Joe Muscolino The Art and Science of Kinesiology

Comment

Comment by Choice Kinchen on December 9, 2009 at 10:39am

Agreed Susan

Comment by Susan G. Salvo on December 9, 2009 at 9:28am

Great insight. Thanks.

Joe, I particularly like your comments about "why we do what we do."

It's broad and respectful.

Comment by Erik Dalton, Ph.D. on December 9, 2009 at 8:57am

Or is the pain coming from nerve endings in the blood vessels and sweat glands? Interesting new line of thought on pain @ http://www.sciencedaily.com/releases/2009/12/091208083524.htm

Comment by Joseph E. Muscolino on December 9, 2009 at 8:47am

I have read through the article too. Thank you for sending it Steve.
Kinesiology is the "study" of motion. As such, we look to study the neuro/musculo/fascial/skeletal system. In so doing, we question why things are done. And as new information comes to bear, we sometimes find that either the reason that we thought we were doing something is different, or perhaps we should not be doing something, or perhaps what we are doing IS good, but another therapy might be more productive.
There are many reasons why we might choose to employ a certain technique.
One is science, or paper, as described earlier in this thread. I am a great believer in research and science, but I am also aware that there are certain limitations to a scientific study in which one one parameter is isolated and there is room for faulty methods and interpretation as well. For that reason, it can be best to wait for a number of studies to be done. We can employ a technique because it was taught to us, perhaps by people who we respect a great deal. As Whitney Lowe calls it, the "Sage on the Stage" scenario. Certainly authorities often are authorities because they have earned it with great study and foresight. But, following an authority can be risky too. They are so often proven wrong, or what they say is improved upon later. And we might employ a technique because it works. The "proof is in the pudding." But perhaps other puddings might taste just as good, or even better, if we try them.
All of these reasons are good reasons, but none of them are fullproof. One reason that I will add is to look at what is being done and try to figure out if it makes sense. Does it fit with the principles of anatomy and physiology as we understand them to be. Granted, we do not know all that there is about A and P, but we are gradually increasing our knowledge.
With ischemic compression, I just feel that all the sensory input from the pressure that I believe makes it valuable can be achieved with a series of repetitive strokes instead, and the further benefit of the deep stroking will be to increase the blood supply, i.e., decrease the ischemia, which is the perpetuating factor for a myofascial TrP.
I welcome people to try deep stroking massage, not just because I say it, and Travell and Simons say it (oops, it was page 141: "This method is probably the most effective way to inactivate central TrPs when using a direct manual approach."), and Clair Davies said it,...but because it is a viable alternative, and it makes sense, given all the research that has been done.
If a TrP is ischemic, then reducing the ischemia should be a top priority.
And causing further ischemia would not make sense (T&S, page 140: ""...when applying digital pressure to a TrP to inactivate it, there is no need to exert sufficient pressure to produce ischemia...there is no reason to believe that additional ischemia would be helpful.") Each stroke of massage can help to do decrease ischemia. Holding a sustained compression would not do this as effectively.
I hope we all keep questioning what and why we do what we do, and keep looking for alternative therapies.

Joe :)

Comment by Michelle Doyle, D.C., CNMT on December 9, 2009 at 12:35am

Steve,
Thanks for sending the link to Boris Prilutsky's article. Excellent article! It really explains the theory, physiology and application of trigger point therapy very well! Very much how we practice this method...I use some corrective cross-fiber technique followed by passive stretches after releasing trigger points as well to help detoxify and oxygenate the muscles. Patients get excellent results and that tells the story. Well written article, I've been looking for an article that explains it in detail like that. Thanks again!

Comment by Choice Kinchen on December 8, 2009 at 9:03pm

Joe, this is exactly the argument you were making in Salt Lake with a couple of other therapists. A couple of them were struggling with your explanations. You say it better than I ever could, but that is the reasoning why I do deep stroking massage on trigger points. And, with my health issues, anything that makes it easier for me to work is a plus. It is/was difficult for therapists to sometimes accept change or a different method/technique simply because that is what was taught to us in school. I can look back at a lot of massage "myths" that we learned without any explanation given on why we were learning them. We just followed.

Comment by Joseph E. Muscolino on December 8, 2009 at 6:04pm

Hi Steve and all,

Please don't get me wrong, I am not saying that sustained/ischemic compression does not work. I believe it does. I have seen it work with my patients. I learned it 25 years ago and did it for a number of years. I am just saying that "perhaps" deep stroking massage works just as well, or even better.
I believe that most people do sustained compression because they learned it from their instructor, who learned it from their instructor, etc. etc.
Personally, I found with my patients that even though sustained compression worked, that when I started off of the TrP and then gradually made my way on to it, i.e., deep stoking massage, the patient seemed to relax and allow it better. I just began to use it based upon the efficacy I found in my practice, without thinking about the research/what was written on paper. It was when I took Clair and Amber Davies' workshop that Clair came out unequivocally for deep stroking massage over sustained compression that I began to think about it. Then I bought the second edition of Travell and Simons and read it page by page and found that they backed deep stroking massage as the best method to deactivate central trigger points and that there is no reason to cause any further ischemia given that the TrP is already ischemic (again, pages 40 and 41). Then I looked at the science of it, and the mechanism of increasing blood flow via deep stroking massage seemed to make much more sense than holding a sustained compression. So, for all those reasons, I am trying to ring the bell for people to consider an alternative to sustained compression. :)
Joe

Comment by Stephen Jeffrey on December 8, 2009 at 4:23pm

Hi again all, here is a quote from Boris Prilutsky's article

6. Ischemic compression as a method of trigger point therapy has been proven by at least 4 decades of massive utilization as a safe and effective method.

7. Ischemic compression techniques are applied by gradually increasing pressure, thus excluding the possibility of doing harm to the patient and to the therapist.

Please see the full article http://www.articlesbase.com/alternative-medicine-articles/trigger-p...

Further the above only referes to the last 4 decades but I'm sure a little research into accupressure ( weather for Tender points/accupuncture points/triggerpoints ) will surely reveal its use in china for many thousands of years ?

Ultimately for every therapist, whatever the technique ! the truth of its effects are written in the tissues of those we treat, not on paper.

I value and rejoice in any therapists application of effective technique I would hope you can all value and rejoice with me in mine ?

Regards steve

Comment by Joseph E. Muscolino on December 7, 2009 at 5:45pm

All research that I am aware of so far shows that a TrP is NOT mediated by the nervous system. It is due to local ischemia that results in a decrease of ATP molecules resulting in an inability to break the cross bridges and an inability to resorb the calcium ions that are already present. Given this, then what value would causing and "holding" further ischemia have?
The goal of the deep stroking (or the release perhaps of the sustained compression) is to decrease the ischemia, not to increase it.
See also pages 40 and 41 of the second edition of Travell and Simons.

Comment by Joseph E. Muscolino on December 7, 2009 at 5:39pm

Hi Steve,

Yes, I took a weekend workshop with Clair and Amber. We went out to dinner together afterward and had a very nice conversation. Then Amber and I had a number of conversations afterwards. I greatly enjoyed meeting and working with them!

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