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 & Bodywork Magazine
Massage Therapy Journal
Trends and Modalities: Are You Still Practicing Old School Techniques?Massage Today April, Vol. 11, Issue 04, 2011, by James Waslaski
An excellent article! We recommend it to readers. It shows that the author deeply understands the subject of manual therapy and what is more important is able to adjust his therapy and teaching in the light of newest data. Unfortunately, this is not the case of many educators who have stuck with their own system of beliefs and consider other options or newer data as a threat to their established views which they have built on for a while. The important value of this piece is that it teaches the practitioners to be open minded and not to be afraid of studying and practicing other approaches. We believe this is the key to the successful practice, because the patients’ interests must be primary to the system of personal beliefs.
For years we have suggested that medical massage is a concept of ‘umbrella’ of clinically effective methods and techniques rather than treatment protocols based on one method or technique. Unfortunately that is how medical massage is frequently presented. We are glad that the author shares our views, and we hope that with time the correct presentation of medical massage concept will be widely accepted by other practitioners in the field.
Improve Your Eyesight: The Natural Way. Massage Today April, Vol 11, Issue 04, 2011, by Judith DeLany, LMT
A very helpful article on the subject of Bates eye exercises which are rarely mentioned in massage literature. We would like to thank the author and Massage Today for bringing this subject up. It is a very helpful tool for the practitioner who suffers from weakened eyesight as well as a great recommendation the practitioner should suggest and even teach their clients with similar conditions.
We would like to add only a small piece of information that Bates exercises also help the clients who suffer from cluster headaches. It is not a major clinical tool, but regular application allows greatly reduced tension which has accumulated in the extraocular muscles which control eye ball movements. The tension in these muscles is one of the contributing factors to the residual headache and tension around the eyes after the main source of the cluster headache was eliminated (e.g. Greater Occipital Nerve Neuralgia).
Iliosacral Pain You Can’t Touch. Massage Today April, Vol. 11, Issue 04, 2011, by David Kent, LMT, NCTMB
This is a very short article which tries to address such important subject as iliosacral pain while carrying a lot of information. However, it didn’t accomplish either of these goals. Reading this article leaves the reader confused. There are many diagrams with various locations of trigger points which are individually explained without any clinical correlation.
Overall this article fits the pattern of other articles by the same author. Mr. Kent took widely used Travel and Simmons Trigger Points Manual. We also think that this article blindly follows the Trigger Point Manual, which is, first of all, a reference book. Let us take, as an example, the description of the trigger point in the soleus muscle:
“TrP 3 is a very rare trigger point and is located in the lateral mid-calf that refers deep into the ipsilateral SI joint.”
The article is correct in this matter. However this is only one side of the coin. Let us discuss an extremely common clinical case which the practitioner may face daily. The patient has pain in the leg and the ipsilateral SI joint. After reading this article the practitioner will concentrate on the treatment of trigger points in the soleus muscle assuring that his or her client that this is the initial cause of lower back or leg pain. However in real life, the situation, more than likely, is the complete opposite.
Tension in the SI joint caused by various conditions (recent pregnancy, spasm in lumbar erectors, QL muscle, etc.) will slightly irritate the L5 spinal nerve, which is one of the main contributors to the sciatic nerve and this is the real reason for pain in the leg. In such a case attempts to address active trigger points in the soleus or gastrocnemius muscles will be the wrong treatment choice and it will never let the practitioner achieve stable clinical results. The correct chain of actions in this case will be to correct problems in the SI joint area before addressing leg pain and tension which; by the way, may disappear by itself, after the cause of the L5 irritation is removed.
