A massage therapist would never know if the case is reversible and treatable, until she tries.

The established, generally acceptable scientific concepts and conclusions, sometimes may not be fully supported by clinical observations and personal experiences. For example, the following is an excerpt from my article:

”If a patient has experienced repetitive mild concussions, he or she starts to develop Post-Concussion Encephalopathy (movement disorders, memory loss, psychiatric behavioral disorders, chronic headaches etc.)”

Why did I specifically emphasized the concussion must be repeatable?  Because I followed generally acceptable scientific concepts and conclusions.

Undoubtedly, repetitive concussions fuel the development of encephalopathies.  However, in my clinical setting, I observed many cases when even a single incident of brain trauma, leads to a significant brain dysfunction.

Also after a brain trauma, brain cells are in the mode that is called “stunned brain,”  “hibernating brain cells,” apoptosis, or “programmed cell death.” All these terms describe the hypometabolic state, when some brain cells go into hibernation to allow other neighboring cells to survive. The main reason for this is an immediate decrease in blood supply to the brain, due to an abrupt increase of cerebral spinal fluid secretions and an increase in intracranial pressure. The purpose of hibernation is a decrease in cellular function to the point when fewer resources of blood supply, such as oxygen, glucose is required for some cell function thus allowing the neighboring cells a chance to survive. Old and good texts, suggest that if during the first nine months, we will not restore adequate cerebral perfusion, to allow hibernated cells/hypometabolic stage, to resurrect to normal function, it would be not reversible degenerative change.

Also after a brain trauma, brain cells are in the mode that is called “stunned brain,”  “hibernating brain cells,” apoptosis, or “programmed cell death.” All these terms describe the hypometabolic state, when some brain cells go into hibernation to allow other neighboring cells to survive. The main reason for this is an immediate decrease in blood supply to the brain, due to an abrupt increase of cerebral spinal fluid secretions and an increase in intracranial pressure. The purpose of hibernation is a decrease in cellular function to the point when fewer resources of blood supply, such as oxygen, glucose is required for some cell function thus allowing the neighboring cells a chance to survive. Old and good texts, suggest that if during the first nine months, we will not restore adequate cerebral perfusion, to allow hibernated cells/hypometabolic stage, to resurrect to normal function, it would be not reversible degenerative change.

I always respected and continue respect all the available, established and reliable scientific data.  However, lately I learned that in the massage field where we have the opportunity to address causes of the problems directly, one will never know whether the clinical case is reversible or not, until she tries.

Most of my career, I declined treating patients who have developed diabetic neuropathies, because in school I was told, that the moment patient developing acute symptoms, pins and needles like pain, nerves degenerate, and this is not reversible.

To patients who referred themselves to me, as well as those referred by physicians, I used to say: ”I’m sorry my massage procedure cannot help in cases of diabetic neuropathies.”

Yet, several years ago a cardiologist, who developed diabetic neuropathy, asked me for a treatment.  When I declined seeing him, explaining that my treatment is not working in these cases he told me: ”Your treatment obviously helped to many my patients who have suffered a failure of arterial circulation in their lower extremities, why would you refuse to  treat cases of diabetic neuropathies?”

Rejecting my objection about irreversible nerve damage, he said “Nonsense.  It’s not over until it’s over! Let’s start, please!” Surprisingly, it was a success.

Today, I’m not declining to treat diabetic neuropathies, and in most cases the treatment brings good results. Surely, it requires more treatments than other cases (at least 15 treatments and then are few more treatments after two weeks break), but it worth it.

It’s not over until it’s over.

Recently, one of my CE students, referred to me her friend, who 18 months ago, sustained a concussion. Please note, it was eighteen, not nine months ago. She tried many treatments, which didn’t work, and practically started to experience the symptoms that could be construed as brain dysfunction, including: sleep disorders, intracranial pressure, memory loss, disorientation and more.

