One of the major obstacles for the massage practitioner to build productive professional relationship with physicians and other health practitioners and establish the successful referral base, is their frequent inability to explain the importance of massage in terms familiar to the Western educated doctors. In other words, we have a communication problem, and until this problem is solved massage therapy will remain on the outskirts of medicine instead of being an integrative part of the treatment of many somatic and visceral disorders.
Here in Journal of Massage Science we strongly believe that need for the real scientific information about massage therapy is long overdue and it must be introduced to massage practitioners. It is time for the massage industry to rely on scientific data to convey correctly formulated message to the medical community and clients. In this issue we are starting the series of publications which will address this exact topic.
Using the world’s best scientific medical and massage sources (please see the caliber of publications this article is based on in the reference list at the end of the article) we will illustrate step by step to our readers how massage therapy affects the healthy and disease stricken body on the cellular, tissue and body levels by employing a variety of the healing factors. Pay attention to this and future articles because they will give enough scientifically based information to have unique leverage in any professional situation ranging from the interaction with physician or with fellow colleagues and students to explaining the benefits of the therapy to the client or patient.
Let’s hypothetically consider two scenarios when two massage practitioners are interviewed by a family physician who is looking to extend their practice and start to offer massage therapy as an integrative part of the standard care provided in the clinic. There are more and more family physicians who are looking for this opportunity. This is a great chance for the massage practitioner, because he or she will guarantee a very busy practice and frequently the office will do billing and communicate with insurance companies.
During the interview, the first practitioner explains his scope of work and justifies the necessary expertise by stressing his ability to balance the body’s energy and normalize the flow of the ‘Qi’ through the patient’s body.
The second practitioner based her expertise on the fact that the therapy she uses changes the bioelectricity in the soft tissue and consequently the entire patient’s body by generating piezoelectrical potentials and streaming potentials as two major healing factors. As you may agree, these are a quite different ways of explaining the healing impact of massage therapy.
The massage practitioner who works in his or her private clinic and would like to build up a referral base among local physicians will face a similar situation if he or she doesn’t have the ability to clearly explain the benefits of the therapy using scientific terminology of Western medicine.
LOCAL HEALING MECHANISMS OF MASSAGE THERAPY
Massage therapy is a way to deliver mechanical stimuli to the body and all local and reflex healing effects of massage therapy are outcomes of this process. Diagram 1 summarized scientifically proved local effects of massage therapy on the human body. This diagram does not include the reflex mechanisms of massage therapy and its impact on the central nervous system. These topics demand a separate discussion. From issue to issue we will cover each segment of this diagram until our readers will have a completely unique understanding of the local healing impact of the massage therapy on the human body. To replay the diagram please click at the beginning of the sliding bar (blue line) located just below the diagram.
In this issue of our Journal we will discuss the effect which is mostly unknown to practitioners. That is the ability of massage to alternate and enhance the cellular function in the soft tissue. This effect is called the cellular stimulation. We guarantee our readers that at this point you may find this critically important information only in our Journal. We will start the discussion of the cellular stimulation by massage therapy with the phenomenon of piezoelectricity, its impact on the body and its role in massage therapy.
PHENOMENON OF PIEZOELECTRICITY
Let’s start with the basic definition. Piezoelectricity is the ability of inorganic and organic matter to generate electrical potentials in response to pure mechanical deformation without application of any external electric or magnetic field. In other words the inorganic or organic matter has inner ability to generate independent electricity in response to its simple mechanical deformation.
The phenomenon of piezoelectricity was discovered by two brothers, French physicists, named Curie, in 1880 (Williams, 1974). The diagram below re-creates their experiment (to see diagram please push play button). The authors tested the behavior of quartz crystal when mechanical force was applied to it under the different angles. If force was applied along the main axis of the quartz crystal its increase eventually crushed the specimen. However, when the authors applied force under the angle (black arrow in diagram) to the main axis it created the combination of the vertical mechanical compression and sheer deformation within the quartz crystal. Such combination of two mechanical factors deformed the atomic structure of the quartz in a way that electric potentials with opposite polarities were formed and were detected on the opposite sides of the quartz crystal.
For many decades after its discovery the phenomenon of piezoelectricity was considered as a unique feature attributed solely to inorganic matter. The situation dramatically changed in the middle of the 20th century.
In 1957 two Japanese scientists, E. Fukada, MD and L. Yasuda, MD discovered the existence of the piezoelectricty in the human bone. This is a very important issue for our further discussion and we will use Diagram 2 which recreates the initial experiment on the human bone conducted in Japan.