Those who have based their teaching and practice on the Trigger Point Manual mostly don’t understand one simple thing. This incredible book is a clinical reference guide which is supposed to guide the physicians to establish correct diagnosis in the most complicated cases. This is why Travell and Simmons have always included a section of “Nerve Entrapment” in every chapter of the book where entrapment can be a potential problem. This fact is rarely mentioned and the author follows the common mistake. Yes, trigger points in the skeletal may form as a result of trauma or chronic overload, but more frequent cause is mild irritation of the nerves which supply the muscles which harbor active trigger points. Thus taking the information about trigger point location from the content of the Trigger Point Manual without informing readers about the bigger picture is a simple fragmentation of the great book and a narrow presentation of its content.
There is another issue with this and previous articles. The active trigger points in the skeletal muscles are not the only contributors to the pain the patients suffer. The article leaves the wrong impression that addressing trigger points by various treatments mentioned in the article (“from Swedish to Thai massage, myofascial release (MFR) to activate isolated stretching (AIS) and the list goes on”) is the solution to the pain experienced by the patient. It is completely incorrect chain of thought. In any of his articles we have reviewed so far Mr. Kent never mentioned that for example the periostal trigger point may contribute to the pain distribution. By the way, periostal trigger points in the area of the S1 joint are an irreplaceable diagnostic tool which point to this area as the real origin of the pain in the leg. What about scarification of the deep fascia, which is one of the main causes of active trigger points in the deep muscle group? The readers will get the wrong impression that the trigger points in the skeletal muscles are the main target of therapy. In the majority of cases they are not because they are theconsequences of other issues and without addressing these initial causes the trigger point therapy or any other technique become useless tools.
At the same time the information Mr. Kent provides in this and other articles about the location of trigger point location as well as charts for their examination are correct and very helpful. The only thing that is missing is an integrative approach to somatic rehabilitation.
How to Help People With Parkinson’s. Massage Today April, Vol. 11, Issue 04, 2011, by Ben Benjamin, PhD
A very good article on Parkinson’s Disease and its treatment by massage therapy. Yes indeed, massage is not able to cure Parkinson’s Disease, but it helps the patient improve and maintain the quality of their life. The patient’s next hope is genetic medicine. It promises to be the ultimate solution. However, until this happens each patient with Parkinson’s Disease should use regular massage as part of the medical management of this debilitating disease.
The True Grit of Muscle Spasm. Massage Today May, Vol. 11 Issue 05, 2011, by Erik Dalton, PhD
An excellent article on lower back pain and dysfunction due to injuries to joint capsules and spinal ligaments. As the author completely and correctly stated, this type of injury triggers reflex spasm in neighboring tissues in the lumbar area. We highly recommend this article to the readers.
Does Fascial Research Alter Assessment? Massage Today May, Vol. 11 Issue 05, 2011, by Whitney Lowe, LMT
This is a good article on the integrative approach to soft tissue rehabilitation. It repeats the basic concepts which are described in the article by T. Myers who based his article on the works of Dr. Jaap van der Wal. The major point of all of these three publications is that ligaments are an integrative part of the joints system support because their fibers share the load elicited during muscle contractions. This is possible because some fibers of ligaments which stabilize the joints interconnect with muscles and tendons and provide dynamic support. Thus it is obvious that the ligaments should be seen as structures which provide static as well as dynamic support.
Yes, this is a completely correct view and it is worth to inform those who are not familiar with this concept and still see ligaments as simple mechanical ropes which hold bones together. It is unfortunate that this widely known and accepted concept of the joint function now only appears in massage publications and provides such a surprising reaction of discovery from authors and practitioners.
Pseudo-Sciatica and Gluteus Minimus Trigger Points. Massage Today May, Vol 11, Issue 05, 2011, by David Kent, LMT, NCTMB
A very good and informative article on anatomy, function, pathology and the differential diagnosis of tension in the gluteus minimus muscle. This is a case where the information provided in the article is 100% on target.
Understanding Central Sensitization and Pain Massage Today May, Vol 11. Issue 05, 2011, by Leon Chaitow, ND, DO
Just a great piece! There is no need to add anything.
