The purpose of this section of the Journal of Massage Science to inform the practitioners about valuable articles that frequently go unnoticed, as well as to point to those authors and publications who exhibit low educational standards. We do not play politics and we are not associated with any publishing company or professional association. We are a completely independent voice and we promise you direct unbiased reviews based strictly on the science.

We would like to clarify our position on articles of a promotional character frequently published in major massage journals. All promotional articles which deal with medical aspects of massage therapy are lamentably similar. They begin with how important the subject of the article is for the massage therapist; proceed with how to apply several diagnostic tests; and then provide only a very short description (if the reader is lucky) of how to actually fix the problem discussed in the article. The next step is to buy author’s video or book or enroll into his or her seminar.

One may ask, “What is wrong with articles intended to promote authors’ publications or seminars?” There are two points we wish to make in response to this question. Firstly, we feel there is nothing wrong with articles intended primarily to promote seminars, DVDs or books that deal with the general-health or spiritual aspects of massage or provide instruction on stress-reduction or therapeutic massage techniques. In our opinion, however, the situation changes completely if the author is presenting a new development or recommendation which he or she claims confers medical benefit to the client. In so doing, the author steps into different territory altogether, in which he or she ought, we believe, to be required to answer to the more stringent standard of medical publications.

Let’s imagine that a physician submits an article to a medical journal in which he stresses the significant incidence of inflammation of the knee, informs the reader of what the clinical symptoms are, and then proceeds to make reference to a new approach he has developed to cortisol injection into the knee — without providing sufficient information on how he executes his method of treatment. There is no medical publication in the world in which an article such as this would stand a chance of publication. Yet, we see such promotional articles in virtually every massage journal. In our view, there ought to be no difference in standard with regard to content requirement between a massage publication or a medical publication, where medical topics are concerned.

Secondly, we recognize that for many authors, it is proceeds from their books, DVDs and seminars which constitute the bulk of their living, and we are thus fully sympathetic to the needs of these authors to promote their contributions to the field. We are convinced, however, that even from a promotional standpoint, authors would invite greater response to their books, DVDs or seminars if, in their articles, they were instead to fully describe the treatment method the propose — to a level of detail and thoroughness allowing the practitioner to take the technique directly to the table, be impressed with its results, and be thus persuaded that the know-how of the author is definitely to be further sought out.

If the author of the reviewed article does not agree with our opinion, we will be more than happy to publish his or her response and have a productive discussion over the article’s subject.

At the end of the year we will recognize and reward the author of the most important publication(s) and point to the authors of the most unscientific publication(s). We hope this will help to raise the bar of published materials in massage journals for the benefit of the entire profession.




Massage & Bodywork


    
Sports Injuries. Massage & Bodywork Nov/Dec:42-51, 2008, by Karta Purkh Singh Khalsa

This is a very good article which gives the reader a great overview of what needs to be done, and what to avoid, during the treatment of sports injuries. It establishes a scientifically based cause-and-effect sequence of events associated with the injury, and its treatment protocol. We liked how, in simple language, the author was able to explain the body’s protective reaction to the injury by turning the affected muscles off and producing the condition of hypotonia so as to give the injured muscle tissue time to heal. This is an important point which is rarely mentioned.

The only thing with which we disagree in the article is the application of massage techniques in the direction from the origin of the injured muscle to its insertion. The author did not offer any explanation for this recommendation. Yes, it is correct that part of muscle rehabilitation requires the application of friction in the direction from the muscle origin to its insertion, but it is usually a very brief part of the treatment.

For the greater part of the treatment, however, the correct way to apply massage techniques so as to speed up muscle rehabilitation is in the opposite direction, that is, from the insertion to the origin. Why is this so important? All muscle injury is accompanied by tearing of muscle fibers and the formation of local hematoma between the myofibrils. This area is always surrounded by interstitial edema which constitutes a protective bodily reaction to the injury, initially helping to stop further bleeding and restricting the size of the hematoma. However, after 48 to 72 hours, the interstitial edema initially produced around the injured site greatly delays healing process. As the author correctly points out in the beginning of the article, increasing of lymph drainage is a critical part of the massage treatment during first 3 to 5 days after the injury. However, in recommending the application of massage techniques in the direction from muscle origin to insertion, the author goes against their own statement.

