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
Massage Therapy Journal
Training Myths and Young Athletes. Massage Today October, 2013, Vol. 13, Issue 10, by Debbie Roberts, LMT
This article presents a case study of lower-back injury. Although the author’s evaluation skills are excellent, the treatment protocols she applies are insufficient. Considering the patient’s age, type of injury and diagnosis, his pain could be eliminated in three to four sessions by implementing correctly developed MEDICAL MASSAGE PROTOCOL. Instead, after three massage therapy sessions, the patient ended up in physical therapy three times per week for six weeks in addition to prednisone therapy. All of this was an unnecessary waste of the patient’s time and insurance money.
Instead of using a combination of lymph drainage massage and ice therapy for all three sessions, the author should have used MEDICAL MASSAGE PROTOCOL. She should use lymph-drainage massage at the beginning of the session, but later address the soft tissue in the lower back on a layer-by-layer basis, slowly eliminate tension and strain built up in each layer separately, remove the protective muscular tension, reset the muscle spindle receptors and, finally, address the periosteum at the insertion of the major-muscle groups. Unfortunately, the author’s evaluation skills did not result in effective treatment choices. The following are quotes that describe her treatment plan:
“The only treatment I did that day was a lymphatic type of massage to help reduce inflammation and spasm. I kept him on his side to avoid any strain to the lumbar region with pillows between his knees. I did alternating massage between my hands and an ice cup the entire one hour. He felt better after the treatment, which relieved the symptoms but not the cause. I saw him two more times.”
“After six more weeks of receiving physical therapy, he was still in discomfort… The orthopedist gave him a course of prednisone.”
The Theory of Orthopedic Massage, Part 2. Massage Today October, 2013, Vol. 13, Issue 10, by Ben Benjamin, PhD
Overall, this is a good article that offers many correct recommendations and concepts. At the same time, the article is an example of some misconceptions found in orthopedic massage.
The author correctly describes the basic approach to the evaluation of soft tissue but it seems his goal was to find and diagnose injury. However, realistically, the treatment that targets areas of pain, in many cases, is not always the correct choice. What is described in the article only applies to patients with acute trauma or chronic overload. If, during the evaluation, the patient tells of the episode when he or she experienced pain for the first time (e.g., the patient lifted a heavy object), the recommended approach to the evaluation and treatment is correct. However, if there is no history of acute injury the patient remembers, the practitioner should not limit the evaluation to the area where the patient feels pain or other pathological symptoms. Thus the first step in a correct diagnosis is the examination of the pathway of the peripheral nerves, which are responsible for the innervation of the affected area.
The following are quotes from the article that uses the clinical symptoms of a rotator-cuff injury as an example of the author’s assessment:
“As one example, resisted lateral rotation of the shoulder is a major indicator of an injury to the infraspinatus muscle-tendon unit. For example, once you’ve identified an infraspinatus injury, pain on passive elevation tells you that the injury is likely located in the tendon at the tenoperiosteal junction, rather than in the muscle.”
These recommendations are clinically valuable only when the injury to the rotator cuff is present. However, in a clinical reality, this is not always the case because mild chronic irritation of the suprascapular nerve that innervates the infraspinatus muscle will 100% mimic the symptoms of a rotator cuff injury without the existence of an injury. Also the soft tissue injury may develop secondary to chronic irritation of the peripheral nerve since the innervation of the affected area is compromised.
The infraspinatus nerve can be irritated on the posterior neck by the cervical paravertebral muscles on the C5-C6 level or on the anterior neck in the upper part of the brachial plexus. The therapist must evaluate these areas first, and if the symptoms are present, treatment must target one or both of these areas. Thus, the assessment recommended in the article is only partially correct and, without a comprehensive evaluation, local evaluation and treatment alone in the area of shoulder will be a waste of time and the symptoms will rapidly reoccur.
These are not rare cases. Practitioners may be surprised at the number of patients with rotator cuff or other soft-tissue pathologies when chronic irritation of the peripheral nerve is a silent trigger, or that the injury developed secondary to chronic inflammation of the peripheral nerve since the innervation of the affected area is compromised.
Another issue we have with the article is the treatment option that is presented as the primary approach: cross-fiber friction. Without doubt, cross-fiber friction is a valuable technique but it is supposed to be a component of a treatment session. The sole use of cross-fiber friction in a treatment protocol is like listening to a symphony which is performed by one violin instead of a full orchestra. As we mentioned in the review above, the practitioner must use a wide array of techniques to restore mobility and elasticity of the soft tissues on a layer-by-layer basis, slowly eliminate tension and strain built up in each layer separately, remove protective muscular tension, reset muscle-spindle receptors and, finally, address the periosteum at the insertion of the major muscle groups. Any less treatment offers only temporary relief.