Pediatric Massage: A Nurturing Intervention for Autism. Massage TodayMay, Vol. 11, Issue 05, 2011
This article is on massage and autism. It is a very important subject. Unfortunately, the article fell short of its subject and readers may learn that massage is good for children with autism and this is an already well-known fact. The article contains very basic information on being patient, showing respect, etc. It doesn’t specify what to do and what not to do, technically how to structure the session, etc. The practical value of the article is very low. We think that the authors need to share more information with readers if they are successful and care about colleagues and the profession in general.
Massage & Bodywork Magazine
Discomfort After Massage. Massage & Bodywork May-June: 29-31, 2-11
This short article is a response to the question posted to Mr. A Riggs. Here is original question:
A client came to me complaining of lower back stiffness and discomfort. I spent a lot of time working on the posterior pelvis and low back. He said he felt much better after the massage, but the next day he called me to say his upper back and neck were stiff and he had a slight headache. Can you tell me what I might have done wrong and how I should handle such situations?
The answers were in the posted question. If there wasn’t a history of acute trauma before, at the moment the client felt pain in the lower back nothing actually happened. The tension and other abnormalities started to develop much earlier but the clients’ body was able to compensate for it. At the moment he felt pain his compensated condition ended and he entered de-compensation stage. In such case the peripheral receptors formed a massive input of alarm information to the brain and the client modified he behavior (start to limp or immobilize lower back) and finally looked for help by making an appointment with ‘Concerned’
Anyone who suffers from chronic tension in the lower back sooner or later develops tension in the upper back and neck and vice versa. The reason for such a connection is the agonistic relationship between the upper and lower back paravertebral muscles. Considering the concept of ‘anatomy trains’ both muscles are seen by may clinicians as one which biomechanically links the base of the skull and the pelvis.
When ‘Concerned’ worked for the long time on the lumbar muscles, which were in the state of decompensation (the pain analyzing system was already triggered) she did not do anything to the cervical upper and middle back paravertebral muscles which were still in the compensatory state (no activation of pain analyzing system, but tension is already there). Lack of a balanced approach to the paravertebral muscles throws the upper back and neck paravertebral muscles into the decompensation state, and this was the real cause of the patients’ neck pain and headache the next day.
The answer of the question of what to do is very simple; always address the neck and upper back when your client has lower back pain and always work on the lower back as part of the treatment if the client has cervical pain or headache.
The Progression of Oncology Massage. Difficult Lesson Learned. Massage & Bodywork May-June:32-39, 2011, by Gayle MacDonald
At the very beginning the author clearly set up the boundaries of the article. The reader will find a lot of short case descriptions of incorrect and correct application of massage for the oncology patients. It seems that the article has the goal to raise awareness about the incorrect application of massage for cancer patients. It accomplished this goal.
Chemotherapy and Massage. 10 Questions to Ask Your Clients. Massage & Bodywork May-June: 40-49, 2011, by Tracy Walton
This is a much better article than the previous one. It shows that the author deeply understands her subject and she was able to inject a lot of important practical information into the article which practitioners must use while working on the cancer patient who is going through chemotherapy. Thank You!
Bodyreading Meridians. Massage & Bodywork, May-June: 72-83, 2011, by Thomas Myers
An excellent aricle on postural analysis. We highly recommend it to the readers
Functional Anatomy. Tibialis Anterior. Massage & Bodywork May-June: 91-92, 2011
A correct article on the palpation of the tibialis anterior muscle.
Essential Skills. Achillies Tendon Injuries. Massage & Bodywork May-June: 96-101, 2011, by Ben E. Benjamin
An excellent article on Achilles tendon injuries and treatment options. We would like to add only two things. An Achilles tendon injury can be mimicked by inflammation of the bursa located under the Achilles tendon and by a spur growing in the direction of the tendon from the calcaneus. The practitioner must remember these two conditions, because in the first case the treatment protocol is significantly different from what is discussed in the article, while in the second case usually surgery is the solution.
