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.
Solving a Client Puzzle. How To Know Whether It’s Tennis Elbow Or Nerve Entrapment. Massage Today January, 2013, Vol. 13, Issue 01, by Whitney Lowe, LMT
Excellent article! It was a professional pleasure to read, and we recommend it to every massage practitioner who practices the medical aspects of massage therapy.
Dosage Affects Immune and Endocrine Response to Massage. Massage Today January, 2013, Vol. 13, Issue 01, by Derek R. Austin, MS CMT, Jolie Haun, Ph.D. EdS LMT, Sandra K. Anderson, BA, LMT, ABT
This is a very interesting article that reviews the results of a study in which the authors examined the impact of once and twice weekly Swedish massage sessions on the human body. We recommend that therapists who practice stress-reduction massage should read the results of this study. More articles like this one are needed.
TDR Massage for Headache Prevention and Relief. Massage Today January, 2013, Vol. 13, Issue 01, by Linda LePelley, RN, NMT
This article discusses headache treatment by the “newly” developed TDR massage. Despite that the treatment offered in the article is a helpful part of an overall treatment protocol of medical massage, the author, as usual in her articles, failed to understand the nature of the pathological changes that occur in the soft tissues affected by headache.
The author recommended treatment of secondary symptoms of headache in the form of scalp tension as the main treatment option, which is a completely incorrect and misleading position. The increased tension in the scalp is not the cause of headache but it is the sequence of other causes: irritation of the greater or minor occipital nerves, Vertebral Artery Syndrome, TMJ Dysfunction etc.
We have discussed all the scientific information about medical massage and headache management in the following issues of JMS in 2012 #2(pathophysiology of headaches); #3 (diagnostic evaluation of the patient with headache), #4 (diagnostic evaluation of the secondary symptoms associated with headache) and in the 2013 issues: #1 (MEDICAL MASSAGE PROTOCOL for headache management) and #2 (treatment of secondary symptoms associated with headache). Please refer to these articles to learn about the science behind medical massage rehabilitation of patients with chronic headache and migraine-type headaches.
At the end of our short review, we would like to share one of the quotes from the article which we really enjoyed:
“As massage therapists, it is not within our scope of practice to diagnose the type or severity of a client’s headache, but once we have determined there is no underlying pathological cause, there is much we can do to relieve, and even prevent, their headache pain.”
We understood the author’s point, that diagnosis is not within the scope of the practice. However, we are simply curious if the therapist does not have right to examine the patient how can he or she can “…determine if there is no underlying pathological cause”? Even in one sentence, the author contraindicated herself. Unfortunately, it has become a bad practice for Massage Today’s Editorial Board members to fail in their oversight of the content of published articles.
Dissection: A Unique Way to Learn. Massage Today January, 2013, Vol. 13, Issue 01, by David Kent, LMT, NCTMB
The author discusses learning the benefits of dissection for massage practitioners offered by the University of Florida School of Medicine. We cannot agree more. If readers have any opportunity to take this or a similar class, please do so. It will completely change your views and practice.
Freeing the Heart: The Role of the Autonomic Nervous System. Massage Today January, 2013, Vol. 13, Issue 01, by Dale G. Alexander, LMT, MA, Ph.D.
After torturing Massage Today’s readers in 2012 with a series of articles on “Freeing the Heart,” the author has finally published a decent piece on the impact of the autonomic nervous system on the heart function. The author’s idea that gastric contents leaks into the pericardium and triggers the cardiac arrhythmia became our inside joke, which we share with other health practitioners who found it equally entertaining.
Of course this article has its own flaws. For example Mr. Alexander states that:
“Considering hypertension and high blood pressure, what I sense has been overlooked is that the 60,000 miles of our human vasculature is principally innervated by the sympathetic division of the ANS (i.e., autonomic nervous system by JMS) as contrasted to the heart’s innervation by both the vagus nerves from the brain and the sympathetic nerves from the spinal cord.”
