Is massage therapy an innocent procedure?

In my previous blogs, I’ve discussed that four years ago, I was hired by the biomedical research company as an massage therapist consultant. This group tried to develop drugs, for the prevention of developments of post-concussion encephalopathies. The outcome of the research, so-called product, was sold for further research and development to some pharmaceutical company. Yet they still kept my paid position.

The members of the research teams possessed various expertise. The last Monday I participated in the all team meeting at the facility meeting room where the principal investigator was preparing to introduce a new team member. This fellow already defended his PhD, and had to do 1500 hrs. internship, in order to be a license clinical psychologist. His ambition was to become a neuroscientist.

While the meeting didn't start yet, most likely, this fellow asked who I was. Another staff team member apparently told him that I was a massage therapist. Then I could hear how the new member said that year and a half ago his wife received a stress management massage, and since then suffered pain and discomfort between scapula.

That pain and discomfort affecting her life in a negative way. She couldn’t sat at the computer for more than 20 minutes at the time, had to take a break, and often woke up because of pain.

One of the team members, who usually teased me (although without much success LOL) said out loud:“…tell this to Boris, he won't believe your wife, he is claiming that massage is the innocent”.

Everybody laughed. I replied: ”you rarely listen to me carefully. I never claimed massage was innocent. I claimed, and am claiming, that appropriately applied massage therapy protocol, have no side effects, cannot harm, and, in most cases, is very effective. In a worst case scenario, sometimes massage may not help but in no case it can harm.”

Then I continued, “how can we consider massage therapy being an innocent procedure, when I proved clinically that massage has been so effective in difficult cases, including and not limited to cases of brain dysfunction, migraines etc. One cannot call innocent such a powerful method. A safe and very effective methodology of treatment shouldn't be confused with innocence. There is principle a difference between these concepts.

Clinicians could easily decipher between innocent and safe.” Then one nice lady - a team member - asked me why was it so important to set a clear distinction between innocence and safety.

I responded that in my field human factor is playing a crucial role in the treatment outcome. I talked about energy work and asked the staff members to use Internet and to make available the following article. THE PLACEBO EFFECT AND ITS ROLE IN MASSAGE THERAPY. PART II

By the way, the principle investigator was already in the room, and as always he didn't interrupt my speech. Contrary to that, he as always encouraged these kinds of discussions.

It's a lengthy article and it would take long time to read it. I suggested to read only this part, for better understanding of what I meant by ”human factor.”

TOUCH AS PERSONAL EXCHANGE OF ENERGIES

The Information in the previous part of this article is common for all health practitioners trained to interact with new patients. We only adjusted this data for massage therapists, since they are under the same umbrella - addressing the body’s malfunctions.

Since we share 75+ years of clinical experience practicing and teaching Medical Massage, we think that we have the right, utilizing scientific data, to express some personal views on the subject.

Touch is the most fundamental and primal sensory stimulation. In the earliest stages of mental development, we rely on touch more than on any other sensory stimuli. In the first several months of our lives, we learn about the surrounding world using mostly touch until our brain is capable of processing and using the data obtained from the more complex sensory organs (vision, hearing, etc.). In addition, blind people who live rich and productive lives proves the true capabilities and importance of touch.

However, touch is not only comforting and informative to our brains. One must also use it as a clinical tool of great importance and effectiveness. We trust people agree that when we touch our patients/clients we start a chain of events in their bodies, which have local and distant healing impacts on the tissues, organs and the entire nervous system. Thus, during the treatment we generate energy (e.g., piezoelectricity, streaming potentials, axon reflexes, etc.) in the patient’s body that promote recovery.

Human minds are constantly thinking, envisioning, imagining, and projecting.These processes are the results of electrical activities in our brains. One can observe and measure these electrical activities from outside of our bodies for example, by Electroencephalography.

Fig. 2 illustrates EEG of the brain recorded at rest with subject opening and closing his eyes.

As you can see, even a simple action as opening eyes is able greatly spike electric activity in the brain and electrodes, located outside the brain and skull can registered it.

The fact that brain activity can be registered and measured by outside placed devices indicates that our brain as well as normal functioning of the entire body, creates and emits a bioelectric field around us. The quality and power of our personal bioelectric field varies from depending on whether we are being healthy, sick or injured, from our age, type of everyday activity, emotions etc. Having this in mind, let’s look at electrical functioning of healthy and affected bodies, and interactions of the therapist with the patient.

