developed post-concussion encephalopathies. Since that time, Boris uses these protocols very successfully in his practice. However, it is pointless to ask him for references. Again, this information was classified. You actually might find some publications in some old Soviet scientific magazines, but it has never been published in English.
In America, massage was a hugely underdeveloped field, because since 1920’s America took a course to chemically produced medications. With time, this field became a very profitable enterprise, and for its proponents, it was not necessary to develop competitive fields. Thus, for a long time, massage in America was looked by the American public as something borderline prostitution or luxury for rich people.
Today, there is a change for the better, but unfortunately, instead of finding out what was done in massage science in other countries, America is going through the hard times of reinventing the wheel.
Well, the US was very good to us and we want to give it back with whatever we can. In the case of Boris – this is his knowledge. If you only knew how many doctors are sending him their patients to try the last time if the surgery could be avoided because in many cases this is exactly what happen? Is this occurs because Boris is some kind of a magician? No, because he knows many scientifically designed protocols and knows very well how to use them. Can references do this?
Thus, I gather the people who bad mouthed Boris, are simply gullible. A knowledgeable person always objects on a quintessence but the other kind objects on technicalities. Why do they need to see the references, because he’s going to read them? No, it just gives them a comfortable feeling that what he’s reading must be scientific.
Ten years ago I was completely incapacitated by frequent life-threatening panic attacks. Pills only made me drowsy. It was Boris who treated me with Medical Massage. When, after the first session, my blood pressure dropped from 200/100 to 160/85, that made me a believer. That’s why I decided to help him, and in the end, he offered me a partnership. Because he is a person with the big heart and it makes me sad when he is so utterly misunderstood and put down.
All the best to you in your future endeavors,
I didn’t know about this letter, and most likely didn’t have to know about my partner’s private affairs. However, a few weeks ago, Karen told Michael that she is planning to publish his letter in massage Magazine March issue and Michael come back to me with this news. We both agree, if massage Magazine will not allow me to publish the reply to Michael’s letter, then we shall request from massage magazine, not to publish his letter.
My partner, Michael, learn from me quite a bit about the history of Medical Massage in general and especially about the secrecy behind Soviet propaganda that used Olympic Games to prove that the Soviet system is much superior to the West. As a matter of fact, Medical and Sports massage played a crucial role in allowing Soviet Olympians from the 60s to 80s to win the most of the Olympian gold. Yet much of Michael have presented in his emotional reaction letter, needs a clarification. Otherwise, readers of massage Magazine will remember only that: ”Again, this information was classified. You actually might find some publications in some old Soviet scientific magazines, but it has never been published in English.”
Pertaining to the late Soviet period of Medical Massage development his description is pretty accurate. However, for the sake of this discussion I should point out that the general history of medical massage is not a secret at all. On the contrary, it is quite well known. I was trained on this fundamental principles and have all the necessary references.
It goes back to the 18th century, when British physician Dr.Head published, his, what we now call, Dr.Head’s zones. During a very long time, observing hundreds of patients, Dr.Head paid attention that in many cases of chronic internal organs diseases, skin within somatic distal components, develop changes in a form of higher skin density, a local low threshold of pain, etc. The great clinical value of his observation soon became obvious. When he performed skin massage in these areas he not only eliminated these abnormalities in the skin but also have had a tremendous healing impact on diseased internal organs. I believe that Dr.Head was the first one who have established visceral somatic reflex concept as well as somatovisceral reflex concept, which allowed to professor Sherback in 1937 to go further and to develop the concept and hands-on techniques of segment reflex massage as we practice it today.No doubt, that Professor Zabludovsly (1913) remarkably advanced massage therapy as a powerful clinical tool and, I would say, that in many cases, it became the most powerful methodology for treatment.
Professor Zabludovsly (1913) was the first one who explained the reflex effect on arterial circulation in non-massaged extremity. The phenomenon was confirmed later by many experimental and clinical studies (Guthberson, 1933; Ebel and
In 2003, at Beverly laboratory of Vascular Studies, I repeated Professor Zabludovsly’s protocol. In Medical Massage Vol.2 text, Dr.Ross Turchaninov extended on this experiment. We have provided him with all post-experimental data. Please keep in mind, I can reproduce the same outcome as you about to read at any time. To study this 15-25 minute protocol is the simpler than studying many other simple step-by-step hands-on medical massage protocols.
