Pseudo- science VS. real clinical phenomena.
Usually, symptoms of painful skeletal muscular disorders, including to limited range of motion, are the results of tensions buildups within muscles and/or fascia/ connective tissue. Very often, in addition to tensions within fascia and/or muscles, trigger points would be developed. For sustainable and rapid results, it is equally important to address these tensions, as well as to handle/eliminate each trigger point. Failure to adequately address all mentioned above abnormalities yields only temporary relief of symptoms without providing sustained results. Lastly, already for many years, often on, people in healthcare fields deny the existence of trigger points, as well as demote trigger point therapy as Pseudo-science.
Providing, of course, the similarity of the definition of what trigger points are, it is hard to understand people who are denying their existence. Having met a person like this, I always wonder if he or she have had clinical experience. Clinicians can argue the nature of trigger points, perhaps offer a different explanation for their existence, but not their very existence.
Only recently I started to understand the origin of the above-mentioned denial.
Here are a few quotes:
”In my opinion, the whole “trigger point” belief system launched by Travell & Simons, and perpetuated by their enthusiastic followers falls into this category.:” Travell & Simons, book represented the opinion, not science. None of the trigger points or their treatments were validated; none were tested for reliability.”
“There were almost no studies in the Travell & Simons book, just testaments. Most of the perpetuating factors were plain wrong, and represented outdated, overthrown junk science.”
It appears, all the denial of trigger points existence and the critique of the science behind it is based on Travell & Simons manual. I am familiar with this manual and believe that Travell & Simons did a good job presenting techniques for trigger points injections. This manual/instruction for MDs describes how to localize and administer mainly corticosteroids injections. They offer around 400 references, but again this is manual/instruction booklet for physicians, rather than a research paper.
In my opinion, the biggest confusion is based on a misconception that Travell & Simons work is a scientific paper rather than a clinical instruction manual. If one to criticize something about that manual, it would be the injection techniques described in there.
Now is the time to discuss trigger points as a clinical phenomenon, as well as consider the science behind the effect of the trigger point therapy.
In general, in the clinical setting, we define trigger points, as a pinpoint localization of pain. Many times, when we experience a painful sensation in a reachable area, by instinct, we palpate this localization and compress it.
So many people who experienced pain found those pinpointed painful localizations and compressed against them. If somebody will ever try to convince you that there is no such a thing as trigger points and will claim that there were no studies like this done, just offer them following information:
Trigger points as a painful formation in the skeletal muscles were described for the first time by German physician F. Froriep in 1843. Another German scientist Dr. H. Schade in 1921 examined them histologically and formed the concept of myogelosis. British physician Dr. J. Mackenzie in 1923 offered the first pathophysiological explanation of the mechanism of trigger point formation and formulated the concept of the reflex zones in the skeletal muscles where the central and peripheral nervous system play a critical role.
The reflex zones concept was further developed by American scientist Prof. I. Korr in1941 in a series of brilliantly designed experimental studies Awad (1973) examined biopsy tissues from trigger points using an electron microscope and detected a significant increase in the number of platelets, which released serotonin and mast cells which released histamine. Both substances potent vasodilators and their increase is a clear sign that body tries to fight with local ischemia in the trigger point area”
In his now classical work, Fassbender (1975) conducted a histological examination of the circulation around the area of the trigger point and proved once and for all that “… the trigger point represents a region of local ischemia”. The same results were obtained by Popelansky et al., (1986) who used radioisotope evaluation of blood circulation around the area of the trigger point.
Thus, trigger point concepts were developed much earlier than the work of Travell & Simons, who based their manual on this pre-existing knowledge.
The science-based concepts alone would not make a difference in a clinical situation.
Appropriately applied introductory massage, followed by connective tissue massage, muscular mobilizations, periosteum massage, including Ischemic compression of trigger points, would make a difference.
It is extremely easy to perform techniques, that helping us to sustain results in cases of painful skeletal muscular disorders.
Must blow to the head happen in order to cause concussion/brain trauma?
In most of the concussion-related literature, a concussion is viewed as the result of a blow to the head. This, generally, is the accepted way of thinking within the medical community, and especially within the fields of neurology.
Four months ago I received a referral, a 43 years old female, a lawyer. She was working late, fell asleep and, according to her, her head was moving toward the desk. Suddenly she woke up, forcibly jerked her head up and, immediately, felt a sharp pain in the neck and a headache. This night she couldn’t sleep. Next day she experienced terrible pressure, headaches, neck pain, nausea, dizziness, disorientation – all the classical symptoms of a concussion.
