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 exhibit low educational standards. 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
Someone Gets Me. Massage & Bodywork Magazine, May/June, 2018
This article was published at a perfect time since it supports the main topic of other articles in this issue of JMS. The author is completely correct when he describes the clinical evaluation of his patient:
“From Mr. H.’s facial expression and the intensity of his gaze, it was obvious he was closely observing me for confirmation that I ‘got’ what he was saying and how important it was. As a high-level tennis player, he was used to reading an opponent’s body language. He was using the same skills of observation on me now.”
All patients who experience any pain or discomfort closely observe and estimate every move or word of the therapist. Therefore, a correctly conducted evaluation, besides giving the therapist a wealth of important clinical data, starts to trigger a healthy Placebo Effect, which assists in further therapy conducted by the practitioner.
Supraspinatus. Massage & Bodywork Magazine, May/June, 2018
This article is dedicated to the anatomy, action and palpation of the supraspinatus muscle. The info in regard to the anatomy and action of the supraspinatus presented in the article is completely correct until it reaches the palpation part. Here are suggestions from the article:
- Palpate the spine of the scapula with your thumb.
- Move your thumb superiorly above the spine to locate the supraspinous fossa.
- Locate the muscle belly in the supraspinous fossa.
- Follow the muscle belly to the acromion process, then locate the tendon laterally between the lateral acromion and greater tubercle of the humerus.
- Resist as the client initiates shoulder abduction to ensure proper location.
This recommendation seems correct if the therapist as well as the author are guided strictly by the anatomical location of the supraspinatus muscle. However, anatomical location and clinical evaluation of the same muscle are two different things if the muscle is located in the middle or deep layers. Thus, following the author’s suggestion is completely wrong because with this approach, instead of palpating the supraspinatus muscle, she actually palpates the horizontal portion of the upper trapezius muscle, which covers the supraspinatus muscle in the supraspinous fossa.
Thus, the recommendation from the article will give zero clinical data about supraspinatus to the author or the reader who follows her recommendations because the trapezius will always exhibit protective tension if the supraspinatus is damaged or harbors active TPs.
To palpate the supraspinatus muscle, the therapist should approach it from the opposite direction. He or she must elevate the free edge of the horizontal portion of the trapezius muscle, exposing the fibers of the supraspinatus muscle directly. With this position the therapist’s thumb can examine the fibers of the supraspinatus muscle directly instead of palpating through the fibers of the trapezius muscle.
We noticed that as long as the author describes palpation of the superficial muscles, she is usually on target. After reviewing her articles for several years now, it has become obvious that in the articles in which the author tries to describe palpation of the skeletal muscles located in the middle or deep layers, she very frequently offers incorrect and even misleading information.
Massage Therapy for Paracyclists Over a Long-Term Training Bout. Massage & Bodywork Magazine, May/June, 2018
A very good article about a rare study which examined the effect of massage on the performance of paracyclists over the long term. We think that its results can be applied to the general population of athletes and sports enthusiasts as well.
What Practitioners Must Know Before Treating Clients with Injuries. Massage & Bodywork Magazine, May/June, 2018
A good article which correctly outlines basic principles of working on clients with acute or chronic pain. What helps is the author’s inclusion of clinical cases as illustrations.
Pain Science Research Meets the Massage Therapy Profession. Massage & Bodywork Magazine, May/June, 2018
A very good article which correctly describes basic ideas behind our understanding of pain and tools to address it.
Watch the Walk: Homolateral Gait, Righting Reflexes and Neck Strain. Massage & Bodywork Magazine, May/June, 2018
This article describes homolateral and contralateral gaits and the necessity of their evaluation.
Is Your Work Valuable? Massage & Bodywork Magazine, May/June, 2018
The article’s topic is very close to Part II of the article about the Placebo Effect published in this issue of JMS.
MASSAGE TODAY
A Lipoma & Soft Tissue Complications: Relieving Sciatic Nerve Pain. Massage Today. April, Vol. 18 (4)
This article describes the clinical case of a patient having clinical symptoms of sciatic pain and a large lipoma in the gluteal area, which caused the irritation of the sciatic nerve. Indeed, the lipomas can cause nerve irritation and trigger symptoms of neuralgia if the fatty tumor forms in the area of a peripheral nerve. Also, it is correct that reducing tension in the fibrotic capsule will decrease inner pressure. However, it has to be done correctly because excessive pressure or work around the capsule in the long run may trigger lipoma enlargement.