Professor Zabludovsly (1913) was the first one who explained the reflex effect on arterial circulation in non-massaged extremity. The phenomenon was confirmed later by many experimental and clinical studies (Guthberson, 1933; Ebel and
The Beverly laboratory of Vascular Studies in California examined the effect of medical massage therapy on arterial blood circulation in lower extremities of healthy adults by using Pulse Volume Recording (PVR), Photoplethysmology (PPG) and Thermography (TMG). All these tests measured blood circulation on the opposite lower extremity, i.e. practitioners worked on the left extremity while circulation was measured on the right extremity. Peripheral circulation was measured before the experiment and after application of medical massage.
Major changes were registered in PVR, which is a pulsate volume of perfusion through the extremity.
Let’s briefly review the results of this study. Initial PVR registered on the right lower extremity was 0.81. After this parameter was registered, a medical massage practitioner applied the treatment of the lower extremity for 15 minutes. After 15 minutes of medical massage, PVR increased to 1.22 and continued to climb during the next 2 hours after the medical massage was over. At the end of the second hour, PVR value was 1.63, i.e. blood perfusion through the contralateral lower extremity showed a double increase even after the medical massage was over.
This study is a great example of the valuable effect of medical massage on the peripheral blood circulation (Prilutsky, 2003). This is why patients with arterial circulation disturbances respond so well to medical massage.
I hope you would agree that it is impossible to overestimate the importance of contralateral extremities massage, in cases of fractures, surgeries, and significant other types of injuries when we cannot apply massage directly to the injured area. More than that, at the time of the experiment we’re described above, my models agreed to wait only two hours in order, to allow us to perform PVR measurements. As you could see after me stopping the treatment, two hours after the treatment, it continued to increase PVR.
Back in the Soviet Union, we have repeated described protocols many times, and reflex
Another researcher- Elizabeth Dickle contributed significantly to massage therapy fields by researching and proposing hands-on protocols that were clinically proven to be a very powerful methodology for treatment since 1929. Below is my extended explanation why I made this claim.
First, a short historical review: Initially, the importance of tension build-up in the connective tissue/fascia and its impact on chronic somatic and visceral abnormalities was made known to the medical community through the work of Austrian physical therapist Elizabeth Dickle in 1929. 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 as a result of Thromboangiitis Obliterans. The disease had progressed to the stage that amputation was a real possibility. Dickle also experienced chronic, lower-back pain caused by her limping. While rubbing her lower back in 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 the most intense warm sensations in her feet were triggered when she pulled the skin on her lower back. After several months of self-therapy, she was able to restore circulation through her lower extremities and prevented double amputation. Powerful stuff.
E. 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 outcomes when treating back and limp disorders, internal organ diseases, etc. for more information just Google Bidegewebsmassage.
The work of Prof. Sherback, which is an absolutely fundamental plateau for medical massage, is also a fundamental plateau 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.
After analyzing all the available data, and experiences of other scientists and clinicians, Prof. Sherback started checking somatic components of chronically unhealthy patients.
The aforementioned changes produce pain when compressed and, in many cases, spawn localizations that are painful regardless of compression. Then a revelation come to him – “a simple revelation” as he put it that made massage a very powerful therapeutic tool.
All diseases of internal organs project pathological impulses on somatic parts that share the same level of innervations with a particular somatic part and trigger changes such as higher density of skin, tension within muscles, fascia, etc. forming reflex zones abnormalities/ somatovisceral reflex. The aforementioned changes in soft tissue can be painful and especially sensitive to touch or pressure.
The most important achievement of his and his students was that, by providing massage and eliminating these reflex zones abnormal changes, they improved the health of thousands of patients.
The huge plateau was established by Drs. Glaser and Delixo after the tremendous work. In 1955, they published segments reflex massage text, including more than 30 maps of reflex zones abnormalities, for individual internal organs diseases, as well as skeletal muscular diseases.
The contribution that prof. Sherback and Drs. Glezer and Delixo made to the development of massage science was indisputable and their influence is hard to overestimate. Similarly, it is impossible to overestimate the contribution of Dr. Sarkisov Serazini, who proposed comprehensive physiological effect of massage approach in 1938 and have established the concept of the physiological effect of massage as we know it today. This foundation allowed further generations of researchers to develop over 60 medical and sports massage hands-on protocols. Thus, the methodical research was done, and optimal step-by-step hands-on techniques where developed, all of which were standing on the foundation of the physiological effect of massage. Here is the link to a short description of the physiological effect of massage. Physiological effect of massage on the human body
During his experimental clinical researches Dr.Sarkisov Serazini said:
”…if you would like to assess the professional capability of a massage therapist, you must assess his capability to perform high-quality kneading techniques. Many different components are necessary in order to achieve rapid and sustainable results, and the quality of kneading techniques is one of this important components.”