While under my care, she received seven treatments, which resulted in her experiencing unbelievable for her improvements. Of course, they made me very happy too. Hallelujah. I surmise that if we wouldn’t increase blood supply to the brain, and, at the time, wouldn’t positively affected the autonomic activities, she would end up with a not reversible dementia and more.  I should also comment that it is difficult to say when, in this case, degenerative changes would become irreversible. But if her condition wouldn’t be treated appropriately, she would surely end up with a permanent dementia, and other symptoms of permanent encephalopathies.


The science of Medical massage stemmed from general biomedical science. Unlike many other healthcare procedures, massage awakes multiple positive changes in functions of organs and systems, including and not limited to vasodilations, suppression of stress hormones secretion and an increase of anti-inflammatory hormones release into the blood.  Massage could provide a profoundly positive impact of cellular function, and can increase blood circulation up to 60%. I can continue talking about new mitochondria production, and more.

Undeniably power of massage is much greater than any other healthcare procedure. I’m talking about our ability to stimulate a healing process.

HIPPOCRATES, the father of theoretical medicine, once said: ”the nature of human body is such that  must heal illnesses on its own, and we as a doctors must stimulate that natural ability of human body to heal itself.”

Massage possesses a great power to stimulate healing process, therefore it’s not over until it’s over, and massage therapists would never know if the case is reversible and treatable, unless they try.

Best wishes,


  1. During the last five years, I have had an opportunity to treat many patients, who have sustained concussions.

The link below, is presenting the history of me starting to treat post-concussion patients.


If NFL uses it, must it be good?

4 weeks ago, I received a concussion patient, in what turned out to be a difficult clinical case, including insomnia, headache/head pressure, disorientation, memory disturbances and more. A client was a 45 years male, who 4 months ago sustained a blow to the head, playing soccer. He was delivered to an emergency room. MRI didn’t find any hemorrhage, lesions, or etc. After 3 weeks of “rest and time,” his primary care physician referred him to a hyperbaric camera oxygen treatment; twice a week, for 2 months. According to the patient, this therapy made him feel worse.

Of course, I wouldn’t present this case to you, if I wouldn’t achieve some evidence of an improvement. So far, thank God, after 11 treatments, the patient is progressing significantly, sleeps better, shows memory improvement, no symptoms of severe intracranial pressure, and more.

As I was contemplating over this case, I asked my patient,

“Why did your doctor decide to refer you to hyperbaric oxygen treatment?”

”NFL use it” The patient responded.

I was somewhat astonished.  Was NFL usage of hyperbaric oxygen treatment a sufficient reason for prescribing this procedure? I talked to the referring neurologist.  He had no answer why primary care physician decided to subject his patient to this procedure.

Hyperbaric chambers technologies were developed in the Soviet Union in the 1970s.

Originally hyperbaric chambers were designed to treat Deepwater divers from decompression sickness. Back in the day of the Soviet Union, these divers used to build underwater constructions, repairing ship bottoms, etc., – a unique occupation, which was in a high demand. To keep these guys in the workforce, scientists developed hyperbaric chambers oxygen treatment, and it was and is a great solution for decompression sickness, arterial gas embolism.

One of the additional expectations for application of this procedure was that it would work in cases of brain trauma/strokes. Although after an extensive testing it proved to have no effect.

It was also recorded that hyperbaric chambers oxygen therapy worked in some cases for non-well-healing wounds. It increased the oxygen level in blood but did not accelerate CSF drainage. And if this was so, how would this oxygen be delivered to brain cells in needed quantities? What about glucose supply to the traumatized brain? Does this oxygen therapy contribute to the balance of autonomic activities? If the hyperbaric cameras have no effect on autonomic activities, then (in my opinion) this hyperbaric oxygen therapy is not working in cases of prevention and rehabilitation from post concussions encephalopathies developments.

To no surprise of mine, I have found this article https://www.nytimes.com/…/effective-concussion-treatment-re…

However, if you have any materials supporting the effectiveness of hyperbaric oxygen therapy in cases of concussions, please do post.

Pseudo- science VS. real clinical phenomena.

Trigger Points

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:

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.

Best wishes.

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

this link

“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.

Bo Jackson’s startling hindsight: ‘I would have never played football’

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.

Best wishes,



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

this link

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