The purpose of this section of the Journal of Massage Science is 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.
Massage & Bodywork Magazine
Safely Navigating Injuries. Massage & Bodywork Nov-Dec: 33-34, 2012
This short article answers one reader’s question about how to safely work in the spa setting on clients with acute injuries. The author is completely correct when he states that “…never work on anyone if you don’t feel confident in the safety of techniques you use”. The article targets those practitioners who work in spa settings that focus on the stress-reduction action of massage and offers some basic suggestions on how to work safely on these clients.
We would like to add that the best method for working on clients with acute injuries is to learn medical massage and how it can really help them, rather than just using safety precautions to avoid further complications.
When the Pieces Don’t Fit. Massage & Bodywork Nov-Dec: 37-39, 2012
Without a long discussion, this is an excellent article, which everyone in the field must read. Please note the sentence at the end of the article: “When the pieces of the puzzle do not fit, do not force them” [emphasized by JMS]. Thank you for the great piece!
Adults With Cerebral Palsy. It’s Not Just A Children’s Condition. Massage & Bodywork Nov-Dec: 37-39, 2012
A great article! It provides readers with important information about cerebral palsy and raises awareness about this debilitating condition. Unfortunately, massage therapy is unable to completely eliminate cerebral palsy, but neither can any other modality. However, the massage practitioner can play a very important role in the life of clients with cerebral palsy, since massage therapy greatly improves their quality of life.
Your Body’s Comfort. Use All Your Massage Tools. Massage & Bodywork Nov-Dec: 46-47, 2012
The article offers a simple exercise that the author called Partner Practice for practitioners to heighten the state of their body awareness. It seems this is a very simple issue, but we bet that many practitioners will be surprised at how much detachment they have between brain and hands while doing stress-reduction massage. The massage practitioner who practices medical massage is in a state of constant awareness, since the client’s body constantly feeds the practitioner’s senses with important information. On the other hand, some practitioners who practice their routine of stress-reduction massage frequently get into a state of mind where the brain wanders while the hands are automatically working. This is where practitioners become vulnerable to stress injuries.
The Partner Practice exercise discussed in the article is a helpful tool, among others, to restore such a broken connection.
Functional Anatomy. Splenius Capitis. Massage & Bodywork Nov-Dec: 49-50, 2012
An informative article that discusses the palpation of the Splenius Capitis Muscle.
Massage Improves Postoperative Experience. Massage & Bodywork Nov-Dec: 52-55, 2012
For those practitioners who would like to expand their practice in the hospital setting to provide therapeutic massage after major surgeries as a part of the patient’s rehabilitation, this article provides general guidelines and, what is more important, scientific references from medical journals where the clinical benefits of massage for postoperative patients have been examined and justified.
MS. Easing Symptoms with Informed Massage. Massage & Bodywork Nov-Dec: 56-65, 2012
This is the main article in Massage & Bodywork Magazine from the reviewed issue. It is dedicated to Multiple Sclerosis (MS), a very debilitating autoimmune disease that attacks the CNS. The article provides considerable helpful and correct information until it gets to the section that is most important for the practitioners and patients: “Step-by-Step Protocol for MS Technique for lower extremities treatment” using massage.
This protocol misses two critical components of the treatment, since the author somehow placed them in contraindications: passive stretching and vibration therapy. She never explained where these restrictions come from or on what scientific basis she makes such strange conclusions, which will now be disseminated in the massage community. Here are quotes from the original article and our review of scientific data that completely refutes the author’s claims:
- First quote from the article:
“Never stretch the limbs of an MS client. You learned in massage therapy school to stretch your client’s limbs to the point of resistance….Exactly the opposite is true when working with MS client [emphasized by the author]. Here’s why: 1) These clients cannot tolerate any form of sympathetic nerve firing which might cause spasms. 2) They might have inadequate physiologic reporting mechanism to sense how far they can stretch. 3) If they have contractures, you can cause harm with even mildly overzealous passive ROM”
This is a problem we observe in many publications when the author does not fully understand the pathophysiology of the disease and draws incorrect practical recommendations, which, after being published, become generally accepted among massage practitioners, since no one challenges such statements or recommendations.