The application of massage techniques from muscle origin to insertion blocks lymphatic drainage and delays the elimination of interstitial edema around and in the injured site itself. By contrast, the application of the massage techniques along the pathway of drainage, i.e., from the muscle insertion to its origin, greatly reduces interstitial edema.

Another advantage of the application of massage techniques from the insertion to the muscle’s origin is the practitioner’s ability to address the contractile apparatus of the injured muscle in a physiological way. The biomechanical pattern of muscle contraction requires the muscle’s shortening in the direction of its origin. This is why the major part of the treatment must be conducted in this direction.

To be completely fair, we should recognize that author included in their article the following statement: “If necessary switch directions”. However, in point of fact, there is really no “if” for the application of massage techniques in the direction of the drainage, i.e., from the insertion to the origin, because the correct direction of massage techniques is one of the defining components of muscle rehabilitation. Besides this one point, the entire article is a great source of valuable information.



     
Connections. Treating the Knee and Lower Extremities. Part I. Massage & Bodywork Nov/Dec:42-61, 2008, by Art Riggs

Bravo! Thank you for this great article! Everything in both articles is based on science and reflects the author’s deep understanding of the topic.

Mr. A. Riggs shows us how articles on medical aspects of massage therapy should be, if they are to be helpful. He takes the reader on a step-by-step journey through a valuable protocol for knee rehabilitation. Reading the article and seeing its illustrations provides the massage practitioner with a very good sense of what to do. We should hope that one day all authors will adopt the same high standard as Mr. Riggs when publishing their material for the massage audience and stop to use national journals to publish the promotional articles.



  
Tuning the Athlete. Breathing and Lumbar Alignment. Massage & BodyworkNov/Dec:62-69, 2008, by Geoffrey Bishop

Overall a very good article. It attests to the author’s understanding of the interplay of many biomechanical components of movement and breathing. However there are several issues we think need to be clarified:

1. The author states: “Since the diaphragm originates from lower six ribs and the upper two or three lumbar vertebrae…”

We would like to offer a small correction. The costal part of the diaphragm originates from the costal cartilages of ribs 7 to 9 and the upper edges of ribs 10 to 12 only.

2. The author states: “Running on relatively flat trails or roads leave this muscle [the quadratus lumborum muscle] more at peace.”

The author’s description of, as he calls it, the Lateral Spring System leaves readers with the wrong impression that the quadratus lumborum (QL) muscle is mostly active during running, jumping, hiking, etc., i.e., it is active when the leg needs to be lifted while the contralateral side of the pelvis remains stable. Considering the author’s overall level of expertise, we suspect this was just an incomplete description rather than a mistake. However, we would like to provide the readers additional clarification to this important subject.

The QL muscles begin to work hard as soon as we get into an upright position. As reported by Knapp (Therapeutic Exercise, Williams & Wilkins, 1978), patients with isolated complete paralysis of both QL muscles are unable to walk even with crutches.

Besides the critical role they play in our upright position (animals don’t have QL muscles, and primates have them in but a rudimentary form), both muscles are major players in the assisting of respiration. These muscles are activated during each inhalation to assist thoracic cage expansion by stabilizing the lower ribs.

However, the critical impact of the QL muscles on the respiratory cycle of athletes is the fact that these two primary respiratory muscles greatly assist each forced exhalation. We suspect that this was the initial cause of the lower back pain in the author’s client. QL tension in professional athletes (because of excessive breaching, especially a lot of forced exhalations) is a very common, but frequently overlooked, problem. The author deserves credit for identifying it and sharing it with readers.

