Articles written by Dr. J. Muscolino always catch our attention because he is able to combine high quality scientific information, which is important for the practitioner, with simple language to make each detail easy to understand and follow.
Many massage practitioners work with chiropractors or just rent rooms in their offices. Such cooperation of the two types of types of somatic rehabilitation under one roof must be extremely beneficial for the patients. However, in the many of cases the chiropractor and massage practitioner just co-exist with each other rather than working on the patients and coordinating their efforts.
Frequently chiropractors have a very limited experience of medical massage therapy and they don’t guide the massage practitioner in his or her quest to help the patient and be a productive assistant. In other words, the chiropractors rarely help the practitioner tune-up their treatment protocols. At best, the chiropractor will refer the patient to the massage practitioner.
Dr. Muscolino represents the new generation of chiropractors who understand the value of massage therapy and greatly appreciate mutual cooperation between the two professions. He has enough knowledge and expertise to help the massage practitioner see the bigger picture of somatic rehabilitation while he can educate his colleagues in the importance of the correct cooperation between massage practitioners and chiropractors.
We choose Dr. J. Muscolino to be our Person of the Month, because of his contribution to massage science, and we would like him to share his experience and recommendations. Here is our interview with the
WHO BUILDS SCIENTIFIC BRIDGES WITH MASSAGE THERAPY
JMS: Please tell our readers about your practice
Dr. Muscolino: Although I am a licensed chiropractor, my style of practice is by no means “adjustment only.” It is a combination of chiropractic, physical therapy, massage therapy, and stretching. I am a strong believer in each of these therapies, and feel that each one is that much more effective when combined with the others.
JMS: How did you get into massage therapy education and practice?
Dr. Muscolino: I first wanted to become a chiropractor because of the role models within my family. Three uncles, three cousins, and my brother-in-law are chiropractors. Once in chiropractic school, I found myself more aligned with the importance of the musculature than many of my peers. After all, joints are passive structures and muscles are dynamic, force-producing structures. If a joint is misaligned, then short of a traumatic injury, what force created this misalignment? If a joint is hypomobile, then aside from fascial adhesions, what force is preventing motion? It just seems to make sense that forces created by musculature have more to do with joint dysfunction than most chiropractors state. I believe that I came to viewpoint because my father was an engineer; engineers by training look at how forces act and interact. Therefore, I am very biomechanically oriented. Seeing the importance of musculature led me to seek out teaching at the local massage therapy school, The Connecticut Center for Massage Therapy. It also led me to incorporate massage into my practice as an integral part of my treatment. In fact, I spend more of my time with patients doing massage than any other therapy.
JMS: From your personal experience do you think that chiropractic schools provide enough valuable information to future chiropractors about the clinical benefits of cooperation with massage practitioners?
Dr. Muscolino: This is difficult for me to answer. I can really only offer an opinion on how the school I attended, Western States Chiropractic College (WSCC), addressed this topic. And my knowledge of that is likely outdated given that I graduated nearly 25 years ago. WSCC was very supportive of the importance of soft tissue work, and by extension, the importance of massage therapy. Although I am not an expert on this matter, I would state that there is somewhat of a divide within the world of chiropractic on the importance of massage therapy. I do not believe that many chiropractors would say that massage is not valuable, but the degree to which they feel it is integrally important can vary quite a bit.
JMS: There are three patterns which the chiropractors employ for massage practitioners. They commonly recommend massage therapy before the adjustment, after adjustment, or the massage practitioner has his or her treatment on a completely different day. What is your opinion on this subject?
Dr. Muscolino: Although I believe that massage is always valuable and an excellent adjunct to chiropractic osseous manipulation, I strongly believe that most often it is of greatest value before the adjustment. There are exceptions to this and it must be decided on a case-by-case basis, but most often, massage therapy’s relaxation of musculature allows an adjustment to more easily release, release with less force, and maintain its increased mobility, if the massage is performed before the adjustment. Unfortunately, I fear that often, the timing of massage therapy within a chiropractic setting is more often determined by the ease of scheduling and flow of the office than when it truly is most effective. This may be due to the fact that although most chiropractors believe in the efficacy of massage enough to include it in their office, many chiropractors do not fullyappreciate its value and the role it can play when truly integrated into the treatment plan for their patients.
JMS: Let us describe a hypothetical situation when you, as a chiropractor, decide to hire the massage practitioner to work on your patients. What criteria do you consider to be important for the massage practitioner to successfully pass the interview and be hired to work in a chiropractor’s office?
