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Acceptable or not as therapeutic?
This may take some reading. It is footnoted but you will need to trace the references if you want to assess the validity.
So is it therapeutic? Most people that have experienced massage know it is without consulting studies.
http://msscentershop.info/content/28/3/153.full.pdf
Any comments?
Views: 352
Replies to This Discussion
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Permalink Reply by Therese Schwartz on
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Hi Daniel - I'm taking next week off - yay! I will read this then and have some hopefully intelligent and/or interesting thoughts!
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Permalink Reply by Gordon J. Wallis on
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Sounds pretty therapeutic to me.
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Permalink Reply by Laura Allen on
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I think most of us agree that massage is therapeutic without having to consult studies. That was a good study--when it came out--and there have been so many since then. If I were doing a case study or writing a paper, I would quote from newer studies. Even back in the dark ages when I was in college, we were prohibited from using research references more than three years old unless they were from classical literature.
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Permalink Reply by Boris Prilutsky on
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Hi Daniel.
I do appreciate your post but just have to say , the proposed article present physiological effect of massage on the human body, in so primitive but complicated way that it made very difficult for me not to criticize. Below you'll find short definition, you are welcome to agree or disagree. In some way, I'm so much agree with Laura. Lately, reference to study “new findings” etc. is become destructive. I don't want to be understood wrong. I do believe in science, and practicing scientifically developed techniques and protocols. Do I reffering myself to the scientific studies every time? Will answer by question on question. What for? For last 15 years,a lot of studies where done in American. Data was published. How much it did contribute to recognition of massage therapy as a medical procedure??? To what degree it helped us to increase business, including to allow us to charge price for healthcare procedure? I'm not talking to ask $120 for procedure, I'm just asking is it possible to sustain business by charging $39. I mean if to consider fixed expenses local and federal tax.
we must find, some practical balance with all this references to different studies . We must to sound scientifically in communications with other healthcare professionals, but most importantly we have to deliver results. Sorry, article that you proposed do not contributing to none of this . I hope you'll understand that I do not have bad intentions just have to react.
Physiological effect of massage on the human body
Two factors define the physiological effect of massage on humans.
1. Local, mechanical factor - expressed by mechanical acceleration of venous blood drainage, some degree of lymph drainage acceleration, passive exercise for soft tissues, and breaking down deposits of calcium in soft tissue and stimulation of its removal from the body.
2. Reflex factor - the main power of massage therapy is its reflexive therapy. By mobilizing skin, connective and muscular tissue, we deform the proprioreceptors, which in turn creates action potentials (electrical activities) that through neurological pathways reaching motor and vasomotor centers. As a reflex (involuntary reaction of organs and systems to original stimuli) the body responds by expressing all positive changes (production in blood pressure , increased blood supply to tissue, normalization of muscular tone , decrease of stress hormones productions and much, much ,much more .)
How much pressure should be applied?
In order to reach results, and to avoid injury from applying vigorous pressure, we must utilize the following definition. 1. Pressure has to be significant (gradually increasing to the maximum extent) but must avoid activating the pain analyzing system. Given the fact that pain is a somewhat subjective sensation and cannot be measured like weight, or blood pressure, we have to design the pressure by consulting our client. The moment when the individual’s threshold of pain is determined, the therapist can properly increase pressure to the determined level. 2. If the applied pressure causes protective muscular contraction reflex, and even if the client encourages you to continue or increase it, you must reduce the pressure and restart the process of gradually increasing pressure to the maximum point that will avoid muscular reflex contraction.
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Permalink Reply by Noel Norwick on
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Hi Daniel: Since you posted in Education, I will note that academics will likely prefer to review the historical progression of opinions/propositions that have been published discussing the subject. For practitioners, research is irrelevant: our concern is much simpler: a. Were we taught how to evoke and can we provide consistently provide positive therapeutic outcomes. b. Do we get regular referrals from M.D.s, DPTs & Occupational Therapists and does the general public believe that massage is therapeutic or merely a non-sexual form of physical pampering that feels good.
Hi Laura: Curious what college you were in & what field you were studying that prohibited the use of research references that were more than three years old? Based on my education at the University of Wisconsin (History/Psychology, BA), University of New Mexico (History, MA) & Columbia University (MBA). I was taught to reference all relevant original source materials that had withstood repeated testing over time and to cite/review with extreme caution all propositions based solely on the most recent research.
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I'm impressed at the level of study done by 1994! Of course more studies have been done since then, but this is an excellent summary of what was known up to that point, and it's an interesting read.
