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.

NEW SCIENTIFIC DATA TO REVISIT ACTIVE TRIGGER POINTS CONCEPT

Science of Massage Institute » NEW SCIENTIFIC DATA TO REVISIT ACTIVE TRIGGER POINTS CONCEPT. Part I