She couldn’t work, drive, or take care of her family. She went to see her primary care physician, who analyzed incident, couldn’t find any objectives for diagnosis, including no evidence of head trauma. If she would hit her head against the desk, it would have been some trauma such as marks/bruising on a front of the head and, possibly, she could remember it too.
The doctor recommended rest, prescribed painkillers and muscle relaxants for neck pain and slipping pills. During the two succeeding weeks, all the symptoms worsened. Also when she tried to handle a court case, she couldn’t even understand the writing or remember the case related details.
Her primary care physician referred her to a neurologist. The later carried out all the neurological examinations like hearing, vision, balance, and coordination as well as cognitive tests such as the ability to focus, memory etc. According to the neurologist, she definitely was suffering from a brain dysfunction similar to a concussion, but hearing her story he couldn’t make a conclusion that this was a concussion because the blow to the head was missing.
Immediately, she was referred for a brain MRI to exclude tumor and other possible causes that can possibly produce the kinds of symptoms, I have described above, as well she was referred to MRI on the neck because of severe pain. All the results come out negative. Neurologist decided to refer her to me saying:” Whatever it is, it looks like a brain trauma without a blow to the head.”
When she appeared in my office I saw lost, anxious, very scared, and disoriented woman. She produced an impression of a person who is disconnected from reality, similar to dementia patients. She couldn’t even present me with the details of her trauma and had to supplicate to the help of her husband on that matter. The only thing she could remember, was the feeling of the forcible jerk, a sharp pain in the neck, and pressure in the head, but even these details of the incident her husband helped her to recall.
According to lady’s husband, for 18 days she couldn’t sleep at all. As always in such cases, the protocol starts from the techniques to accelerate lymphatic and cerebral spinal fluid drainage, and to reduce tension within cervical muscles. After 15 minutes of receiving massage, she felt asleep for 20 minutes. She woke up a new person, smiling, reporting much less pressure/intracranial pressure, feeling somewhat better.
I have provided her with 15 treatments. After two weeks break, took her back for more supportive treatments, to sustain more balance in autonomic activities. She is back to work, fully functional, and without a shred of insomnia.
Now back to the question:” Must blow to the head happen in order to cause concussion/brain trauma?
According to the professor Dembo, not only blow to the head can cause a concussion.
“When we run, jump, or even walk, neuronal and axonal membranes are stretched in the normal physiological range.
A mechanical significant shake produces a long range of motion forcible head jerk, which in turn brings about a sudden not physiological sprain of neuronal and axonal membranes. This sprain initiates a release of many different neurotransmitters, and post-traumatic cellular derangement, increasing an excessive amount of cerebral spinal fluid secretion, leading to:
- an inadequate blood supply to the brain,
- an inflammatory condition,
- becomes an obstacle to a blood supply for normal brain function and much-needed extra blood supply to repair damages.”
The reaction I have described above is exactly the same as the one that people experience after a blow to the head. The only difference is that the victims of a blow experience an additional contusion related trauma, such as bleeding etc.
An insufficient blood supply along with dysfunctional mitochondria – intracellular source of reactive oxygen species, if not addressed timely, little by little lead to chronic /degenerative encephalopathy. With time, it can lead to movement disorders, dementia, psychiatric behavior disorders, chronic headaches etc.
I would stress the importance of understanding that immediate post-concussion symptoms are also an expression of encephalopathy, but they are different from chronic /degenerative encephalopathy. The stage of the complete degenerative encephalopathy is not reversible. However, a functional encephalopathy is reversible. Our main duty as massage therapists is in preventing the development of degenerative encephalopathy.
It is possible only when we adequately restore cerebral circulation as well as balance autonomic activities. Yes, by providing simple to perform techniques allowing to accelerate lymphatic and cerebral spinal fluid drainage, by reducing tension in cervical muscles we almost immediately changing the clinical picture for the better. Does it mean we are preventing a non-reversible chronic /degenerative brain disease?
The answer is no. If at the time immediately following a concussion, we will not balance autonomic activities, and establish the balance between sympathetic and parasympathetic activities, then non-reversible degenerative changes would happen because autonomic irregularities will not allow adequate blood supply to the brain.
An autonomic nervous system determines adequate blood supply to the brain, and there are no doubts that balancing autonomic nervous system activities demands a greater amount of treatments.