3. Fig. 3 shows the application of, as the author calls it, the Diaphragm Webbing Technique on the right side, to “…separate the fascial adhesions that often occur in the diaphragm and liver area.”

We respectfully submit that this is a completely useless technique when applied on the right side. It should be used only on the left side and, as the author mentioned, with the hand positioned with palm up, the palm-down position being less effective.

The application of the technique is useless on the right side as the edge of the liver finds itself just under the last rib, and the practitioner’s fingertips rubbing against the liver itself would cause only uncomfortable sensations, without any benefits to the diaphragm. If the practitioner were to apply stronger pressure so as to go under the rib cage, in the area where the author’s hand is shown in the photo, he or she would be pressing against the gallbladder, which would trigger additional uncomfortable sensations for the client.

Finally, this technique on the left side should be performed with the lower extremities bent at the knee and hip joints. This position greatly helps to relax the muscles of the anterior abdominal wall.

There is a special technique to address the diaphragm on the right side, and it is called the Liver Pump. As can be seen in the video of this technique, the practitioner uses the base of his hand to press into the abdomen and slides his hand forward during the client’s prolonged exhalation. The practitioner’s hand should reach the rib cage on the right side at the beginning of the client’s prolonged inhalation and should keep the same pressure while the client inhales. In such a case, the practitioner stabilizes the liver, preventing its inferior shift by the descending diaphragm. Because the client continues to inhale, the right dome of the diaphragm is pushed down and is stretched over the superior surface of the stabilized liver.



4. Fig. 5 shows the application of the technique which targets the pelvic floor diaphragm to “… stimulate tone in the levator ani muscles of the pelvic floor while restoring balance to all pelvic ligaments and coccygeal structures.”

This is in fact a very valuable technique. The problem is that its execution is incorrectly presented in the article. The application of counterresistance to the client’s inhalation, by placing the hand on the coccyx as shown in Fig. 5, will do very little to the levator ani muscle in particular, and to the pelvic floor in general.

During the inhalation, the intra-abdominal pressure lowers and the levator ani muscle counterresists it by contracting and slightly pulling the coccyx upward. This is why pressure which additionally pushes the coccyx forward (i.e., upward) will do very little for the levator ani muscle. The only hope during such an application is indirect stretching of the levator ani muscle by additional stabilization of the coccyx during the deep inhalation. However, even this elusive goal is impossible to achieve with the hand placed at the angle shown in Fig. 5. The angle must be much smaller (bring the forearm down more), because the practitioner needs to push on the coccyx itself.

Contrary to the author’s recommendation, all scientists have stressed the importance of direct stretching of the levator ani muscle while the coccyx remains unrestricted (Lewit: Manipulative Therapy in Rehabilitation of Motor System, 1985; Malbohan: J Man Med, 4:1989).

The simplest way to do this is through the application of the same technique the author has presented, but in a different way. The client slightly spreads their legs and places them in external rotation while the practitioner places the base of the hand between the spread buttocks cheeks in the area of the anus (see photos below), i.e., inferiorly to the coccyx. The upper extremity should assume a smaller angle of placement than the author has presented in his Fig. 5. In this position, ask the client to inhale while pushing the base of the hand against the levator ani muscle as the client then proceeds with a prolonged inhalation, i.e. the practitioner counterresists inhalation with his or her pressure.

Despite the fact that this treatment is conducted through the underwear as well as the sheet or a thin towel, the practitioner should obtain the client’s permission (best, via a signed form) before the treatment is begun. The entire procedure must be explained in details. Also, there exists a much more sophisticated protocol of postisometric muscle relaxation developed by Dr. Lewit to address the pelvic floor, which is less uncomfortable for the client.



