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 present very questionable views in their writings. 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.

 

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A Common Problem For The New Moms And Professional Athletes.Massage Today 11(8), 2011, by Elaine Stillerman, LMT

This great article is dedicated to the rarely mentioned issue of weakened linea alba and diastasis recti, which forms between both rectus abdominis muscles. The test for early detection of diastasis recti is described. The treatment option discussed is Tupler Technique used in the majority of cases only if client has very small diastasis. For the clients with a larger split, there are only two options: To live with it or get surgical reconstruction of linea alba.

We would like to make only three small additions:
1. Different degree diastasis recti is very common in men after age of 50.
2. One of the complications of the diastasis recti is called ventral hernia. In such a case, the abdominal organs protrude between both rectus abdominis muscles and the widening split. With large distasis recti the abdominal organs may become herniated and compressed if the person lifts a heavy object or during defecation. Such herniation of abdominal organs requires immediate abdominal surgery.
3. The practitioners should check linea alba on every client after labor, athletes and males especially around 45-50 with excessive belly fat. If the first signs of diastasis recti are detected by the test described in this article, the practitioner should immediately inform the client about it and suggest preventive and treatment options before the diastasis recti enlarges.



    
Let’s Talk about The Most Common Shoulder Injury. Massage Today 11(8), 2011, by Ben Benjamin, PhD

The article offers a completely wrong answer to the posted question. The subscapularis muscle is not the most common shoulder injury. There is no any reliable medical source that supports this strange conclusion. It is such an obvious fact that it is very surprising to read it in the post of a widely published author.

According to a great number of anatomical and histological studies, the most common shoulder injury is rotator cuff injury and the subscapularis muscle mentioned in the article is part of it. However, from all rotator cuff tears (partial or full-thickness) the supraspinatus muscle is the most frequently injured one. Here are results of two major studies recently published on this matter.

Matava et al., (2005) examined 306 cadaveric shoulders and reported that largest percentage of rotator cuff tears were associated with supraspinatus tendon (32% incidence of partial-thickness tears and a 19% incidence of full-thickness tears).

Kim et al., (2010) examined 360 shoulders and found that the most common place of shoulder injury is the area where the tendon of the supraspinatus muscle unites with the tendon of infraspinatus muscle.

These are only two examples from a large number of studies that always pointed to the supraspinatus muscle tendon as the most frequent origin of shoulder pain. This information is widely available and this is why it is so surprising to read post where subscapularis muscle is defined as a main source of the shoulder pain.

There is a reasonable question: What is the difference if supraspinatus or subscapularis is most commonplace for the shoulder injury?

First of all the post incorrectly answered the question which more likely the author himself posted (since there was no reader’s name identifying who posted original question). In such case, it is matter of correct scientific data. However, the correct answer means much more than a fight for scientifically sound data presented in massage publications. The problem is much bigger. The practitioners who will read such misleading data are going to examine and treat clients with shoulder pain considering the fact that they more likely dealing with injury of subscapularis muscle. In such a case, they will lose time and waste the client’s money by knocking on a completely wrong door as suggested by the article.

In some chronic cases of rotator cuff injury the clinical picture becomes so confusing (because of a long history of pain) that it takes time to determine the place of the original injury even with extensive clinical experience. Those practitioners who do not have such clinical experiences and rely on educational sources will make mistakes by using the article’s recommendations.



REFERENCES

Matava, M. J., Purcell, D. B., Rudzki, J. R. Partial-Thickness Rotator Cuff Tears.Am J Sports Med, 33: 1405, 2005.
Kim, M.H., Dahiya, N., Teefey, S.A., Middleton, W.D., Stobbs, G., Steger-May, K., Yamaguchi, K, Keener, J.D. Location and Initiation of Degenerative Rotator Cuff Tears. An Analysis of Three Hundred and Sixty Shoulders. J Bone Joint Surg (Am), May; 92(5): 1088-1096, 2011.