More details and techniques descriptions you can find in this part one and part two articles.
You’re welcome to post any questions, comments, agreements disagreements.
There is no doubt in my mind, that many victims of a car accident, as far as a concussion is concerned, are misdiagnosed.
Car accidents victims and especially rear end accident victims, when a head is jerked back and forward (whiplash) or from side to side without a blow to the head, often complain about having severe headaches, neck pain, sleep disorders, dizziness, and disorientation. In such cases when a concussion is not addressed with time people end up developing brain dysfunctions such as chronic headaches, memory loss, a sharpness of mind and more.
We are happy to announce that Boris’
New instructional DVD,
presenting the role of medical massage in post-concussion rehabilitation is now available!
For more detailed description
please follow the link in the description
“Never play football?” I respectfully disagree.
My partner forwarded to me the link to the article featuring the interview with Bo Jackson. You’ll find it below, where Bo Jackson shares a startling hindsight that he: “I would have never played football. Never. I wish I had known about all of those head injuries, but no one knew that. And the people that did know that, they wouldn’t tell anybody.”
With all due respect for Mr. Jackson’s opinion, I would have to respectfully disagree and below I will be happy to present my considerations.
All that I am going to say is based on my personal experience and the familiarity with a so-called “uniform way” of feeling and thinking of Olympians and professional athletes.
This group of people is quite a bit different from an average person when it comes to their physiological potentials. Our individual physiological potentials have limits. No matter how hard an average person would work out he or she cannot become an Olympian or a professional athlete. Not many of us can sustain a workload that will compel a heart to beat 220 times per minute when at rest it beats 45 times per minute. Can you imagine a physical load and a psychological pressure that such a person must undertake? Professional athletes are born with this superhuman physical potential to withstand huge physical and psychological overload.
And what about a psychological state of mind? Without a special super strong state of mind, one cannot survive the environment of professional sports, including sustaining constant various multiple physical traumas, and not only to the head. In addition to the already mentioned superior physiological potential and a state of mind, in order to succeed one has to have a gift for a particular sport, including individual body constitution. Being an exception from this rule Bo Jackson only confirms this rule. This array of qualities is necessary in order to survive and succeed in professional or Olympic sports.
Today, in retrospect, being a victim of brain trauma and having a better judgment that came with age, Bo Jackson truly believes that, had he known back then the same information that he knows today, he would withdraw from football.
Yet, in his 17 or 18, experiencing his power and uniqueness of his physiological potential, Bo would probably sign any document, acknowledging all risks including, but not limited to brain trauma. He would play, would sacrifice, for the name of his ambitions, physical and mental power.
As an evidence of it, today public is much more aware of contact sports, football, lacrosse, soccer, boxing, etc., and dangerous side effects of these competitive sports, including concussion. Did this change anything?
On that thought, my partner wrote an interesting piece on concussion awareness https://medicalmassage-edu.com/contemplation-about-concussion/ Although I would like to take a credit, that’s probably a year prior to this movie I wrote an article on concussion for Massage Magazine. I was inspired when saw an interview of Ray Rice.
Personally, I wasn’t aware on pandemics of brain trauma in the US until the incidents with Ray Rice.
I’m discussing my position in my blog sighted below https://medicalmassage-edu.com/an-injustice-to-ray-rice/
With all this public awareness, is there any decrease in participation for these sports? Do parents stop taking kids for football, lacrosse or soccer practice? Especially teenagers involved in these sports.
To summarize, I would like to stress that despite public awareness of the danger of contact sports, American football will continue to be popular as it always was. It is a big part of an American culture. Participation of kids in competitive contact sports will never decrease. This phenomenon is also a big part of an American culture, just like a number of car accidents steadily increasing proportionally to the number of car on streets and freeways. While whiplash resulted from a car accident is as significant cause of concussion as contact sports.
However, we don’t need to despair, even when speaking of the most dangerous detrimental effect of contact sports – “the silent killer” known as asymptomatic concussions. It assaults people without obvious symptoms and brain dysfunction develops little by little.
The preventive measures do exist! In the late 1960s, professor Dembo developed and initiated a preventive program that, by order of the Soviet government, was implemented in all youth sports organizations, as well as in adult competitive teams. Lately, I invested much time learning the details of this programs. Amazingly, this prevention program has a quite simple implementation, based on the original concussion protocol. For many years this program clinically proved itself, including its effect on the improved longevity of the Soviet Olympians, compared to the Western teams.
