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
Helping Clients Achieve Ease in Movement. Massage & Bodywork Magazine, Sept-Oct.:32-33, 2013, by Art Riggs
As usual, this is an excellent article by this author. We know that, unlike some authors who only lecture, Art Riggs actually works with his clients on a daily basis. His down-to-earth column is a real gem in Massage & Bodywork Magazine since it presents real clinical experiences based on authentic procedures used in the treatment room. In this article, the author discusses the steps for restoring the elasticity of soft tissues in professional and amateur golfers.
Transversus Abdominis. Massage & Bodywork Magazine, Sept-Oct.:49-50, 2013, by Christy Cael
The article correctly describes the anatomy, physiology and palpation of the transversus abdominis muscle.
Stand Up Against Lower-Back Pain. Massage & Bodywork Magazine, Sept-Oct.:104-107, 2013, by Whitney Lowe
This is an excellent review of the potential causes for lower back pain due to occupations that require standing. We applaud that the author insists that massage of the iliopsoas muscle through the anterior abdominal wall and intestine is an incorrect and potentially harmful approach to the treatment of lower-back pain.
Visualizing Joint Surfaces During Passive Motion. Massage & Bodywork Magazine, Sept-Oct.:108-109, 2013, by Mary Ann Foster
A very good article on the patterns of joint movements, which provides basic terminology and explains the basic principles of passive-joint movements.
Working With the Masseter. Massage & Bodywork Magazine, Sept-Oct.:114-117, 2013, by Til Luchau
An excellent article on intraoral treatment for cases of TMJ dysfunction that is accompanied by tension in the masseter muscle.
Muscles as Team Players. Massage Today, June, 2013, Vol. 13, Issue 06, by Erik Dalton, PhD
An important article that reminds practitioners that muscles work together, and that their balanced relationship is the key for the proper function of the musculoskeletal system.
Dealing with Painful Foot Injuries, Part 2. Massage Today, June, 2013, Vol. 13, Issue 06, by Ben Benjamin, PhD and Karen Ball, LMT
The article reviews self-help hints and tools to reduce foot pain, and may be helpful for practitioners who spend hours on their feet.
Freeing the Heart: Protection of the Hip and Shoulder Joints. Massage Today, June, 2013, Vol. 13, Issue 06, by Dale G. Alexander, LMT, MA, PhD
This author offers a long-awaited article that finally makes sense on the subject of the hip and shoulder relationship to heart function. The article correctly identified that tension developed in the shoulder and hip joints contributes to the restriction of chest expansion and consequently will affect pulmonary and cardiac functions.
As usual, the author was unable to resist adding his strange opinions to his article. This time, the author informed readers about his personal theory on how our primate ancestors developed the anatomo-physiological arrangements of the shoulder and hip joints. According to the article, the author explained weaknesses in different parts of the joint capsule is caused by the simple fact that sudden trauma (e.g., an ancestor fell from a tree and safely rolled on the ground) was a main factor in the development of such weak areas, and in the positioning of the head of the humerus and head of the femur in the shoulder and hip joint. In actuality, human ancestors started to use completely different biomechanics by changing from walking on all fours to an erect, bipedal position, and that the force of gravity changed the anatomical arrangements of the body, including the major joints. These facts, as well as many other evolutionary and natural factors, somehow escaped the author’s attention.
Adventitious Tissue Structures of Elevated Tissue Density. Massage Today, June, 2013, Vol. 13, Issue 06, by Linda LePelley, RN, NMT
One of the most ridiculous articles published in massage journals lately. The author continues to disseminate unscientific ideas using Massage Today as a vehicle. First of all, we hold no doubt of LePelley’s ability to help her clients who are in pain, but her explanations …!