     
The Ligaments of the Sacrum. The Primary Cause of Lower Pack Pain. Part 2. Massage & Bodywork, Nov/Dec:99-105, 2008, by Ben E. Bengamin

We did not read Part 1 of this article, but we will review here Part 2. The author of the article is wrong on so many points that we don’t know where to begin. However we will try to address the major controversies as succinctly as we can:

1. The very title of the article is misleading. Trauma of the ligaments of the sacrum is not a primary cause of Lower-Back Pain. As a matter of fact, it is a rare pathology which the practitioner is likely to only very seldom see in his or her practice. From the title of the article, however, the reader will get the sense that trauma to the ligaments of the sacrum is a condition he or she sees on a daily base. Following the author’s recommendations would send the practitioner down the wrong path of treatment while other more common causes would be overlooked.

Why is trauma of the sacral ligaments not a primary cause of lower back pain? The ligaments are the first to suffer, even with a small traumatic impact, if the joint they control has a large range of motion, as is the case, for instance, with the talofibular ligament on the lateral surface of the ankle joint, or the medial collateral ligament of the knee. Excepting cases of direct impact, the necessary condition for trauma of a ligament is its over-stretching. Barring instances of direct impact, anatomically the sacral ligaments are affected to a much lesser degree by traumatic force applied to the sacroiliac joint or the sacro-coccygeal junction, because these joints do not involve actual movements (except during labor). In other words, traumatic impact to the lumbo-sacral area must be very powerful and direct (as in, for instance, a fall from a height) to actually damage the sacral ligaments. There is an exception for the iliolumbar ligament which can be strained but only after the trauma and sprain of short rotators.

The most common causes of lower back pain are tension or spasm in the lower back muscles (erectors, short rotators, quadratus lumborum), various abnormalities of the intervertebral disks, tension and scarification of the lumbodorsal fascia, or inflammation of the sacroiliac joints (especially as a result of chronic tension in the piriformis muscle). Only after all these causes have been ruled out, and there is severe trauma accompanying the initial lower-back pain, should the practitioner consider the trauma of individual ligaments as the principal cause of the patient’s lower back pain.

To settle the question of this mistaken representation in the article, we quote a basic anatomy textbook used in medical schools all around the country: “The lower back pain is often misdiagnosed as a sacroiliac (ligamental) sprain. There have been essentially no documented instances of sacroiliac sprain. Lower back pain is usually of muscular origin, the result of either arthritis or a herniated disk…” (E. W. April: Anatomy, 1990).

2. The author recommends the Flexion Test among lower-back assessment tests, and states that, “With normal range of motion, the person can touch the floor (with his or her hands).” Image 1 shows a young lady flexing her upper body forward and touching the floor with both hands. 

The normal range of flexion in the lower back is 80 to 90 degrees. The author, however, presents us with a case of 130-degrees forward flexion as a physiological norm. While there are indeed people who enjoy a high degree of elasticity and, as the young lady in the picture, are able to reach 130 degrees of flexion and touch the floor, they constitute a lucky minority. What concerns us is that readers will use Mr. Bengamin’s guidelines and will have the mistaken impression that a maximum 90-degree capacity of lower-back flexion is pathological.

3. The author suggests that disk pathology be differentiated from trauma of the sacroiliac ligament on the basis that: “With a disk injury, pain is almost never referred down both legs at once and does not alternate between right and left legs. With a sacroiliac ligament injury, pain is frequently referred down both legs and may alternate legs as well.” This statement is incorrect. 

Pain from the sacroiliac ligament or from any other sacral ligament will never radiate down the leg; for the author to differentiate sacral ligament pathology from disk pathology on such a wrong assumption is not only incorrect, but also, by even suggesting such a differentiation, endangers the practitioner’s practice. A practitioner following the author’s recommendation will treat disk pathology on the flawed assumption the he or she is dealing with trauma of the sacroiliac ligament. Such a mistake can end up costing both the client and the practitioner a great deal.

4. There is a complete mess with Figures 4 and 5, which, according to the author, present the pattern of pain radiation from the sacroiliac (Fig. 4) and sacrotuberous (Fig. 5) ligaments. This part is supposed to deliver important diagnostic clues for the practitioner, but instead delivers complete nonsense. 