Don’t take me wrong. I’m not missing Soviet government dictatorship, and don’t believe that in this country, in order to implement concussion prevention and management programs we need the help of Vladimir Putin LOL.
All that needs to be done is to establish, the real clinical approach to a rehabilitation from a concussion, prevention of encephalopathies developments, as well as to prevention of concussions. The prevention is implemented with neuromuscular re-education and correction of biomechanics. In such a case, an athlete’s neck and body will be able to absorb and withstand forces applied against the head, and, possibly, can prevent brain trauma.
Also, it is quite easy to address and prevent the complications of an asymptomatic concussion. In order to accomplish this task, one must routinely to perform these concussion preventive techniques. Even parents can do it if properly trained.
Please post questions, comments, agreements or disagreements.
We are happy to announce that Boris’
New instructional DVD,
presenting the role of medical massage in post-concussion rehabilitation is now available!
For more detailed description
please follow the link in the description
Plans for 2017
This year I’m planning to teach a considerable amount of workshops. The topic of these workshops will be ”The rehabilitation from concussions and the prevention of developments of brain dysfunction.
It is a simple hands-on massage protocol but it has to be performed adequately, with the understanding of the complexity of the post brain trauma conditions. Otherwise, the procedure will be like a bandage on a life-threatening wound.
To become a successful outcome oriented medical massage practitioner, one must not only learn a hands-on sequence of techniques but also acquire a deep understanding of details, including but not limited to the influence the human factor on a successful outcome and much more. I would love to see all of you at my seminars, but prior to inviting you to attend them, I decided to share what I believe it takes, in order to successfully implement this protocol.
Last year I lost the opportunity to teach an eight-hour class for a pretty dedicated group of massage therapists. When a seminar was almost scheduled I’ve got cold feet. During an eight-hour hands-on seminar, I could have, perhaps, taught a sequence of techniques. However, the hundred-dollar question here became “Is this enough time to prepare one to treat brain dysfunctions?” In the heart of hearts, I knew – eight hours is not enough. Therefore, I decided not to do the seminar.
A friend of mine told me that, as far as he is concerned, an eight-hour seminar often can be offered as an introductory to the topic.
This makes sense. Now, in retrospect, I think I lost the opportunity to introduce this wonderful, safe and effective methodology that addresses concussion. On the other hand, many would be able to see it not only as an introductory but as hands-on training. Then, with the certificate of the seminar completion, they would make an attempt to treat people, who could be in early stages, of dementia, psychiatric behavioral disorders, movement disorders, Parkinson etc.
Of course, during this eight-hour introductory presentation, I wouldn’t be able to provide the details of much-needed clinical wisdom, to manage the discussion, answer all questions, to provide a perspective in the seminar summary, and to spend additional time for my own hands-on demonstrations etc. Therefore, this year I decided that from time to time I would conduct 3 hr introductory seminars, just to educate on the brain trauma, process of brain dysfunctions developments, on factors that cause the development of encephalopathies, to present details on extreme role of medical massage protocol, including screening of my instructional DVD that including, detailed theoretical explanation, as well as step by step hands-on , to manage questions/ answers as well as additionally to offer my own hands-on demonstrations.
I believe that after attending these introductory seminars, people will be able to make an informative decision, to pursue training on the subject of concussions or not.
This topic became my late passion. Think about it! Using massage techniques, we can stop the development, and even reverse early stages, of dementia/Alzheimer’s disease, psychiatric behavioral disorders, movement disorders, Parkinson and more.
Please follow soon coming announcement on upcoming seminars. Looking forward to seeing you at my introductory seminars.
Attn: if you would like to invite me for a presentation of introductory seminars at your school, or other professional organizations, please e-mail to email@example.com
if you would like to join our mailing please and receive notification about upcoming seminars please e-mail to firstname.lastname@example.org
please click this link for more detailed information on this subject https://medicalmassage-edu.com/an-injustice-to-ray-rice/
Medical massage VS. bronchial asthma ???
Recently I have received an FB message “medical massage VS. bronchial asthma ???”
Short and to the point. Isn’t it? LOL. Yes, indeed. There is a significant room for a medical massage when managing bronchial asthma.
Bronchial asthma and bronchitis are very common disorders of the respiratory system. Various factors can cause bronchitis and asthma – viral infections, allergic reactions, etc. Massage therapy and bronchial drainage can play an important role in the treatment and management of the aforementioned disorders. We can assume that in cases of bronchitis & bronchial asthma the activities of the sympathetic nervous system are diminished. Massage therapy has the ability to depress or stimulate the divisions of the autonomic nervous system and can be an invaluable tool in depressing the parasympathetic activities, thereby balancing the activities of the sympathetic and parasympathetic nervous system.