Yes, it is correct that the sympathetic nervous system is responsible for the innervation of the circulatory system while the heart is innervated by both the sympathetic (stimulates cardiac function) and the parasympathetic (inhibits cardiac function) divisions. However, as usual in his articles, Mr. Alexander makes one-sided conclusions that support his personal views, which in the majority of cases are in complete disagreement with science. Mr. Alexander does not know, which is unfortunate, or he purposely misleads, which is sad, readers about the innervation of the circulatory system.
If the author refered to any medical physiology textbook before writing the article he will learn that the sympathetic division of the autonomic nervous system has two types of receptors that innervate blood vessels: a-receptors and b-receptors. a-receptors are responsible for the vasoconstriction and this is what the author referred to in his article while b-receptors of the same sympathetic nervous system are responsible for the vasodilation. It appears in his article, that the author is completely unaware or hides this fact on purpose.
Let us say, that we are exercising and while doing so our sympathetic nervous system becomes very active. If Mr. Alexander’s idea is correct as he “sensed it” according to his article, activation of sympathetic nervous system must trigger general vasoconstriction. However, in the physiological reality, which never occurred to the author, exercise triggers general vasodilation. In such case, the same sympathetic nervous system the author blames for everything is responsible, depending on the circumstances, for the general vasodilation because b-receptors are activated and the vasoconstriction because a-receptors are activated.
Finally, on a personal observation: Besides a couple of errors, which are minor compared to the previous pieces, the article correctly explains the influence of the autonomic nervous system on the cardiac function. This information is available in every basic textbook on Medical Physiology, which is probably what was used by the author. However, the information in the article is presented in a very peculiar way. Mr. Alexander’s entire article is filled with the author’s personal remarks such as: “From my point of view,” “I propose,” “My premise is,” “I sense,” (our favorite); “I speculate,” etc. There is no need to present yourself as a profound thinker while using well-known information, which might not be known to some readers. If an author knows something, it is professional to just share that knowledge without giving readers the wrong impression that the information in the article is only a result of your own deep thinking process. It is simply not.
At the end of this review, we also would like to express our very deep and profound thanks to Annie Dundon, Glenn Gaffney, Katie Truax-Alexander and Dr. Ed Charlton for their editorial support and guidance to Mr. Alexander, which finally put his articles on the right track.
Following a Road Less Traveled. Finding the cause of chronic shoulder pain where you least expect it. Massage Today February, 2013, Vol. 13, Issue 02, by Debbie Roberts, LMT
What a great article! It is fun to read, very educational and shows readers how important the thinking processes are to therapists if he or she would like to be clinically effective. We think that articles such as this one encourage all practitioners to work in the medical massage field. Thank you, Mrs. Roberts!
Fear Avoidance and the Issue of Chronic Pain. Massage Today February, 2013, Vol. 13, Issue 02, by Nicole Nelson
Great article which illustrates that: “…pain may involve more than structural problems, making our job as massage therapists a bit more intricate than addressing leg length discrepancies or elevated shoulders.” We can sign under each word in this statement. The author is doing an excellent job of supporting her article and views with the proper analysis of the scientific data. We recommend that Mr. McCann, whose article we have also reviewed below should read this piece to see how good article supposed to look.
Know What to Look for in That Other Tunnel in the Wrist. Massage TodayMarch, 2013, Vol. 13, Issue 03, by Whitney Lowe, LMT
Very informative and important article which is dedicated to the irritation and compression of the ulnar nerve in the Guyon’s tunnel in the wrist. This is a very rarely mentioned pathology, and the article gives a very good overview of the problem, its diagnostic evaluation and consequent treatment options.
Pain Rehabilitation Associated with the Head, Neck and Shoulders.Massage Today March, 2013, Vol. 13, Issue 03, by Don McCann, MA, LMT, LMHC, CSETT
First of all, in this review we are not reviewing the Structural Energetic Therapy (SET) developed by the author since he successfully hid it from readers and has made it impossible to draw any conclusion from the article about what SET actually consists of. We are reviewing the article itself, which is strictly a promotional article. It is really strange but Massage Today is the only national publication which continues to publish empty, promotional articles like this one.