In reality, Fig. 4 shows the pattern of pain radiation in case of injury of the iliolumbar ligament, which the author didn’t even mention, despite the fact that this ligament is the more frequently affected one (there is chance that this information was covered in the Part I of the article). Readers please be aware that this pattern is not associated with the sacroiliac ligaments.

According to the author, Fig. 5 shows the pattern of pain radiation from the sacrotuberous ligament, with the affected areas on the lower extremity being: the posterior surface of the thigh, the posterior surface of the lower leg and the bottom of the heel. We are simply speechless. Such statement goes against all basic principles of the body’s anatomy and the physiology of nerve impulses conductance.

It doesn’t matter how badly the ligament is injured, the pain from it will never radiated down the thigh, the lower leg or to the foot, as shown by the author. There is only one explanation, and that is that the sciatic and/or tibial nerves are affected. There is no other explanation to justify such pain radiation.



   
Preparing the Neck and Shoulders for Deep Work. Massage & BodyworkJan/Feb:121-125, 2009, by Til Luchau

Overall it is a good and helpful article. We praise the author for referring to the rarely mentioned clinical significance of the layered arrangement of the soft tissue, and for stressing the necessity of the treatment being conceived and applied in such a way that takes into account this fact. This layered aspect of the soft tissue anatomy is very frequently overlooked when the practitioners work on soft tissue abnormalities — seeing, as they frequently do, the affected area as one bulk of tissue. The techniques and approaches shown are useful and will definitely assist the therapist when working on the fascia of the posterior and anterior neck.



Massage


     
How Can I Apply Myofascial Release to Address Clients’ Low-Back Pain?Massage 151, Dec:50-51, 2008, by J. F. Barnes, PT

In his column, Mr. J. F. Barnes provides the reader with a short but very grounded review of one of the Myofascial Release techniques to address low-back pain. Considering the column format where the author is limited by space it is very good source of practical information. We appreciate how the author was able to incorporate theoretical aspects of working with fascia, using the simple language and analogies (we especially liked the bug story), into a column dedicated to the clinical application of Myofascial Release. We gave the article 5 stars because in the column format the author was able to incorporate a lot of practical and theoretical information.



  
Lympho-Fascia Release. Massage 151, Dec:70-73, 2008, by B. Chikly, MD, DO

At the outset, we would like to state that Dr. B. Chikly is among the few educators who really master their subject, and is a true scientist. Indeed, he is one of the best sources of information on Lymph-Drainage Massage in the world. We like his article for emphasizing several very important theoretical points which the practitioner needs to understand in order to correctly apply this type of medical massage such as to accelerate lymphatic drainage.

What we like less is the promotional aspect of the article. We should have been even more impressed if instead of using two pages to tell readers how successful his students have been in using the Lympho-Fascia Release Technique, he had (either in a bullet format, or, better, in a step-by-step description with photos) shared with readers how this technique is to be applied. We are certain that such a gesture would have been greatly appreciated by readers and would have been even more likely to convince them to enroll in one of Dr. Chikly’s seminars — something which we encourage everyone to do!



Massage Therapy Journal


   
Jaws. How Massage Can Help Clients Dealing With Temporomandibular Dysfunction. Massage Therapy Journal 47(4):65-74, 2008, by Patricia O’Rourke and Michael Hamm

Good article on TMJ dysfunction. Great illustrations. The authors correctly pointed out several very frequently overlooked issues in the treatment of TMJ dysfunction. Oral splints are a pure waste of the client’s money if they are molded from the pathologically changed bite caused by the TMJ dysfunction.

Every patient with TMJ dysfunction before a bite impression is made by a dentist needs first to go through 3 to 4 sessions of medical massage so as to restore normal bite. Only in this case will oral splint work at night. Another important issue mentioned by the authors is the necessity of addressing the anterior neck during the treatment of TMJ dysfunction.

The only problem we have with the article is the very general description of the treatment protocol. The authors correctly stress the importance of intraoral treatment of TMJ dysfunction. Unfortunately for TMJ patients, however, current regulations of massage therapy of basically every state prevent the massage practitioner from conducting such intraoral treatment.