It seems that the author removes passive stretching from the arsenal of practitioners who work on the MS patient based on the assumption that muscle spasms in patients with MS are the result of the increased activity of the sympathetic nervous system or that its stimulation will trigger such spasm. First of all, the muscle spasticity is not an initial symptom of MS; it is a complication of MS. According to Harrison’s Principles of Internal Medicine, the muscle weakness and sensory abnormalities are observed in 72% of newly diagnosed patients with MS. Yes, during the latter stages of MS, spasticity becomes a problem, but the author of the article failed to understand that this spasticity is not the result of increased sympathetic tone but rather of damage to the autonomic nervous system as a result of demyelination. These are two completely different scenarios.
It seems that the author is not aware that in patients with MS both systems, sympathetic and parasympathetic, can be similarly affected and modern medicine is not able to make such drastic conclusions as the author did. Here is one of the quotes that illustrates our point:
“Thus various sections of the autonomic nervous system may be involved in MS plaques and the overall prevalence of e.g. sympathetic or parasympathetic nervous system alterations may be difficult to access.”
S. Merkelbach et al., Journal of Neurology (2006)
As many studies show, many patients with MS do not exhibit symptoms of activation of the sympathetic division. McDougall and McLeod (2003) detected the abnormal sympathetic skin response in only half of the patients with MS. Thus, the author’s explanation that “…these clients can’t tolerate any form of sympathetic nerve firing” is overstretching, especially if MS is newly diagnosed and there is no spasticity developed yet.
Finally, if the author is correct that any form of sympathetic nerve firing is prohibited in patients with MS, what about the exercises? According to many studies, patients with MS symptoms greatly benefit from exercise programs (Rietberg et al., 2005; Snook and Motl, 2009), but any exercise requires a great increase in sympathetic nerve firing. Someone is wrong here: medical sources or the author of the article. We are giving the readers the chance to decide.
In reality, the clinical fact is very simple: passive stretching is one of the most important tools for the treatment of patients with MS. We may provide numerous studies that support this statement. Here are two examples:
Brar et al. (1991) examined the effect of baclofen and the combination of baclofen and passive stretching on patients with MS who suffer from significant spasticity. The authors concluded that stretching, when added to the treatment protocol, greatly enhanced the beneficial effect of baclofen and reduced the level of spasticity.
Also, readers may easily check out the Mayo Clinic website with regard to strategies for the treatment of MS symptoms: Multiple sclerosis – Symptoms and causes – Mayo Clinic.
As you may see, the first option mentioned on the Mayo website with regard to spasticity treatment of patients with MS is passive and self-stretching. We think that readers will agree that the Mayo Clinic is a very sophisticated and scientifically oriented source of such information, which the author of the article somehow missed.
- Second quote from the article:
“Do not use mechanical muscle vibrators to quiet spasms which can stimulate the sympathetic nervous system; use only your hands”
Electric vibration is a very powerful stimulant. As a matter of fact, the vibratory stimuli are even able to override pain stimuli. However, it seems that the author writes about vibration without knowledge of its effect on the body. The vibratory stimulation has a dual effect on the function of the muscles. Yes, the author is correct that vibration increases muscle tension, but it happens only after a vibratory stimulus is introduced to the skeletal muscle or the massager is constantly moved back and forth along the targeted muscle. However, if the massager stays still for at least one minute, especially in the middle of the muscle belly, where the motor nerve enters the muscle, the vibration triggers deep muscle relaxation. Many studies have confirmed the clinical effectiveness of electric vibration on spasticity and other motor abnormalities including postural changes in patients with MS (Schuhfried et al., 2005; Diego et al., 2012). It is puzzling why the author missed such clinically important information.
Conclusion
- Passive stretching is a critical component of the massage treatment of patients with MS. This therapy must be conducted within the patient’s comfort level without activation of any uncomfortable sensations. The practitioner must teach the patient to self-stretch, especially before and especially after the exercises.