From article to article, the author states she is puzzled by the presence of “rubbery, firm areas” in the soft tissue that are very painful when pressure is applied. She labels them Elevated Tissue Density (ETD). This is a correct clinical observation. Yes, indeed, these areas have been well known in medicine since the 1930s and even have a scientific name and explanation. Unfortunately, the author did not make even the basic effort to find out this information, but developed her own absurd theory about their origin. Here is the author’s new achievement:
“My thoughts regarding the etiology of elevated TD involve the lipid-rich components of our extracellular fluids, which I believe are attracted to the bio-polymeric nature of our cartilaginous tissues. This attraction, combined with a variety of dynamic factors, including body heat, compressive force, overuse, injury, hypo-hydration, torsion, sheer force, tensile force, inertia, chemical environment and fluid viscosity may cause the extracellular fluid to accumulate, thicken and eventually precipitate into gelatinous plaque. Over time, I believe that these plaques harden and become mineralized, turning into the rubbery nodules or bone-like overgrowth of arthritic joints, as well as contributing to many other conditions. The plaque may be as thin as a sheet of a single layer of fascia cells or it can form a large area of many tissue layers sandwiched together, such as those found over arthritic hip joints and the thick, tender pads which so often develop at the medial aspect of knees.” (I suspect that the main component of this conglomeration is cholesterol.)”
We do not even know where to start with our assessment of this information in our review. One needs to work really hard to fit so much nonsense into one paragraph. Let us discuss this incredible mix of unscientific data, personal beliefs, and correct ideas step by step in the form of a letter to the author.
Dear Mrs. Linda LePelley,
1. Elevated TD, which you recently discovered for yourself in the form of rubber density pathological changes in the soft tissue, is actually called myogelosis and has been known since 1930s. These areas can also develop in the fascia and aponeurosis and, in these cases, are called Connective Tissue Zones (CTZ).
2. “My thoughts regarding the etiology of elevated TD…”
Your thoughts about the etiology are completely inaccurate since, according to scientific data, elevated TD or myogelosis and CTZ, to be completely correct, are not the results of “lipid-rich components of extracellular fluids”. As a matter of fact, the first link in the chain of events responsible for the formation of these areas is the deposit of glycosaminoglycans (GAG) between myofibrills. GAG is the combination of proteins and sugars. Eventually, pro-collagen deposited by fibroblasts in the same areas uses GAG as a framework. Later, the pro-collagen fully matures into collagen fibers. This network of collagen fibers gives these areas a rubber-like density. As you can see, no “lipid-rich components of extracellular fluids” are involved.
3. You are completely wrong if you think that “lipid-rich components… are attracted to the bio-polymeric nature of our cartilaginous tissues.” It may surprise you but all areas you described in your article-right heel, medial edge of the scapula and lower back-do not have cartilaginous tissue. This is a simple anatomical fact. These bones are covered by the periosteum.
4. You are correct in stating that “dynamic factors, including body heat, compressive force, overuse, injury, hypo-hydration, torsion, sheer force, tensile force, inertia, chemical environment and fluid viscosity may cause the extracellular fluid to accumulate and thicken”
5. “I believe that these plaques…”
Do not believe yourself because “gelatinous plaques,” to which you constantly refer do not mineralized since if they did such changes would be visible on simple X-rays and this is not the case. “Gelatinous plaques,” as you call them, are transparent and do not appear on X-rays. Thus, it is impossible to see them with the mineralization you somehow linked them with.
6. What did you want to say when you stated “sheet of a single layer of fascia cells”?
We would like to inform you and Massage Today that neither the superficial nor deep fascia contains “single layer of the fascia cells” because there is no such thing as fascia cells. Fascia is a fibrous tissue comprised of various fibers: collagen (the most abundant), elastic and reticular. The only cells that are present in fascia are fibroblasts, which produce collagen and cells that migrate into the fascia, e.g., mast cells or myoblasts. However, even those cells are never arranged in layers but rather are sporadically caught by the net of fibers.
7. Please drop your suppositions about cholesterol. They are absolutely groundless. Cholesterol accumulation is not the cause of elevated tissue density.
Yes, obese patients have a tendency to have more musculoskeletal pain. However, as it was recently shown by Rechardt et al, (2013), increased concentration of bad lipids in the blood may intensify pain not because of the accumulation of lipids and cholesterol in the soft tissue as LePelly suggested but by the narrowing of the supplying arteries.
In relatively rare cases when cholesterol is accumulated in the soft tissue, it is called cholesterol granuloma and xanthoma. These pathological formations are considered to be benign tumors.
