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Massage, Joint Mob & Spinal Manipulation...alternative shams?
Just released: new literature review in Journal of Chiro and Osteopathy: "Effectiveness of manual therapies: the UK evidence report" http://www.chiroandosteo.com/content/18/1/3/abstract
Are alternative therapies such as as massage, joint mobilization and spinal manipulation really a sham? If so, why are these modalities becoming increasingly popular? How can we improve their effectiveness?
Views: 524
Replies to This Discussion
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Permalink Reply by Mike Hinkle on
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I saw this yesterday. Looks like the UK Chiros and Osteos are growing fearful of how much good is being done by UK Massage Therapists. Stephen and Rick from the UK were saying how this was being played out.
I think that western medicine is concerned about the effects of massage. I think this same western thought has been affecting massage research. Lots of growth coming.
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Permalink Reply by Erik Dalton, Ph.D. on
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Michael:
Posted this yesterday on Facebook Myoskeletal Alignment page. Here's the thread...some excellent points on this controversial subject:
Michelle Doyle Great article...posted it on my wall also.
Erik Dalton Yes, seems to fly in the face of what some are saying about the effectiveness of joint mobilization.
Michelle Doyle Yes, indeed
Bodhi Haraldsson Joint mobs have been shown to be effective as stated in the article. How ever joint mobs tend to be the most effective if used along with exercises. On their own they have moderate to low effectiveness in general. The same goes for massage.
Erik Dalton Yes Bodhi, specially designed home-retraining exercises are essential for supporting and enhancing all forms of bodywork including nerve mobilization (Butler), trigger point work, etc. Travell always recommended stretching (active and passive) following a treatment and Ida Rolf included specific movement work to help reprogram aberrant neuro-motor patterns. In the latest edition of MTJ magazine, Joe Muscolino offers seven helpful self-care tips for our clients presenting with forward head postures. Hopefully, all pain management therapists have access to strenthening/stretching exercise programs to help their clients/patients in pain.
Michelle Doyle Yes, I agree, joint mobilization can be effective if done with appropriate soft tissue work, stretches and home exercises. And it's especially important that the client follow through with the self-care program to obtain the best results.
Christy Fletcher Strouse I value research, but it's limited. I KNOW from personal experience that Chiropractic has helped me (along with Pilates, manual therapy and stretching). Sure it's anecdotal evidence, but when you've had back pain since you were a teenager, you pretty much know what works and what doesn't. People that knock Chiropractic, or any unconvential treatment, are probably the ones who don't suffer, and if they do.. don't seek proper treatment (instead pop pills or go for surgery).
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Permalink Reply by Robin Byler Thomas on
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Thanks Eric, I can add this to my data base. WOW, it just came out. I skimmed it and found it repeats what most of the other reviews have said.
It has excellant tables that are easy to read, for those of you who want a quick summary of this review (reviews are long because they are reviewing many studies). Keep in mind that even when a summary says evidence is inconclusive in an area for massage therapy, most of these studies are considered favorable (or going in the right direction, we just need more rigorous investigation).
Follow Eric's link to the abstract, click on the PDF link on the upper right side of the page for the whole study (wait a few seconds for it to load). Once the PDF is up look to the bookmarks on the left of the page for the figures (or tables) if you'd like the quick summary.
The conclusion of this review states: "Massage is effective in adults for chronic low back pain and chronic neck pain." Most of the rest of the review is inconclusive, but favorable, for massage and many other conditions (based on RCT's only that were not rigorous enough for our current standards.) There are many pilot studies, observational studies, and a few whole system studies that conclude massage therapy is worth more investigation.
It's nice the DC's included us in their review.
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Eric, forgive me for being uninformed as I have not taken any of your classes yet, but using this review's terminology, where do place your work?
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Hey Robin, I'm honored you're interested enough in what I teach to respond.
Like many, I entered the bodywork field as a chronic pain client. A therapist touched me, changed my life and I knew I wanted to dedicate the rest of my life to helping people with my hands. I believe a therapist's passion is usually sculpted by the teachers/researchers/authors who've influenced them the most. For me it was Ida Rolf, Philip Greenman (and all the Michigan State College of Osteopathic staff), Vladimir Janda, and Serge Gracovetsky. Whenever possible, I like to steal theories/techniques, etc. from teachers I've co-taught with including Aaron Mattes, David Kent, James Waslaski, Tom Myers. and Jim Asher at the Rolf Institute. However, I only give them credit when they're actually in the room or have students present.