Noel, I think I'm lucky - all of my clients know that the work I do is therapeutic rather than just pampering that feels good! I have an exceptional group of clients. I don't get referrals from other health professionals but my practice is as full as I want it to be at the moment.
One statement caught my attention:
Deep massage causes sufficient muscle damage to
elevate the serum concentrations of myoglobin23 and
the enzymes glutamic oxaloacetic transaminase,
creatine kinase and lactate dehydrogenase.
The thought of doing muscle damage makes me uneasy - any thoughts on what type of deep massage this is? Does this involve the musculature reflex contraction that Boris talks about?
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Hi Therese:
1. You might be lucky, but since your practice is as full as you want it to be, you have reason to be proud.
2. Across the nation, our vocation/profession is contracting and schools have been closing due to a failure to gain recognition/referrals from the medical mainstream and respect from the general public. Regarding respect, several questions we might all consider are: a. Why aren't coupons for medical treatment & discounts for regular visits common? b. Why don't M.D.s sell Rx drugs, nutritional supplements, etc? c. Why do most M.D.s think massage, at it's best, is merely palliative care?
3. As Boris has previously noted (and I agree), pressure should not be applied sufficient to activate the recipient's pain analyzing system. Pressure must be significant (sufficient to achieve the desire effects), but not so forceful as to cause pain (flinching away, gritting of the teeth, holding of the breath, screaming, etc). A Boris quote that comes to mind is something to the effect that massage performed with sufficient force as to cause pain (or soft tissue damage) may be useful in learning to manage one's anger, but it cannot be considered to be therapeutic massage. :~)
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Dear Therese.
The statement from article you brought: “Deep massage causes sufficient muscle damage to
elevate the serum concentrations of myoglobin23 and
the enzymes glutamic oxaloacetic transaminase,
creatine kinase and lactate dehydrogenase.”Is describing post trauma phenomenons, and in no case describing deep tissue massage therapy,techniques which must be include in every type of treatments by means of massage.
To describe this necessary deep tissue mobilization, as article proposing is absolutely misleading. The matter-of-fact after reading this article ,you expressed your concern about damaging muscles. Just to clarify this wrong information about deep tissue mobilization below I am offering, some information from my article:Four Strategies for Deep Tissue Massage .
I hope it will help you to get perception about deep tissue mobilization .Hoping to hear from you back if it was helpful or maybe you have different views on this subject .
Best wishes and very happy 2012
PS.you're welcome to visit my website www.medicalmassage-edu.com
and click on free instructional medical and sports massage lessons .one of this lessons is dedicated to hands-on demonstration of Four Strategies for Deep Tissue Massage
Any soft tissue mobilization provided by the hands we traditionally call massage therapy. The goals of most technical approaches of massage procedure (mobilizing skin, fascia, muscles, periosteum etc.) are to release tension within muscles and fascia, to increase blood supply to the tissues, and to cause multiple positive changes in the functions of organs and systems. We all know that our body consists of superficial as well as deeply located muscles, fascia and other tissues. In my opinion, deep massage therapy is not a separate modality but must be part of any clinical work whether it is stress management massage, orthopedic massage, sports massage etc.
To ensure that we are achieving the most profound physiological effect on the body of the client possible, massage should be performed as deep as possible. The deeper we massage, the more we stimulate the nervous centers, and the more and faster the reflexive therapeutic effects will occur,bigger amount
of endorphins production,ext
Deep Tissue Massage
4 strategies:
1. To work in the inhibitory regime
In order to reach safe rapid and sustained results for neuromuscular disorders or for stress management, we must perform massage in the inhibitory regime. Every nerve receptor has its own level of adaptation, which means its capability to produce electrical activities (also known as impulse or action potential). The rhythm of massage strokes should be about 70-80 movements per minute and the technique application on the massaged area should be prolonged while gradually increasing pressure and minimizing disconnection. This produces a massive amount of nervous impulses that travel to and excite corresponding nervous centers. With the prolonged application of the massage techniques, the nervous centers become inhibited by the massive, continuous flow of afferent electrical impulses from the massaged area. Performing massage in inhibitory regime, eventually not increasing production of action potential, but the flow of afferent neural impulses from the contact area of our hands will continue. At this point, the membranes of the nervous cells become repolarized; unable to generate or conduct efferent impulses, and as a result, the tension in the soft tissues of the massaged area is reduced. Reflexively, the body responds by vasodilation, a reduction of pain sensation and muscular relaxation. This approach aims at reducing the sympathetic tone and restoring balance between the sympathetic and parasympathetic divisions of the autonomic nervous system.