Dear Mrs. Linda LePelley,
We do not ask much, just that before you begin work on your next article, please open the Internet and check your thoughts. They may not align with modern science. If you continue to skip this important part of your writing process, your articles will confuse practitioners, which we are sure will be detrimental to the profession.
Rechardt M, Shiri R, Lindholm H, Karppinen J, Viikari-Juntura E.Associations of metabolic factors and adipokines with pain in incipient upper extremity soft tissue disorders: a cross-sectional study. BMJ Open. 2013; 3(8): e003036.
Windisch A., Reitinger A., Traxler, H., Rander H., Neumayer C., Feigl, W.Morphology and Hisochemistry of Myogelosis. Clin Anat, 12(4): 266-271, 1999
Help in Understanding Parkinson’s, Part 2. Massage Today, June, 2013, Vol. 13, Issue 06, by Ann Catlin, LMT, NCTMB, OTR
Part 2 gives a very general overview of treatment options for patients with Parkinson’s Disease (PD). Only three modalities are mentioned: Alexander’s Technique, Neuromuscular Therapy and Swedish Massage. We disagree with the author when she states that, in her opinion, Swedish massage is “…especially effective for PD symptoms,” and scientific studies supported our point of view. However, the author has a point by saying that Swedish massage has the impact of “…substantial changes in mood.”
We observe such misunderstandings quite frequently. PD is an extremely complicated health problem, which requires a multidisciplinary approach to its treatment from all medical professionals and, at the same time, requires an integrative approach to somatic rehabilitation by massage practitioners. This is the only correct clinical solution. Instead of measuring three modalities against each other, the author should emphasize that the correct clinical approach to the treatment of PD is a combination of modalities. In such case, the practitioner must employ elements of Neromuscular Therapy to improve “… motor symptoms of PD, which would contribute to improved ability to perform activities of daily living” and Swedish Massage to enforce “…substantial changes in mood.”
We hope that one day practitioners and educators will start to embrace the concept of using somatic rehabilitation especially for chronic conditions. Such an integrative approach will encourage therapists to combine techniques and approaches instead of locking themselves into a narrow treatment philosophy or using only the one or two modalities they are comfortable practicing.
Freeing the Heart: The Importance of the Vagus Nerves/Cranial Nerve X. Massage Today, July, 2013, Vol. 13, Issue 07, by Dale G. Alexander, LMT, MA, PhD
We carefully read Alexander’s article as well as some references he provided to support his ideas. The article is correct in some instances. Yes, indeed, the body has a so-called enteric nervous system, which is quite extensive and manages the functions of the GI tract without 100% control from CNS. The enteric system is able to work independently by using a widespread system of neurons and sophisticated production of neurotransmitters through GI tract similar to those that control brain function.
Neurogastroenterology is a relatively young branch of neuroscience, yet it already has made significant contributions to medicine. For example, Campo et al., (2003) as well as many other scientists, pointed to the gastrointestinal (GI) disorders as one of the major contributing factors to the development of depression or mood disorders in the same patients later in life. This phenomenon is easily understood in the content of serotonin production by the enteric nervous system. A decrease in serotonin concentration is the primary cause of a variety of psychological and psychiatric disorders. This is why serotonin re-uptake inhibitors, which are prescribed to patients with depression, anxiety and other abnormalities, also greatly improve their GI functions.
However, there are several statements in the article that fluctuate from being debatable to simply incorrect.
The author was greatly surprised by the well-known fact that the vagus nerve is 10% motor and 90% sensory, and he used this fact to form his own conclusions. There is nothing unusual about the vagus nerve being mostly a sensory nerve. Since the enteric nervous system is able to function independently from CNS, the brain and spinal cord do not need to send motor output to control GI function. Considering that the GI tract has a large absorption surface and pathogens can easily enter through the circulation system, the emphasis should be on immediately obtaining all sensory information about the function of the patient’s GI function and all possible dangers.
