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.
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
Attract Clients with Sports Massage Taping. Massage 156, May pp.55-57, 2009, by Jeremy Maready
The article reads more as advertising, but this is a case when advertising is a good and needed tool to promote important and effective therapy. Let’s be frank, sports taping is not 35 years old, and was not invented by Dr. K. Kase. It was used by Greek and Roman physicians and athletes. However, it is true that Dr. Kase developed a more advanced product for taping which is now known as a ‘Kinesio’. Thus he deserves a lot of credit. Taping as a medical procedure must be widely used when it is indicated.
We highly recommend to readers to use taping as an additional tool to help their clients, especially those who are going through therapy while continuing to use affected muscles.
Massage & Bodywork
Tape It Up. Massage & Bodywork, May/June Pp. 52-59, 2009, by Karrie Osborn
This is another article on sports taping using the ‘Kinesio’ product. This article offers very little for the practical application of taping, but this was not the author’s goal. The author raises the important subject of taping itself, and for this particular reason the article is an important contribution.
Bodywork of Fibromyalgia. Massage & Bodywork, May/June, pp. 80-89, 2009, by Karta Purkh Singh Khalsa
Thank you for the great article! The author gave an excellent review of the modern views on Fibromyalgia and its treatment options.
There is one important issue we would like to emphasize. The author cited various causes of FM from existing medical sources. Overall, the author inclines to the more accepted cause of FM: ‘muscular pain is the key feature of fibromyalgia, but it is probably not a muscular skeletal problem’.
This is a commonly accepted view on FM etiology. This view and the theory associated with it dominated FM treatment for more than two decades. During this time we did not see any decrease in the spreading of FM among the population. On the contrary, the new FM cases rapidly spread despite the application of treatment protocols based on the dominant theory of FM having originated in the brain.
There is another theory which has very strong scientific and clinical foundations. However, this theory is not supported by the pharmaceutical industry. As a result it has a very limited exposure and a limited number of studies were conducted. This theory, which is frequently called the theory of peripheral origin, (in difference to the theory of central origin) claims that the changes detected in the function of the brain are a secondary reaction of the central nervous system to the constant bombardment of the brain by chronic pain stimuli originated in the affected skeletal muscles. The main reason for muscular pain is constant low-grade tension in the skeletal muscles formed as a result a shortage of ATP, which is a major fuel for muscle contraction and relaxation.
We would like to praise the author for mentioning this information, “…people with FM have lower levels of ATP, the body’s cellular energy molecule, and a lower capability to make ATP in their muscles.” In one of the upcoming issues of our Journal we will discuss in detail origin and massage treatment options for FM patients.
Functional Anatomy. Levator Scapula. Massage & Bodywork, May/June, pp. 97-98, 2009, by Christy Cael
The tension in the levator scapula muscle (LSM) is the condition the massage practitioner encounters every day in his or her practice. The tension in this muscle is one of the main causes of upper back pain and chronic headaches. Thus the correct examination of the LSM is a great subject for any article.
This is the second article by the same author on the anatomy and palpation of the individual muscle (see our review of the Pectoralis Minor Muscle palpation in the March-April issue of JMS). This article has a similar structure with the same positive and negative features. The author correctly describes the anatomy, physiology, innervation pattern, etc. However, the main value of the article is supposed to be the correct way of palpation of the LSM and this is the exact weakness of the article.
The video shows the way the author recommends the palpation for the LMS. Let us also cite the article:
“1. Stand beside your client’s head and find the superior angle of the scapula on the same side
2. Find the transverse processes of the upper cervical vertebrae with the fingertips of your other palpating hand
3. Follow the muscle belly of the levator scapula inferiorly towards the scapula”
The author correctly describes in the first two statements the detection of the origin and insertion of the palpated muscle. However, the palpation itself is recommended incorrectly. As the author correctly pointed out, “…this muscle lies deep to the broad trapezius muscle at the same depth as the rhomboids”. Thus the approach recommended by the author has very limited value, because the fibers of the trapezius muscle block access to the LSM, especially during the palpation of its upper part. The correct way to palpate the LSM consists of two independent parts (see video).
During the first part of the palpatory evaluation, the practitoner examines the upper segment of the LSM, i.e. above the twist. The body anatomy allows us to examine the upper part of the LMS directly instead of the palpation through the fibers of the trapezius muscle, which covers the LMS. As you can see in the video the practitioner’s finger slides down along the fibers of the LMS under the edge of the trapezius muscle.