In an attempt to try to integrate osteopathic spinal mechanics into a deep tissue format, Myoskeletal Alignment was born. The only thing new I feel I've added to the equasion is the use of bones as levers to release motion-restricted joints. Muscle energy also shares the same goal except this technique engages the barrier less directly.
I call the Myoskeletal approach 'articular stretching' rather than joint mobilization since the client is actively engaged in a specific movement as slow sustained finger/fist/thumb/elbow pressure releases the fixated joint complex. The aim is to restore motion to all soft tissues in the osteoligamentous canal including fibrotic joint capsules, spinal ligaments, transversospinalis muscles and associated fascia. Long answer to a short question! Thx for the post Robin.
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Thanks for your reply Eric and I don't mind long answers. That's gives me a better idea of where you fit.
Were any of the studies reviewed based on your work, the work of the people you've studied with, or articular stretching in general?
Erik Dalton, Ph.D. said:Hey Robin, I'm honored you're interested enough in what I teach to respond.
Like many, I entered the bodywork field as a chronic pain client. A therapist touched me, changed my life and I knew I wanted to dedicate the rest of my life to helping people with my hands. I believe a therapist's passion is usually sculpted by the teachers/researchers/authors who've influenced them the most. For me it was Ida Rolf, Philip Greenman (and all the Michigan State College of Osteopathic staff), Vladimir Janda, and Serge Gracovetsky. Whenever possible, I like to steal theories/techniques, etc. from teachers I've co-taught with including Aaron Mattes, David Kent, James Waslaski, Tom Myers. and Jim Asher at the Rolf Institute. However, I only give them credit when they're actually in the room or have students present.
In an attempt to try to integrate osteopathic spinal mechanics into a deep tissue format, Myoskeletal Alignment was born. The only thing new I feel I've added to the equasion is the use of bones as levers to release motion-restricted joints. Muscle energy also shares the same goal except this technique engages the barrier less directly.
I call the Myoskeletal approach 'articular stretching' rather than joint mobilization since the client is actively engaged in a specific movement as slow sustained finger/fist/thumb/elbow pressure releases the fixated joint complex. The aim is to restore motion to all soft tissues in the osteoligamentous canal including fibrotic joint capsules, spinal ligaments, transversospinalis muscles and associated fascia. Long answer to a short question! Thx for the post Robin.
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OK Robin: For those who didn't read the pdf of the study, here's the encapsulated findings from review of the literature. I'll bold the pieces I feel are relevant to my work:
"Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Massage (whatever that is) is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome.
I don't think sciatica, coccydynia, fibromyalgia or TMJ will ever be adequately controlled via manual therapy to allow conclusive findings. Are we really 'fixing' the true sciatic sufferer or is the body figuring it out on its own? Is the pain arising from a lumbar radiculopathy or a backward sacral torsion?
However, I do believe, the more you know, the better your chances of helping all the above mentioned disorders.
The body is inseparable; what affects one part always affects the other. Personally, I believe anyone performing rigorous deep tissue or assisted stretching work should first have a good basic working knowledge of spinal biomechanics, neurodynamics and visceral function/structure. So much to learn and so little time...dang it!
Robin Byler Thomas said:Thanks for your reply Eric and I don't mind long answers. That's gives me a better idea of where you fit.
Were any of the studies reviewed based on your work, the work of the people you've studied with, or articular stretching in general?
Erik Dalton, Ph.D. said:Hey Robin, I'm honored you're interested enough in what I teach to respond.
Like many, I entered the bodywork field as a chronic pain client. A therapist touched me, changed my life and I knew I wanted to dedicate the rest of my life to helping people with my hands. I believe a therapist's passion is usually sculpted by the teachers/researchers/authors who've influenced them the most. For me it was Ida Rolf, Philip Greenman (and all the Michigan State College of Osteopathic staff), Vladimir Janda, and Serge Gracovetsky. Whenever possible, I like to steal theories/techniques, etc. from teachers I've co-taught with including Aaron Mattes, David Kent, James Waslaski, Tom Myers. and Jim Asher at the Rolf Institute. However, I only give them credit when they're actually in the room or have students present.