     
Massage Therapists Team With Pediatric Cardiology Professionals to Examine the Effects of Massage on Exercise Performance and Heart/Lung Function in a Sample of Children With and Without Heart Disease. Massage Today July, Vol. 11, Issue 07, 2011, by Massage Therapy Foundation Contributor

This is a report on the study designed and conducted by the Massage Therapy Foundation in cooperation with pediatric cardiologists to examine the role and impact of massage therapy as an additional clinical tool to help children with cardiac abnormalities. We hope that more and more studies like this one will be conducted by the Massage Therapy Foundation, which in our opinion is the only organization which really cares about scientific research in the massage therapy field. Practitioners should use the results of this study published in International Journal of Therapeutic Massage and Bodywork 2010, 3(3) as a reference tool to establish professional relationships with cardiologists and pediatricians.



   
The Inside-Out Paradigm: The Intake Interview. Massage Today July, Vol. 11, Issue 07, 2011, by Dale G. Alexander, LMT, MA, PhD

The subject of the article is a very important one. We understand that this review can be seen by some readers as controversial but we wish to express our opinion. Everyone has their own style and way to conduct the initial client interview. This is a very personal subject. The article provides 10 questions that are suggested as basic tools during initial interview. Some of them are valid questions while some raise brows. Here we would like to express concerns about some of the recommended questions and overall tone and goal of the suggested interview.

The article mentioned clinical massage that the author practices and it is logically to think that it is different from stress-reduction massage. A large part of the interview suggested in the article is based on the psychological aspect of client’s ailments. Let us quote:

“I seek to discover the earliest sign or symptom that has the longest history as this has assisted me most often to unravel what is happening within their physiology, accreted trauma or might be an indicator of a genetic link or deficit/defect. At the cognitive level, my job is to assist them to connect the dots between the events of their lives and to unhook from the ones that are acting as a drag on their healing. Assisting clients to find their way toward acceptance and/or forgiveness is still a higher octave of our work.”

We hate to say it, but what is suggested as a guideline for the initial interview is really the responsibility of a clinical psychologist. By the way, this is the author’s original profession and he definitely knows his subject considering fact that he has Ph.D. in psychology. Without any doubt, he as a psychologist has sufficient clinical tools “to assist clients, on a cognitive level, to connect the dots between the events of their lives and to unhook from the ones that are acting as a drag on their healing.” However, how is such an initial interview supposed to be conducted by a massage practitioner who lacks such expertise and is suppose to “connect the dots.”

We greatly disagree with the statement that: “Assisting clients to find their way toward acceptance and/or forgiveness is still a higher octave of our work.” This is our personal opinion but what the article suggested is not the high octave of our work. We see the “high octave of our work” first of all in quick and successful somatic rehabilitation. Acceptance and/or forgiveness is a psychologist’s work. The same way as we do not expect a clinical psychologist to free the sciatic nerve from the irritation by the piriformis muscle no one should expect the massage practitioner to work as a psychologist and “connect the dots” in their clients’ lives.

The article provides 10 magical questions, but somehow it missed the magical answers. For example, article suggested that the practitioners should ask a new client: “How would you describe the years of your puberty? Any growth spurts?” If the author considers that these questions are so important for the treatment of client with, say, Post-traumatic Tennis Elbow then the article must explain what is the exact value of these questions to the practitioner’s plan of treatment, and how he or she should evaluate the client’s answers. Let us say the practitioner discovered the client was a very troubled teen. So, what interpretation, value and clinical meaning has this answer for the therapist, and how should it affect his or her treatment plan for Tennis Elbow? Without explanation of the value of these questions they are pure waste of practitioner’s and client’s time.

By the way, we know the normal growth during puberty occurs in the form of the growth spurt which begins at about age 11 in girls and 13 in boys. This pubertal growth spurt usually lasts 2-3 years and is accompanied by sexual development. In such case, asking an adult about a growth spurt is the same as asking if he or she ever went through the puberty. What is the exact value of this question? There are other questions on the recommended list which simply belong to another profession.