The tissue above the thumb is the lateral edge of the upper portion of the trapezius muscle and the examiner’s thumb examines the fibers of the LMS directly. The author mentioned the area of the muscle’s twist as a palpable thickness, and she considers it a normal structural feature of the LMS. This is not always the case, because one of the main trigger points in the LMS is located exactly in the area of the twist. The approach is advocated by the author for the palpation of this area is completely useless, because this part of the muscle can be palpated only from the side as is shown at the end of the video.
The second part of the palpatory examination targets the lower part of the LMS between the twist and the muscle insertion into the upper medial angle of the scapula. The author is correct that this part of the LSM can’t be palpated directly because the fibers of the trapezius muscle will completely block the access to the underlying LSM. Thus the practitioner must examine the LSM through the fibers of the trapezius muscle.
However, this part of the palpatory examination offered by the author is also incomplete because the placement of the thumb the author advocates gives the practitioner information about the tension in the trapezius muscle which inserts into the scapula in the same area but atop of the LSM. The correct thumb placement we show in the video below. Pay attention to the difference in the angle of the thumb placement in this video as compared to the placement of the thumb recommended by the author (see first part of the video).
Finally the author recommends stretching of LSM. This information is also incorrect. During the passive stretch the client should use only the power of the arm to rotate and pull down the head and stretch the LSM The author recommended that active rotation of the head and the active stretch. This is a much less effective tool to release tension in any muscle under tension.
To release tension in the LSM the practitioner should recommend passive stretching during prolonged exhalation which the author did not mention in the article at all. All of these mistakes and misrepresentations make the article much less valuable for practitioners
Essential Skills. Biceps Injuries. Massage & Bodywork, May/June, pp. 104-109, 2009, by Ben Benjamin
A very good, informative and linically correct article. There is only one addition we would like to mention. If the client has pain in the biceps, belly, or its tendons, and he or she did not remember any trauma associated with this pain, the practitioner should always examine the anterior neck for possible tension in the anterior scalene muscle and anterior shoulder for possible tension in the pectoralis minor muscle.
In both of these areas the musculocutaneous nerve which innervates the biceps brachii muscle can be irritated. As a result the client will exhibit the exact clinical picture the author discussed in the article. However, in these cases the treatment of the biceps itself will bring only temporary relief without stable clinical results, and the practitioner must concentrate on the anterior neck or shoulder instead.
Ah What Relief – Deep Tissue Sculpting for Low Back Pain. Massage & Bodywork, May/June, pp. 60-69, 2009, by Caroline Osborne
This article reviews the Deeep-Tissue Sculpting (DTS) developed by the author and its application for clients with lower back pain. So what is DTS and how does it help clients with lower back pain? Let us quote the author:
“Sculpting is a form of deep-tissue massage characterized by firm, constant compression applied parallel to the muscle fibers” and “…the techniques are intended to affect the deeper muscular structures, as well as the more superficial structures” (bold by JMS). Basically the rest of the article is an illustration of these two statements.
Now, let us dig deeper. In the article there is no reasonable explanation as to why the practitioner must apply strokes in the direction parallel to the muscle fibers only and how the author plans to address the deep structures using such a narrow approach.
The author tries to address the very anatomically complicated area of the body while the client suffers from lower back pain. She purposely restricts her own and the potential readers’ arsenal of applied techniques using only compression and deep effleurage strokes along the fibers. The techniques the author recommended are legitimate and they should be applied during the treatment. However, it’s a failure to use only them.
Where is the effleurage along the drainage which the author completely disregards if one will look at the pictures in the article? Where is the friction at the origin and insertion of the muscles she plans to work with? Where is the kneading in the inhibitory regime to decrease the activity of the muscle spindle receptors? Where is the passive stretching to activate the Golgi tendon organ receptors and reduce tension in the affected muscles?, etc.
It seems that DTS chases only one goal to make the practitioner’s work as difficult and as pointless as possible. Instead of enriching the practitioners potential and his or her technical arsenal, it promotes professional weakness.
Let us illustrate our frustration by concentrating upon a couple of points. As mentioned above, the main ‘groundbreaking’ feature of this method is the application of deep effleurage strokes alone or in combination with compression arranged in the direction parallel to the orientation of the muscle fibers. Thus, the method completely excludes the strokes in the cross fiber direction. If the practitioner uses the strokes along the fibers only, he or she will never be able to reduce tension in the lower back muscles for many reasons. We will name just two:
1. If the client has lower back pain. His or her muscles will always generate protective muscle tension. It is correct that the strokes along the fibers will address the superficially located skeletal muscles. However, any further increase of the vertical pressure during the strokes in an attempt to reach, for example, quadratus lumborum through the fibers of the eractor spinae muscles will immediately trigger protective muscle tension. This will ruin any chance to work on the deeper muscles, and frequently increase already existing spasm.