Tendons of the Thumb. Massage Today. April, Vol 18 (4)
Very helpful information in this article about anatomical locations of the inflamed tendons that will greatly help therapists with local treatment. As the main therapeutic tool, only cross-fiber frictions were discussed, and it is correct, but at the same time it is a very insufficient treatment option.
Why You Should Clear the Common Bile Duct: A Necessary Protocol for Your Treatments. Massage Today. May, Vol 18 (5)
This article is dedicated to biliary drainage and its role in the function of the digestive system and the entire body in general.
Exploring Osteochondritis Dissecans. Massage Today. May, Vol 18 (5)
The article is dedicated to Osteochondritis Dissecans or detachment of a piece of cartilage or cartilage and subchondral bone from the tibia or femur. In such cases, the so-called ‘joint mice’ form, and these piece(s) of cartilage start to float inside of the joint, triggering joint pain and the sensation of the joint being locked.
To examine the knee for the presence of Osteochondritis Dissecans, the author recommended the so-called Wilson’s Test or, to put it more correctly, the Wilson’s Sign. From the very beginning of its publication in 1967, this test has been considered by the majority of physicians as having very low clinical validity.
In 2003, this issue was specifically examined by Conrad and Stanitski and the study confirmed that Wilson’s Sign indeed has very low validity in establishing Osteochondritis Dissecans as a main cause of knee pain.
From this point of view, it is a mistake to follow the recommendation from the article, and to suspect Osteochondritis Dissecans, therapists should rely mostly on the presence of the sensation of the knee being locked during active movements while it is accompanied by a jolt of acute pain. It is true that the same sign can be triggered by meniscus damage, but in both scenarios the next step in evaluation is a knee MRI, which will indicate the presence of meniscus trauma or Osteochondritis Dissecans.
Massage Therapy is useless when the patient has Osteochondritis Dissecans, and the only ultimate solution is endoscopic removal of the free-floating piece(s) from the joint cavity.
REFERENCES
- Conrad JM, Stanitski CL. Osteochondritis dissecans: Wilson’s sign revisited. Am J Sports Med. 2003;31(5):777-778. doi:10.1177/03635465030310052301
Anterior Muscles of the Lower Leg: Exploring Structure, Function, & Energetic Concepts. Massage Today. May, Vol 18 (5)
This article is about anterior leg muscles and their functions. Everything is correct in the article, but the article has a lot of very general information, and it has very limited practical value after one finishes its reading. So, the way information is delivered is the problem, and it is obvious that the author can offer more, but the article doesn’t deliver it.
Choosing Our Words Wisely … Language Matters. Massage Today. May, Vol 18 (5)
This article is dedicated to the importance of therapists’ communications with oncology patients. This is an absolutely vital issue since the words therapists use can be helpful for the patient’s recovery or counterproductive. The main articles in this issue of JMS address a similar topic – the importance of correct communications with clients/patients.
MASSAGE THERAPY JOURNAL
Fascial Therapy: Benefits & Contraindications for Massage Clients. MTJ, Winter, 56(4), 2017
This article, while giving a lot of good information, unfortunately makes the same mistakes in regard to fascia and its pathological changes we frequently observe in massage publications. Here are the misconceptions and misrepresentations that diminish the value of the article:
- Initial causes of fascial tension are listed in the article as: direct trauma, poor posture and dehydration. However, one of the main causes of fascial tension is mild irritation of peripheral nerves (sometimes even its cutaneous branches).
It looks like the authors are completely unaware of the fact that in the majority of clinical cases, fascial tension is a reflex reaction of the CNS to the irritation of the peripheral nerves. Such a fundamental concept of somatic rehabilitation as the concept of Connective Tissue Zones, which was developed by E. Dicke (1953) more than 60 years ago, is not even mentioned in the article.
Connective Tissue Zones as areas of fascial tension are formed in the superficial and deep fascia as a reflex reaction to chronic somatic and visceral abnormalities (Langevin and Sherman, 2007). In cases of CTZs, the postural changes the authors see as an initial cause are in reality a protective reflex reaction of the CNS. From this perspective, the treatment of patients by addressing postural changes while the CTZs are active is a pure waste of time and the patient’s money.
- Very surprising is the list of contraindications to fascial work listed in the article. Acute brachial plexus neuritis and peripheral neuropathy listed as contraindications are direct indications for fascial work.
It is complete nonsense to list Osteoarthritis as a contraindication because fascial tension always accompanies the clinical picture of OA, and fascial work is a mandatory component of the therapy for this somatic abnormality.