Yes, massage practitioners need to consider all aspects of the client’s body but the initial interview for the client (let us take the same case of Post-traumatic Tennis Elbow) who came to the clinic looking for help must be conducted quickly and efficiently to obtain enough clinical information relative to the case and eliminate pain as soon as possible. If the practitioner was quickly successful, obtained the client’s trust (based on overall success of Tennis Elbow’s treatment) and the practitioner has enough expertise to “connect dots” in the client’s life. It is the responsibility of the client to pay for other types of treatment sessions to address psychological problems.



     
Human Silly Putty. Massage Today July, Vol. 11, Issue 07, 2011, by Erik Dalton, PhD

This is a very good article that correctly pointed out the importance of the everyday overload of somatic structures as a main reason for many myofascial syndromes. The sooner practitioners switch from the concept that trauma is a main cause of somatic abnormalities, the better the care they will be able to provide to their clients.



    
Frontal Headaches and Myofascial Trigger Points. Massage Today July, Vol. 11, Issue 07, 2011, by David Kent, LMT, NCTMB

The article explains correlations between active trigger points and frontal headaches. The article is very informative and well-illustrated. We may only add that one of the frequent reasons for the frontal headache is Greater Occipital Nerve Neuralgia, and if this is the cause of the frontal headache the trigger points and subsequently trigger point therapy used to eliminate them is knocking on the wrong door. In these cases, the active trigger points are the consequences of Greater Occipital Nerve Neuralgia.



     
Understanding Lumbar Disc Herniation. Massage Today July, Vol. 11, Issue 07, 2011, by Whitney Lowe, LMT

An excellent and much needed article! It removes the common fear and misunderstanding that practitioners should avoid working on clients with herniated intervertebral disk. This is myth and correctly formulated medical massage protocol is the main line of defense to prevent spinal surgery. We express our own opinion by observing results in our and similar clinics but we are sure that neither physical therapy or chiropractic care alone are unable to achieve results even closer to treatment outcomes medical massage therapy is able to deliver.



Massage & Bodywork Magazine


    
Fibromyalgia’s Mysteries. How To Ease the Client’s Symptoms With Informed Massage. Massage & Bodywork September/October, 34-41, 2011, by Charlotte Michael Versagi and Rita Diane Woods

A very good article about Fibromyalgia (FM) and its treatment using massage therapy. The article has many strong points and correctly presents the initial steps in FM therapy. It is good source of information for those practitioners who have just started working with FM clients or who are in the initial stages of the therapy. The emphasis on correct treatment of tender points is very helpful.

The recommended protocol for the massage session is great first step, but if practitioners would like to address FM more efficiently, medical massage techniques must be used later after the introductory period of therapy discussed in the article is completed.



     
Assess Fibromyalgia with Confidence. Massage & BodyworkSeptember/October, 42-47, 2011, by Cara McGuinness

This is another good article on Fibromyalgia. We think that this piece is even more valuable because it guides the practitioners through the steps and the mindset the practitioner needs to correctly approach the FM patient at the very beginning. The article raises the important point of the necessity of correct assessment and communication with the client who must be involved in the treatment process. Considering the strong psychological component of FM, such client involvement in the treatment process is a key factor in overall treatment success.



     
Understanding The Healing Process. Massage & Bodywork September/October, 48-53, 2011, by Christy Cael

A great article which reviews the step by step healing processes in the soft tissue and, what is more important, correlates proper massage techniques with each stage of the reconstructive process occurred in the affected soft tissue.



     
Bodyreading Meridians. Superficial Back Line. Massage & Bodywork, September/October, 70-81, 2011, by Thomas Myers

The author continues his excellent series of articles on ‘anatomy trains’ as he defined this topic. Mr. Myers deserves a lot of credit from practitioners. He was able in a simple and visual format to re-introduce the subject of anatomy into many practitioners’ lives and practices. Those therapists who saw anatomy as a ‘dry’ science in massage school are now able to experience it in the dynamic form directly associated with clinical application. Thank you!



     
Table Lessons. Mechanics of Whiplash. Massage & BodyworkSeptember/October, 86-87, 2011, by Douglas Nelson

A great example of clinical reasoning! We think the article similar to the ‘Table Lessons’ column greatly contributes to the practitioners’ interest in the medical aspects of massage therapy. The majority of educators offer the practitioners various massage protocols of different degrees of effectiveness. However, it seems that very rarely someone teaches practitioners such critical skills as clinical thinking.