Medical massage contains technical disciplines such as connective tissue massage/fascia release and mobilization, muscular mobilizations, trigger point therapy, circulatory massage, and more. This was my fundamental training in theoretical concepts as well as very intensive hands-on practice. As you can see no secrets what so ever.
Surely Drs. Glezer and Delixo’s segment reflex massage text, have never been translated into English. Here comes a million dollar question. If hasn’t been translated into English, can it still be scientific? Incidentally, it has been translated into Russian, German, Polish, and Hungarian.
By the way, Dr. Ross Turchaninov’s textbooks in English, covers the works of all the scientists I have mentioned above, including interpretation of science of massage. I believe this book presents more than 600 references.
In Part 3. I will discuss the secrecy of medical and sports massage developments during the Soviet Era.
Out of scope of practice or just politics?
by Boris Prilutsky
|As you may know, some time ago due to complaints Massage Magazine requested, to remove my article Specially designed medical massage protocol is the most powerful methodology for management of concussions symptoms and much more
The main complaints were:
Regrettably, Massage Magazine decided to give up. “Regrettably”, because if we would discuss the issues stated in this complaint, I am positive that everyone would be able to learn even more about our scope of practice and about other aspects of massage practice that could have arisen in a professional discussion.
Again, regrettably, and despite my promise to provide references, Massage Magazine didn’t allow me to respond to these complaints and removed my article. As far as references are concerned, I always had them. Only, in this case, I elected not to include them.
I have a friend, who is an MD, neurologist, and sports medicine expert, as well as Ph.D., and a great hands-on massage therapist. He was a student as well as the right hand of Prof. Dembo. Much older than me, during the 1970s, he was my mentor and then took me to work in his group. Almost 10 years later, he proposed me a partnership in private practice. We still are very close friends.
When I shared my frustration with him, he asked me whether within the editorial board of massage Magazine there were any professionals in our field, and if so, why didn’t they allow me to answer to the allegations? I had no answer for him at the moment. However, later, contemplating on the issue, I surmised that the magazine was subjected to so much pressure that the editorial board chose this way of handling the situation.
In my view, the magazine’s refusal to publish my rebuttal is a detrimental practice, not worthy of democratic society standards. I remember publishing a short article in “Massage Today.” It included the proposal to address trigger points. One lady disagreed with my approach. “Massage Today” published her disagreement and published my rebuttal a well. It so happened that my opponent agreed with me, but our personal agreement or disagreement was of little significance. More importantly, the readers of this professional massage magazine could learn from our discussion.
Having said all of the above, I actually want to compliment Karen on her courage in allowing me to clarify the situation by posting my reply on Massage Magazine FB page. Even though most likely, the amount of subscribers to a printed magazine is much greater than Facebook membership, it is some reconciliation after all. Therefore, I will use this opportunity to present my position regarding allegations stated above.
1. All the information I’m presenting in my article is out of massage therapy scope of practice.
The concussion-rehabilitation protocol is nothing more than a massage protocol – a sequence of massage manipulations – effleurage, friction, petrissage, tractions, massage techniques to accelerate lymph as well as cerebral spinal fluid drainage etc. that I like any other massage therapist use in massage therapy procedures. Those of you, who rented my instructional videos know that I perform all stated above techniques. If massage technique that I am proposing as a part of this protocol is out of massage therapy scope of practice then we all practice out of the scope of practice.
As for the protocol itself –it was developed by Professor Dembo and his research group in 1964 for a use of massage therapists just like any other massage protocol of Medical Massage.
The concepts presented in my article I learned in 1973 from the internal informative leaflet of Soviet Ministry of Health, the department number 4. In addition, I was trained in to perform hands-on massage protocol in the classroom.
2. Massage therapists cannot treat psychiatric disorders and certainly can’t promote themselves as mental health professionals.
I never presented or/and promoted myself as a mental health professionals.