2. Ironically, the only way the practitioner may reduce tension in the deep fascia which covers the deep muscles is to use strokes in the direction perpendicular to the fibers i.e. exactly what the author failed to understand and use. This is especially vital in the beginning of the therapy, when the pain is the strongest.
The superficially located muscles are more moveable compared to the deep muscle covered by fascia. The superficial muscles attached the deep fascia through the system of the fibrotic bridges. The tension in these bridges is one of the major contributors to the spasm developed in the deep muscle layer.
The only way to reduce tension in the fibrotic bridges and stretch the deep fascia is to apply massage techniques (especially kneading) in the direction perpendicular to the fibers. In such cases the practitioner moves the more mobile, superficial muscle group across the more fixed deep muscle group stretching the fibrotic bridges and consequently reducing the tension in the deep fascia and deep muscle groups. These are the only two grave mistakes the DTS makes in regard to the treatment of the client with lower back pain.
Massage therapy is a wonderful profession because of its democratic approach to treatment. Everyone has some special tricks up their sleeves. If the author of DTS promoted her method as a stress reduction therapy it is up to her and her followers to use it as long as their clients are happy. The situation changes completely when the author tries to address the medical condition such as lower back pain. This abnormality has many different causes, and each cause requires unique medical massage treatment.
The information in the article is not only useless but even harmful because the author’s recommendation of sliding the elbow down the lower back between the paravertebral muscles and spinous processes is contradicted in cases of lower back pain, at least during the first couple of sessions.
Pathology Perspective. On Your Feet! Morton’s Neuroma. Massage & Bodywork, May/June, pp. 110-113, 2009, by Ruth Werner
A very good and informative article especially for the massage practitioners who are on their feet for hours and who are in the risk group for Morton’s Neuroma. The only weak point of the article is a very general description of massage treatment. It is important for practitioners to be aware of Morton’s Neuroma, but how to treat it is even more important subject. Unfortunately, this issue had a very limited exposure to the article.
Myofascial Techniques. Working With Wrist and Carpal Bones. Massage & Bodywork, May/June, pp. 122-129, 2009, by Til Luchau
The author is correct when he states at the beginning of the article, “Wrists are amazing structures.” The article dscribes two techniques which the author teaches in his DVD’s and website, ‘Scrubbing Technique’ and ‘Transverse Arch Technique’. According to the author, both techniques are very effective tools to treat ‘carpal tunnel compression symptoms’.
The author justifies the clinical value of both techniques on the assumption that the compression in the carpal tunnel is a result hypomobility between carpal bones especially the inappropriate position of the capitate bone.
Despite the fact that the author is correct when he mentioned the hypomobility of the carpal bones and the capitate bone’s misalignment as possible causes of the CTS, the article is very misleading because the reader will get a completely wrong impression that these factors are the main causes for the Carpal Tunnel Syndrome (CTS). In fact they constitute a very small percentage of the cases.
Let us enumerate the common causes of CTS (Musculoskeletal Examination, 1998):
1. Repetitive motions in the wrist joint (especially flexion)
2. Irritation of the brachial plexus by the anterior scalene muscle and/or by the pectoralis muscle.
3. Trauma (fracture, contusion, hematoma)
4. Osteorarthrosis of the carpal bones.
5. Pregnancy.
6. Endocrine disorders; diabetes mellitus, hypothryodism.
7. Ganglion and gout.
The author’s causes are part of the first and fourth group, but they are not initial triggers, but rather the consequences of the original problem. In such cases the author uses a small percentage of CTS cases and generalizes them on all clients. Additionally, he recommended techniques, which target the outcomes of the problem instead of its origin.
The author made a correct analogy between the line of the carpal bones as a bow and the transverse carpal ligament as a bowstring. However, he makes a very strange conclusion based on the assumption that the capitate bone is positioned incorrectly. In Fig.4 the author illustrated the article with an MRI image of cross section of the carpal tunnel and he emphasized in green line transverse carpal ligament which is part of the reflexor retinculum.
He then states, “Since problems come from the bow being to flat and crowding the contents of the carpal tunnel the last thing we want to do is lengthen the bowstring.”
Opposite to the author’s statement the MRI image the author provides as an illustration shows the normal arrangement of the carpal bones, but very flat transverse carpal ligament, which in normal cases has to have the dome-like shape. The MRI image in the article shows the completely flat ligament. Thus, if one will read the MRI image correctly he will understand that the reason the patient has symptoms of CTS is a compression of the content of the carpal tunnel including the median nerve by the very flat transverse carpal ligament (i.e. tight bowstring) rather than the elongated bow. It looks like the author tries to justify his article exploiting the fact of unfamiliarity by the readers with the MRI images.