- The practitioner must use an electric massager with a semisoft contact area or use a towel. The massager should be placed in the middle of the muscle bellies of muscles which exhibit symptoms of spasticity. Never move the massager; stay in the same spot to use the inhibitory effect of electric vibration.
REFERENCES
- Brar SP, Smith MB, Nelson LM, Franklin GM, Cobble ND. Evaluation of treatment protocols on minimal to moderate spasticity in multiple sclerosis. Arch Phys Med Rehabil. 1991;72(3):186-189.
- Diego A, Hernandez C, Molina Rueda F, Cano de la Cuerda R. Effects of vibrotherapy on postural control, functionality and fatigue in multiple sclerosis patients: a randomized clinical trial. Neurologia. 2012;27(3):143-153. doi:10.1016/j.nrl.2011.04.019
- McDougall AJ, McLeod JG. Autonomic nervous system function in multiple sclerosis. J Neurol Sci. 2003;215(1-2):79-85. doi:10.1016/S0022-510X(03)00205-3
- Merkelbach S, Haensch CA, Hemmer B, Koehler J, König NH, Ziemssen T. Multiple sclerosis and the autonomic nervous system. J Neurol. 2006;253(suppl 1):I21-I25. doi:10.1007/s00415-006-1105-z
- Rietberg MB, Brooks D, Uitdehaag BM, Kwakkel G. Exercise therapy for multiple sclerosis. Cochrane Database Syst Rev. 2005;(1):CD003980. doi:10.1002/14651858.CD003980.pub2
- Schuhfried O, Mittermaier C, Jovanovic T, Pieber K, Paternostro-Sluga T. Effects of whole-body vibration in patients with multiple sclerosis: a pilot study. Clin Rehabil. 2005;19(8):834-842. doi:10.1191/0269215505cr919oa
- Snook EM, Motl RW. Effect of exercise training on walking mobility in multiple sclerosis: a meta-analysis. Neurorehabil Neural Repair. 2009;23(2):108-116. doi:10.1177/1545968308320641
Human Movement. An Introduction to Therapeutic Kinesiology. Massage & Bodywork Nov-Dec: 70-77, 2012
A very good introduction to kinesiology presented from the massage therapy perspective.
Restoring Smooth Movement. How Active Release Technique Can Help Athletes and All Your Clients. Massage & Bodywork Nov-Dec: 94-97, 2012
The subject of the article is the so-called Active Release Technique (ART). The article also discusses the Graston Technique, although, according to the article, this modality is not within the scope of the massage therapists’ practice. We do not want readers to think that we are criticizing ART. We cannot do that, since the article does not provide any idea of what ART is all about. This piece is a great example of what we hate about some massage publications. It is simply a promotion piece.
If ART is so great, why does the author not explain the mechanism of its innovative power? What makes it so unique and effective compared to Myofascial Release? From the article, we learned that myofascial release was its original name, but since this name was already taken, the author changed it to an easier name to sell, namely ART.
If the article is a simple promotion piece without any scientific justification for its claims, it treats readers poorly. If the author is unable or afraid to say more, she should not write such an article in the first place.
The portion of the article’s title that ART will “Help ALL Your Clients” is a very sad sales pitch.
Delivering Care for Delivery Workers. Massage & Bodywork Nov-Dec: 106-109, 2012
The author has a very helpful column that looks at the somatic abnormalities the practitioner may encounter in the therapy room from the point of view of occupational hazards associated with the type of work that patients may do. It is a great help for practitioners, since simple questions during the initial interview (e.g., “What do you do for a living?”) should direct the practitioner’s thoughts in the correct diagnostic direction and help during further evaluation of the client’s tissues.
Working with the Sacroiliac Joints. Massage & Bodywork Nov-Dec: 114-117, 2012
A very good and informative article on SI joint dysfunction. We agree with the author when he says that SI joint dysfunction is more likely responsible for greater than 15-21% of lower-back pain than commonly believed.
