he 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
Massage Therapy Journal
Massage & Bodywork Magazine
The Forgotten Hamstring. Working on the Short Head of the Biceps Femoris Muscle. Massage & Bodywork May-June: 31-32, 2013, by Art Riggs
A very good article on the roles and treatment options for the short head of the biceps femoris muscle. Generally speaking, the author deserves considerable credit for his column since in a very short format (2-3 pages) he manages to deliver valuable information based on his own clinical experience. The article is written in an easy-to-read format, which additionally helps readers with different educational backgrounds.
Sometimes Pain is the Sum of Many Factors. Massage & Bodywork May-June: 35-37, 2013, by Douglas Nelson
The article by itself is a very simple piece but the author tries to deliver an important message: The pain your client has is not the result of only one factor (of course with the exception of accidents) but rather the sum of factors that slowly push the body in the wrong direction. Usually for a while, the body is able to compensate for such changes but they slowly build up until one particular moment when the sudden movement of even a simple sneeze becomes the last drop that overflows the cup. Then the client enters the stage of decompensation in which pain becomes the major factor.
Coracobrachialis. Massage & Bodywork May-June: 53-54, 2013, by Christy Cael
The author hosts a column on palpation in Massage & Bodywork Magazinein which she supposedly educates readers about the palpation of various muscles. We noticed a trend in her articles. As long as Mrs. Cael discusses the superficially located muscles, her articles are accurate. However, as soon as the author enters the area of complicated anatomical relations her articles fail readers greatly. This article is an excellent example of that failure.
The author discusses the palpation of the deeply located coracobrachialis muscle, but her recommendations are completely wrong. The position of the left thumb she uses for the palpation of coracobrachialis muscle as presented in the picture is incorrect since it compresses the neurovascular bundle composed from nerves that innervate the upper extremity and brachial artery and vein.
First of all, such mode of palpation when important neurological and vascular structures are compressed against bone, the humerus in this case, is unacceptable. Secondly, it completely misleads the practitioner who thinks that he or she is on the trigger point in the coracobrachialis while in reality the compressed nerves will trigger the pain.
We frequently criticize Mrs. C. Cael’s articles. We do not want readers to conclude we are targeting her column without reason. For example, here is quote from the article on how the author palpates the coracobrachialis muscle:
“1. Locate the anterior border of the scapula
2. Palpate posteriorly and laterally along the medial surface of the humerus
3. Locate the muscle belly deep and medial to the biceps brachii following toward it insertion on the medial shaft of the humerus
4. Ask the client to perform shoulder adduction, resist to ensure proper location.”
As you can see, there is not even a mention of the strategic location of the coracobrachialis muscle in regard to underlying nervous and vascular structures.
Let us now read how the coracobrachialis muscle must be correctly palpated. We will use the best scientific source on this subject Travel and Simmons “Trigger Point Manual. Volume 1”:
“…slide finger into the axilla beneath the deltoid and pectoralis major. The tip of the digit encounters the adjacent bellies of the short head of the biceps brachii and, more posteriorly, the coracobrachialis… The axillary neurovascular bundle passes along the coracobrachialis and must be displaced posteriorly (bold by JMS) to permit the digit to explore the fibers of the coracobrachialis by rolling them against the humerus”
What Mrs. Cael suggests in her article is to roll the nerves and vessels against the humerus. This is an unacceptable mistake that was printed in a national publication. If the author is unsure of her facts, she needs to do some basic research before she gets in front of her computer to write new article.
Elegance of Neuromodulation. Massage & Bodywork May-June: 88-97, 2013, by Jason Erickson
The article is dedicated to the type of bodywork called Neuromodulation and it targets skin to control pain analyzing system with different types of skin stretching, compression and rolling. Everything in the article is correct even mentioning that Neuromodulation should be part of a larger approach where other modalities are used to address different tissues.
We have only one problem with the article, or more precisely with Neuromodulation itself. As stated in the article by its author, D. Jacobs developed Neuromodulation in 2007. If this treatment option was developed only six years ago why do thousands of practitioners around the world who practice medical massage every day use exactly the same techniques described in the article when they try to eliminate cutaneous reflex zones developed as a result of nerve irritation or compression? Readers will get the completely wrong impression that Neuromodulation is a new and unique method of therapy.