Understanding Core Distortion: Unlocking Your Potential. Massage TodayOctober, 2013, Vol. 13, Issue 10, by Don McCann, MA, LMT, LMHC, CSETT
The article addresses core distortion that, when treated, is suppose to unlock you or your patient’s potential. The article is correct on some issues. However, Mr. McCann’s mistake, which he continues to make from article to article, is the fact that, in many cases, core distortion is not the cause of the various body pains discussed in the article but their consequence. We have already reviewed similar articles in previous issues of JMS in which authors, including Mr. McCann, do not realize that core distortion frequently is the body’s protective reaction to chronic pain and, in this case, what happens to the core is completely irrelevant.
First, the practitioner must control the pain-analyzing system and address the origin of the pain. Only after this critical step is achieved, should the practitioner consider the various distortions in the patient’s posture and body mechanics and, if needed, correct them. In many cases, the elimination of the pain source allows the body to correct these abnormalities by itself.
Here is a strange quote from the article:
“Ninety-five percent of musculoskeletal pain and dysfunction results from the lack of support within the core distortion.”
What is the source of this information? We would like to see a reference that supports such a ridiculous statement. It seems this statement serves only to support one cause: promotion of Structural Energetic Therapy developed by the author.
If the patient, especially a young person, does not suffer from acute or chronic pain but has poor posture with a visual imbalance, the author’s approach would be helpful. In any other case of chronic pain, the core distortion is the body’s attempt to cope with pain and diminishing it by changing body mechanics and posture.
Other important clinical observations, which we witness on a weekly basis in our clinic, are the various somatic therapies, which have been used on older patients with the promise of improving their posture or performing activities, such as golf, etc. In such cases, chiropractors, PT or massage practitioners noticed postural abnormalities with various restrictions even though their older patients do not exhibit significant clinical symptoms. After reading Mr. McCann’s and similar articles, practitioners who found such changes in their patients will convince them that his or her treatment will greatly improve patient’s quality of life. Eventually, the attempts to correct core distortions without clinical justification often result in these seniors coming to our or other clinics for relief from pain resulting from such therapies.
For older patients, many body or core distortions are the result of the motor cortex rearranging the entire somatic system. For example, pelvis tilt or rotation is the only way the body is able to keep the L5 spinal nerve from compression from a bulging disk or the straightening of cervical curvature through the head’s forward projection is the body’s protective reaction to avoid additional vertebral artery compression. Unjustified attempts to correct visible physiological distortions including core distortions may greatly compromise the health of older patients.
Yes, the older patient exhibits core distortion but, at the same time, this imbalance assists in the process of natural ossification of intervertebral disks, which, when complete, will keep older patient out of pain for the rest of live.
Examining the Anterior Pelvic Tilt. Massage Today November, 2013, Vol. 13, Issue 11, by Whitney Lowe, LMT
We suggest that Mr. McCann, whose article we just reviewed above, read this article by Mr. Lowe to better understand the subject he writes about. Contrary to Mr. McCann’s article, Mr. Lowe clearly emphasizes that pelvis distortion is a result of outside forces that trigger misbalance, and these initial triggers must initially be addressed.
There are some questionable areas in Mr. Lowe’s article especially with regard to leg discrepancy if the patient has an anterior pelvic tilt. The author is correct when he states that leg discrepancy in the pelvic tilt is functional and a result of outside forces, e.g., quadratus lumborum muscle which imbalances the pelvis. However, the explanation of this fact provided in the article is debatable.
“The assumption that an anterior pelvic tilt would push the lower extremity inferiorly also discounts the fact that when you are standing on the lower extremity, the pelvis physically cannot push the leg down” (?????? by JMS). Instead, the pelvis rotates around the hip joint.”.
If the person in a weight-bearing position stands on his or her feet, the pelvis creates vertical pressure to the hip bone because of the force of gravity and the person’s weight. Furthermore, soft tissues run between the pelvis and hip bone add additional force, which will increase the pressure on the hip bone with the anterior tilt. The notion of the pelvis just going back and forth around the hip joint without pushing the leg down is simply puzzling. It seems that the author approaches the relationship between the pelvis and the femur from a very mechanical view and, in a clinical reality, this is never the case. We are positive it is incorrect to view the complex relationship between the femur and the pelvis based strictly on the mechanical model of a machine.
