Deep and Dark Secrets of Medical Massage

From the author:

As an instructor, I often witness a curious phenomenon. Many massage therapists expect me to disclose some "deep and dark secrets" of mine; some "magic" spot on the client’s body where they can press and relieve clients from suffering. When faced with such idiosyncrasy, I always experience a feeling of peace and power. These practitioners seek truth about massage, and it is very easy to teach them the truth about the power of massage. It is easy for me to share with them and give a detailed explanation of "secrets" and clinical results that have come to me through my over 48 years of clinical experience, as well as through the experiences of my teachers and students. To summarize these "secrets" in a couple of words in order to acquire the body of knowledge of medical massage, to acquire a clinical ability to help people suffering from difficult conditions, a practitioner should:

1. Understand that medical massage practitioners are not healers; we simply stimulate the healing process.
2. Understand (not merely memorize) the abnormality that he or she is treating.
3. Understand the importance of adjusting your energy status in order to protect yourself from the negative influence of the client’s energy, as well as to be able to incorporate your "energy work" into treatment.
4. Deeply understand how your touch affects physiological processes in the human body.
5. Avoid treating our work as hard labor but instead see it as an art of healing.

Today's writing, I will dedicate to a more detailed extended explanation, hopefully to the point that my readers will be able to convert this knowledge into the ability, with our own hands, to help people who are terribly suffering. In summary of my introduction, I would like to declare: "Because medical massage is a science-based research-developed methodology, there are no deep dark secrets in medical massage, just a necessity to understand. In the process of skills development, there are questions to clarify, and in my today's teaching, I will do my best to provide as many answers as possible.

Best wishes, Boris Prilutsky

As a beginning of clarifications, I would recommend visiting the following pages for self-massage protocols: https://www.medicalmassage-edu.com/products/self-treatment-programs/as well as instructional protocols: https://www.medicalmassage-edu.com/instructional-massage-programs/

Please scroll down the pages to read answers to frequently asked questions.

Medical massage is a stimulator of the healing process; process means time, time for healing.

For some reason, our patients, when receiving prescriptions from MDs, consume them for a long time without expecting immediate relief, and if experiencing side effects of a particular medication, they run back to doctors who immediately prescribe new different medications. Patients are suffering and looking for relief.

This same scenario occurs when our patients receive 12-20 physical therapy treatments; usually, none of them expect immediate relief. However, when receiving a massage procedure, for some reason, expectations are, I would say, unreasonable. Even in difficult cases, patients want to experience results almost immediately. The Latin word "Doctor" means educator; we must be well educated in order to educate our patients well. Well-educated patients help us to stimulate the healing process and successfully rehabilitate them, which is to sustain results.

In the first meeting with our patients, we must make it clear: "Medical massage is a stimulator of the healing process; process means time, time for healing." Having said that, I strongly believe that after the first 3 to 5 treatments, patients must experience some evidence of improvement, such as less pain, improved functional activities. I don't want to repeat myself; the subject of the healing process stimulated by medical massage I have covered in my blogs. It includes but is not limited to the role of medical massage in muscular syndromes, stimulation of healing processes in cases of disk herniations, the role of medical massage in the body and mind approach, and more. In case you missed it, you are welcome to read my blogs.

The foundation of all medical and sports massage protocols is the physiological effect of massage on the human body. This understanding must be fully and completely adopted by medical massage practitioners.

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 the 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 mechanoreceptors, 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 hormone production, etc.

To ensure that we achieve the most profound physiological effect on the body of the client, massage should be performed as deeply 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. 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. Client’s reports of "too much pressure" even in the absence of 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. Each instructional program includes my hands-on demonstration as well as detailed explanations of how to perform different types of the most useful must-do kneading/petrissage techniques utilized in Medical Massage procedures.

Science of Massage and Energy Work:

Over the many years that I have been in the massage therapy field, I have performed and viewed a number of my colleagues performing different types of massages with a wide range of results. Interestingly, the physiological effect of massage alone, along with the variance in the body and mind conditions of each individual massage receiver, could not explain this phenomenon. There were always additional effects caused by what we would now refer to as "energy work."