The harvested bone was placed in the holder and electrodes of amplifier were attached to the opposite surfaces of the bone to record the possible generation of electric potentials. After that the authors applied the mechanical pressure on the opposite end of the bone. As you may see on the part ‘a’ of the diagram, the application of pressure triggers tension (or stretch) on one side of the bone while the opposite side becomes compressed.
At the moment of the pressure application Dr. Fukada and Dr. Yasuda were able to register negative electrical potentials on the compressed side of the bone. These potentials returned to zero as soon as the further increase of pressure ceased but initial pressure was still maintained. At the moment pressure was released and the bone came back to its original form, the authors registered positive electric potentials on the tensed surface of the bone.
Why was this discovery so important? Imagine that every step you make causes constant deformation of each bone in your body and, as a result of these deformations, your bones were able to independently, from the central nervous system, generate electricity. This electric potential becomes one of the major factors in supporting the proper function of the skeletal system and as you see below in maintaining the physiological balance in the function of soft tissue and even inner organs.
Dr. Fukada and Dr. Yasuda also showed that application of the external electric current with different polarity to the bone has a completely opposite impact on its function. If a positive electric current was applied to the bone it caused its resorption (i.e., weakening), while application of the electric current with negative polarity stimulated bone growth and remodeling. This discovery became the foundation for a very effective medical treatment of delayed in fracture healing.
For our discussion it is important to find out what happened after the initial publication of Fukada and Yasuda. After the original paper was published in 1957 and scientists around the world agreed on its importance it was immediately accepted that inorganic component of the bone called apatite is responsible for the generation of the piezoelectrical potentials in the bone.
As we know bones are composed of two major parts: organic part presented by the collagen fibers and mineral part (Ca, P, etc) forms apatite (see Diagram 4).
The organic part gives the bone elasticity, while the inorganic part gives the bone its firmness and stability. Since the brothers Curie discovery piezoelectricity was attributed to the inorganic matter it was obvious for everyone that apatite was directly responsible for this phenomenon.
Everything went upside down when in 1961 two American scientists R.O. Becker, MD and C.A. Basset, MD published their paper showing that collagen fibers or the organic part of the bone is directly responsible for piezoelectrical potentials generated by the bone. This study sent shock waves through the world’s medical community because if the collagen fibers in the bone were able to generate electric potentials the collagen fibers in other tissue and organs are able to do exactly the same. As we know the collagen is a major framework material for the organs and soft tissue and it is everywhere in our body.
After Dr. Becker and Dr. Basset original publication the scientists rushed to examine the possibility of piezoelectricity in other tissue. The results were astonishing. It was found that elasine in the skin (Shamos, Lavine, 1967), collagen in tendons (Anderson and Eriksson, 1968), collagen in ligaments (Fukada, Hara, 1969), actine and myosin in skeletal muscles (Fukada, Ueda, 1970), and even some individual amino acids (Vasilesku, 1970) an DNA molecules (Fukada, 1982) exhibited piezoelectrical properties. All of this allowed Dr. M.H. Lavine to conclude that “piezoelectricity is a property of most, if not all, tissue in the plant and animal kingdoms”.
MASSAGE THERAPY AND PIEZOELECTRICITY
As we know now all organs and tissue in our body exhibit piezoelectric properties, but what theoretical and practical value does this information have for the practitioners and massage therapy profession in general? Why do we spend time even discussing this matter in our massage Journal? Here are the answers to these questions.
The seemingly theoretical concept of piezoelectricity has great clinical value for the massage practitioners. Massage therapy is a way to deliver mechanical stimuli to the soft tissue and one of its great clinical outcomes is generation of the piezoelectrical potentials in the massaged area.
Let me as an example briefly review the impact of massage therapy strokes on collagen. As mentioned above, the collagen fibers are the most important and abundant in our body. They form the structural frame of all organs and tissue and are a major repair material used to restore tissue after any trauma or inflammation.
Each collagen molecule is a strong dipole, i.e. it has two oppositely charged ends (see Diagram 5). The head is bigger part and it has a slightly larger positive charge while the tail is smaller and it has a slightly smaller negative charge. Thus overall charge of each collagen molecule is positive.
Collagen molecules unite together to form different anatomical structures (tendons, ligaments, bones, structural frame of the inner organs, etc.). All collagen molecules in combination with other electrically active proteins generate a, so called, fixed electric charge of each organ and tissue.
Thus, the fixed electric charge is a cumulative charge of all electrically active molecules in the area. Even under normal conditions this charge constantly changes as a result of the individual person’s physical activity, diet, level of stress, etc. Despite of these constant fluctuations, changes in the fixed electric charge stay within the physiological range assigned to this particular tissue.