Bioelectricity of the Patient

We now know that MRI can register and observe changes in the brain’s activity associated with acute and chronic pain and it showed that normal electric activity generated by the brain is profoundly changed in cases of chronic somatic or visceral abnormalities.

Fig. 3 illustrates what parts of the brain are lit up at rest in a healthy subject and how much changes in the electrical activity of the brain registered in the patient with Fibromyalgia, which is an excellent clinical example of long lasting chronic pain (Sponaugle, 2012).

Fig. 3. Electrical activity of the brain in healthy individual and the patient with Fibromyalgia (Sponaugle, 2012).

This picture is an example of central events triggered in the brain itself during and after its bombardment by low-grade nociception from peripheral receptors, located in the affected soft tissues. It is a well-documented fact that MT has a profound impact on the function of the CNS, from altering activity of the autonomic nervous system while helping patients with insomnia or debilitating psychiatric disorders (Barr and Taslitz, 1970; Weinberg et al, 1988; Dossetor, et al., 1991; Posadzki et al., 2011).

However, various electrical events also happen on the local level, for example, in the soft tissues affected by chronic inflammation and/or injury. We now know that healthy and normally functioning soft tissues exhibit slightly negative electrical charge and this charge can be registered and measured. In the injured or inflamed soft tissue, normally negative charge changes and becomes positive. Tissue or organ recovery coincides with slow diminishing and eventual disappearance of ‘positive’ potentials and restoration of normal ‘negative’ charge. (Basset, 1971; Becker and Selden, 1985)

Even this short review proves that the normal functioning of our body besides being electrically controlled emits a so-called bioelectrical field. It consists of central (brain electric activity) and peripheral (conductance of nervous impulses, streaming potentials, heart contractions, and pulsation of major arteries, etc.) components. Each of us has such a field depending on aging, pathology or types of activity we are exposed to changes of its magnitude during our lifetime. The normal distribution of electrical charge and consequently normal body functions are altered in the patient with pain and dysfunction, especially in chronic cases. Thus, restoration of normal electrical activity in the tissues and organs becomes a critical component of somatic rehabilitation by means of MT.

Besides activation of the PE before treatment starts the skillful therapist uses a large variety of clinical tools to restore the normal bioelectricity in the soft tissues by using a variety of clinical tools, from application of friction under the specific angle of 45 degrees to trigger larger piezo electrical events to resetting muscle spindle receptors using Muscle Energy Techniques.

Bioelectricity of the Therapist

The therapist’s everyday activities including his or her work also are the result of electrical events. Thus, a healthy therapist while working with the patient also emits bioelectrical potentials. Their magnitude and quantity will increase if the therapist is constantly engaged in the treatment process. We believe the therapist, who for example, performs the same full body massage routines from day to day frequently, becomes disengaged and while working he or she starts to think about other things, like what to have for dinner. In these cases, therapy itself elicits a less healing bioelectrical field compared to the Medical Massage therapist who constantly analyzes changes in tissue structure, monitors the patient’s body response, adjusts or alters massage techniques, observes the patient’s breathing and response to the pressure, etc.

Thus, while working on the patient the therapist makes intellectual efforts to follow the anatomy of the area, understand the pathological events that happened there, and constantly analyze and adjust the treatment process. There is no doubt that practicing clinical aspects of MT stimulates the therapist’s mind and makes work more exciting. However, to do that the therapist’s brain must also emit and enhance bioelectrical potentials, and if the patient will register their presence, it increases the healing power of MT.

We would highly recommend that therapists start training and enhancing personal bioelectrical field. Pull out an anatomical chart, textbook or play videos associated with the patient you are currently working on. As you read or watch the materials, try to see in your mind’s eye layers of the soft tissues in the affected area and their interactions. Imagine you work in these areas and in your mind’s eye clearly arrange it step-by-step.

You will see how much easier your work will be when you start actual therapy and the patient will immediately feel it because he or she will feel your confidence. Such preparation has another very important benefit. Since the flow of the therapy was previously established in your head, you are now freed your mind and can concentrate on the small changes that body and tissue will produce as a result of your therapy. It will also give you a better control of the treatment process if after the therapy you mentioned to the patient what you observed and plan to do next. It greatly enhances the PE.