For those practitioners working within a medical setting, application of intraoral treatment is of the greatest value. Practitioners in a non-medical practice ought instead to address the pterygoid muscles, using Postisometric Muscle Relaxation. There is no mention of extraoral approach to these muscles in the article.



 
Headache Relief. Massage Therapy Journal 47(4):127-130, 2008, by Marta Brown Menard, PhD, CMT, Cynthia Piltch, PhD, CMT

This article is a review of the literature on the treatment of headache using massage therapy. We appreciate the authors’ attempt to address this very important subject. From our point of view, the article requires several clarifications.

1. The etiology of chronic tension headache (CTH) is well known. Chronic tension of the posterior cervical muscles (upper portion of the trapezius and semispinalis capitis) at their insertion into the occipital ridge irritate or compress the greater (more frequently) and/or the lesser (less frequently) occipital nerves. Another even less known cause is irritation of the greater occipital nerve by the obliquus capitis inferior muscle. Because both nerves innervate the scalp and the cranial aponeurosis, CTHs are triggered. 

2. The authors formulated the following chain of event in cases of CTH: sustained tension of cervical muscles – local ischemia in these muscles – formation of trigger points – CTH. However, this is not the entire picture, and basing their treatment on this incomplete picture is the reason massage therapists are frequently unable to efficiently control CTHs. The correct and complete chain of events is: sustained tension of cervical muscles – local ischemia in these muscles – formation of trigger points – irritation of greater and/or lesser occipital nerves – periostal trigger points along the occipital ridge and skull – tension in the cranial aponeurosis – CTH. In other words, CTH is a clinical outcome of Occipital Nerve Neuralgia. 

3. While evaluating results of a 2002 study conducted by Quinn et al., the authors of the article conclude that “…the study protocol included stretching and myofascial release as well as trigger point work…, it is impossible to know the relative contributions of each modality versus the combined impact of them all on reducing headache frequency and intensity.” In other words, an integrative approach to the treatment of CTH seems irrelevant because it is impossible to examine the individual contribution of modalities.

This is a grave mistake. The authors (Quinn et al.) of the study are real clinicists who understand that medical massage is a concept which demands the combining of different modalities. It is simply impossible to obtain stable clinical results in the treatment of CTH, or any other chronic somatic disorder, using but a single modality (e.g., myofascial release or trigger point therapy). For this reason, it doesn’t make sense to even study the impact of any single modality, and thanks to Quinn et al., this completely erroneous approach to the study of the medical benefits of massage therapy has been successfully challenged. We hope that their example will bring an end to the trend whereby studies examine the impact of stress-reduction massage alone on serious somatic abnormalities.

4. Separately, we would like to address the recommendation of Dr. J. Muscolino mentioned in the article on the topic of trigger point therapy. We respect works of Dr. Muscolino. We believe that authors of the article didn’t got entire picture of the author they cited. The application of 30 to 60 deep strokes across the myofascial trigger points is not only modality to eliminate trigger point. This constitutes the same type of error we have discussed above. 

This type of friction, developed by Dr. J. Cyriax (1985), is part of a trigger point therapy protocol which is to include work conducted in the inhibitory regime, ischemic compression, as well as stretching or postisometric muscle relaxation. A recommendation to use cross-fiber friction alone, ischemic compression alone, or stretching alone is a way to transfer an active trigger point into a sleeping or latent state instead of to bring about its complete elimination. The latter can be achieved only if the practitioner uses the integrative approach to trigger point therapy.



    
Joint Mobilization of the Thoracic Region. Massage Therapy Journal47(4):133-138, 2008, by Joe Muscolino

We liked the article of Dr. Muscolino on mobilization of the thoracic region. It was written from a chiropractor’s point of view, and the recommendations contained within it definitely can, and should, be used by practitioners who work with chiropractors, especially as a preparation to adjustment conducted by the physician. The independent use of such mobilization by massage practitioners without supervision may go beyond the current legal description of the massage profession in some states. Thankfully, however, it is articles such as this one that can in time be expected to contribute to legal changes to the scope of the massage profession.