As we continue to apply inhibitory techniques to a massage area, the more superficial soft tissues relax, allowing us to work into deeper and deeper layers of tissue. The deeper we mobilize, the greater the amount of receptors we can stimulate. The more receptors we stimulate, the more we ensure that our performance may achieve the maximum therapeutic effects.
2. Shift superficial tissues to expose deeper layers
Sometimes it is only possibility to get to the deeper layers of muscles and other soft tissue, is simply moving the superficial tissues out of the way. The superficial soft tissues in some areas must be shifted in order to reach the deeper layers. One example of this strategy is in the medical massage treatment for piriformis muscle syndrome. In the treatment of this challenging disorder, we must directly massage the piriformis muscle (a very deep muscle; originating on the anterior portion of the sacrum and inserting into the greater trochanter). In order to access this very deep structure, we must first medially shift the gluteus maximus muscles and hold them out of the way while we apply massage techniques on the piriformis muscle.
3. Compression; shifting superficial tissues followed by transmission of pressure to the deeper layers
The additional strategy for deep tissue mobilization is to utilize techniques for compression of tissue. In this case, the transmission of pressure thru the superficial to the deeper layers of tissue will significantly contribute additionally to the release of tension in fascia and muscles as well as stimulate the production of endorphins, etc. There are many benefits to using deep compression techniques in massage therapy. Of the mechanical factors, compression techniques allow us to gradually tear down any deposits of scar tissue, or in the case of chronic inflammation, adhesive scar tissue and/or soft tissue phenomena.
Piezoelectrical Effect of Massage Therapy
Both inorganic and organic substances have the ability to generate electrical potential in response to pure mechanical deformation. This is referred to as the piezoelectrical phenomenon. During the performance of massage therapy, we are deforming the tissues, cells, and molecules thereby generating/creating piezoelectrical charges. In massage, the main cause of piezoelectric phenomenon is the deformation of collagen molecules. One should remember that elastin and keratin also carry piezoelectric properties. As we know, our molecules are surrounded by large amounts of extracellular fluid (at least 70-75% of our body is water). By performing massage therapy we not only generate electrical impulses that travel thru peripheral nerves which conduct their way to the central nervous system, but also piezoelectrical charges of electricity. These piezoelectric charges move out in all directions, thru extracellular fluid and other molecular structures, creating streaming potentials that travel to the inner organs and there create massive additional afferent impulses. These afferent impulses from the inner organs in turn further stimulate centers within the central nervous system and increase the power of reflexive therapy (positive changes in function of organs and system due to original stimulation by massage).
4. Performing massage under stretching of the muscle
In some cases when we are trying to massage the deeper layers of soft tissue, it is helpful and sometime even necessary to first stretch the superficial structures before applying massage techniques to the region. For example, when performing massage therapy in cases of TMJ disorders, we must massage all masticatory muscles as deeply as possible. During treatment, we hold the client’s jaw open to expose the belly of the masseter muscle and other chewing muscles.
Sometimes, clients can develop functional limitation of range of motion for different reasons. For example, after surgery or immobilization of a joint due to a break, or some chronic inflammatory condition, muscles can develop a state of contracture ( for example in the knee region, deficit of extension/flexion). Over time, continuation of this condition can lead to the muscles and tendons becoming functionaly shorter. When we stretch out the structures and apply massage while the structure is under stretch, not only will it encourage the restoration of normal length and elasticity, but it also allows for much deeper mobilization.
How much pressure should be applied?
Nowadays, some massage therapists make no distinction between the concepts of strong massage and deep massage. Most of us agree that strong massage will not always be deep massage. There is no doubt that when we perform deep tissue massage it feels stronger. The question is how much pressure should we be applying?
In order to reach results, and to avoid injury from applying strong pressure, we must utilize the following rules. 1. Pressure has to be significant (gradually increasing to the maximum extent) but must avoid activating the pain analyzing system. Given the fact that pain is a somewhat subjective sensation and cannot be measured like weight, or blood pressure, we have to design the pressure by consulting our client. The moment when the individual’s threshold of pain is determined, the therapist can properly increase pressure to the determined level. 2. If the applied pressure causes protective muscular contraction reflex, and even if the client encourages you to continue or increase it, you must reduce the pressure and restart the process of gradually increasing pressure to the maximum point that will avoid muscular reflex contraction.