Dr. Muscolino: I believe that any massage has therapeutic value, even massage given in say, a spa setting by a therapist who knows little science. Certainly there are always body-wide effects on para/sympa flow, circulation, and the general value of touch, etc. However, having said this, I feel that in a clinical setting such as a chiropractor’s office, it is critically important for the massage therapist to truly understand base anatomy, physiology, kinesiology, and pathology. This allows for the critical thinking necessary to most effectively be able to competently assess and treat the musculoskeletal conditions that chiropractors commonly see. Certainly many other criteria are important, but this is, in my opinion, the most important one.
JMS: In your opinion, what massage methods and techniques are important for successful somatic rehabilitation especially working with chiropractor?
Dr. Muscolino: Hmm… I do not know that I have an answer to this question. Perhaps I would say the ability to perform deep tissue massage and stretching. However, I am NOT a believer in “techniques,” per se. I believe that every technique has value, or it is unlikely that it would exist. However, I also do not believe that any one technique holds all the answers, as so many proponents of techniques would like us to believe. One of the problems that I often have with techniques is that they all too often offer a cookbook approach to treatment. I strenuously object to this. One of my favorite sayings is: “Follow the person who seeks the truth, beware of the person who has found it.” Therefore, I recommend learning as many techniques as possible and adding them to your “tool chest.” Then use the appropriate combination of “tools” as appropriate for the client on your table at that time. This brings me back to my belief that what is most important is a true understanding of the mechanism of a client’s problem. This comes from understanding anatomy and physiology, which allows for the critical reasoning necessary to know how to appropriately select the treatment tools that are needed for each client.
JMS: What advice would you like to give to our readers?
Dr. Muscolino: Always go back to the basics. I tell my students that if you understand your anatomy, you can figure out physiology. Knowing physiology then allows you to figure out pathophysiology; this allows you to figure out assessment, and this allows you to figure out treatment. It all stems from knowing and UNDERSTANDING anatomy. Learn your anatomy and you can figure out all the rest. I know that this may not be the chic or hip answer, but I strongly believe it to be true. It also allows you to evaluate everything you hear about, read about, or learn at workshops. Otherwise, you have no choice but to believe everything that an “authority” states simply because he or she is an authority, because you cannot evaluate it for yourself. I realize that we do not know everything there is to know about the human body, but we do understand many of the basic principles, and learning what you can allows you to be better prepared to make informed decisions about treatment options for your clients. Also, clients rarely present with a condition as simple as presented in textbooks. They usually present with some variation of a condition, or even more likely, a combination of conditions. Being an effective clinical therapist requires the ability to weigh the various factors and creatively determine a treatment program that best suits each circumstance. It also requires being able and willing to constantly modify the treatment approach based upon the presentation of the client at each visit. Foundational knowledge of anatomy and physiology allows for the critical reasoning skills which best allow for this. So, what advice would I give to your readers?, Go back and study your anatomy! 🙂
Dr. Joe Muscolino is a licensed Chiropractic Physician and has been an instructor of musculoskeletal and visceral anatomy, physiology, kinesiology, pathology, and palpation and assessment courses at the Connecticut Center for Massage Therapy for the past 23 years. Dr. Muscolino also runs numerous advanced study workshops, including deep tissue, body mechanics, stretching, and joint mobilization workshops, as well as Anatomy in Clay workshops, cadaver labs, and in-services for instructors of massage therapy; he is an NCBTMB approved provider toward certification renewal. Dr. Muscolino also serves as a subject matter expert on the Exam Committee for NCBTMB, and is a member of the Editorial Review Operational Committee (EROC) for the Massage Therapy Journal (mtj). Dr Muscolino is the author of The Muscle and Bone Palpation Manual, with Trigger Points, Referral Patterns, and Stretching; Kinesiology, the Skeletal System and Muscle Function; The Muscular System Manual, the Skeletal Muscles of the Human Body, 2nd edition (3rd edition out on November 2, 2009); The Musculoskeletal Anatomy Coloring Book, 2nd edition; Musculoskeletal Anatomy Flashcards; and Flashcards for Bones, Joints, and Actions of the Human Bodypublished by Mosby of Elsevier, and used within massage and bodywork curricula throughout the country. Further, he has a regular column entitled Body Mechanicsin the mtj. Joe can be contacted at www.learnmuscles.com.
Category: Person of the Month