What separates a good therapist from a great one?

A sense of touch is a demarcation line that sets apart a good therapist and a great one. The greater therapist being the one who constantly delivers better results. In order to be able to deliver better results, it is very important to understand physiological effect of massage on human body. In the following clip hopefully would answer these questions. The definition of massage

What is this simple approach to massage therapy and how is it different from other approaches?

Our lives are full of events that are connected by cause and effect. For instance, if we lift and release an object it’s going to fall down. Gravity existed long time before Galileo and Newton described its behavior quantitatively. Millenniums before their time, knowing nothing about gravity beyond its cause and effect relation, military engineers created machines that catapulted rocks over the wall of besieged cities. Today, you can rarely find a person who’s not familiar with the force of gravity and Newton’s laws.

Yet to a large degree, the nature of gravity is still a mystery. We understand much more about it now, but there is always one more “why” to which no one has an answer. After all said and done, gravity is just that. However, this doesn’t preclude us from counting on gravity to be there for us every time and to use its cause and effect relation to our advantage.

Electro-magnetic force is another example of such natural phenomenon. The magnetic field is produced by the motion of electric charges. Conversely, the movement of the magnetic field causes electrical current. The nature of these phenomena is very complex and like gravity, not very well understood. Yet this does not preclude us from generating electricity by rotating magnets on electrical stations.

Going back to the massage business… science can explain many things, but it cannot explain everything. It can measure and record a detailed cause and effect relation that guides practitioners in the field. It can tell us which manipulations need to be done, and in which sequence these manipulations need to be performed, in order to achieve the desired effect.

As paradoxical as it may sound, in order to achieve sustainable results, a “complete understanding” is not necessary. For example, if a client suffers from the negative effects of stress, a massage therapist should have a clear understanding of the abnormalities caused by stress. It’s not necessary to understand the problem on the molecular, atomic or subatomic levels. However, it is very important to understand that stress causes arteries to contract, resulting in other negative side effects such as an increase in heart rate, a rise in blood pressure, an increase in blood sugar levels, etc.

But it’s not important to understand the exact triggering mechanism of such contractions, or the neuron chemistry which allows the transfer of such signals from the brain to the arteries. In other words, each problem has to be dealt with on its own level of abstraction. It is much more important for a massage therapist to know which of the scientifically developed protocols for stress management to apply and to be able to perform them masterfully.

We must remember that scientists and massage therapists possessing expertise in different fields.

The bottom line is: massage therapy is about results and massage therapist is the one who delivers it.

The scientific community has given massage serious consideration only in the last 100 years.

As a therapeutic tool massage has been known and used since ancient times. The scientific community has given it serious consideration only in the last 100 years. Within this time, scientists have discovered many important factors that links massage with the treatment of multiple diseases. Most of these works are written in a very complex way and a massage practitioner can have a hard time extracting their practical benefits.

Thus, although there are many ingenious protocols that allow massage to have a pinpointed affect on many different ailments, for all practical purposes that are not accessible to massage therapist. Also, among variety of approaches to training and massage therapy protocols for hands on implementations, only those methods proved themselves in clinical trial that deliver results: such as less pain, improved range of motions, less sides effects of stress, etc.

I believe that scientists and researches should not only develop advanced methods of treatment, but also have a duty to present it in a simplifies way, adjusted to the average level of theoretical understanding indigenous to the majority of therapists in the massage field.

This approach of leaving complex and intricate details out of the picture and leaving only essential, easily understood and easily implemented information, I call “the simple approach.” I will offer a more detailed explanation of what I consider simple approach to massage therapy in the next post.

Medical Massage is not a remedy for all diseases. Yet it is so powerful, that for the sake of one’s well-being, it cannot be ignored.

Massage therapy is not a remedy for all diseases. Yet it is so powerful, that for the sake of one’s well-being, it cannot be ignored. We cannot rely on “feel good” sensations only. To achieve the best results, treatment strategies and underlying concepts have to be understood and step-by-step protocols should be followed to the letter. Only in this way, massage therapy methodology contributes to human health in a dramatic way. The simplicity of massage is learned by discipline, desire, dedication, and acceptance of the mission.

Hippocrates, the Father of Medicine, once said, “The doctor must be experienced in many modalities but especially in massage. Massage can cause tight joints to relax and loose ones to become stable.”

Thousands of years have passed. Today we have much additional scientific data, clinical outcomes and experience regarding the power of massage therapy. It is not limited to the treatment of support and movement systems only. I hope that my blogs will contribute to your inspiration, passion and love of this wonderful treatment method. I believe in simple approach to therapy by means of massage.