If we will apply very strong pressure that will activate the pain analyzing system (activation of the pain analyzing system causes reflexive protective muscular contraction) and will continue to vigorously perform the massage, this kind of act actually traumatizes the muscles, causing inflammation of the muscles and following development of trigger points within the muscles and other difficult pathologies of muscular system. By gradually applying pressure we not only avoid injuring the client, but as you understand, we also relax the superficial layers of tissue that allow us to mobilize the tissue to the deepest possible extent.
In Closing
Whenever performing massage for therapeutic purposes, it is imperative to mobilize tissues as deeply as possible. However, we must never force the way to go deep. Remember the protocol for application of pressure; it must be significant, but without activating the pain analyzing system. We can mobilize only as deep as the body will allow us to. As you understand from my article, to create conditions for deep therapeutic massage is a only guidelines for the deep tissue massage
Therese Schwartz said:I'm impressed at the level of study done by 1994! Of course more studies have been done since then, but this is an excellent summary of what was known up to that point, and it's an interesting read.
Noel, I think I'm lucky - all of my clients know that the work I do is therapeutic rather than just pampering that feels good! I have an exceptional group of clients. I don't get referrals from other health professionals but my practice is as full as I want it to be at the moment.
One statement caught my attention:
Deep massage causes sufficient muscle damage to
elevate the serum concentrations of myoglobin23 and
the enzymes glutamic oxaloacetic transaminase,
creatine kinase and lactate dehydrogenase.
The thought of doing muscle damage makes me uneasy - any thoughts on what type of deep massage this is? Does this involve the musculature reflex contraction that Boris talks about?
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Boris - thanks! That is really good information. It confirms much of what I've thought about good deep tissue but didn't have information to really back up my ideas. This is how I do massage (although I don't know yet how to move the gluteus maximus out of the way! That sounds like it would be really useful for clients with sciatica; I have about a dozen of those).
Is the muscular reflex contraction the same thing as one of my clients who's quads and hamstrings (but especially quads) quiver/shake when I'm working on them? It's usually not the one I'm working on that is the "worst" - one or more of the other muscles will shake a lot. I've never figured out how to keep it from happening. He has lots of issues - a ton of scar tissue from a grenade blast in Vietnam, neuropathy, diabetes, and more.
I will definitely watch the video this week!
Noel - thanks, I am proud of what I've accomplished in building my practice! I've been able to really help some folks and they've referred friends and family to me.
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Hi Therese.
I'm glad you finding this information as a good one. You said:” This is how I do massage (although I don't know yet how to move the gluteus maximus out of the way”
during my long career I used to meet people who never got formal training in medical massage but somehow using healthy intuition/giving talent, performed it perfectly correct. Most likely you having this gift. But most of us in order to perform health beneficial procedure, we have to be trained. On the other hand, some of us who are applying vigorous, trauma resulting pressure, OR driven by desperation of”I don't know what to do” or has been trained by instructors who having no clue about deep tissue massage. I hope many, will be able to learn from our discussion. Below you will find short fragment from my up coming orthopedic massage/physical therapy aide/ chiropractor assistant program. I hope my managing company will be not angry on me for releasing it. In any case now you will have some picture how to shift gluteus, which allow you to reduce layers of muscles which make much easier and much more effective effort to simulate Piriformis Muscle in case of sciatica.
http://www.youtube.com/watch?v=o7KtuUolJUI
Best wishes.
Boris
Therese Schwartz said:Boris - thanks! That is really good information. It confirms much of what I've thought about good deep tissue but didn't have information to really back up my ideas. This is how I do massage (although I don't know yet how to move the gluteus maximus out of the way! That sounds like it would be really useful for clients with sciatica; I have about a dozen of those).
Is the muscular reflex contraction the same thing as one of my clients who's quads and hamstrings (but especially quads) quiver/shake when I'm working on them? It's usually not the one I'm working on that is the "worst" - one or more of the other muscles will shake a lot. I've never figured out how to keep it from happening. He has lots of issues - a ton of scar tissue from a grenade blast in Vietnam, neuropathy, diabetes, and more.
I will definitely watch the video this week!
Noel - thanks, I am proud of what I've accomplished in building my practice! I've been able to really help some folks and they've referred friends and family to me.
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Thanks Boris - that was very helpful! It's not so difficult to move the gluteus when you can see it in action!
I was trained by someone who, when asked what she did for a living, replied "I make grown men cry". I've had to "unlearn" 95% of what I learned. So I think I do have a gift - but I also am driven to really do what is best for people and I knew that what I was taught wasn't good. Additionally, I was in a great deal of pain myself trying to massage like that.
I like how you use your elbow/forearm and hand together. I learned something like that from Val Guin's DVD's, but I'm not as graceful at it as you and Val are! Time to practice...
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