In an attempt to try to integrate osteopathic spinal mechanics into a deep tissue format, Myoskeletal Alignment was born. The only thing new I feel I've added to the equasion is the use of bones as levers to release motion-restricted joints. Muscle energy also shares the same goal except this technique engages the barrier less directly.
I call the Myoskeletal approach 'articular stretching' rather than joint mobilization since the client is actively engaged in a specific movement as slow sustained finger/fist/thumb/elbow pressure releases the fixated joint complex. The aim is to restore motion to all soft tissues in the osteoligamentous canal including fibrotic joint capsules, spinal ligaments, transversospinalis muscles and associated fascia. Long answer to a short question! Thx for the post Robin.
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Howdy Rick:
First of all, I really love many of the European, Australian and Canadian osteopaths. Some wonderful new ideas coming from your part of the world. Check out the John Bayliss book Spinal Mechanics and Bony Locking. He and my buddy Jerry Hersh are ripping away at the very foundation of my biomechanical belief system (the Fred Mitchell 'muscle energy' model). It's sad for me but, regrettably, they present a pretty convincing case against the Laws of Spinal Motion and pelvic mechanics during gait.
I'm surprised you're finding resistance for soft tissue therapy in Europe. International sales for videos and books has skyrocketted for many USA educators...they seem to be eating the myofascial thing up. Tom Myers' tells me his largest attended classes in Europe are DO events.
Back to Massage ~ The problem with scientifically validating massage is defining the terminology. I believe it's a pipe-dream trying to legitimize any body of work that encompases such a vast variety of modalities. What the heck is massage anyway...assisted stretching, energy work, Rolfing, healing touch, Feldenkrais, muscle energy, spa massage, sports massage, pain management... and on and on.
Gonna have to 'weed-out' a very distinct category of massage, locate legitimately qualified therapists, and then try to figure out what we're testing for. Ain't gonna satisfy me until someone defines the 'brand' of therapy that's being studied.... and then it's still a 'crap-shoot'.
For now, my suggestion is to just believe in what your client's bodies are telling you...are they more relaxed, do they seem to feel better, are they sleeping better, how's their gait, are they living more in their body, any ROM changes, is the athlete's time improving...how bout their injuries? If you're passionate about touch therapy, in time, recognition and acceptance will come... no matter where you live.
Rick Britton said:As a UK Massage Therapist I have to say that the clients I see have usualy followed one of these paths BEFORE they get to my office (I am mostly treating pain):
1. Gen Prac 2. Analgesics. 3. return to Gen Prac no better 4. referal to specialist (Orthopaedics/Rheumatologist/Physiotherapist) 5. MRI Scan 6. Visit DO and or DC for Joint Manipulation 7. return to Gen Prac not much better. 8. Hear about man with magic hands by word of mouth
or
1,2,3,4 then 5. Surgery 6. return to Gen Prac 7. Live with pain 8. Hear about man with magic hands by word of mouth
Unfortunately the role of soft tissue bodywork in treating pain is little known in the UK and this sequence is repeated time and time again. I really don't know what is to be done to promote soft tissue bodywork up the ladder. GPs will not refer to MTs, Rolfers and the like.
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Thanks Eric. So, is your articular stretching technique the same as the chiropractors joint mobilization?
Erik Dalton, Ph.D. said:OK Robin: For those who didn't read the pdf of the study, here's the encapsulated findings from review of the literature. I'll bold the pieces I feel are relevant to my work:
"Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Massage (whatever that is) is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome.
I don't think sciatica, coccydynia, fibromyalgia or TMJ will ever be adequately controlled via manual therapy to allow conclusive findings. Are we really 'fixing' the true sciatic sufferer or is the body figuring it out on its own? Is the pain arising from a lumbar radiculopathy or a backward sacral torsion?
However, I do believe, the more you know, the better your chances of helping all the above mentioned disorders.
The body is inseparable; what affects one part always affects the other. Personally, I believe anyone performing rigorous deep tissue or assisted stretching work should first have a good basic working knowledge of spinal biomechanics, neurodynamics and visceral function/structure. So much to learn and so little time...dang it!
Robin Byler Thomas said:Thanks for your reply Eric and I don't mind long answers. That's gives me a better idea of where you fit.
Were any of the studies reviewed based on your work, the work of the people you've studied with, or articular stretching in general?