Anyone who follows Alexander’s articles will notice an interesting tendency. The author will use scientific data as a justification to support his own strange and sometimes bizarre theories. As we reviewed in this issue of JMS, the author’s previous article tries to explain weaknesses in major joint capsules and the complex anatomical arrangement of the head of the humerus and head of the femur in shoulder and hip joints by the fact that our primate ancestors were falling from trees and rolling to safety.
Here is a new one about the author’s hypothesis on the cause of human aging (please notice his humble beginning: “my latest premise…”)
“My latest premise about human aging is that the vagus nerves, for many possible reasons, cedes the functioning of the digestive system to the enteric nervous system which is probably overseen by the celiac plexus. The ceding of this responsibility is proposed to be the result of the need for the organism as a whole to concentrate its efforts toward running of the heart/lung complex and its contributions to our ability to speak.”
It is an inexplicable mystery how exactly the vagus nerve “…cedes the functioning of the digestive system to the enteric system”. The vagus nerve is just a pathway that only conducts information back and forth without playing any role in its generation. Let us make a simple analogy. Imagine that the author attributes a fire in a town to the road that connects the town to the state capital. Would anyone believe that? We do not think so but it is exactly what Alexander is telling readers in his article.
We are perfectly aware of the fact that the author may argue that an accident occurring on the road may delay fire trucks coming from the capital to help put out the fire. However, in the case of vagus nerve, this is not the case. Remember the author’s fascination with the vagus nerve being only 10% motor? If we continue the analogy we used, 10% of putting out the fire in the town would depend on the condition of the road (i.e., the vagus nerve) because the rest, 90%, of fire extinguishing capacity comes from the firefighter service based in the town itself or, in our case, the ability of the enteric nervous system located in the GI tract to control its functions independently.
As Ying Li , Chung Owyang (2003) showed, cutting the vagus nerve and completely eliminating the overseeing of CNS over the GI function triggers an adaptive reaction from the enteric nervous system, which now continues to work completely independently even without 10% motor input.
Also, why does the author believe that the celiac plexus, which is just a large railway station and is part of NS, elicits control over enteric nervous system since it is able to work independently from CNS? It is simply puzzling how someone will consider that such a multidimensional biological process as aging, which is the result of a wide array of factors from genetics to environment, can be squeezed into the concept of one cranial nerve ceding the functioning of the digestive system to the enteric nervous system. In his newly developed theory, Alexander successfully solved problems that have challenged modern gerontology, and considers this fact his personal achievement.
It seems that only Massage Today will publish Alexander’s theories, which from article to article, address more and more universal topics and successfully solves them in the pages of the same publication.
Campo JV, Dahl RE, Williamson DE, Birmaher B, Perel JM, Ryan ND.Gastrointestinal distress to serotonergic challenge: a risk marker for emotional disorder? J Am Acad Child Adolesc Psychiatry. 2003 Oct;42(10):1221-6.
Ying Li, Chung Owyang. Musings on the Wanderer: What’s New in Our Understanding of Vago-Vagal Reflexes? V. Remodeling of vagus and enteric neural circuitry after vagal injury. American Journal of Physiology, Gastrointestinal and Liver Physiology, 285 (3): G461-9, 2003
The ABC’s of Meeting with Physicians, Part 2: The Meeting. Massage Today, July, 2013, Vol. 13, Issue 07, by David Kent, LMT, NCTMB
It is gratifying that the subject of interaction with physicians is discussed. The article correctly emphasizes basic concepts of such interactions. There are two things we would like to add. First, practitioners must speak using the same language as a Western-trained physician. You will have far less success if concepts of energy, karma, etc., are part of the discussion. Secondly, start with local family physicians. Every family practice has a number of patients who are considered “dead weight”. Please understand this analogy in its correct perspective.
Every family physician has a number of patients with chronic pain who have gone the rounds of specialists and ended up in the same office with the same symptoms. Every time they visit the doctor, they complain about the same pains but the physician has already used all available treatment options. These patients strain the resources of the office of a family practice since they demand solutions but the doctor is unable to offer anything further except increasing the dosage of pain medication. Massage therapy practitioners with medical massage training and expertise might want to ask these overtaxed family physicians to send the most difficult patients since there is nothing to lose for the doctor’s office. By helping some of these difficult patients, the therapist will be able to get more and more referrals from the same physician. Doctors will greatly appreciate you and your treatment since you were able to alleviate his or her practice of these difficult patients.