The Many Faces of Botox. Where Does Massage Fit? Massage & BodyworkMay-June:102-105, 2011
A very interesting article on Botox, its history and application. Considering the popularity of Botox it is very helpful to educate the practitioners about this treatment and how it is related to massage.
Myofascial Techniques. Working With Ankle Mobility. Part II. Massage & Bodywork May-June:110-115, 2011, by Til Luchau
A very good and informative article. The techniques which are discussed only partially cover the issue, but this is understandable that there is no space in the article to cover all of them, including techniques which should cover the ankle joint itself.
Bodyreading Meridians. The Superficial Front Line. Massage & BodyworkMay-June: 74-79, 2011, by Thomas Myers
This is another article on anatomy and biomechanics of the fascia and muscles by the same author. It is a great source of important information which teaches the practitioners to see the soft tissue as an efficient web which supports body mechanics instead of seeing each muscle or tissue separately. Such an integrative approach allows the practitioner to see the bigger picture and allows him to formulate treatment more efficiently.
Functional Anatomy. Sternocleidmastoid. Massage & Bodywork May-June: 87-88, 2011, by Christy Cael
The anatomy and function of the SCM is correctly presented. The mode palpation is the authors’ personal preference, but it is OK as long as the thumb in the picture in the article doesn’t apply vertical pressure. Also, this way of palpation gives very general information, because palpation addresses the entire belly muscle without an actual detailed examination of the muscle tissue. In an ideal scenario the proposed way of palpation should be used at the beginning with a following detailed examination of the muscle tissue.
However, the self-stretching part of the article is completely incorrect. If the reader will try to stretch the SCM muscle as it is proposed in the article (lateral flexion to the opposite by side puling the head using the opposite hand placed on the ipsilateral temple area) he or she will feel the tension on the side of the neck because, in this position, the upper portion of the trapezius is targeted. One may feel it as string on the lateral neck.
To self-stretch SCM as well as the anterior scalene muscle the client needs to turn their head to the opposite side, and after that tilt it backward using the base of the opposite hand placed just above the lateral end of the brow on the same side. This is the only position to efficiently isolate SCM.
Essential Skills. Frozen Shoulder. Massage & Bodywork May June: 92-99, 2011, by Ben E. Benjamin
The article is on a very important subject of Frozen Shoulder (FS). The author is completely correct when he says that: “Adhesive capsulitis, or traumatic arthritis of the shoulder, can be an extremely painful and debilitating condition”.
The only issue we have with the article are the treatment options. First of all, it is a really difficult process to completely recover the shoulder joint after several months of FS. The article is completely correct in mentioning corticosteroid injection by the physician as a first critical step. After that the article suggests repetitive stretching for 3-5 weeks as a main treatment tool. Yes, the passive stretchings are very important, but this is far from enough.
Passive stretching only without detailed work using various massage and manual therapy techniques on all surfaces of the joint and all major players affected by FS will take forever. In complicated cases when the rotator cuff is involved (because of contracture) the passive stretching only approach is simply a dead end.
Blood Cancers. When Helpful Turns Harmful. Massage & Bodywork May-June: 100-105, 2011, by Ruth Werner
A very needed article, especially because it emphasizes multiple myeloma cancer. This is a very important issue because multiple myeloma shows itself at the very beginning as back, neck, or pelvic pain. These patients usually start with massage therapy, physical therapy, or chiropractic adjustments. If the patient’s pain doesn’t change its intensity in a week the practitioner should recommend the client to see a primary physician to do a basic X-ray, which will always show primary bone lesions even at the very beginning. We actually have a similar case in our clinic three months ago when a 55 year old women was referred to the clinic with middle back pain. According to her she started to have constant moderate middle back pain after working on her backyard. At that time the obvious explanation of her pain was that she overloaded her middle back muscles. However, after two weeks of unsuccessful therapy we reported her condition to the primary care physician who ordered an X-ray which showed several multiple myeloma lesions in the ribs, thoracic vertebrae and skull. The sooner treatment of multiple myeloma starts, the better will be the life prognosis for the patient. Always remember about the possibility of multiple myeloma when you encounter the client with treatment resisting pain, especially in the pelvis and back.