Massage Today
The Missing Link: A New Paradigm for Soft Tissue Therapy. Massage Today October, 2012, Vol. 12, Issue 10
Overall, the article is correct on many levels, but what bothers us is that the author promotes its main subject as a silver bullet for everything. He sees that all abnormalities of the musculoskeletal system are the results of distortion between the cranium and the anterior/posterior rotation of the ilia and tipped sacrum. Let us quote:
“Since approximately 95 percent of musculoskeletal pain is due to the body collapsing further into the core distortion pattern over time, it is unfortunate that none of the other techniques is able to effectively release this distortion.”
We would like readers to pause for a second and imagine that 95% of musculoskeletal problems have only one simple explanation: a distortion between the cranium and the anterior/posterior rotation of the ilia and tipped sacrum. On top of that, the author writes such nonsense in a way that it seems that it is a well-established medical fact. Forget about bulging disk, osteoarthritis of the knee, carpal tunnel, tendinitis, pronator muscle syndrome, subluxated ribs, etc. All of these and hundreds of other pathologies are simply the result of distortion between the cranium and the anterior/posterior rotation of the ilia and tipped sacrum or they are conveniently placed in the 5% that is not mentioned in the article.
Does the condition mentioned in the article exist? Definitely, and more than likely the author’s treatment could help some clients. However, why do you need to justify the importance of one approach with such ridiculous claims while in the process deriding anything else (Neuromuscular Therapy, Connective Tissue Massage, Myofascial Release, etc.) as a treatment option? Is it just personal ego or an attempt to fill up a classroom with enough students? We think that the author fails to understand the importance of promoting an integrative approach to somatic rehabilitation in which the patient is the center of the therapy rather than what the practitioner knows or is comfortable with. The article presents a one-sided approach and contributes to the further fragmentation of an already fragmented profession, which is detrimental to the industry, the practitioners and, more importantly, the patients.
Understanding the Difference Between Clinical and Spa Massage. Massage Today October, 2012, Vol. 12, Issue 10
The author gives the readers a clear differentiation between spa and clinical (medical) massage. This article is especially helpful for new massage graduates who are trying to find their own place in the industry.
The Peroneals: Anatomy and Function. Massage Today November, 2012, Vol. 12, Issue 11
This is a very good article on the anatomy and physiology of the peroneal muscles and treatment options when pain and tension develop there. The author is correct with the recommended treatment protocol. The only critical information missed in the article is the very important fact that if the patient did not suffer a previous injury, the main reason for tension and pain in the peroneal muscles is mild irritation of the spinal nerve in the lower back or the sciatic nerve in the gluteal area.
Tissue Density Restoration Massage for Restless Leg Syndrome. Massage Today December, 2012, Vol. 12, Issue 12
We have already reviewed an article (see Good Apples/Bad Apples — Jul 2012, JMS) by the same author who promoted Tissue Density Restoration (TDR) massage as a solution to the treatment of Osteoarthritis. She based her treatment on the fact that “crusted” and mineralized tissue around the affected joint is made from the fat tissue, and the massage therapist can melt them away and cure Osteoarthritis. It is difficult to imagine such writing comes from a registered nurse, but this lack of scientific data in many massage publications is a sad reality.
After successfully solving the problem with Osteoarthritis and putting orthopedic surgeons out of work, since there is no further need for joint decompression, cleaning or replacement, the author moved on to new disorders. Now the main topic is Restless Leg Syndrome (RLS). Again, we learned that patients with this abnormality developed plaques in the soft tissue that are 60% fat. Apparently, the author detected with her unique palpation skills the plaques in the soft tissue that no one was able to detect before, even though numerous studies have been performed to examine the origin of RLS, including studies on cadavers.