Erik Dalton, Ph.D. said:Hey Robin, I'm honored you're interested enough in what I teach to respond.
Like many, I entered the bodywork field as a chronic pain client. A therapist touched me, changed my life and I knew I wanted to dedicate the rest of my life to helping people with my hands. I believe a therapist's passion is usually sculpted by the teachers/researchers/authors who've influenced them the most. For me it was Ida Rolf, Philip Greenman (and all the Michigan State College of Osteopathic staff), Vladimir Janda, and Serge Gracovetsky. Whenever possible, I like to steal theories/techniques, etc. from teachers I've co-taught with including Aaron Mattes, David Kent, James Waslaski, Tom Myers. and Jim Asher at the Rolf Institute. However, I only give them credit when they're actually in the room or have students present.
In an attempt to try to integrate osteopathic spinal mechanics into a deep tissue format, Myoskeletal Alignment was born. The only thing new I feel I've added to the equasion is the use of bones as levers to release motion-restricted joints. Muscle energy also shares the same goal except this technique engages the barrier less directly.
I call the Myoskeletal approach 'articular stretching' rather than joint mobilization since the client is actively engaged in a specific movement as slow sustained finger/fist/thumb/elbow pressure releases the fixated joint complex. The aim is to restore motion to all soft tissues in the osteoligamentous canal including fibrotic joint capsules, spinal ligaments, transversospinalis muscles and associated fascia. Long answer to a short question! Thx for the post Robin.
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Not really. Check out my You Tube Channel for a visual demo of a basic articular stretching routine:
http://www.youtube.com/watch?v=lKhkLHLarYQ&feature=PlayList&...
Robin Byler Thomas said:Thanks Eric. So, is your articular stretching technique the same as the chiropractors joint mobilization?
Erik Dalton, Ph.D. said:OK Robin: For those who didn't read the pdf of the study, here's the encapsulated findings from review of the literature. I'll bold the pieces I feel are relevant to my work:
"Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Massage (whatever that is) is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome.
I don't think sciatica, coccydynia, fibromyalgia or TMJ will ever be adequately controlled via manual therapy to allow conclusive findings. Are we really 'fixing' the true sciatic sufferer or is the body figuring it out on its own? Is the pain arising from a lumbar radiculopathy or a backward sacral torsion?
However, I do believe, the more you know, the better your chances of helping all the above mentioned disorders.
The body is inseparable; what affects one part always affects the other. Personally, I believe anyone performing rigorous deep tissue or assisted stretching work should first have a good basic working knowledge of spinal biomechanics, neurodynamics and visceral function/structure. So much to learn and so little time...dang it!
Robin Byler Thomas said:Thanks for your reply Eric and I don't mind long answers. That's gives me a better idea of where you fit.
Were any of the studies reviewed based on your work, the work of the people you've studied with, or articular stretching in general?
Erik Dalton, Ph.D. said:Hey Robin, I'm honored you're interested enough in what I teach to respond.
Like many, I entered the bodywork field as a chronic pain client. A therapist touched me, changed my life and I knew I wanted to dedicate the rest of my life to helping people with my hands. I believe a therapist's passion is usually sculpted by the teachers/researchers/authors who've influenced them the most. For me it was Ida Rolf, Philip Greenman (and all the Michigan State College of Osteopathic staff), Vladimir Janda, and Serge Gracovetsky. Whenever possible, I like to steal theories/techniques, etc. from teachers I've co-taught with including Aaron Mattes, David Kent, James Waslaski, Tom Myers. and Jim Asher at the Rolf Institute. However, I only give them credit when they're actually in the room or have students present.
In an attempt to try to integrate osteopathic spinal mechanics into a deep tissue format, Myoskeletal Alignment was born. The only thing new I feel I've added to the equasion is the use of bones as levers to release motion-restricted joints. Muscle energy also shares the same goal except this technique engages the barrier less directly.
I call the Myoskeletal approach 'articular stretching' rather than joint mobilization since the client is actively engaged in a specific movement as slow sustained finger/fist/thumb/elbow pressure releases the fixated joint complex. The aim is to restore motion to all soft tissues in the osteoligamentous canal including fibrotic joint capsules, spinal ligaments, transversospinalis muscles and associated fascia. Long answer to a short question! Thx for the post Robin.
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