All of the body’s mechanoreceptors have various levels of adaptation (their capability to increase production of action potentials.) A massive stimulation of receptors allows us to affect the activities of different subdivisions of an autonomic nervous system according to our needs.
Before the treatment, it is very important to perform the Dermographism test to determine an imbalance between the activities of the sympathetic and parasympathetic nervous systems. This test is performed in a few strokes with a semi-sharp object (corners of the fingernails will do) on the paravertebral zones from approximately L/S to the neck. The initial white Dermographism changes to red Dermographism, which disappears in a short amount of time.
The white Dermographism should change to red within less than 30 seconds. When red Dermographism stays for a prolonged time, sometimes even becoming edema like raised lines, this is the evidence that the parasympathetic nervous system is in much more active tone. If it changes very quickly from red back to white, or stays prolong white, it is a sign that the sympathetic nervous system is much more active. In cases of bronchial asthma and bronchitis parasympathetic activities dominate.
In other cases, we work in the inhibitory regime as an attempt to depress activities of the sympathetic nervous system and to achieve desired balance. In the case of asthma, it should be opposite – the massage must be intensive, with the techniques mobile, not staying in one place like the inhibitory regime, intensive performances approximately 100 times per minute.
The strokes must be very intensive. No light touch, no effleurage.
Back of the fingers, 5-6 times on each side.
Back of the fingers cross-fiber direction on paravertebral zones.
Back of the fingers from the top of the trapezius to the middle of the back.
Back of the fingers rotations for the top of the traps.
Fingertips petrissage bilaterally on the neck muscles.
Power thumb strips for the upper back area.
Petrissage #7 (with knuckles) for the upper back area (after massive connective tissue)
Petrissage on the neck, up and down.
Comb the ribs
Petrissage #3 for the neck
The approach is simple – intensive stimulation. It shouldn’t be, prolonged stimulation leading to adaptation of mechanoreceptors. Remember in most cases the inhibitory regime creates stimulation of the parasympathetic nervous system and will not contribute to the therapeutic effect. Conversely, the further suppression of sympathetic activities can even cause the person to have an asthma attack on the table. We want to depress the activities of the parasympathetic nervous system by doing this intensive massage for 20 minutes. Please don’t confuse “intensive massage” with aggressive vigorous pressure massage. We must be careful to not activate the protective muscular spasm…
It is very important to perform the vacuum/suction tapotement. In cases of bronchial asthma and bronchitis, we perform this technique for a much longer time than in cases of other treatments. The application of vacuum techniques should be focused on the upper and middle back.
It is very important to perform this technique correctly – when performed right, the hand makes a hollow sound as it strikes the skin.
After the massage is over we perform bronchial drainage. In cases of bronchitis and bronchial asthma, it’s not only mucous, which obstructs the airways causing breathing difficulties, but also the higher tonus of the smooth muscles of the bronchi.
The bronchial drainage techniques are the kind of breathing exercise. When the patient exhales, we squeeze his diaphragm like a ball, squeezing out as much air as possible from the capacity of lungs.
At the point of the maximum exhalation, we ask the patient to start coughing. This causes a kind of stretching and exercise for the bronchi as well as allowing the drainage of mucous from bronchial structures. This kind of bronchi manipulation causes the removal or drainage of the mucous and thus helps prevent bacterial infection and possible subsequent development of pneumonia. Additionally, bronchial drainage techniques also reduce the tension in the bronchial smooth muscles and contribute to the restoration of normal metabolism in these tissues encouraging the swelling and inflammatory condition to go away little by little.
This methodology was proposed by Soviet physician Dr.Lominoga and is described by Dr. Ross Turchaninov in Medical Massage Volume 2, https://medicalmassage-edu.com/product/medical-massage-volume-ii/.
On my DVD Vol. 5 https://medicalmassage-edu.com/product/volume-5-3/
I’m offering an explanation and hands-on demonstration.
It is extremely important to understand that two goals such as suppression of parasympathetic activities, as well as mucous drainage and reduction of tension within smooth muscles of bronchi, are equally important in order to achieve sustainable results including frequency reduction of asthma attacks, the necessity of medication consumptions including and not limited to use of steroids.