The Sternocleidomastoid Muscle and Cervicogenic Headaches. Massage Today November, 2013, Vol. 13, Issue 11, by David Kent, LMT, NCTMB
The article is dedicated to the fact that cervicogenic headaches can be triggered by tension and active trigger points in the sternocleidomastoid muscle. Yes, indeed, tension in this muscle can be one of the possible causes of headache. However, this is not the most frequent cause of cervicogenic headache since the major contributors are the posterior cervical muscles. In any case, the sternocleidomastoid muscle must be examined in every patient seeking treatment for headache.
Timing is Everything: Shoulder Instability and Labral Tears. Massage Today December, 2013, Vol. 13, Issue 12, by Debbie Roberts, LMT
There is no doubt that the author demonstrates her excellent diagnostic skills in her articles. In her first article, (Massage Today, October, 2013, Vol. 13, Issue 10), her evaluation was correct but she formulated an inadequate treatment protocol. In this current article, the author has made the correct decision. Based on the type of injury, its mechanism and clinical finding, a consultation with an orthopedist was the correct decision before any massage treatment.
Know What You Are Dealing With: Radiation Therapy and Massage.Massage Today December, 2013, Vol. 13, Issue 12, by Tracy Walton, LMT, MS
A good review article on radiation therapy and what therapist should do while the patient goes through the radiation therapy.
Ancient Cupping Tools Brought into the Modern Therapeutic World.Massage Today December, 2013, Vol. 13, Issue 12, by Shannon Gilmartin, CMT, CMCE
This is an excellent article on cupping that complements the article on the same subject published in this issue of JMS.
Using TDR Massage When Treating Sciatic Nerve Pain. Massage TodayDecember, 2013, Vol. 13, Issue 12, by Linda LePelley, RN, NMT
The author continues to promote her personal invention in the form TDR, which in reality is just another name for the basic massage therapy strokes she performs on her clients. It is great news for massage practitioners that in this article, the author avoided the disturbing theoretical conclusions she made before in the pages of Massage Today. Unfortunately, we were forced by the author and Massage Today’s Editorial Board to spend significant time reading and reviewing the inaccurate conclusions in her articles. Even in this article, the author tried to inject her own theoretical conclusions that are, as usual, contrary to medical science.
One of the examples is a new term Mrs. LePelley created to describe areas with increased tissue density – adventitious tissue structures. Here is the author’s explanation from her previous article:
“I refer to these tissue structures as “Adventitious” because they are extraneous and they do not belong where they occur”
So, the author found an area of increased tissue density that she tries to explain its presence on a basis that it is “extraneous.” “Extraneous” to what? Instead of seeing such areas as a local pathological change in the soft tissues on different levels, she describes them as some kind of foreign formations. These areas are pathologically changed, and have their own already widely accepted names: connective tissue zones, hypertonus, myogelosis, etc., depending on the tissues in which they developed. It is completely unprofessional to create your own terminology and, thus, confuse readers.
Massage & Bodywork Magazine
To Results. Massage & Bodywork Nov/Dec 2013, 35-37, by Douglas Nelson
This article does not offer much practical information nor does it pretend to. At the same time, this is great motivational piece since it illustrates the most critical aspect of medical massage: Never give up! The author did an exemplary job describing his case and, despite repeated failures in assessment, he remained committed to finding and curing the cause of the patient’s pain. Eventually, he achieved his goal without sending the patient to PT, a DC or an orthopedist.
We always offer the following analogy for our students: When dealing with complicated cases of chronic pain, the therapist should imagine that he or she walks in a hall filled with closed doors. The solution is behind one of the doors but you will never find it until the therapist knocks on every new door if the previous does not open. Personal ego and an erroneous belief system are the two major reasons for treatment failure. Mr. Nelson’s article greatly illustrates this point.
What a Headache! Get a Handle On a Moving Target. Massage & BodyworkNov/Dec 2013, 44-47, by Ruth Werner
A very good article that offers a general review of headache and emphasizes the importance of massage therapy as a treatment option. From our clinical experience, medical massage is a major tool to help patients with headaches. In cases of true migraines, massage therapy helps decrease the intensity and frequency of attacks. However, in cases of tension and cluster headaches, it is a first treatment option which, in many cases, is able to completely cure headache. We agree with the statement from the article that:
“It is quite possible for a skilled massage therapist to build a practice based on expertise with headache management”
Temporalis. Massage & Bodywork Nov/Dec 2013, 51-52, by Christy Cael
An accurate article on the anatomy, function and palpation of the temporalis muscle.