I also know, that without home self-massage program, it would be difficult to sustain results in cases of painful back and limp disorders, stress related illnesses such as essential hypertension, tension headaches, anxieties, sleep disorders, major depressive disorders etc. Subsequently, I will try to share my knowledge in a practical way that, in some way, could contribute to your well-being.

Critical Thinking vs. Clinical Thinking

The critical thinking is based on: analysis, critique and conclusions. In our field in most cases critical thinking is necessary at the time of meta-analysis. If scientists have an interest in research and development of hands-on protocols/techniques, the purpose of which is to accelerate quantities of lymphatic drainage, scientists analyze huge amount of available data on the subject, including, physiology of lymphatic system, its main duty, etc. The same approach applicable in preparation of research on different subjects, related to lower back disorders, neck and upper back disorders etc.
At the time of meta-analysis unsuitable or unacceptable data should be filtered out. Concurrently, a researcher must choose the related data in order to write down the research protocol. Finally, research should be organized; i.e. the decision should be made on laboratory tests, diagnostic equipment, what type of techniques to apply, etc.
Dr.Chernich was a great meta-analysis specialist and a very good massage therapist at the same time. (If you are not familiar with with Dr.Chernich’s methodology please watch this Boris’ vido clip)However, it can happen, that scientist might not be clinician, but have training and a proclivity to critical thinking and thus make right recommendation for upcoming research. One can be great critical thinker, but have no desire or ability to develop great clinical skills in massage therapy. These are the two different specialists.
Of course, the best combination is when meta-analysis is done by a person who combines both expertise: critical thinking and clinical experience. If the meta-analysis is not done well, then there is a poor chance that research outcome will be up to standards. The resulting theory, having not proved itself clinically, would just remain a theory – not useful in a treatment room.
Lately, in average 50% of research data, cannot be reproduced. Something is very wrong with it – maybe not well performed meta-analysis, contributes to this statistics.
I believe that the following is a good example of how critical thinking was applied. Please take a look at the following New York Times article by titled
“Does Massage Help After Exercise?”
When Dr.Ross Turchaniov and I had the opportunity to read this outrageous interview by Professor Michal Tschakovsky, then by applying critical thinking, we started a step-by-step analysis of this research data. We did figure out that practically all that professor Tschakovsky did in the research and presented in an interview to New York Times, was absolutely wrong. We both came to the conclusion, that he and his team either didn’t do meta-analysis or it was of very poorly quality. We have proposed critiques and explanation in regards to the wrong research data and of course conclusions, that Tschakovsky offered in his interview to New York Times.
You will find within this interview to the New York Times, the reply of AMTA president, sounding something like this: ”more research have to be done.” In this case it wasn’t “more research” that needed to be done but a simple and good analysis, that surely required critical thinking.

Clinical thinking VS. Critical thinking.

As I stated above meta-analysis demands critical thinking which is, analysis, critiques and conclusions. Clinical thinking demands a bit different approach such as analysis of subjective information provided by client, objective data of hands-on soft tissue evaluation such as, examinations of tensions within fascia, muscles, existence of trigger points etc.
As an example of clinical thinking please read below, my case presentation, that first was published more than a year ago in the journal of massage science. I’m happy to report that the client, which case I presented, feels very well, long since off all the heavy addictive medications, and this November will get married. I am invited to share the happy moment.

Best wishes.
Boris

ABDOMINAL/VISCERAL MASSAGE IN CASES OF SEVERE BACK PAIN

Patient female, 26 years old. Works in finance. Single, but in a committed relationship.

MAIN COMPLAINTS

Severe pain at left side lower back. Sitting position and/or changing from a sitting to standing position triggering intolerable pain. Walking slowly for up to 15 minutes has reduced the intensity of the pain, but walking for longer than that would once again increase it. Two-three days before her period the intensity of pain dramatically increased, forcing her to spend a few days in bed. Patient was practically disabled for four months prior to her visit to our clinic.