The following is an excerpt from my blog:
”The hands-on protocol starts from combining massage techniques for acceleration of cerebral spinal fluid drainage, lymph drainage massage techniques. It is followed by the lateral neck compression massage techniques, acupressure techniques for tension headaches and the full body medical stress management massage. To understand why this protocol is utilized with repeated success, I am referring you to how the biomarker was established, and summarize that the concussion biomarker is irregularities of the autonomic nervous system. After accelerating drainage of an excessive amount of cerebral spinal fluid, we immediately increase much-needed blood supply to the brain. However in order to sustain the normal cerebral circulation, normalization of autonomic activities is a must. No other methodology but massage therapy possesses this significant power/effect to balance sympathetic and parasympathetic activities. Again, the post-concussion conditions developing vicious cycle, such as secretions of excessive amounts of CSF, following by Insufficient blood supply along with dysfunctional mitochondria – intracellular source of reactive oxygen species, Programmed cell death and more, immediately reflecting in autonomic irregularity. In order to achieve sustainable results, a therapist must perform all techniques I mentioned above in order to restore blood supply and at the same time, stimulate autonomic activities to achieve the maximum possible balance.”
Thus accusing me of presenting myself as an expert for psychiatric disorders, is just as groundless as to blame me in proclaiming myself an expert in support and movement disorders, etc. I am a massage therapist, who possesses skills and knowledge in performing therapy by means of massage, which is the capability to address causes that produce pain and dysfunction. As human body has a potential to heal itself, by performing massage we stimulate this healing process.
3. Only healthcare providers can address concussions, massage therapists have no business in this cases.
The answer to this questions has to do with the distribution of tasks. Certainly, medical doctors have to diagnose the problem and prescribe the treatment plan. However, it is the obligation of a massage therapist to execute the treatment. The misunderstanding perhaps happen because the post-concussion rehabilitation protocol, so widely known and implemented for a long time in the Eastern Europe, is not very well known in the US. So the permission to use the protocol comes down to the factor of its legitimacy.
I said earlier, it was developed by scientists and it has been tested by many years of implementation in the field. Professor Dembo’s research established that the nature post-concussion biomarker was irregular autonomic activities. It was a challenge to find references to support his research written in or translated into English. The best support for his research (in English) is this video that I discovered it accidentally, and very timely. Please watch the following video:
Random picked, 21 post-concussion patients demonstrated irregular autonomic activities. This is a very solid evidence. I would recommend reading the information scientifically based and clinically proven information on physiological effect of massage on human body.
Irregular autonomic activities are very sensitive phenomena. When an individual suffers from a post-concussion encephalopathy, including irregular autonomic activities, he or she cannot control himself even under regular circumstances, which otherwise could be controlled by a healthy person. Under these circumstances just an insignificant emotional or mental irritation can escalate into absolutely irrational behavior; to, what we would call, psychiatric behavioral disorder.
In a case of successful application of massage protocol, directed to address post-concussion phenomenon, including an approximate balancing or sympathetic and parasympathetic activities, in most cases, the development of brain dysfunction could be prevented, including movement disorders, dementia, as well as psychiatric behavioral disorder.
4. I didn’t include references, supporting my statements.
Prior to answering the question of references I would like to post my own question to the complainers: Will the list of references help a patient suffering from post-concussion encephalopathies?
The friend I mentioned earlier, told to me, that the first time Professor Dembo’s research paper was published in 1965 at “Physical Culture and Sports publications” and suggested that I could have given references to this publications. However, I wasn’t sure that searching in old Soviet magazines was the right approach in this case. At the time when Professor Dembo proposed the Post-Concussion Rehabilitative Medical Massage Protocol, the prevailing opinion in the contemporary scientific community was that the terms such as a stunned brain, hibernating brain cells, apoptosis or programmed cell death meant the same thing – a non-reversible cell death. That means that a reversible apoptosis as well as the post-concussion inflammatory response, weren’t possible because the brain was incapable of marshaling a post-concussion inflammatory response due to the selective permeability of the blood–brain barrier (BBB).
Today, 40+ years later many researchers support all that Prof. Dembo hypothesized and clinically proved. The outcomes were reproduced thousands of times.
However, my point still stands; will the list of those references help a patient suffering from post-concussion encephalopathies?
When Prof. Dembo proposed this concept and massage protocol, he was a maverick in this research and, therefore, couldn’t offer any references because, as it was mentioned above, it was contrary to the prevailing opinion of the contemporary scientific community on the issue. Yet has his method been less effective because of this?