Myofascial Techniques. Assessing Sciatic Pain. Massage & Bodywork May-June: 110-115, 2011, by Til Luchau
An excellent article, especially the part which presents the differentiation between Axel and Apendicular Sciatica. This is a critically important issue, because it greatly affects treatment protocol. We highly recommend it to practitioners.
Chronic Pain. Research and Clinical Applications. Massage & Bodywork May-June: 115-116, 2011, by Diana Thompson
A very good article which is dedicated to the latest research in chronic pain and its treatment options. It is also a very helpful and resourceful source of the references.
Lymphatic Drainage Therapy. Massage Magazine 179. April: 60-64, 2011, by Bruno Chikly, MD, DO, Alaya Chikly, LMT
This article is dedicated to basic lymph drainage massage application. A very good and informative article, and we would like to recommend the works of Dr. Chikly to anyone who would like to learn Lymph Drainage from the real expert and great contributor in the field.
Resistance Training. Self-Care Strategy for Massage Therapists. Massage Magazine 180, May: 68-73, 2011, by Jeffrey Forman, PhD
This article is dedicated to self-care for the massage practitioners in a form of resistance training. The author is completely correct to raise this topic. The article has very good practical value, because it outlines a basic program of resistance training as well as emphasizing the simple and effective exercises. It is a great way to build up and maintain your professional stamina.
The Role of Massage Therapy in Addressing Chronic Pain. Massage Magazine 180, May: 54-60, 2011, by Whitney Lowe
Considering the fact that Massage Magazine usually publishes articles in journalistic format this piece which is dedicated to chronic pain and massage therapy more than likely satisfied the Editorial Board. While reading the article it is obvious that that the author knows, and is able to share more information with the readers. But is seems he is restricted by a journalistic way of presenting scientific data. It is a helpful source for the student or those practitioners who are at the beginning of their career.
Connective Tissue Massage. Massage Magazine 180, May: 54-60, 2011, by Chris Kagen
A very good review of connective tissue and various techniques which are used to address pathological changes in this type of soft tissue. The article has a good reference base, and is able to guide the practitioner who would like to learn this extremely important method of massage therapy.
Massage Therapy Journal
Sports Massage, Blood Flow and Lactic Acid: What Does Evidence Say?Massage Therapy Journal V50(2): 97-100, 2011, by Martha Brown Menard, PhD, CMT
The article analyzes the article which examined the clinical value of sports massage and was published in Medicine & Science in Sports & Exercise in 2010. We are glad that the author made conclusions similar to ours that the original article is biased. From our point of view it is also unscientific and showed that authors really didn’t know what they tried to examine.
We reviewed the same article in great detail in September/October 2010 issue of JMS. In a couple of words if we paraphrase the famous slogan “It is the sports massage protocol stupid!”
Reversing Anatomy: From Muscle to Myofascial Meridians. Massage Therapy Journal V50(2): 89-94, 2011, by Joe Muscolino, DC
A simply excellent article! It is a real enjoyment to read.
Massage & The Spinal Cord and Spinal Nerves. Massage Therapy JournalV50(2): 65-83, 2011, by Andrew J. Kuntzman, PhD, LMT
The best way to deal with this article is to make a copy of it, place each page in a protective cover, and keep it in the therapy room as a great professional source until its information completely sinks in and becomes clinical routine.
Practicing Sports Massage. Massage Therapy Journal V50(2):65-83, 2011, Editorial
This article gives the reader a very general overview of working in a sports massage environment. It gives some basic tips for the practitioner to navigate in the unfamiliar environment which are definitely helpful. It is helpful for those practitioners who think of getting into this field.