Although modern medicine associates RLS with many different causes: it is a symptom of peripheral neuropathy, it is caused by hyperreflexia, it is the result of a deficit or inability to metabolize iron or changes in dopamine metabolism, the author on her own detected some mystical plaque that “engulfs and traps nerves, which when irritated, begin to twitch”. As readers may see, Linda LePelley, RN, NMT, is on the cutting edge of science in regard to RLS since she bases her assumptions on one critical piece of knowledge: “as all my work indicated.” Is such a ‘scientific’ approach supposed to completely disarm any possible critic?
Here is another great quote from her article:
“Take note of the area at the medial aspect of the knee. It often forms a large, sensitive plaque within which nerves are engulfed and irritated. Much of your time may be spent here, carefully massaging crusted-over nerves, which feel like large, firm strands and bands.”
If, before writing the article, the author had simply bothered to open any anatomy textbook, she would have found that on the medial aspect of the knee there are no major nerves she felt encrusted that needed to be massaged. The common peroneal nerve is on the lateral aspect of the knee and the tibial nerve is located deeply on the posterior aspect of the knee.
So what plaques did the author feel, since in these areas the tissue density was present? We think it is time to enlighten the author about these dense areas she felt and called plaques. RLS is a disorder of the central or peripheral nervous system, and as a result of inappropriate innervation of the tissues, connective tissue zones (CTZ) are formed in the superficial and deep fascia. One of the major symptoms of CTZ formation is hardening of the fibrotic bridges that connect the superficial fascia to the skin, and these bridges pass through subcutaneous fat, making subcutaneous tissue harder, since it is now ‘glued’ between the superficial fascia and the skin. This is the real cause of tissue density that the author palpated. CTZs are a consequence of RLS rather than its cause. Instead of inventing a new pathology, which exists only in the author’s imagination and on the pages of Massage Today, the author should open any textbook on Connective Tissue Massage, and she would be able to find a very simple explanation of her palpatory finding.
Yes, in the article, the author mentioned that her research in the medical literature did not show that any plaques exist as an abnormality in the soft tissues, but this fact did not stop her anyway. We constantly ask ourselves this question: Why are articles like this one printed in massage publications? Why do some authors think that it is acceptable to feed readers such nonsense and, what is more important, why is such nonsense published? It still puzzles us.
The treatment called TDR, offered in the article as a solution to RLS, is very basic. At the same time, the combination of other modalities (e.g., connective tissue massage, PIR, vibration therapy, etc.) is a much more effective clinical tool.
A Chronicle of a Kyphotic Tennis Player. Massage Today December, 2012, Vol. 12, Issue 12
The article describes a fictional tennis player with pain and weakness in the right arm and wrist joint and explains the nature of her symptoms by the fact that she has “kyphotic posture + suspect anatomy + poor biomechanics + repetition of movements” and describes potential treatment. We completely agree with such a theoretical arrangement, but we would like to add that the patient may have similar symptoms if her anterior scalene or pectoralis minor muscle entraps the brachial plexus. In these cases, the proposed treatment is useless. We would like the readers to remember that.
Learning to Train the Myofascial System. Understanding Tibial Fractures and Medial Tibial Stress Syndrome. Massage Today
A good and informative article on the subject of tibial fractures, treatment options and prevention.
Massage Magazine
Swell. Fascia as Sponge. Massage Magazine November, 198:52-55, 2012
A great article!
Massage Therapy Journal
Calming the Tremors. Massage Therapy Journal Winter, V. 51(4): 90, 2012
This short article is a contribution by a reader who used massage to calm the client’s Essential Tremor (ET). We think that Nicole Riou deserves a lot of credit, especially since she decided to address this abnormality using massage therapy, since generally massage is not the first treatment option for patients with ET.
We would like to emphasize to the readers that massage therapy should be used as the initial treatment option for patients with ET, and if it is ineffective, the patient may use other treatment modalities. The article greatly illustrated this fact.
Stretching the Lower Back. Massage Therapy Journal Winter, V. 51(4): 17-22, 2012
A great article! As usual, Dr. Muscolino wrote a very good and informative piece.
Category: Good Apples, Bad Apples
Tags: JMS 2013 Issue #1