Bodywork For the Eyes. How Visual habits Can Create Body Tension.Massage & Bodywork Nov/Dec 2013, 83-89, by Marybetts Sinclair
An excellent article especially with regard to its topic. Since 2009 when JMS started reviewing articles in national professional massage publications, this is the first article that addresses such an important but overlooked topic as the correlation between eyesight and various types of the body tension. This article starts this important discussion, and the author and Editorial Board deserve considerable credit for addressing this issue.
We would like to make some additions. The eye treatment was not mentioned in the treatment options suggested in Mrs. Sinclair’s article. We discussed it in the issue #2, 2013 of JMS. We have observed countless times significant improvements in a patient’s eyesight after several eye treatment sessions were performed.
Now, About You. Addressing MT Injuries. Massage & Bodywork Nov/Dec 2013, 102-107, by Whitney Lowe
A great article that discusses the most common professional injuries experienced by massage therapists as well as prevention and treatment options.
Assessing Joint Actions Along Lines of Muscular Pull. Massage & BodyworkNov/Dec 2013, 108-109, by Mary Ann Foster
A very good article on assessing joint biomechanics and the application of PIR to restore the anatomical length of the affected muscle and eliminate muscle tension.
Working With Bone. Massage & Bodywork Nov/Dec 2013, 114-117, by Till Luchau
A very informative article on bone physiology. The section on treatment reflects the author’s expertise with Myofascial Techniques. He approaches treatment from this perspective only, discussing myofascial techniques that target mobility, motility and connection. These are helpful techniques but they are not what the article promises in its title. Yes, the tension in the soft tissues that insert into the bones is an important component of the therapy, but pathological changes in the periosteum itself is an equally important target of therapy if these changes are present. Unfortunately, the article offers no information on working with the periosteum itself, which is what needs to be done when practitioners treat the bone.
Massage Therapy Journal
A New Angle on Refreshing Your Practice. Massage Therapy Journal 25(4): 36-43 2013, by Carole Osborne
The article discusses the benefits of the side-lying position for clients and massage therapists. Without doubt, the side-lying position is a critical position for pregnant women, and also can be beneficial for elderly clients or clients after abdominal, thoracic or facial surgeries. The author of the article accurately discussed other conditions that require the patient to lie on their side: pacemaker, colostomy bag, chemotherapy port, radiation burn, etc.
The side-lying position can be part of the medical massage session if the therapist determines that he or she will be able to provide additional clinical benefits while the patient is placed on a side when a specific technique is performed. The article also gives a detailed description on how to position and drape the client on the side. This information will be greatly appreciated by many practitioners.
However, when Mrs. Osborne discusses the side-lying position in clinical applications, she makes incorrect conclusions and claims the use of the side-lying position alone will “boost your business.” We greatly disagree. Here are examples of her assertions:
“Most therapists, for example, have a long-term client whose progress has plateaued. Getting a new angle on your work (i.e. side-lying position by JMS) with that client might solve those stagnations…”
If the therapist plateaued in his or her treatment it means only one thing that incorrect treatment protocol was chosen and putting the client on a side won’t change a thing. It is similar to the situation when one trying to solve math problem by sitting on different stool.
“Remember, too, that the joint neutral positioning achievable on the side often improves effectiveness with chronic pain because you are able to address the multi-dimensional nature of pain”
This statement is simply bizarre. We would appreciate it if the author would explain how keeping a client suffering from chronic pain on a side “addresses the multidimensional nature of pain”. If the therapist would like to restore the proper function of the lower back muscles, including the various layers of fascia, he or she must address both sides of the lower back even if it is a one-sided pathology. The side position makes this goal impossible to achieve.
The side-lying position in cases of lower back can be used only when the patient is experiencing agonizing pain, and any attempt to place him or her on the stomach with a pillow under the abdomen are impossible. Only in these cases, can the practitioner start with the patient on a side, but even within the first session, the therapist should carefully assist the patient onto the stomach with pillow support. In cases of chronic lower back pain, the side-lying position can be used briefly if the practitioner decides to employ special techniques. However, to use the side-lying position as a treatment tool for the entire session only makes treatment more difficult for the therapist without significant clinical benefit to the patient.
Massage & Chronic Pain. Massage Therapy Journal 25(4): 46-51 2013, by Rachel Syms
The article, written in a journalistic style, offers very basic information on Myofascial Pain Syndrome and Fibromyalgia. The information is helpful for therapists unfamiliar with the subject and the role massage therapy plays in the treatment of both conditions.
Category: Good Apples, Bad Apples