If one will get familiar with various protocols, let’s say for the Carpal Tunnel Syndrome which are sold in various media forms, he or she will very soon find that despite the great sounding names of ‘newly developed’ methods or techniques, all of them continue to espouse the same information as ultimate solution. However, rarely someone will teach practitioners to investigate somatic abnormality to discover if the protocol for Carpal Tunnel Syndrome needs to be applied at all despite the presence of local symptoms of Carpal Tunnel. Mr. Nelson’s column is among the few that attempts to fill this vacuum.



    
Functional Anatomy. Transversospinalis Group. Massage & BodyworkSeptember/October, 89-90, 2011, by Cristy Cael

A Good article on the anatomy and palpation of the transversospinalis group. The active stretching recommendations as homework for the client are very helpful.



 
Essential Skills. Pulled Hamstring. Part I. Massage & BodyworkSeptember/October, 94-95, 2011, by Ben E. Benjamin

The article is about the injury of hamstring muscle. It correctly describes the anatomy and function of the hamstring muscles as well as some examination tests. However, we have two problems with this article. The first one is the fact that from article to article the author continues to proclaim that sacroiliac, sacrotuberous and/or sacrospinous ligaments in the pelvis cause referred pain to the hamstring area as well as all way to the leg. In the author’s words:

“In addition to the nerve root being compressed by herniated disk, this same type of pain can be produced by injury to the portion of the posterior sacroiliac, sacrotuberous or sacrospinous ligaments”

This is a completely incorrect statement. The sciatic nerve pain and pain as a result of ligamental injury are so dramatically different that it is impossible and simply wrong to mix them together. It creates clinical confusion. The nature of ligamental injury excludes the pain reference to such distant areas. In cases of ligamental injury, the pain remains local or radiates locally. Pain in the hamstring area if it isn’t caused by the injury has only one explanation which is irritation of the spinal or peripheral nerve. It is possible that the sprain of sacroiliac ligament may secondary irritate L5 spinal nerve. However even in this case the primary cause of the referred pain is nerve irritation.

The second issue is tests that are recommended to examine hamstring muscles. They are completely correct but one critical piece of information is missing. The article is correct when it emphasized that the same clinical picture of hamstring pain could be the result of the local injury as well as caused by the irritation or compression of the spinal or peripheral nerve. However, in the latter case, the proposed tests are useless because they will be likewise positive if the client has a hamstring injury or if he or she has pain on the posterior thigh as a result of nerve involvement. So how to conduct injury verification correctly?

The practitioner must examine and rule out involvement of the spinal or peripheral nerve first. If there are no clinical symptoms to indicate spinal or peripheral nerve involvement and the client had history of trauma or muscles overuse, the practitioner should use recommended tests to determine the area of the hamstring injury. If the therapist will start with the application of tests recommended in the article and they are positive in both cases, he or she will waste time on the local therapy while the real cause will be located in the completely different area (e.g. piriformis muscle).



    
Body Awareness. Fine-Tune Your Table Height. Massage & BodyworkSeptember/October, 106-107, 2011, by Barb Frye

A very practical and helpful article, especially for those who have just begun massage therapy. We can’t agree more with the article’s main points that the height of the massage table must be adjusted correctly, and the therapist must use body weight as a critical component of each stroke.



  
Myofascial Techniques. Assessing Sciatic Nerve Glide. Massage & BodyworkSeptember/October, 110-115, 2011, by Till Luchau

The article is about sciatic nerve entrapment and its evaluation. The article discusses a test to examine inflammation and sciatic nerve entrapment as Sciatic Nerve Glide Test. The correct name of the test discussed in the article is Straight Leg Rise Test (SLRT). Why the author decided to alter the correct and worldwide accepted name of the test is a mystery. This is an example of a trend we see from publication to publication. Some educators try to alter the name of a test or treatment procedure and associate it with their own name or teachings. Considering that many therapists are not familiar with correct terminology, the actual origin of information becomes a widespread marketing practice. We think that this is very unfortunate because it intensifies already existing confusion and it robs original authors of our respect and appreciation.