The situation changes dramatically if the soft tissue or inner organ were traumatized, or has developed inflammation, etc. The fixed electric charge within the affected area immediately changes its normal value as a result of the pathological process. Diagram 6 describes this process and the healing mechanism the massage therapy employs to normalize electrophysiology in the affected soft tissue. We will discuss issue of the streaming potentials in the next issue of Journal of Massage Science.
As we now know any inflammation or trauma of the soft tissue increases the positive fixed electric charge and the collagen fibers are one of the major contributors to this process (see Diagram 7). Swelling, rupture and twisting of the normal collagen fibers (see #1 in Diagram) greatly contribute to the increase of the positive fixed charge in the soft tissue (see #2 in Diagram). The healing process after initial trauma orinflammation is always accompanied by slow restoration of the fixed electric charge in the affected area.
During the massage, external mechanical stimuli in form of repeated application of massage strokes deform the collagen molecules (see #3 in Diagram) and generate the piezoelectricity which increases the negative fixed electric charge. As we discussed above, the negative electric charge has the greatest impact on the proliferation, growth and regeneration of the tissue (see #4 in Diagram).
Also, the increase of the negative charge in the affected area is the critical factor in the correct alignment of the pro-collagen fibers before their maturation into the fully developed collagen fibers. The delay of this process slows the local healing. Thus the restoration of the fixed electric charge is a critically important process in reducing the tension in the soft tissue and eliminating the physical and even mental stress. At the same time it is an equally important component in speeding up the healing process.
The concept of piezoelectricity gives the practitioners a lot of important clinical tools to apply therapy correctly and optimize the outcomes of the treatment. For example the study conducted by Shamos and Lavine in 1967 showed that human skin exhibits the largest piezoelectrical potentials if the mechanical stimuli are applied under a 45 degree angle. This is a very important practical recommendation, as the massage practitioner needs to generate the greatest number of piezoelectrical potentials during the treatment.
Let’s compare the common application of effleurage and friction strokes with the application of the same strokes using a 45 degree angle. The video below presents the application of both techniques.
If the practitioner wants to optimize performance and enhance healing potential of the therapy he or she needs simply change the angle of the applied strokes and this factor alone without even learning additional massage techniques will greatly help practitioner to build up successful practice.
Modern technology allowed scientists to measure the piezoelectrical properties even within a single collagen fiber. In the recent study Minary-Jolandan and Yu, (2009) showed that single collagen fiber is able to generate piezoelectric coefficient of 1 pm V(-1) and summation of piezoelectrical charges generated by each collagen fiber allow the entire tendon to generate electric potential up to tens of millivolts, depending upon the size of the tendon. The authors of this study strongly reinforced the previously mentioned publication of Shamos and Lavine who found that only shear deformation of the collagen fibers triggers the piezoelectrical effect. Thus the angle of the application of the pressure during the massage strokes (45 degrees are the most preferable) is a critical factor in the generation of the piezoelectricity and normalization of the electrophysiological properties of the soft tissue.
A very important article for massage practitioners was published in 1977 by one of the most respected scientific authorities in the field of bioelectricity Professor B. Lipinski, MD. Using his experimental data he formulated the theory which links the therapeutic effect of soft tissue manipulations, acupuncture, Hatha Yoga and the action of negatively charged air ions with piezoelectrical properties of the biological tissue.
According to this theory, proteins, mucopolysaccahrides, nucleic acids, etc. which compose all tissue of our body are able to generate piezoelectricity. Thus, these substances have the ability to transfer the externally applied mechanical energy (e.g. by massage strokes) into electric energy inside the soft tissue.
The author showed that stimulation of the soft tissue in the special areas on the body produces the electric current. This piezoelectrically induced current activates the healing processes in the stimulated area, and it is able to flow “towards the internal organs along the semiconductive channels of biological micromolecules”.
I would like the readers to pause for a second and fully comprehend the theoretical and practical value of this information for the entire massage therapy profession. Imagine that every time you apply mechanical pressure to the soft tissue in the form of massage strokes you actively produce the electric current in these tissues, and it has enormous healing potential on the cellular, tissue and organ levels. This electric current is able to travel to the distant parts of the body, including the inner organs and normalize their function.
The healing impact of the massage treatment is directly correlated with the total amount of piezoelectrical potentials the practitioner need to generate during the therapy. If the practitioner doesn’t use correct tools and tips (e.g., angle of the strokes, speed of the strokes, greater variety of massage techniques, etc.) he or she greatly diminishes the healing outcomes of the treatment and undermines his or her efforts and practice.