At the same time the article, even in basic terms, didn’t discuss the nature of Sports Massage as well as its difference from basic stress reducing or medical massage applications. Reading the article leaves the impression that Sports Massage is commonly used modalities which are applied on the athlete. For Example in the Massage Specific Skills section of the article the reader is informed that:
“use some type of myofascial or active release, positional release, trigger point or lymphatic techniques” and “So, being certified or having advanced training in one or more of these areas is important.”
Yes, to be able to use these modalities is of great help and practitioners should learn them. At the same time they don’t have anything to do with Sports Massage. The Myofascial Release is one modality while Sports Massage is a totally different modality with completely different rules of application. For example the application of Myofascial Release before sports competition will decrease the athlete’s performance. At the same time, if during a sport event, the athlete strained their gastrocnemius muscle, the application of Myofascial Release becomes priority. In the article there is no differentiation between Sports Massage as an effective tool of improving the athlete’s performance and help him, or her, to achieve their physiological peak and treating injuries as a result of trauma or overuse.
This is the most common mistake in regard to Sports Massage and MTJinstead of understanding the nature of the modality and inform the readers felt into the same trap. Please remember one critical difference – Sports Massage doesn’t have anything to do with sports injuries. For those cases Myofascial Release or Trigger Point Therapy are used. Scientifically grounded Sports Massage is aimed to optimize the athlete’s performance and speed up recovery and nothing else!
If you would like to read more about the science of Sports Massage, please go to the September-October 2009 issue of JMS.
How Do We Know What We Know? Massage Therapy Journal V50(2): 34-43, 2011, by Joseph Muscolini, DC
This is a very unusual article. It touches a subject which is rarely mentioned in massage literature. The author deserves credit to think and write such an interesting article on the subject of how we learn new things. What is especially helpful that this information, which some may think is irrelevant for a massage publication, is presented from the practitioners point of view.
The article correctly separates our way of learning into three major categories; authority model, research model, and new knowledge model. The authority model, which the practitioners experience in massage therapy school, or during every new continuing education seminar, is the most controversial one. We agree with the author that the students of the countless seminars is supposed to accept the knowledge they have obtained as correct and clinically effective, based solely on the authority of the presenter. In such models the practitioners don’t have any means to justify learned information and it frequently creates the situation when another seminar on the same subject presents a completely different point of view. As a result, confusion is the major obstacle in the further development of the profession. This unfortunate situation exists because there are no scientific standards in massage therapy, and no one is able to enforce them even if they exist. AMTA never showed any leadership in this matter, and there is a very small chance it will. At the same time it is very difficult to impose such standards, because they will undermine the spiritual aspect of massage therapy.
The research model is the best way to go, but the author is correct that it is impossible to do a scientific study on each technique and test their effectiveness against a placebo. In JMS we try to provide as much scientific data from various sources, but it is a drop in the ocean.
The new knowledge is the best way for the practitioner to go, because it requires their active participation. It expects the practitioner to be able to always examine the effectiveness of any new modality using research and clinical application. The author is correct in one very important recommendation. The practitioner who really cares about his or her skills and well being of their clients should never blindly accept any new technique or approach. The first critical step is to ask very simple questions: “Why is what you are suggesting supposed to work?” and “What are your recommendations based on (anatomically, physiologically or scientifically?). If such simple questions puts the presenter in an uncomfortable position and he, or she, instead of delivering a clear answer, starts to generalize, you are more than likely dealing with an incompetent teacher.
The author illustrated the new knowledge model with several examples: stretching brachioradiallis and vastus medialis and lateralis muscles, as well as trigger point therapy. However, in the last case we completely disagree with the article. Let us quote the part in question:
“…using trigger point (TrP) treatment as another example, if TrP is understood to be local ischemia of the tissues, does it make sense to create any further ischemia with deep pressure? And if deep pressure is administered, does it make sense to hold it for a prolonged time? What are we trying to accomplish and are we accomplishing it as effectively as possible? Given that ischemia is the problem (because it cause a decrease in blood supply that then causes a decrease in ATP molecules that are needed to break the actin-myosin cross-bridges that create the contractions) then wouldn’t a stroking technique that increases local blood supply be more efficient? Therefore, wouldn’t multiple, short deep effleurage strokes be more effective when treating TrP’s than holding sustained compression? These are the kinds of questions that can be asked and answered without benefit of authority, research studies and months of testing in your practice.”