There is another aspect we would like to mention here. We believe that every therapist has had the experience of working on the client/patient, which made the therapist uncomfortable in some strange and unexplainable ways. It is almost a gut feeling that this is a wrong patient/client relationship and after the treatment is done the therapist felt drained emotionally and physically. In these cases, the patient or client generated a bioelectrical field and it interfered and affected the therapist’s body normal bioelectric activity. Therefore, it is so important to trigger PE before the treatment starts. In such case, you as the therapist deliver therapeutic impact while also protecting yourself from emotional and mental drainage elicited by some patients who suffer from sometimes years of chronic pain.

Bioelectricity Triggered During the Massage Treatment

He hope the previous discussions illustrate that patient and therapist separately produce bioelectrical fields.They interact with each other during the massage session via touch, enhancing or interfering with the treatment process. Massage therapy by itself is way to deliver mechanical force to the soft tissue. While doing that, therapists alter the CNS by activating peripheral receptors. At the same time, the therapists actively change local electrical events in the soft tissues by increasing the negative charge and decreasing the positive charge,resulted from trauma or inflammation. For a full review of scientific data on this subject, we refer readers to articles published in the previous issues of JMS:

1. Piezoelectric properties of soft tissues:

https://www.scienceofmassage.com/2010/01/how-massage-therapy-heals-the-body-part-i/

2. Streaming Potentials in the soft tissues:

https://www.scienceofmassage.com/2010/03/how-massage-therapy-heals-the-body-part-ii/

Thus, MT triggers local and central changes in the body’s bioelectrical activities and at the same time, it activates our patients’ brain self-regulatory mechanisms. Natural forces within us are the true healers of disease.

Electrical activities occur in our bodies 24/7. All organs and systems communicate with the central nervous system as well as with each other through electrical impulses and biochemical reactions. The constant movement of electrical charges in our body induces the bioelectric field around us. The task of a massage therapist is to adjust and correctly channel this energy towards healing and self-healing.

In an analogy, we see the MT as the electrical engineer who changes fuses, restores electricity conductance and stimulates electric potentials to enhance current flow. One can achieve this with correctly designed touch therapy by working with soft tissues locally, playing and altering activity of peripheral receptors, and eventually CNS. However, if therapists underestimate the importance of addressing the patient’s brain even before therapy starts they lose critically important and powerful ally of the entire treatment process.

REFERENCES

For references please refer to the original article.

If you would like to better understand the physiological effects of massage on the human body and incorporate energy work into your treatments, you may consider medical massage educational video #10, from our CEU Program.

If you are interested in purchasing the entire CEU program including additional support and examination materials, please follow this link.

Believe it or not, for a few minutes after reading, it was a silence in the room. I could see how some of the members were rereading the article again. I made a joke “energy work in action.”

Then I summarized, “as you understood, we cannot call massage therapy innocent procedure. The mindset is crucial in my occupation. Being many years in practice, after this brief presentation, and discussion, as an a massage therapist, I felt empowered, my own human factor is empowered.”

I decided to share this story with you, because I strongly believe, and based on my personal experience, this kind of discussion makes us much more powerful massage therapists. Sky is the limit in skills improvement, and human factor in our occupation is crucial.

My answer was:” whatever this procedure was, it wasn’t performed therapeutically like a massage ought to be performed. It caused her harm, and I speculate, the person who performed the message, applied vigorous pressure, triggered protective muscular spasm, continued for some time to compress muscles in that condition. In other words, he simply inflicted an injury. ”I agreed to look at his wife. After I will see this lady, and if I will see her, I will share my findings and opinion.

The application of vigorous pressure, is not the only contraindications in Medical Massage. Because massage therapy is Not an innocent procedure, in my next blog I will disclose other not appropriate application of massage that could cause harm, aggravation.

You're welcome to share your thoughts. If some of you would feel empowered please post, it's professional family discussion, can help to all of us. If some of you will not feel empowered, also post, and explain why not, we will reply and it's can be very good discussion to advance our skills.

Best wishes and happy holidays season to you and yours.