In the interim, the friend I mentioned above, Dr. Ross Turchaninov, my kids, and my current partner convinced me to always present references, in order to avoid unnecessary “misunderstandings”. Ok, from now on I will always present references. At the same time, I find this attempt to pretend, making a terrible disservice to our communities, including professional publications. Many times, following the given references within published articles, I discovered that they had nothing to do with presented subject relying on the fact that editorial board is not checking, or not capable of check them. How about the readers? Do most of them ever follow or read references that come with each article?
When massage Magazine removed my article, without allowing me to reply to those complaints my partner wrote Karen Manahan editor in chief an emotional personal e-mail. To his and later to my surprise Karen decided to publish his letter. To me, her decision seemed odd; to refuse me to publish a reply to complainers, and, suddenly, to agree to publish my partner’s letter? The readers might remember these sentences from his letter: ”Again, this information was classified. You actually might find some publications in some old Soviet scientific magazines, but it has never been published in English?” and, as a result, be left with the partial or wrong impression.
In my next post, I will include the text of his letter – the same text as it was printed in the editorial section of “Massage Magazine.” My partner is not massage therapists or in any way connected to our field. Therefore, in the next blog will offer my additional explanations and clarifications regarding the information he included into his letter.
A contemplation about “Concussion”
By Michael Gaft
I would like to start by saying that I am not a massage therapist or a medical professional and my interest in this matter is rather philosophical than medical.
Recently, I watch “Concussion” movie and was impressed with it in a couple of different respects, least of which was a great job by Will Smith imitating Nigerian accent.
It was very touching how Will Smith portrayed Dr. Omalu. He’s shown a person of unusual courage, resolve, and perseverance, and, at the same time, someone very humble, without preemptive sassiness and tantamount of drama. “The true American” as they put it in the movie. I might add “the true citizen of the World” since it’s not only in America that the big business is throwing its weight around. Maybe that belief in the exclusivity of the US as a beacon of justice and opportunity actually kept him going through the entire ordeal and the success, he has eventually enjoyed in the US, couldn’t have been possible somewhere else. That and the pretty partner that Hollywood has furnished Will Smith in the movie. Surely, behind every great man, there’s got to be a great woman. “Serse la fam” so to speak. Not sure whether this is how this reality happen in the life of real Dr. Omalu as he is not as tall and handsome as Will, but let’s give this plot line the benefit of a doubt.
It’s actually amazing that the real Dr. Omalu was able to persevere through that struggle. Even being truly righteous and courageous, he was also very lucky. I am thinking of many doctors who on the brink of such discoveries were shut down, intimidated, were stripped of their licenses, lost their jobs or, perhaps, careers.
However, to me, the most striking inference of the movie was in the fact that Mr. Omalu had to make the discovery of chronic traumatic encephalopathy (CTE) in 2002, while this phenomenon was discovered many years earlier, before he was even born, in the Soviet Union. Only this condition was detected in connection with boxing rather than with Football. However, as I can recollect, Joe Luis had the 750 lb punch, as was the case with many other knock-out artists, which is quite enough to create a concussion and leave a person with CTE.
As I was saying, this phenomenon was discovered in the Soviet Union in 1963 in connection with a very famous, at the time, boxer Valery Popenchenko, who was called “Mr. Mystery Knock Out.” Rather than describing the history here I’d like to offer you the link, where Boris discusses it at length.
Interestingly, not only that in the Russian doctors discovered these encephalopathies, but they also developed the massage protocols to handle this condition. Among many bad things that a police state might enforce, this came out good as all the boxers and athletes of other sports susceptible to the possibility of concussion were obligated to go through the appropriate treatment and only then were allowed to return to training.
If instead of pushing the players to the field after sustaining the concussion, NFL would employ these very safe and cheap treatment protocol, there would be no brain damage and consequent deaths of so many icon players. I remember this sentiment coming many times from Boris when visiting him in the past, I saw huge burly fellows leaving his office after receiving this protocol. So I actually very glad that the movie like this has finally arrived.
The whole situation with Dr. Omalu discovery reminded me the case of the father of genetics Gregor Johann Mendel who made his discoveries in 1865 and 1866, and which had been forgotten to be rediscovered in 1900’s.
As I am contemplating about the movie and the real case that this movie is about, I have a bitter taste in my mouth – “what a waste” of a talent! Why can’t we, as the only Homo sapiens on this planet, communicate the knowledge and be helpful to one another?