In reality, the concept described as Neuromodulation is very old and, as a matter of fact, is the first stepping stone in medical massage development that is founded in the work of British physician Herald Head who, in the 19th century, developed the concept of cutaneous reflex zones, now known as Head’s zones. Since the work of two German physicians, Dr. Glezer and Dr. Dalicho (1955), the techniques described in Erickson’s article are successfully used by medical massage practitioners without knowing that someone later at the beginning of 21st century will re-invent them under the attractive name “Neuromodulation.” This is great example of so-called re-packaging of the same ideas without giving credit to their original authors.
Soothing Mom’s Aches and Pains. Soft Tissue Strategies for New Mothers. Massage & Bodywork May-June: 102-105, 2013, by Whitney Lowe
Very informative article on important changes in the soft tissues of the female body that occurs after child birth. The risk of potential injuries is discussed as well as general treatment options.
Increasing the Mechanical Advantage with the Optimal Posture. Massage & Bodywork May-June: 107-108, 2013, by Mary Ann Foster
This is a good introductory article about kinesiology and its effect on balancing the muscular system. Several articles we reviewed before discussed kinesiology as a first treatment option. In clinical reality, kinesiology should be used later in treatment. It is a very helpful treatment tool when the patient’s pain analyzing system is under control; the muscle tension is eliminated as well as secondary developed reflex zones. At this point of the treatment, kinesiology becomes an excellent clinical tool since it helps finalize the entire treatment by restoring muscle balance and prevent similar symptoms happening in the future. It seems that the author of this article shares the same vision.
Working With Thenar Eminence. Massage & Bodywork May-June: 114-117, 2013, by Til Luchau
Very good article on thenar abnormalities. Pathology, possible compression syndromes as well as some treatment options are discussed.
Proper Body Mechanics in All Postures. Massage & Bodywork July-August: 42-43, 2013, by Anne Williams
Bodywork is the generation of mechanical energy and transferring it to the client in the form of massage strokes. If we agree with this basic principle, it means that correct body mechanics must help generate as much energy as possible with the least possible physical strain. Practitioners can achieve this goal only when they use proper leverage. Without understanding the concept of leverage, practitioners will burn themselves out very quickly or be unable to perform more complex techniques that are part of medical massage. As Archimedes said in 200 BC, “Give me a lever long enough and a place to stand, and I can move the Earth.”
This article is incorrect in every suggestion. Ironically, what is described as a wrong body posture actually is a correct one. It seems that the concepts of center of gravity, third point of support, leverage, isotonic contractions and so on are not familiar to the author. Since it would be a long review to correct all the mistakes in the article, we offer one example. Here is quote from the article on how the practitioner should position his or her body while working on the client located directly in front:
“In the symmetrical stance, the feet are shoulder-width apart with the toes pointing forward. The knees are slightly bent and directly above the feet. The back is straight…”
Let us just generally enumerate the mistakes that will injure the practitioner’s back with repetitive usage of such posture which is also presented in the picture:
1. There is no contact with the table which eliminates chance of having third point of support for the practitioner’s body weight.
2. Feet placed on the same level eliminate any possibility to easily shift weight from foot to foot in the anterior posterior direction.
3. Instead of bending both knees, they need to constantly work with mild flexion/extension to provide shock absorption and allow the muscle pump of the lower extremities to work easily instead of increasing peripheral vascular resistance when muscles are under steady pressure.
4. In the recommended position, the center of the gravity pushes on the L4-L5 disks instead of being transferred in front of the body by slightly bending the upper body forward and using body weight as a component of each stroke.
5. Locking the lower back in a straight position makes back muscles work in the isometric instead of isotonic regime and is directly responsible for their spasms and tension building in the vertebral segments.
These incorrect body mechanics recommended in article contribute to the main reasons practitioners leave the massage therapy profession. Articles similar to this one that are frequently published in professional publications contribute to this unfortunate fact.
If you are looking for a method to reduce body strain while increasing your professional efficiency, please refer to the very important article “Body Mechanics” published in November/December 2009 issue of JMS. In this article, we cover the most common mistakes in body mechanics and provide all necessary biomechanical and physiological explanations.