TALE OF TWO PRACTITIONERS
Now let’s come back to the hypothetical case of two massage practitioners we discussed at the beginning of the article, who are being interviewed for the potential work in the family practice medical office.
After reading this article who do you think will have the advantage during the interview: the first practitioner, who described his work as a way to enhance healing thorough the balance of body energy, remove the energy blocks and normalizing the flow of ‘Qi’, or the second practitioner who described her work as stimulation of the healing process by normalizing fixed electric charge, generating piezoelectricity and enhancing the maturation of collagen fibers?
Ironically both practitioners described the same process, but they used strikingly different language. While talking to the physician, first practitioner used the 5000 year old language of Oriental health practitioners while the second practitioner used the 21st century scientific explanation of the same phenomenon.
This is a great example of how massage practitioners routinely undermine their work in the eyes of medical community and clients. If you would like to be successful in this profession you must be familiar with modern terminology, current scientific theories and be able to explain your work in making sense way.
I would like the readers to understand the article’s goal correctly. It in no way undermines the achievement of the Oriental thinkers and health practitioners. Using great observation skills and intuitive minds they were able to discover long ago the same processes in the body we just now are able to understand. They were greatly ahead of us.
Five thousand years ago no one knew about electricity in general and bioelectricity in particular. This is why people called it ‘Qi’ or healing energy, but it is unacceptable in 21st century to describe the therapy to the Western educated physician, client or patient using ancient figurative language filled with metaphors. This is not a way to build up practice in Western society.
It doesn’t matter what type of bodywork you are practicing or teaching, Swedish massage, acupressure, neuromuscular therapy, or reflexology you are not in any case affecting the flow of some mystical healing energy. This is a complete fairy tale and scientific nonsense. Instead, your treatment triggers a chain of electrophysiological changes in the soft tissue and the entire patient’s body.
Unfortunately for the entire profession these changes were incorrectly labeled as healing body energy. This 5000 year old term deprived the scientific basis for the massage therapy, and we need to change it as soon as possible in the schools curriculums, in the certification exams and even in the publications where it is a very common subject. Please, educate clients, colleagues, students or other health practitioners on this fundamental matter.
I am perfectly aware that many practitioners will continue to use this concept because it is very difficult to change already established system of beliefs. However our Journal addresses this article to the practitioners who are ready to open their minds, embrace the science in massage therapy and learn and practice its application.
The successful massage therapy practice relies on two major pillars: spiritual-psychological aspect of massage therapy and its scientific foundation. While the first aspect is very well developed and greatly enforced in massage education and literature, the modern scientific understanding is lagging behind, and must be changed for the benefit of the profession and health of the clients. Thus, the goal of this and our future articles on this subject is to give the practitioners a clear scientific understanding of the healing impact of the massage therapy. Masterminding this knowledge is an effective way to build up the flourishing practice and, at the same time, it will help the further development of the entire massage therapy profession.
Becker R.O., Selden G. The Body Electrics. “Williams Morrow & Co, Inc”, New York, 1985
Fukada E. Piezoelectricity of Biological Materials. In: Electronic Conduction and Mechanoelectrical Transduction in Biological Materials, 125-127. Edited by B. Lipinski. ‘Marcel Dekker Inc.’ New York, 1982
Fukada E., Hara K. Piezoelectric Effect in Blood Vessels Walls. J. Phys. Soc. Japan, 26:777-780, 1969
Fukada E., Ueda H. Piezoelectric Effect of Bone. J. J. Appl. Phys., 9:844, 1970
Fukada E., Yasuda I. On the Piezoelectric Effect of Bone. J. Phys. Soc. Japan, 12:1158-1162, 1957
Lipinski B. Biological Significance of Piezoelectricity in Relation to Acupuncture, Hatha Yoga, Osteopatic Medicine and Action of Air Ions. Medical Hypotheses, Jan-Feb, 3(1):9-12, 1977
Minary-Jolandan M., Yu M.F. Nanoscale Characterization of Isolated Individual Type I Collagen Fibrills: Polarization and Piezoelectricity. Nanotechnology, Feb. 25, 20(8):5706, 2009
Shamos M.H., Lavine L.S. Piezoelectricity as a Fundamental Property of Biological Tissue. Nature, 213:267-269, 1967
Vasilescu D., Cornillon R., Mallet G. Piezoelectric Resonances in Aminoacids.Nature, 225: 635, 1970
Williams W.S. Sources of Piezoelectricity in Tendon and Bone. CRC Critic. Rev. Bioengineer., 2(1):95-118, 1974
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