Let us quote a medical article (Goats and Keir, 1991) on clinical application of fascial work published in the British Journal of Sports Medicine. We bolded the indications that are absolutely contrary to what the authors mentioned in their article:
“CTM [i.e., fascial work] can benefit patients suffering from cardiac and respiratory diseases, peripheral circulatory deficits, neurological pathologies, gynecological and obstetric problems and disorders of the digestive and urinary tracts. The other community of therapists, although accepting some of these recommendations, use CTM primarily to relieve the symptoms of spinal and peripheral joint dysfunction, osteoarthritis and rheumatoid disease, nerve root pain, sciatica and neuralgia.”
Here is another example of a mistake from the article. Why did Baker’s Cyst get into the category of contraindications? It seems that even the authors can’t explain this choice well. Removing the tension in the fascia due to the presence of Baker’s Cyst won’t help with Baker’s Cyst itself, but it will reduce fascial tension developed in the leg and thigh and address postural changes the authors worry so much about.
- All postural assessments described in the article are valuable, but before they are conducted the therapist MUST rule out even mild irritation of the peripheral nerves which supply the fascia. If it is not done, the postural changes the authors observe in the clients are a secondary protective reaction. Only after nerve irritation is ruled out should the assessment recommended in the article be performed.
If the authors had just published their own opinions, it could be the start of a new discussion. However, this article is the introduction to a CEU course the authors developed for therapists under the umbrella of the American Massage Therapy Association. Unfortunately, it seems that this program reflects only partial views of a very complex topic and has great gaps which misrepresent the nature of fascial tension and its treatment.
REFERENCES
- Dicke E. Meine Bindegewebsmassage. Marquardt; 1953.
- Goats GC, Keir KAI. Connective tissue massage. Br J Sports Med. 1991;25(3):131-133. doi:10.1136/bjsm.25.3.131
- Langevin HM, Sherman KJ. Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms. Med Hypotheses. 2007;68(1):74-80. doi:10.1016/j.mehy.2006.06.033
MASSAGE MAGAZINE
The Mechanisms of Pain: What We Don’t Know. Fascia, Feeling & Sensation. Massage Magazine. 263, April, 2018
A very good article on fascia, its innervation and its impact on CNS functions.
Can Massage Therapy Help Relieve Sciatica? Massage Magazine. 263, April, 2018
The main message of this article is absolutely correct. Indeed, even in cases of severe disk pathology, with time the intensity of symptoms greatly diminishes or even disappears completely. However, there is one critical aspect of sciatica’s treatment that is completely missed.
Despite the fact that in many cases the symptoms of sciatica will go away, the issue which triggered sciatica will not. In such cases, early conservative treatment will prevent re-occurrence of the same or even worse sciatica symptoms in the future. This is why the patient, even with a short history of Sciatica symptoms, must be treated, and usually the first treatment option is Medical Massage.
Even those patients who were treated conservatively with time show a relapse of the same symptoms later if therapy wasn’t supported. As it was reported in the frequently mentioned study (Weber, 1983), up to 24% of patients receiving conservative treatment for sciatica-type symptoms due to disk pathology experienced ‘relapse’ within 4 years. We observe the same results in our clinic and every new flare-up usually has more intense symptoms.
Thus, the conservative therapy in the form of a supportive Medical Massage session, after successful elimination of initial clinical symptoms, should be conducted monthly. Additionally, there is a percentage of the patients who didn’t feel any reduction of symptoms in 3-4 weeks after their appearance. For the patients in this group the same therapy is the first treatment choice.
That brings us to the part that is completely missed in the article, and it dramatically decreases its practical value. The author didn’t give even a hint of what he recommends to treat sciatica. Instead, he stated:
“Massage for sciatica is a niche that is waiting to be filled”
We would like to inform the author and Massage Magazine’s readers that this niche has been very well filled for years now with Medical Massage therapy which is used around the world to treat cases of sciatica as the first line of defense. If it fails, the other more complex modalities should be used. It is simply shocking to read a statement like this one in a national massage publication.
REFERENCES
- Weber H. Lumbar disc herniation: a controlled, prospective study with ten years of observation. Spine. 1983;8(2):131-140. doi:10.1097/00007632-198303000-00003
Address & Prevent Your Lower Back Pain With Self-Care Trigger Point Therapy. Massage Magazine, 266, July 2018
A good article on self-therapy and prevention of lower back pain.
Category: Good Apples, Bad Apples
Tags: JMS 2018 Issue #2