Peripheral Neuropathy. A Panoply of Problems. Massage & Bodywork July-August: 44-47, 2013, by Ruth Werner
This is a very good overview of peripheral neuropathy. It does not provide any practical recommendations on how to treat the patients with this pathological condition but overall it is difficult task.
Massage therapy plays a supportive role and its goal is to slow down the disease and increase the patient’s quality of life. Varieties of very careful (at the beginning) sensory stimulation are the best treatment option: touch, pressure, ice, hot, vibration, compression, gentle pinching, percussion should alternate with each other during the session. However, sensory stimulation needs to be conducted only within the patient’s comfort level.
Flexor Hallucis Longus. Massage & Bodywork July-August: 51-52, 2013, by Christy Cael
The article’s subject is the palpation of the flexor halluces longus. Despite that the article is correct about the anatomy and physiology of the hallucis longus muscle, the actual palpation section of the article presents the palpation of flexor halluces longus’s tendinous part in the tarsal canal without examination of the belly itself. Thus, the article has only partial practical value for practitioners.
Irritated by Impingement Syndrome? Addressing Serratus Anterior and the Trapezius May Help. Massage & Bodywork July-August: 82-87, 2013, by Peggy Lamb
Excellent article! Thank you!
Take a Stand Against Plantar Fasciitis. Massage & Bodywork July-August:102-105, 2013, by Whitney Lowe
A very good and informative article on Plantar Faciitis with clear illustrations. The only piece of important information is missing in the article is the fact that very frequently Plantar Fasciitis is the result of mild irritation of the tibial portion of the sciatic nerve. In such cases, the local treatment on the sole of the foot is useless since the real problem is located on a completely different level starting from the sacroiliac joint all way to the tarsal tunnel. In all these areas, mild irritation of the tibial nerve will trigger the same clinical picture as Plantar Fasciitis without it being so. We see patients with this cause of Plantar Fasciitis on a weekly basis after they have gone through different local therapies without getting stable clinical results.
Treating Adaptive Muscle Patterns. Massage & Bodywork July-August:107-109, 2013, by Mary Ann Foster
This is the second part of an article on kinesiology and its use to restore muscle balance. It is a very helpful source for those who may be interested in adding kinesiology into their massage practice regimen.
Working With Fibula. Massage & Bodywork July-August:114-117, 2013, by Til Luchau
Great article! We highly recommend it to readers.
Dealing with Painful Foot Injuries, Part 1. Massage Today April, 2013, Vol. 13, Issue 04, by Ben Benjamin, PhD and Karen Ball, LMT
This is the first part of an article on painful injuries. It provides a very general description of some abnormalities on the foot but missed many important ones. There is no significant valuable information for readers in this article.
Help in Understanding Parkinson’s Disease, Part 1. Massage Today April, 2013, Vol. 13, Issue 04, by Ann Catlin, LMT, NCTMB, OTR
This is Part I of a two-part article on Parkinson’s Disease. The author does a very good job briefly describing the pathophysiology and clinical picture of Parkinson’s Disease. We are curious to read Part II where treatment options in the form of massage therapy will be discussed.
Reclaiming Functional Feet: The Janda Short Foot Exercise. Massage Today April, 2013, Vol. 13, Issue 04, by Nicole Nelson
Great article! As one commentator correctly mentioned in her post about this article that it is great that Dr. Janda’s ideas are finally reaching American massage therapists. We would like to add only one important piece of information to the article. Mild irritation of the tibial portion of the sciatic nerve or tibial nerve itself (e.g., inside soleus canal) will greatly contribute to the functional impairment of the major players on the plantar foot. In these cases, local treatment on the foot itself addresses only the consequence of the real problem, which lies in a completely different area far above foot which is exhibiting clinical symptoms.