For me, the effect of "energy" on the human body became evident back in my postgraduate days when a group of my colleagues and I conducted an energy-related experiment.

It is a well-known fact that a person who stands still is experiencing low arterial blood supply to the lower extremities, and this supply decreases proportionally to the duration of standing still. Typically, the increase in blood supply would be stimulated either actively by movement or passively by massage, etc. The purpose of this experiment was to test whether the arterial blood supply to the lower extremities could be increased without any mechanical stimulus.

Our research group performed two successive measurements of the amount of arterial blood supply to the lower extremities in the experimental group. This group was composed of highly trained massage practitioners. Both measurements were taken by an ultrasound Doppler. In the first test, each member of the experimental group simply stood still on one spot for ten minutes. In the second test, each of them performed extensive visualization of arterial blood moving through their extremities for fifteen minutes. Surprisingly, the second measurement recorded much higher blood supply for all the participants despite the fact that none of them had moved for a total of twenty-five minutes.

The effects of "energy work" are unavoidable in performing massage; thus, practitioners have to be prepared to channel it properly. Without a practical understanding of what’s involved in "energy work," many practitioners miss the opportunity to be more effective.

Mysteries and metaphysics have surrounded energy issues for many years. Different esoteric theories have been built around this subject for many years. My purpose is not to create another theory or break down the dependency between "mind and matter" to the Quantum Mechanics level. My purpose is to share my practical experience in "energy work" and to give massage therapists a mental tool that will help them deal with "energy work" in their daily practice. This method relies on the knowledge of basic anatomy, physiology, and physics. Below, I will summarize these necessary disciplines in the light of their connection to massage to use them as a reference for further discussion of the "energy work" process.

Anatomy and Physiology of the Cardiovascular System:

The cardiovascular system consists of the heart, arteries, arterioles, capillary networks, venules, and veins. Blood itself is also an anatomical part of the cardiovascular system. The human heart is a very energetic muscle. For an average of about 80 years, without taking a break, the heart performs a pumping action approximately 80 times per minute. Blood is pumped out of the heart through the arterial blood vessels (those that carry blood away from the heart), towards the periphery of the human body under pressure. Even structures that are topographically located above the heart will get an adequate blood supply. Normal blood pressure is considered 120/80. The duty of blood supply is first to deliver oxygen, nutrients, and hormones to all 55 trillion cells in the body, which compose our different tissues.

Arterial Blood Flow:

Arterial blood distribution first goes through arteries, then arterioles, and then through the huge network of capillaries – tiny blood vessels, some so small that they will only allow the passage of one red blood cell at a time. It is on this microscopic level of vessels where basic metabolism – the gas exchange – occurs. The surrounding cells consume everything they need (oxygen, nutrients, etc.) from the capillary blood supply. When this exchange of material occurs, the arterial blood is depleted of its supplies and will then be given up to the venous blood circulation.

Venous Blood Flow:

Venous blood flows toward the heart slower than arterial blood flowing outwards from the heart and is under less pressure. As venous circulation works its way toward the heart, it will be cleansed passing through the lymphatic system, liver, and kidneys, allowing metabolic waste products to be removed. It will then flow through the lungs, become saturated with oxygen, and will be ready to repeat the circulation cycle again, 24 hours a day, 7 days a week. Venous blood drainage is supported mechanically by muscular contraction, which occurs whenever we move. Throughout venous circulation, there are valves located on the interior of the vessels. Valves open only when blood flows towards the heart. Rhythmic contraction of the muscles supports venous blood drainage. During massage, we activate a similar but much more powerful mechanical action by performing squeezing techniques only towards the heart, in the direction of the venous blood flow. Thus, we mechanically accelerate the flow of venous blood drainage significantly and we substantially increase local arterial blood supply to the tissues. This movement goes against the flow of arterial blood, but its influence can’t disrupt its flow as it is under superior pressure.

The acceleration of venous blood drainage described above is one of the factors of the physiological effect of massage of direct and local mechanical factors. Another factor is an indirect effect, achieved through the nervous system pathways, and is not limited to the local area being massaged. The Neuro-reflexive aspect is the main power of massage therapy.