PATIENT HISTORY AND CLINICAL EXAMINATION

Initially this pain wasn’t severe, and patient had it periodically. She described pain as intermittent and it was minor irritant. A pediatrician, a children’s orthopedic surgeon, and lately gynecologists have concluded that her pain is myofacial in nature.
Over the last five years the pain has gradually increased in its intensity and become chronic. The last four months were especially difficult, because the pain became constant. She couldn’t work and her day-today life was greatly affected. The patient became depressed, anxious, and mentally exhausted.
In a desperate attempt to help her primary care physician referred her to the Multidiscipline Pain Management Center in the hope of addressing her condition with combination of acupuncture, chiropractic adjustments and physical therapy. This approach failed and her pain and disability increased. The pain became so intolerable that she was hospitalized. Strong pain killers didn’t block the pain, but high dosage of oral corticosteroids consumption provided some relief from her pain.
After an intense flair up her pain management physician recommended surgery of electrodes insertion in the spinal cord to prevent pain stimuli reaching the brain. However, the Pain Management center’s psychiatrist insisted that such treatment be postponed and antipsychotic medications, as well as psychotherapy, should be tried first.
The patient was referred to our clinic by a physician who was Board Certified in Physical Medicine, and who had been invited to consult the patient when she was hospitalized. While I was talking with the physician, she informed me that all necessary tests, including CT and MRI, had found no significant spinal abnormalities.
I asked if the patient had any abdominal (including gynecological) surgery. The answer was “Yes”. Her appendix was removed when she was 12 years old. Just out of interest I asked if the CT with contrast which was done. The answer was “No”. The day after my conversation with physician I had the opportunity to examine the young lady in my office.
During examination of her lower back, she reported slightly increased local pain when pressure was applied over her left back and left gluteal area. However, the pain had moderate intensity without obvious presence of acute trigger points in the lower back and gluteal muscles Resting muscle tone on the left side was significantly higher, and the fascia exhibited areas of tension in various degrees. Regardless, these symptoms didn’t match the intensity of the lower back pain, associated with Lumbalgia.
Clinically thinking and because no acute trigger points at lower back area ,I decided to start with abdominal massage in order to accelerate venous blood and lymph drainage. These techniques are gentle and always feel pleasant. After a few minutes of the application of drainage techniques she began to cry. My first thought was that my therapy had increased her pain intensity, and I asked her about it. She replied, “No, it didn’t increase my pain.” At this moment, it was obvious to me that she had released psychological tension and suppressed emotions. This is very common in patients who suffer from intense chronic pain, and such a reaction was great hope for successful rehabilitation.
After application of abdominal drainage techniques she reported a significant decrease of pain intensity in lower back region. I asked her to sit up. To our great surprise, the pain didn’t come back as she sat still for more than 10 minutes. At this moment it seemed clear that her severe back pain was a result of significant venous stasis and lymphedema in the abdominal cavity. Shortly after her visit to me her primary care physician ordered a CT scan with contrast. This test showed significant adhesions and abnormal and abundant post surgical scar tissue in the lower abdominal cavity. This CT test finding increased my confidence, and we began a treatment course using abdominal massage as the main therapeutic tool.

ABDOMINAL MASSAGE (AM). GENERAL INFORMATION

AM starts with the gentle mobilization of the anterior and lateral abdominal walls. These facilitate the more efficient application of drainage techniques, as well as various visceral massage techniques that target the internal organs located in the abdominal and pelvic cavities. At least 35% of the total arterial blood supply is provided to organs within the abdominal cavity. This mean that the same quantity of venous blood must naturally be drained from the abdominal cavity, If drainage is impaired, venous stasis develops and various functional abnormalities may manifest (e.g. Diverticulosis, Irritable Bowl Syndrome, Constipation) genito-urinary system (e.g. Infertility, PMS, Prostatitis) or pre-existing pathological conditions may worsen.
The first goal of AM is to eliminate venous stasis and reduce the Abdominal Lympdema. Secondarily to improve the inner organs’ function and reduce abdominal and lower back pain. The next targets of AM are to address existing (?) so adhesions and affected inner organs using visceral massage techniques.

MEDICAL MASSAGE PROTOCOL

I started with 12 to 15 minutes massage in the lumbo-sacral area combining basic therapeutic massage techniques with a following application of Connective Tissue Massage. This part of the session I finished with lumbar muscle mobilization using at least 50% of the time on the application of kneading techniques.
The next target was the lateral abdominal walls I spent around 7 minutes on their mobilization. I spent up to 15 minutes on the mobilization of the anterior abdominal wall and pelvic region. The successful mobilization of the abdominal wall allowed me to efficiently apply abdominal drainage massage techniques, and finally work on the adhesions in the left lower abdominal quadrant for another 10 minutes. Her lower back pain was almost gone after the first five treatments. In total she received 15 sessions of medical massage. I added stress reduction massage for the back and upper neck to the last 5 sessions. Currently she doesn’t have any lower or back pain, but she still feels anxiety attacks which are becoming more rare. I continue to see her weekly for full body stress management massage, and I still include AM in the treatment. I believe that 5 to 6 weeks of such maintenance will break the vicious circle of stress her body has accumulated during her ordeal, and she will be able to completely recover and have a completely normal and pain free life.
As soon as it was obvious that she was on her way to recovery I insisted that she refuse to go on disability and go back to work. She was reluctant at first but she was glad that she followed my advice and it is already a month since she has returned to work practically pain free. Now she feels her fiancé is ready to propose.



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