The article itself is like a mirror which reflects everything about what is wrong with the clinical application of massage therapy. The article promotes what the author call the “golden nugget” of somatic rehabilitation. Let us analyze the article about this piece of gold from a basic scientific point of view.
1. THERE IS NO SILVER BULLET IN THE SOMATIC REHABILIATTION
Generally speaking, many therapists are under the impression that there is one modality, which they will learn one day that will change the practice forever and make them clinically successful in every case. Many educators effectively use this widespread belief to their benefit.
Following this sad pattern, the article opens with a groundless plea that here it is a new miracle in the form of Structural Energetic Therapy (SET) which promises in one sweeping motion to cure “…painful TMJ symptoms, shoulder issues, headaches, neck pain caused by whiplash, tension, arthritis, disc issues and even stenosis.”
Without even thinking twice, the author puts into one basket a variety of somatic abnormalities and links them not by the pathophysiology or by clinical picture but the treatment he advocates in the form of SET. It is simply astonishing. All these complicated sometimes multi-layered somatic abnormalities are simplified to accommodate the clinical application of SET that from now on cures everything.
The successful somatic rehabilitation comes not from one modality but from and integrative approach in which several modalities are combined for every patient. This concept is effectively suppressed and resisted by everyone who would like to proceed with the fragmentation of this great profession for their own personal benefit.
2. WHERE IS THE CHICKEN, WHERE IS THE EGG?
In this is never-ending story in continuing education, we have observed so far: countless seminars, books, DVDs and diagrams all pounding the practitioner with the same misleading concepts. Structural changes in the form of tilted pelvis, round back, flat cervical lordosis or different level of the shoulders holds the key to the various somatic abnormalities, and this misleading concept is foundation of entire article. Let us quote the author, who espouses many similar quotes in the article.
“Again, you are limited in treating the soft tissue symptoms without first releasing the torsion and the high/low shoulder patterns caused by the core distortion no matter how good your soft tissue treatment is.”
The body and its functions have a very logical arrangement. We would like the author of the article in addition to all readers pause for a second and follow this body logic. As you may see in the quote, the author’s position is that only reversing the structural changes by SET will allow the practitioner to obtain stable clinical results. However, this is a completely inaccurate and self-misleading concept.
Let us say that the patient has acute pain in the right shoulder. First, the body’s response to acute pain is protective muscle tension, which will lock the affected joint to prevent movement that may cause additional damage. The practitioner may see that as restriction of ROM or as “high/low shoulder patterns.”
In another scenario, the patient suffers from chronic pain in the right shoulder. In this case, the initial protective reaction becomes fully developed structural changes. In both cases, according to the article, the practitioner should remove the structural changes, which is supposed to solve the entire problem. However, as we discussed above, the structural changes are body’s response to the initial trauma or irritation of the nerve that supplies the affected area. Thus, removing structural changes using SET or any other similar approach will address the consequence rather the underlying and real problem that initially triggered the pain.
Thus, the only correct approaches to somatic rehabilitation is, first of all, to find, isolate and remove the initial source of pain by using medical massage techniques (“myofascial restructuring, structural integration, neuromuscular or other deep tissue treatments”) which the author considers less clinically valuable just because he thinks so.
Does elimination of structural changes have merit? Yes, it definitely does. If we follow the basic concept of integrative approach to the somatic rehabilitation discussed above, we will find that SET and similar techniques may be of great help in later stages of the therapy. For example, the therapist has successfully eliminated the source of chronic pain and, if after the pain is gone, the examination reveals the patient still has structural changes, then the therapist should address it with SET or other techniques. It is a very common case since long-lasting chronic pain changes entire body mechanics as the author correctly mentioned in the article.
In summary: The article puts the chicken before the egg since any scientifically sound somatic rehabilitation will address structural changes only after pain is no longer a factor. In many cases, after the successful elimination of pain, the body takes its guards down and structural changes melt away by themselves. Only if they are still present after the pain is eradicated, may the practitioner address them with SET or any other similar modality.