Allostatis: A New View of Stress and How it Affects the Body. Massage Today, July, 2013, Vol. 13, Issue 07, by Nicole Nelson
An excellent article that offers new insights on many well-established beliefs about stress.
The Theory of Orthopedic Massage, Part 1. Massage Today, August, 2013, Vol. 13, Issue 08, by Ben Benjamin, PhD
Overall this is a good article that offers some basic concepts of medical massage. With all due respect to Lowe, we do not think the term “Orthopedic Massage” that he coined (according to the article) is the correct one. In the article, the author describes the conditions that go well beyond orthopedy but are somehow considered part of it. However, this is just our personal opinion and overall the name is immaterial as long as practitioners are taught to do things correctly.
A New Model for Low Back Pain and Dysfunction. Massage Today, August, 2013, Vol. 13, Issue 08, by Dale G. Alexander, LMT, MA, PhD
A very well-written article.
When Feet Take a Beating: Working with Morton’s Neuroma. Massage Today, September, 2013, Vol. 13, Issue 09, by Whitney Lowe, LMT
A very good article on Morton’s neuroma.
Tissue Density Restoration Massage for Plantar Fascitis. Massage Today, September, 2013, Vol. 13, Issue 09, by Linda LePelley, RN, NMT
The treatment of Plantar Fasciitis (PF) suggested in this article overall is a correct approach but lacks the precision of a ready-to-apply protocol. The clinical application of medical massage is far more superior to the author’s personal observations since the application is based on the anatomy and biomechanics of the foot as well as the fact that the upper parts of the lower extremities and lower back may hold the real key to PF.
It is a very good sign that the author finally stopped spreading her own theory about nature of elevated tissue density, which she usually links with the accumulation of lipids and recently even with cholesterol (see review above).
“I myself, not being a research scientist, can only guess about and hope that one day it (etiology of elevated tissue density) is determined”
We have already informed the author in this issue of JMS that the nature of elevated tissue density is already well-determined, but it appears she simply missed this important information. Apparently this is why elevated tissue density puzzles her so much and takes so much space in her articles.
Vacuum Therapies for Pain Relief. Massage Magazine, 208:22-26, 2013, by Anita Shannon LMT, Rita Woods, LMT
The article gives a general overview of vacuum therapy for pain relief. Vacuum therapy is an excellent tool for massage practitioners to employ. Unfortunately, the article is only a general description of vacuum therapy without any practical recommendations. To be fair to the authors, more likely it is not their fault but rather Massage Magazine’s strange policy to publish articles in a journalistic format rather than as a serious professional source of information that readers can immediately implement in the therapy room.
Neuromuscular Therapy. Help Clients Live Better in Their Bodies.Massage Magazine, 208:22-26, 2013, by Lara Stillo, HHP
The title of the article promises a discussion of neuromuscular therapy. Unfortunately, this is not the case. The article starts with a short (less than 1/3 of a page), very general description of neuromuscular therapy. Later, the author states that:
“One of the best ways to understand neuromuscular therapy is via specific cases and how neuromuscular therapy, as an approach, addresses the issues”
Following this statement, the rest of the article is a general, brief description of three cases in which the author was able to help her clients. The article does not describe the clinical value of neuromuscular therapy nor does it give readers enough valuable clinical information in the form of clinical-case examples to learn from.
Another excerpt from the article wherein the author describes the nature of trigger point says:
“Trigger points are small, contracted spots in the muscle that may be extremely difficult, or even impossible, to release”
It is really strange to read that the trigger point is “extremely difficult or even impossible to release.” If this is the case, the practitioner would be unable to find the initial cause of the trigger-point formation. In another scenario, she encountered a condition called myogelosis. First of all, myogelosis is not a trigger point and despite its impossibility to be completely relieved, is a very well-controlled condition.
Neural Manipulation. Massage Magazine, 208:60-64, 2013, by Jean-Pierre Barral, DO, MRO (F), RPT
This great article is an excellent example that even in the journalistic style used by Massage Magazine can be helpful if the author bases his or her writing on the essential information and knows the subject.