Structural Anatomy of the Central Nervous System:

The central nervous system is composed of the spinal cord and the brain. Much processing of afferent perception information and efferent responses happens in both upper and lower centers. The peripheral nervous system originates from the spinal cord and provides innervations to inner organs and systems, as well as to the somatic parts, such as the skin, connective tissue, muscles, etc. At the very endings of the peripheral nervous system, there are proprioceptors located in the skin, muscles, connective tissues, etc., that respond to touch, pressure, temperature, vibration, pain, etc.

The moment you touch mechanoreceptors, you cause the generation of action potentials (afferent impulses), which will stream and stimulate the central nervous system including motor, vasomotor, and other centers. Massage therapy techniques and special petrissage/kneading techniques create massive electrical activities (action potential.) Due to these electrical activities, organs and systems of our body respond by vasodilation, increased blood supply, relaxation of muscles, etc. This is what reflexive therapy is all about. Therapeutic reflex is the body’s involuntary reaction to an original stimulus that causes multiple positive changes in the functions of organs and systems.

With reflexive therapy, this reaction is expressed by positive changes in the functions of organs and systems, which includes reduction of left atria work due to vasodilation. Please keep in mind that stress causes vessels to constrict (arteries carry enough smooth muscles and nerves to constrict). Peripheral vascular constriction amplifies peripheral vascular resistance to blood flow towards the heart, to which the left atria immediately responds by increasing output, to overcome such resistance. This condition can lead to stress-related heart attacks and can accelerate the development of arteriosclerosis. In order to achieve reflexive therapy results, a massage therapist must perform the massage in the inhibitory regime.

Inhibitory Regime:

Every time a therapist’s hand touches a patient’s body, the touch is detected by the mechanoreceptors in the immediate contact area of the patient’s body. Mechanoreceptors respond by sending afferent impulses or action potentials from the contact area to the central nervous system. The nature of this signal is electrical and is propagated via a chemical reaction through the peripheral to the central nervous system.

It is important to note that the ability of mechanoreceptors to respond to touch is limited. After a certain amount of time and providing that the touch is not painful, mechanoreceptors will almost totally stop releasing and propagating sensory impulses – the patient barely will feel the pressure in the contact area even though the same level of pressure persists. The phenomenon of decreased sensitivity, which means mechanoreceptors have reached a level of adaptation.

The level of adaptation is quite interesting and an important state of mechanoreceptors, including but not limited to proprioceptors, with far-reaching consequences. Specifically, within the nervous system, a condition of repolarization of neurons exists. The motor and vasomotor centers which include pain-analyzing systems respond to this kind of stimulation by vasodilation, muscular relaxation, and other positive changes in the functions of organs and systems due to repolarization of the neurons, following a reduction of pain sensation and more. In other words, actions undertaken by a massage therapist during the course of performing the inhibitory regime awaken the aforementioned reflexes, which makes massage therapy a leading methodology in the field of reflexive therapy.

A thorough explanation of this biochemical phenomenon is beyond the scope of this book and may be further studied in textbooks of cytology, physiology, and biochemistry. However, I don’t believe that this type of extensive studies would be beneficial for obtaining rapid and sustained therapeutic results. What is important for a massage practitioner to know is that the "Inhibitory Regime" is the manner of performing massage that takes advantage of the aforementioned phenomenon, and that’s what makes massage therapy so unique and powerful.

To work in the inhibitory regime means to keep massage manipulation in a rhythm of 70-80 movements per minute while gradually increasing pressure and minimizing disconnection. Consequently, receptors will eventually reach their adaptation level.

This approach aims to restore balance in activities between the sympathetic and parasympathetic divisions of the autonomic nervous system. Thus the goal of massage in the inhibitory regime is to balance the activities of the sympathetic and the parasympathetic nervous systems. The status of these subdivisions of the autonomic nervous system, functioning in balance, results in one of ultimate health.

Using Sense of Touch for Energy Work:

Thought is energy. Thinking, envisioning, imagining, and projecting are all electrical activities in our brain. These impulses create energy fields (electromagnetic fields) around us. These electromagnetic fields can protect your personal state of energy from disturbances and will increase the power of all activities caused by your hands-on massage. Energy work positively influences our hands-on therapy efforts and allows us to manipulate the energy of our client(s). By focusing and projecting our understanding of anatomical and physiological processes transpiring in our patient while we’re giving a massage, allows us to increase our powers of healing to the maximum extent.