3. CONSTANT REPACKAGING OF THE SAME IDEAS UNDER NEW NAMES
The original concept of structural integration was developed by I. Rolf, and all ideas McCann discusses in his article are a repackaging of Rolf’s concept. Thus, it seems that the author invented the bicycle. Of course, it is much more time consuming to learn Ida Rolf’s concept and successfully practice it. Instead the “golden nugget” is offered to readers. The most amazing part of the article is that the author successfully hid from readers what is required in the practical application of SET. There is no glimpse into the treatment protocol simply a link to a website with a list of conveniently provided classes. Thus, the article itself is an empty promotional piece that does not provide any valuable information to readers.
Massage & Bodywork Magazine
Lymphedema and Massage. What You need to Know. Massage & BodyworkJan/Feb: 42-45, 2013, by Ruth Werner
A very good article on a very important subject of Lymphedema, its development and pathophhysiology.
Anatomical Snuffbox. Massage & Bodywork Jan/Feb: 49-50, 2013, by Christy Cael
Very good article on the anatomy of the snuffbox, its palpation and stretching.
The Pelvic Lift. A Rolf-Approved Session Finisher. Massage & BodyworkJan/Feb: 96-101, 2013, by Tomas Myer
A great article on the pelvis-lift technique and especially the author’s tribute to Ida Rolf.
What Is Deep Tissue Massage? Massage & Bodywork Jan/Feb: 102-105, 2013, by Anna Williams
An excellent article on deep tissue massage. This article and article contributed by B. Prilutsky on the same subject, which is published in thecurrent issue of JMS, complement each other.
Building Treatments For Construction Workers. Massage & BodyworkJan/Feb: 106-109, 2013, by Whitney Lowe
A good article about the most common injuries suffered by construction workers with pathophysiology and treatment options. However, we think the treatment protocols must go beyond cross friction and passive stretching, which are discussed in the article. We would add lymph drainage massage just after the injury and PIR as the final part of somatic rehabilitation.
Working With The Ilia. Massage & Bodywork Jan/Feb: 114-117, 2013, by Til Luchau
A very informative article. Highly recommended read.
Knowledge Is Power: Help Clients Understand Their Conditions. Massage & Bodywork Feb/Mar: 35-37, 2013, by Douglas Nelson
We hope that readers do not miss this article. It seems simple and discusses a single case of interaction between the therapist and the patient, but the subject of this small article is very important. The therapist must invest time and energy on working with patients to explain every detail about what the therapist found during the examination, what these finding mean to the patient and what the practitioner plans to do as treatment options. The therapist must be sure that the patient works in conjunction with the practitioner rather than only acting as a spectator who observes their treatment from the side. Only by this active engagement in the treatment process can the patient give the therapist the feedback necessary to achieve stable clinical results.
Pervasive Pain. Central Sensitization Situation. Massage & BodyworkFeb/Mar: 42-45, 2013, by Ruth Werner
This is a very good and informative article on such an important subject as pain. Our only problem with this article is the absence of information on the impact of massage on the central sensitization. There is a lot of scientific data that confirm this impact, and we plan to address this important issue in special articles in future issues of JMS.
Pectineus. Massage & Bodywork Feb/Mar: 49-51, 2013, by Christy Cael
A good article on the anatomy, action and palpation of the pectineus muscle.
Working With Shoe-Bonding Arch. Massage & Bodywork Feb/Mar: 114-117, 2013, by Til Luchau
A very good article written on feet deformation as well as its treatment options.
Massage Therapy Journal
Psoas Major Function. A Biomechanical Examination of The Psoas Major.Massage Therapy Journal V 52 (1), 17-31, 2013, by Joseph E Muscolino
A simply exceptional article! Mr. McCann the author of previously reviewed article could learn what the real “gold nugget” of professional information is supposed to look like. The article is dedicated to psoas major muscle’s anatomy and function, but it is a multilayered piece. The author went to great extent to cover other topics including the type of muscle contraction, muscular biomechanics, etc., and links all information in one logical, evidence-based and scientifically sound piece. Thank you very much!