The most interesting part, from our point of view, is that the article is both correct and incorrect at the same time. Yes, the article is completely correct that short intense effleurage (or friction, even better) strokes are a very helpful tool for addressing active trigger points in the skeletal muscles. However, the article places this treatment <b.against< b=””>the ischemic compression and clearly doubts the effectiveness of the last one.
First of all we think that the clinical effectiveness of these two techniques never should be measured against each other. In the scientifically sound trigger point protocol they must be used together. Intense effleurage/friction strokes should be applied first with the following use of ischemic compression. In such cases the practitioner triggers vasodilation in the area of the trigger point using a mechanical effect of massage strokes to support vasodilation (i.e. effleurage/friction strokes) and after that he, or she, reinforces the vasodilation using reflex mechanism (i.e. ischemic compression).
Now we would like to address the questions the article raised in regard to the need of ischemic compression as a clinical tool. Here the readers will find themselves in the situation which was correctly described in the article. Two opposite views on the same subject – the effectiveness of ischemic compression. We can provide a list of the references which will support our point of view. We are sure that the author intend to do the same. In such a case it is obvious that the authority model doesn’t work for the reader who would like to get final closure on the subject. Was he, or she, right to use ischemic compression on the client or are the article’s new recommendations correct and should ischemic compression be put to rest?
To find the correct answer to this situation we propose readers use the new knowledge model. First of all we should agree that local circulation in the soft tissues (e.g. skin and skeletal muscles) follows the same basic rules. Keeping it in mind, lets make the following experiment. Please pinch the skin on your inner forearm for one minute. The pressure should be significant but just below the pain threshold. In such a case you are re-creating ischemic compression in the skin on the forearm. After you release compression the immediate picture you will see is a white spot which matches the compressed area. This is local ischemia as a result of skin compression. Soon you will see that this white spot changes color to pink or red. This is hyperemia or direct evidence of vasodilationas a result of ischemic compression. However, this vasodilation isn’t the result of mechanical effect of effleurage/friction strokes (you just compressed skin). This vasodilation is a direct result of oxygen deprivation in the compressed tissue. In other words cutting blood supply to the compressed tissue triggers reflex vasodilation, because body will do anything to restore oxygenation of the tissue which has experienced even a short period of hypoxia.
To do that the reserve capillaries must be open, and this allows an extra amount of oxygenated blood to rush into the compressed tissues, which you observe as skin redness. In a minute the skin color restores and it means that reserve capillaries are now closed and normal circulation is restored. This exact chain of events happened in the area of the active trigger point and this is why ischemic compression is so important tool which, of course, should be combined with proper preparation of the soft tissues in the form of effleurage/friction application. Thus, by finishing this simple experiment you were able to answer the question raised in the article: “Does it make sense to create further ischemia with deep pressure?” Yes it does because local hypoxia triggers local vasodilation using reflex mechanisms (e.g. axon reflex).”
Our opponents may have reasonable counterargument that this simple experiment didn’t prove anything because it was used on the tissue (skin in our test) which initially had normal circulation and the trigger point is area of local ischemia where there is insufficient local circulation. This final doubts can be easily put at rest by using more sophisticated experiment which we will discuss in the next issue of JMS in the article about mechanisms of vasodilaion.
To learn more about reflex mechanisms involved in in vasodilation as a result of ischemic compression please read our four – part article “Science of Trigger Point Therapy” in the March/April, May/June, July/August and September/October2009 issues of JMS. We will also discuss the subject in the next issue of JMS. We are open for further discussion.
Category: Good Apples, Bad Apples