Massage Today


   
The Progression of Cervical Stenosis Toward Cervical Spondylotic Myelopathy (CSM), Part 4. Massage Today 8(12):16; 21, 2008, by D. Alexander, PhD, LMT

We did not read Parts 1 to 3, but what we read in Part 4 is very impressive. We hope to see a time when articles like this one (in regard to the medical aspects of massage therapy) will be common in massage literature. There are points we are not in agreement with completely, but the author is sufficiently scientific and gracious in his claims such as to indicate that he would like to “…consider these as theories.” In a time when articles are full of personal egos, Dr. Alexander’s article strikes a completely different tone for it initiates a conversation and an exchange of ideas.

Now for the points with which we are not in agreement. Based on our combined clinical experience, we don’t believe that the author’s idea of tension in esophagus as an important factor in the eliciting of tension on the cervical intervertebral disks (as a part of whiplash neck injuries) is correct. According to the article: “The gut tube is suspended directly from the craniocervical junction.” True, this is how it appears in anatomy textbook illustrations. However, in the actual living human body there is no such suspension. If one dissects a human body, one will find that the esophagus, as the rest of the inner organs, has a very sophisticated system of support which makes free suspension unnecessary. In the case of the esophagus, this system relies on three factors: the upper esophageal sphincter, the lower esophageal (cardiac) sphincter, and soft-tissue support in the posterior mediasteum.

The upper esophageal sphincter is located on the level of C6 and is formed by the crycopharyngeal muscle which is the first point of support for the esophagus. This muscle hugs the esophagus and anchors it to the posterior surface of the larynx and upper trachea. At the level of the diaphragm, the esophagus is supported by the lower (cardiac) sphincter which in turn is supported by the diaphragm itself. The laws of mechanics dictate that an object cannot be in free suspension if it has two major points of support.

It is correct that the middle part of the esophagus is much more mobile, however it is not a tight tube, as the nature of food propulsion, especially through the mediastinum, requires some degree of mobility and recoil on the part of the esophagus.

Additionally, the esophagus in the posterior mediastinum has a very complex system of local support through the arrangement of the fibrotic bridges which elastically attach the outer layer of the esophageal walls to the tissues and organs of the posterior mediastinum. These are the reasons why the esophagus does not hang directly from the craniocervical junction and is thus unable, anatomically, to elicit significant pressure on the cervical disks. Despite this point with which we disagree, we would like to state once more how greatly we appreciate the overall high quality of Dr. Alexander’s article, and how important we feel it is to raise questions in the way Dr. Alexander has done, for the sake of the clients’ health.



     
Manual Therapy Choices: A General Approach to Parkinson’s Disease.Massage Today 8(12):19, 2008, by L. Chaitow, ND, DO

We greatly appreciate Dr. Chaitow’s work and his valuable contribution to the field of manual therapy and medical massage. He has shown practitioners his wisdom one more time in his short column. It is not the treatment of Parkinson’s Disease which is the subject of the column, but rather the necessity of an integrative approach to its somatic rehabilitation. This simple fact is not fully understood by the majority of practitioners and, what is more important, is not promoted by many educators. As a result, we have trigger point therapists, myofascial release thrapists, lymph drainage massage practitioners, neuromuscular therapists, etc.

All of these are valuable methods and techniques, but as Dr. Chaitow correctly points out, “… if only a limited range of skills and modalities have been acquired (by the practitioner), choice may be limited by that alone.” As long as “educators” will further fragment manual medicine and medical massage as a profession and promote only their own frequently questionable recommendations, practitioners and ultimately patients will be on the losing end. Dr. Chaitow sees the bigger picture, and we greatly appreciate his knowledge and expertise.


Category: Good Apples, Bad Apples

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