Infant Massage. Massage Magazine March, 202: 46-51, 2013, by Phyllis Hanlon
This is a journalist-type article on Infant Massage. The author emphasizes the important point that, for a healthy infant, the massage practitioner’s job is to teach the parents to work daily on their babies. Everyone is a winner in this case.
Clinical Assessment. Is It Carpal Tunnel Syndrome or Median-Nerve Compression? Massage Magazine April, 203: 42-47, 2013, by Whitney Lowe
The article is dedicated to a very important subject: Median nerve compression along its pathway that may trigger a 100% clinical picture of Carpal Tunnel Syndrome while the real cause is hidden in a completely different area. The article does an excellent job of providing readers with the correct location of areas where the median nerve can be entrapped and a guide to the various tests to examine cases of Median Nerve Neuralgia to differentiate it from the Carpal Tunnel Syndrome itself. This part of the article is excellent and illustrations are a considerable help. Also, we would like to cite from the article:
“There have been cases in which carpal tunnel syndrome surgeries have been performed, only to find later, after symptoms fail to improve, the problem is not in the wrist but in the thoracic outlet region.”
We completely agree with this quote, and we would like to add that it is more than “…there have been cases…”. In our clinics, we regularly encounter patients who have gone through unnecessary carpal tunnel surgeries or were scheduled to do surgery while the real cause was in a completely different part of the neck or upper extremity. Unfortunately, this is a widespread problem. We would like to express our appreciation to the author who addresses such an important topic.
Now let us discuss what is lacking in the article. The treatment strategies presented are insufficient or, in some instances, incorrect. Let us quote the article:
“Because there are potentially multiple sites of entrapment, working the entire arm and the upper chest region has clinical advantages”.
No, such approach does not offer clinical advantages especially at the beginning of therapy. It confuses the CNS and undermines the practitioner’s efforts to achieve stable clinical results. Let us come back to the first part of the article. As it was correctly pointed out by the author, the median nerve can be entrapped by intervertebral disk or paravertebral muscles on the posterior neck, by the anterior scalene muscle on the anterior neck, by the pectoralis minor muscle on the anterior shoulder, by the pronator teres muscle on the anterior elbow or, finally, on the palmar surface of the wrist by the flexor retinaculum.
Now let us say that the part of the brachial plexus, which gives origin to the median nerve, is compromised by the pectoralis minor muscle on the anterior shoulder. In such case, the patient will exhibit clinical symptoms of Median Nerve Neuralgia in all parts of the upper extremity, which are innervated by the median nerve and are located below the level of anterior shoulder where it is entrapped by pectoralis minor muscle.
According to the article, the therapist should work along the entire pathway of the median nerve starting from the posterior neck all the way to the hand. However, this is an incorrect approach since the practitioner must concentrate on the area of entrapment because it holds the key to the entire clinical picture. The nerve must be freed as soon as possible and it makes no clinical sense to work on anterior scalene muscle (in our discussed case) if the brachial plexus is not affected there. At the same time, it is completely irrelevant what has happened to the forearm and hand since these symptoms in the patient are secondary symptoms.
The correct actions in our discussed case will be the specific application of MEDICAL MASSAGE PROTOCOL for the Pectoralis Minor Muscle Syndrome to free the brachial plexus first to restore the nervous impulses conductance along the median nerve. If after the treatment, the symptoms of the median nerve’s entrapment by the pectoralis minor muscle disappear but the patient still has residual clinical symptoms of Median Nerve Neuralgia, which is frequently the case, only at this point should the practitioner work on the tissue below the anterior shoulder to eliminate residual components of the initial clinical picture.
There is another strange suggestion in the article:
“However, you should never directly massage an impinged nerve”.
Of course no one is supposed to apply deep compression or percussion along the inflamed nerve, but initial Lymph Drainage Massage as well as application of the light longitudinal and cross fiber frictions as well as manual or better electrical vibration along the pathway of the affected nerve are parts of every clinically sounded MEDICAL MASSAGE PROTOCOL. Ironically enough, three paragraphs below, the author advocates exactly that since the article suggests neural-mobilization technique. According to the description, this technique consists of a variety of pulling and stretching along the affected nerve.
Category: Good Apples, Bad Apples