The Journey to Find the Cause of a Pain in the Butt. Massage Today May, 2013, Vol. 13, Issue 05, by Debbie Roberts, LMT
Overall this is a very good article. It is fun to read and it shows that the author is a very thoughtful and caring therapist with an above-average level of professional expertise. The article describes the author’s attempts to help a client with a gluteal pain, which had tendency to radiate to the thigh. As it was later revealed by CT, the client had damaged the disk and, at this point, the author’s position changed. As she stated at the end of the article:
“We can often times be fooled by thinking it is a muscle because we are in the business of treating dysfunctional muscles and getting temporary relief of symptoms. By not over treating and encouraging the patient to seek further tests, we play a vital role in our clients’ health and well-being.”
The author is completely correct that over-treating of somatic abnormalities is a real problem. Look at some clients who go through countless visits to DC, PT or MT who treat them with the same protocol over and over again, telling the patient that the body needs time to heal. Despite our general agreement with the author’s position, we completely disagree with the final statement of the article. A damaged disk is not the reason to stop medical massage therapy. As a matter of fact, medical massage therapy is the last line of defense before spinal surgery. We are not saying that medical massage therapy can decisively help all patients with degenerative disks problems but it is a solution for a significant percentage of them.
The pressure on the intervertebral disk comes from three major sources: the force of gravity, the patient’s weight and protective muscle spasm of lumbar erectors, quadratus lumborum muscles and short rotators. MEDICAL MASSAGE PROTOCOL allows the restoration of the normal anatomical length of these muscles and resets muscle spindle receptors to the new normal threshold of their activation. These two major treatment outcomes in many cases significantly change the clinical dynamic since they greatly reduce pressure built up in the vertebral segment and unload the compressed disk. It gives patients a chance to make long-lasting lifestyle changes (lose weight, strengthen lower back muscles, start to use inversion table, change daily routine, etc.). As a result, patients are able to lead a normal life without risk of spinal surgery. We observe such results on weekly basis in our clinic.
Thus from our perspective, the final conclusion in the article discourages practitioners to learn correct and effective MEDICAL MASSAGE PROTOCOL and deprives patients of such an important treatment option.
Technique Synergy: Blending Unique Combinations for Success. Massage Today May, 2013, Vol. 13, Issue 05, by Whitney Lowe, LMT
The author defined the article’s subject as “technique synergy.” This topic is very important and overall it is known under the commonly accepted name of the integrative approach to evaluation or treatment. However, the author decided to coin his own definition and he has all right to do so. We are glad that people have finally started to discuss the integrative approach to somatic rehabilitation, which will benefit the entire profession.
The article attempts to illustrate “technique synergy” with the example of diagnostic evaluation of Carpal Tunnel Syndrome. This is where the article becomes confusing. The article discusses several tests that the practitioner supposedly used to make the evaluation of Carpal Tunnel Syndrome easier. Each test presented in the article is correct in its execution and even in interpretation of its results. However, the author makes incorrect clinical conclusions from these tests, and consequently makes incorrect recommendation for practitioners.
The article discusses: Phalen’s Test, Phalen’s Test Modification, Hand Elevation Test and Tethered Median Nerve Stress Test. The article states that all four tests are designed to clinically confirm presence of Carpal Tunnel Syndrome. Unfortunately, this is not correct, and this misleading conclusion will steer practitioners to an application of incorrect treatment protocol.
In clinical reality, only Phalen’s Test and Tethered Median Nerve Stress Test (without any additional modification also discussed in the article) will give any valuable clinical information about possible irritation or compression of the median nerve in the carpal tunnel. Phalen’s Test Modification or Hand Elevation Test have nothing to do with Carpal Tunnel despite that their reading will besimilar to Phalen’s Test and Tethered Median Nerve Stress Test: parasthesia, numbness, or burning pain on the wrist and palm.
A positive Phalen’s Test Modification will indicate an irritation or compression of the brachial plexus on the anterior neck by anterior scalene muscle while a positive Hand Elevation Test points to the irritation or compression of the brachial plexus on the level of anterior shoulder by the pectoralis minor muscle. Thus, their positive reading does not accurately confirm the presence of Carpal Tunnel Syndrome but points to two completely different pathologies: Anterior Scalene Muscle Syndrome and Pectoralis Minor Muscle Syndrome. Both these syndromes will produce a similar clinical picture of Carpal Tunnel Syndrome while the real trigger is located in the completely different, higher level: the anterior neck and anterior shoulder.