Expert Advice. As My Clients have Aged, the Incidence of Osteoarthritis I See in My Practice has Grown. How Can I Best Help With This? Massage Magazine, 209:38-39, 2013, by Deborah Reuss, HHP, NCTMB
Osteoarthritis (OA) is a widespread problem that has different causes. In response to the question sent to Massage Magazine, the expert gave some valuable information about OA, and stated that clients with OA react positively to Swedish massage based on a couple of studies that are mentioned in the article.
Unfortunately, using full body Swedish massage as a clinical tool to deal with OA is comparable to jousting with windmills. Of course, clients feel better since Swedish massage, as any type of bodywork, inhibits the activity of the pain analyzing system, reduces stress and maintains some basic elasticity of the soft tissue. However, all of this does not halt or decrease the development of OA.
There is a type of medical massage, called Periosteal Massage (PM), which was specifically developed for cases of OA by two German physicians, Dr. Vogler and Dr. Krauss. This is the modality that should be used on every client with OA to slow its progress. PM in combination with work on the soft tissue around the joints and work on the origin of innervation of the affected joint is the only sound solution that results in stable clinical results.
Medical Massage. Massage Magazine, October:52-56, 2013, by Karen P. Armstrong, NCTM
This article is a basic introduction to the application of massage therapy in hospital practices. Basically, the article concentrates on the application of therapeutic massage in the hospital setting and is only a small portion of the medical massage concept, which is broader and much more sophisticated. Full-scale application of medical massage is an excellent clinical tool for patients in every hospital department. The author describes what is currently accepted in the hospital setting. Let us hope that one day the concept of offering the full range of medical massage in hospitals will be fully accepted.
Massage & Stretching to Address Plantar Fasciitis. Massage Magazine, 209, October:64-67, 2013, by Thomas J. DuBois, LMT, NCTMB
Generally, this is a good article on Plantar Fasciitis. However, we think the weak part of the article is that it concentrates only on one treatment option, Active Isolated Stretching (AIS). Despite that AIS is a very helpful technique, the integrative approach to patients with Plantar Fasciitis is a much more sophisticated and efficient clinical process.
The integrative approach to Plantar Fasciitis identifies its initial cause and uses multiple modalities to alleviate the effects of the condition. Using only one modality as a treatment option significantly reduces the clinical effectiveness of the therapy. For example, many patients with Plantar Fasciitis develop this abnormality secondary to a low-grade irritation of the tibial portion of sciatic nerve even though they have never felt any other symptoms of Sciatic or Tibial Nerve Neuralgia. It does not matter how successful the application of AIS is, the same symptoms will return sooner or later because the practitioner has only addressed local soft-tissue abnormalities without diagnosing the initial cause. What about Chronic Calcaneal Spur or Soleus Canal Syndrome, which can be a secondary trigger for Plantar Fasciitis? In all these cases, work on the bottom of the foot is completely irrelevant since the real cause is in a completely different part of the lower extremity. Only after the original cause is treated, should the practitioner work on the plantar fascia itself. However, even in this scenario, other modalities such as cross-fiber friction (which the author appears to have ignored), or Periosteal massage, must be combined with AIS to create a more effective treatment protocol.
Massage Therapy Journal
Body Mechanics. To Flex or Extend? Massage Therapy Journal, 52(3): 17-25, 2013, by Joseph E. Muscolino
Thank you for an excellent article! We highly recommend it to everyone who is in the medical massage field or wishes to move their practice in this direction.
Massage & Arthritis. Massage Therapy Journal, 52(3): 54-61, 2013, by Rachel Syms
The article discusses the application of massage for clients with rheumatoid arthritis (RA). The article is an excellent source of information to educate the general population about the clinical benefits of massage therapy for patients with RA. However, it has only limited professional value for practitioners.
Integrating Assessment Into Intake. Massage Therapy Journal, 52(3): 62-79, 2013, by Julia Goodwin, LMT
Excellent article about initial evaluation of the client. Thank you!
Category: Good Apples, Bad Apples