The opening scene in the movie, where Dr. Omalu is subjected to inquest regarding his credentials, is very indicative of the overall US approach to an “alien” source of knowledge. It wasn’t enough to say that he was a pathology anatomist and established the cause of death on a daily basis. He had to mention that he had degrees from the several accredited American schools, before his testimonial been given any weight. It sort of blows my mind. Here it is this protocol that prevents long-lasting brain damage, just take it.
Surely, there is some justifiable safety precaution here for who knows what people came from other countries can claim? Thank god the US has enough of its own quacks. However, if someone offers methods of treatments that has been proven safe and effective over many years, why not give them the benefit of the doubt enough to test them?
Another unsettling moment in the movie was when NFL finally started listening to Dr. Omalu’s reasoning only because one of their own upper-level managers, ex-football player, also committed a suicide. Do we have to wait for another fifty years until someone like Dr. Omalu would develop the protocol in the US?
Diverticulitis and lower back pain
Prior to getting familiar with the case I am about to describe, I highly recommend to read this article. http://medicalmassage-edu.com/critical-vs-clinical-thinking/
I called this article “Critical vs. Clinical Thinking.” I hope we all agree that critical thinking is involved in most situations of our life, including and not limited to intellectual dynamics of clinical thinking. But if critical thinking will compel you to a search for scientific data, it will lead you astray from the specific clinical picture thus becoming useless and having nothing to do with clinical thinking process and the outcome of it.
Last Monday, September 7th, 2015, a 47-year-old lady, a nurse practitioner came to me, complaining about an intensive lower back pain; more toward the left side. According to her report, the last three days it was getting worse. Painkillers and anti-inflammatory drugs did not really help.
Palpation is the part of a massage therapy examination procedures where we try to discover trigger points, tension within the fascia, muscles, etc. I didn’t discover many trigger points that would support skeleton-muscular disorder in the lower back. The description of symptoms she offered, and what I have felt with my fingers didn’t match. However, when I examined abdominal, even a light touch produced an unusually sharp pain, and mostly on the left site. I told her that this was not the case for a massage therapist, and highly recommended her to go to an emergency room. She asked me to explain her my suspicions.
As usual in such cases, my responses that I am not a medical doctor and cannot diagnose, but from my experiences it didn’t look good. I also explained to her that if the trip to an emergency room would not entail any real concerns it also would also not pose any threat – better be safe than sorry. However, if this is a life-threatening condition, not going to ER, at the very least, is irresponsible.
She told me that she was a nurse practitioner and she could diagnose and that she wanted to hear my opinion. I said that her condition looks like diverticulitis, and, possibly, her condition was progressing. I felt with my hands an unusual stuff. Luckily I examined her at a hospital research laboratory, a few yards from ER where I volunteered to walk to.
Three days later, when I was back in the laboratory, I asked about her and the guys who knew the story praised me, claiming that my actions saved her life. I answered what saved her life was simply my refusal to treat at that moment.
What it turned out to be was a difficult case of peritonitis, including infected pouch ruptures, spilling intestinal contents into the abdominal cavity. The client’s condition required emergency surgery, IV and significant amount of Antibiotics. She was in a life-threatening condition. The confusing part of the diagnostic process was the fact that she didn’t experience abdominal pain, but the pain in the lower back.
There are cases when people complain about pain in certain body parts, which isn’t an indication of orthopedic disorders. We, as massage therapists, should be careful prior to starting a treatment if we cannot palpate obvious trigger points that can explain the symptoms. I advise forming questions in a specific manner. They should clarify if a client feels pain in places where trigger points, related to the described symptoms, usually reside. Unless this is done, it is easy to misinterpret the complaint and come to the wrong conclusion. It could be a coincidence. A person can develop trigger points, but similar to what happened in this case, it wouldn’t be related to diverticulitis.
In the aforementioned case, I asked the questions in the manner I recommend. The client’s recognized the presence of trigger points, but they were not related to her lower back pain. She just described what she felt, and this helped me to make the right decision, after careful investigation of abdominals. Three days later, I went to visit her at the hospital. She presented me to nurses and doctors as a hero. I responded that all my heroism was in the fact that I decided not to provide a treatment.
Sometimes even doctors can make mistakes and refer us patients with a similar clinical picture. In the above case, it was very easy to miss diverticulitis without complaints on the abdominal pain, high fever, and much nausea. Just a light touch was enough to determine that this is not the case for a massage therapist, and to come to a conclusion that this was diverticulitis. We are not only the first door-keepers but sometimes, also frontiers in recommending the urgent medical attention.
You’re welcome to post any questions, comments.