Again, when performing massage techniques, especially kneading/petrissage, it is important to try to imagine to see with your hands what eyes cannot see. There is a massive phenomenon of electrical impulses/action potential formation resulting from the deformation of proprioceptors as well as piezoelectric streaming potentials. Whenever we touch the body, we are causing the creation of these electrical charges. Please always imagine these energetic streamings, and you will stimulate the healing process within your clients much more effectively.

Pathology and Energy Work:

Our skeleton consists of approximately 206 bones. Everywhere location where two bones meet they create a joint, held together by ligaments. Ligaments are very strong, elastic, belt-like, soft connective tissue. Ligaments hold two bones in place, surrounding and stabilizing the joint. Surfaces of each two bones that compose a joint are covered by soft tissue called cartilage. Cartilage provides a smooth, frictionless apparatus to allow the surfaces to slide against one another.

If cartilage becomes inflamed, deformed, or develops fissuring, and/or erosion, this pathology is called arthritis. The inflammation in the joint is called a suffix named "itis" (here it stands for inflammation). If a joint region is sprained (pulled), or strained (overloaded), it is very possible that tendons, ligaments, bursa, muscles, etc., can develop inflammation. In the case of sport-related injury in the knee region, for example, there may be physical effects such as contusion, twist, and sprain/strain, which can cause a person to develop arthritis, periarthritis, and more.

For massage therapists, it is extremely important to understand that in any situation with inflammation, whether it is arthritis, tendonitis, or bursitis, the expression of these pathologies will be swelling of the tissues, excessive volume of extracellular fluid accumulation, and stasis of venous blood, which disallows arterial blood supply (oxygen and anti-inflammatory hormones like hydrocortisone). In the inflamed areas, the demand for blood supply is much higher than the actual blood supply during the time of inflammation. Pain is a signal/message about the swelling of the tissue, stagnation of venous blood, which decreases arterial blood supply (oxygen supply), and accumulation of an excessive amount of extracellular fluid. The result is a raised muscle resting tone.

Every joint in the body has the same structural components, and though the sizes and forms of these components vary, the development of pathologies and their expression is similar throughout. Bear in mind that all these processes of pathology cannot be seen from the outside if there is no inflammation of the capsula.

It is extremely important for the massage therapist to understand pathology to the degree that he can begin to heal by simply placing hands on the region and imagining all the expressions of pathology. There is no doubt that if, in addition to the energy work I described before, when we perform techniques for the acceleration of venous blood drainage, edema reduction, trigger point therapy, etc., then rapid and sustained results can be expected.

To make all of the things mentioned above a little more organized, I propose the following structure to massage therapy approach:

1. Knowledge – This is your memorization of the facts, i.e., structural anatomy and physiology, as well as pathological developments in cases of disorders as described above.
2. Understanding of Knowledge – When knowledge and understanding are combined inside of you (this place could be in your heart, or your soul, somewhere inside where your sense of touch/feelings lives), it is transported to your hands, in order to perform soft-tissue mobilization as well as energy work.
3. Knowledge and Visualization – When knowledge and understanding are combined inside of you (this place could be in your heart, or your soul, somewhere inside where your sense of touch/feelings lives), it is transported to your hands, with which you perform soft-tissue mobilization as well as energy work.

A person may have knowledge about the expression of pathologies such as bursitis, tendonitis, arthritis, etc., but if he applies excessive pressure on the region, we can all agree, his understanding of this knowledge is very limited. By placing our hands on an injured area and imagining what is going on under our hands, we are creating active thoughts (energy matter) that, in addition to all positive physiological effects of massage therapy, allow us to manipulate chi in such a way that the healing process will be amplified to the greatest extent possible. In my program number 10, I am teaching in detail the science and energy work.

Practical approach to physiology - Volume #10

Dear friends,

In the learning process, the importance of asking questions to improve practical skills cannot be overestimated. At the end of each article, you have the opportunity to post questions, as well as to share your own experiences.

Best wishes, Boris Prilutsky