SLRT (or as it called in the article Sciatic Nerve Glide Test) was originally proposed by French physician Dr. C. Lasegue in 1864. Several years later in 1880 another physician from Serbia, D. L Lazarevic, gave SRLT its modern form. From this point to re-name a test which used routinely around the world since the end of 19th century is simply irresponsible on the author’s side.

Another issue is the test itself as it is described in the article. Yes, this test will point to the sciatic nerve inflammation. However article claims that by doing this test the practitioner will be able to find out if sciatic nerve is entrapped by the so called appendicular causes or, in other words, nerve entrapment in the “buttocks, hip or leg.” versus axial cause, which is spinal nerve root entrapment. This is a completely incorrect and misleading statement. SLRT (or how it is called in article Sciatic Nerve Glide Test) will be equally positive in cases of axial andappendicular entrapment of the sciatic nerve.

Let’s say that a practitioner has client who started to have mild to moderate symptoms of sciatic pain and visited the massage clinic first. The therapist performs SLRT and discovered it is positive. SLRT is a very sensitive but unfortunately very inaccurate test (Deville et al., 2000). Despite what the article said SLRT gives 100% information that sciatic nerve is inflamed (i.e. the test is sensitive) but it tells very little where to find the nerve entrapment (i.e., test is inaccurate). It will be positive in all cases of Sciatic Nerve Neuralgia.

Considering the article’s suggestion, the practitioner will rule out disk protrusion and start to address sciatic nerve entrapment as a result of, let’s say, piriformis muscle tension. In such a case, he or she is not going to accomplish anything if the origin of sciatic nerve entrappment or irritation is intervertebral disk, short rotators or lumbar erectors around sacroiliac joint. In all these three cases, a completely different to piriformis muscle treatment protocol should be used. The article states:

“Use what you learned from performing Sciatic Nerve Glide Test to choose where to work next”

This is a completely irresponsible statement. SRLT (or how is is called in the article Sciatic Nerve Glide Test) alone will never enable the practitioner to choose “where to work next.”

This article is great example of a recent pattern we are observing in professional publications in which authors publish articles and make recommendations on medical aspects of massage therapy that are only partially correct.



REFERENCES

Deville WL, van der Windt DA, Dzaferagic A, Bezemer PD, Bouter LM. The test of Lasegue: systematic review of the accuracy in diagnosing herniated discs.Spine, 25 (9): 1140-7, 2000.


     
Somatic Research. Whiplash Associated Disorders. Massage & BodyworkSeptember/October, 116-120, 2011, by Diana L. Thompson

An excellent, well-presented article that reviews the issue of Whiplash Injuries. It is very helpful as a basic information source for therapists to understand the mechanism and importance of these injuries. The treatment option part of the article gives only a general description of the treatment options but it was not the main goal of the article.



Massage Therapy Journal


     
Neural Plasticity. Massage Therapy Journal 50(3): 89-94 2011, by J Muscolino, DC

A very informative overview of the nervous system and its basic functions especially the phenomenon of neural plasticity. Overall it is a complicated issue and the article was able to present information in a simple and easy-to-grasp concept.

We would like to emphasize an important concept mentioned in the article that readers might miss. The phenomenon of neural plasticity is one of the important contributors to the chronic characteristics of myofascial abnormalities. The author is completely correct when he emphasized that practitioners must create rehabilitative and a self-rehabilitative program for the clients suffering from chronic myofascial syndromes. Very frequently just fixing the problem brings only temporary relief which quickly fades away without a supportive therapy program.



Massage Magazine


     
Gaga Over Heels. Massage Magazine 184, September: 52-55, 2011, by Erik Dalton

A very good article. It is not a scientific piece but it is fun to read. The article was able to deliver a lot of important information while maintaining an easy-to-read style. The main topic of the article is how high heels affect postural balance and feet. Considering that a majority of females have high heels in their closet and some wear them a lot, the topic of the article is greatly appreciated.


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