We would like to emphasize for the readers that the two most common factors responsible for CTS are compression of the median nerve by the flat transverse carpal ligament (i.e. the compression force is directed into the carpal tunnel) or by the inflamed synovial sheets of the tendons of the flexors who compress the median nerve against the transverse carpal ligament from inside (i.e. the compression force is directed from the carpal tunnel). In both scenarios the treatment must concentrate on the of lengthening the transverse carpal ligament.
In regards to the two techniques the author recommended as a treatment of CTS. They are very useful and the practitioner must apply them, but only as a small part of the treatment protocol. Both techniques, the author called them Scrubbing and Transverse Arch Technique) must be used at the beginning of the treatment to correctly adjust carpal bones including the capitate bones. It is very easy to adjust carpal bones and, after that, the practitioner must immediately switch to the application of other techniques to ‘open’ the wrist and stretch the transverse carpal ligament. The application of both techniques alone does not bring stable clinical results under any circumstances.
One more reason the article is wrong is the fact that the author was not able to provide any reliable, professional source from medical literature which supports this very strange theory and its clinical application.
Massage Today
Research in Water and Fascia. Micro-tornadoes, Hydrogenerated Diamonds & Nanocrystals. Massage Today, 8(6):8, 2009, by Leon Chaitow
Excellent article! The modern technology allows the scientists to have fresh and sometimes ground-breaking insight into the issues which even 5-10 years ago were considered settled. This short but valuable article gives the reader an overview of these new findings in the physiology of the fascia and, at the same time, provides a list of references for those who would like to read more scientific data from the leading scientists in the field.
Some practitioners will say that articles like this one do not help them to succeed professionally and this thought is a great mistake. Professional success is directly correlated with the intellectual capacity of the practitioner and Dr. Chaitow is the author who holds high standards for all of his scientific publications.
Postpartum Depression. Massage Today, 8(6):10, 2009, by Elaine Stillerman
This article touches the very important and frequently overlooked subject of Postpartum Depression. The author exhibits a deep understanding of the subject and she emphasizes rarely mentioned clinical associations between Postpartum Depression and other abnormalities, for example autoimmune thyroiditis which also contributes to the development of depression. We understand that this article has a more general goal, but still the practical recommendations (e.g. various treatment options) will be a very helpful addition for the readers.
Dry Eyes, Dry Mouth: Sjorgen’s Syndrome. Massage Today, 8(6): 12, 2009, by Ruth Werner
Like many other articles of Mrs. R. Werner, this article about Sjorgen’s Syndrome is a very valuable source of clinical information for the practitioner. Unfortunately, massage therapy has a limited clinical impact on the disorder itself except in cases when joints are affected.
However, it does not diminish the value of the article. The fact that the massage practitioner knows about this abnormality and understands its mechanism helps him or her to interact with the client more efficiently, and builds up the client’s trust.
As soon as the client who suffers from Sjorgen’s Syndrome (or other disorders) sees that the practitioner is familiar with this abnormality and is aware of its complications the client will be much more willing to get treatment from this particular practitioner.
The Importance of Scar Tissue Release Therapy. Massage Today, 8(6):17, 2009, by Marjorie Brook
The topic of this article is of great importance. The author correctly exhibited her professional frustration with the inability and unwillingness of traditional medicine to deal with the skin scarification after trauma or surgery.
We completely agree with the author who said, “It is my hope that with modern science starting to recognize the importance of fascia and the effects o scar tissue release will be brought to the forefront of the therapy. Massage therapists can make significant and long lasting changes in the health and well being of their clients by incorporating scar tissue therapy into their treatments.”
The only way the patient who has a scar formed in the soft tissue may make it less noticeable is to use the service of the plastic surgeon after the scar has already formed. However, correct protocol of scar tissue release prevents scar formation, or makes it more elastic if the practitioner works on the client while scar tissue still soft and elastic.
Despite the fact that this subject is rarely discussed in massage publications and the author’s attempt is greatly appreciated, the article itself has very limited practical value. The author mentioned three cases of scar tissue release on her clients who greatly benefitted from the therapy.
However, she failed to inform the readers what exactly her treatment protocol was and how exactly she was able to help her clients. The absence of the applied protocol and very general description outcomes in each case (e.g. “Laura’s scars have faded by 85 percent”) greatly decreases the article’s practical value for the readers.
Category: Good Apples, Bad Apples