At the end of the article, the author also mentioned that Tethered Median Nerve Stress Test can be even more specific in regard to Carpal Tunnel Syndrome if the forearm supination becomes an additional component. The article is wrong again since if the sensory abnormalities triggered on the palm during forearm supination, it means that the median nerve is now irritated or compressed on the level of anterior elbow by the pronator teres muscle, and the practitioner now faces another abnormality called Pronator Teres Muscle Syndrome, which again has nothing to do with Carpal Tunnel Syndrome despite exhibiting the same clinical symptoms.
Thus, the major mistake of the article is to confuse the clinical value of the described tests, which will have a significant impact on treatment outcomes. For example, the practitioner uses the Hand Elevation Test and finds it is positive since during its execution the patient feels numbness forming on the palm of the elevated hand. If the practitioner follows the article’s advice, he or she will think the patient has Carpal Tunnel Syndrome and, as a result, will use the local treatment protocol to free the median nerve in the area of carpal tunnel. However, as we discussed above, the Hand Elevation Test points to the irritation of the median nerve on the level of the anterior shoulder by pectoralis minor muscle. In such case, the only correct choice of the therapy is work on the anterior shoulder to free the brachial plexus from the irritation by pectoralis minor muscle.
Thus, despite that the article has a noble goal of promoting an integrative approach to the diagnostic evaluation or how it is called “technique synergy,” the examples used in the article misleads practitioners, and directs them to the wrong treatment choice, which diminishes the clinical effectiveness of treatment.
Massage Therapy Journal
Helping Clients to Manage Migraines. Massage Therapy Journal 52(2); 54-77, 2013, by Helen Tosch
The article is a very good review of different types of headaches, the clinical symptoms associated with them and some pharmacological treatment options. This article can be a great educational piece for the general public to provide some basic understanding of the migraine and very general description of available treatment options. However, in regard to massage therapy as a treatment option, the reader gets very limited knowledge in the form of “massage is good.”
This article is great example of what is wrong with Massage Therapy Journal (MTJ). It seems that the majority of articles published in MTJ are written as if the magazine’s audience is the general public. Being the official publication of the American Massage Therapy Association (AMTA), with only four issues published each year, MTJ lives in its own world disconnected from the sizable section of American practitioners who need and crave the scientific and clinical support which MTJ is unwilling or unable to provide so far. We agree with many therapists with whom we communicate who said that MTJ is the last publication they will use to find scientifically sound professional information, which is a very sad fact.
Working the Hands in Concert-The Force Couple Technique. Massage Therapy Journal 52(2):15-23, 2013, by Joseph E. Muscolino
Articles by Dr. Muscolino are only the bright spot in MTJ. They consistently provide very helpful information. We think that Dr. Muscolino will find himself in much better company in, let us say, Massage & Bodywork Magazine, rather thanMTJ.
Muscolino’s article discusses bi-manual approach to somatic work. Everything is correct there. The only problem we have with the article is its topic in regard to massage practitioners. The author is a very skillful chiropractor and he shares his expertise with the readers who don’t have same level of training. Despite that the article warns that this treatment must be conducted only after special training, we still believe that it belongs more in the chiropractic field rather than massage therapy. Besides the need to have extensive training, this approach may put massage practitioners who practice it in legal conflict of interest with local Chiropractic Boards.
Massage Through Movement. Kinessage. Massage Magazine 206, July 2013, 50-54, by Katheleen Gramzay, LMT, NCTMB
The article discusses Kinessage that is combination of bodywork and practitioner’s movements at the same time. It is a different look on stress-reduction bodywork, and may help those who would like to ensure personal flexibility while doing different types of stress reduction bodywork.
Total Body Balancing. Massage Magazine 206, July 2013, 44-47, by Kerri D’Ambrogio, DOM, AP, PT, DO-MTP
The goal of the article is to introduce Total Body Balancing to readers. The article correctly discusses important issues but it does not provide any specifics, making it impossible to conclude how Total Body Balancing is different to, let us say, Myofascial Release. Thus, the article leaves the readers clueless about Total Body Balancing except this general description, which can be applied to many different types of bodywork.
Category: Good Apples, Bad Apples