There were three exceptional submissions to JMS for 2021 International Case of the Month Contest:
- Luis Fernando Carreras Perez, LMT – ‘Medical Massage Vs Chronic Viscera-Somatic Disorders’ Medical Massage Courses & Certification | Science of Massage Institute » MEDICAL MASSAGE vs CHRONIC VISCERA-SOMATIC DISORDERS
- Don Lozon, LMT – ‘Medical Massage Vs Severe Whiplash And Limited Time’ Medical Massage Courses & Certification | Science of Massage Institute » MEDICAL MASSAGE VS SEVERE WHIPLASH AND LIMITED TIME
- Allen Stanley, LMT, CMMP, CMLDT – ‘Manual Rehabilitation Of Burn Patients’ Medical Massage Courses & Certification | Science of Massage Institute » MANUAL REHABILITATION OF BURN PATIENTS
Luis, Don and Allen sent us their clinical cases and each of the submissions was unique in a sense. Each contestant who is our former or current student illustrated, in practice, the clinical effectiveness of the Medical Massage Concept and the educational and professional value of SOMI’s Medical Massage Certification Program. However, Our readers chose Luis’s submission as the most informative. So, it is our pleasure to have a second interview with Luis. He was already Person of the Month once due to his exceptional clinical and educational skills (JMS #2, 2020 ). This time we asked Luis for another interview but this time as:
Winner of 2021 JMS’s Case of the Month International Contest
JMS: Our congratulations on winning the JMS Case of the Month Contest!
L.F.C. Perez: Thank you! I also would like to thank all the readers who voted for the case I submitted to JMS. Other clinical cases submitted 2021 were excellent and learned a lot from reading them!.
JMS: What pathologies are you frequently working with?
L.F.C. Perez: The variety of pathologies I work with is vast. Recently I had a number of new patients after strokes, scoliosis, and after knee replacements. However professionally the most recent important clinical case was visceral complications from cancer (mesothelioma). The patient developed severe kyphosis and breathing restriction due to the pain and soft tissue tension. After just three sessions of Medical Massage (I used a combination of Connective Tissue Massage, Trigger Point Therapy, Stretching Massage, and somatic respiratory techniques) the patient was able to improve his posture, no pain during his breathing and it accompanied significant drainage from the lungs and bronchial tree. The patient is a medical doctor, and a gastroenterologist and he was so impressed with the clinical outcomes of the Medical Massage therapy that he bought a Medical Massage textbook for himself and currently studying it while planning to share it with his colleagues at the cancer institute!
JMS: What methods and techniques are in your clinical arsenal?
L.F.C. Perez: My practice is clinically oriented and to deliver effective therapy I need a vast arsenal of methods and techniques. It allows me to be flexible while developing an individual treatment strategy. My education and my professional carrier allowed me to accumulate such knowledge. My treatment toolbox includes: Therapeutic Massage as a preventive and supportive therapy, Connective Tissue Massage, Segment-Reflex Massage, Lymph Drainage Massage, Periostal Massage, Stretching Massage, Manakov’s system, Vibration Massage, Cupping, Hot Stone Massage, Visceral Massage, Neuromuscular Therapy, Muscle Energy Technique and tuina TCM. For each patient, I use only techniques and modalities which fit into the profile of abnormalities he or she suffers. Thus each Medical Massage session is a combination of therapies that changes while I am building clinical response.
JMS: How important is clinical evaluation for your treatment strategies?
L.F.C. Perez: The most important clinical evaluation tool is the palpation to differentiate tension in different layers of the soft tissues: skin, superficial and deep fascia (i.e., Connective Tissue Zones CTZs), skeletal muscles in various locations, and periosteum.
Here is a recent example I observed: the patient had a tibial fracture during a water ski accident. After the fracture healed, the patient had severe restrictions in the knee ROM. She was sent by the orthopedic surgeon to a physical therapist with the recommendation to do aggressive passive stretching of the knee to restore ROM. That was done by PT without significant improvement for a couple of months. When I saw a patient for the first time his passive knee flexion was 110 degrees and the level of pain was 10 as soon as this angle was reached.
My evaluation indicated the presence of very active CTZs in the superficial and deep facias which wrapped the rectus femoris and tibialis anterior muscles. I suggested changing their approach to rehabilitation entirely and instead of repeatedly and aggressively stretching all layers of the soft tissues at the same, using passive stretching as the only treatment tool, decompressing shortened fascia first and then decompressing soft tissues in the thigh and leg using layer by layer approach. I used Connective Tissue Massage and Massage of Manakov’s System. Just after the first treatment session, the intensity of pain dropped to level 5. From session to session knee ROM steadily increased and in four sessions it was almost normal!
Conclusion: no one performed simple tests to examine the degree of tension in the patient’s superficial and deep fascia and PT aggressively stretched the knee using ROM without paying attention to the activation of the pain analyzing system. As a result, such an unfortunate treatment strategy did only one thing – increased protective muscle tension which contributed to the knee contracture due to the rectus femoris muscle and fascia shortening. I witness results of such a regrettable approach to somatic rehabilitation regularly in my clinic.
JMS: Could you describe your average treatment course for our readers?
L.F.C. Perez: I give an average treatment scenario only after a detailed evaluation of soft tissues layer by layer and considering how long the patient had the symptoms and how old he or she is. Usually, I can fit my Medical Massage treatment within between 5 to 15 sessions. Breaks between sessions I set up individually for each patient depending on the intensity of initial reaction and degree of progress. Usually, I wait 2-3 days after the first session and after that, I usually use one-day breaks between the sessions. Only with this approach does Medical Massage allows me to build up a stable and efficient clinical response. It is simply amazing how effective and efficient medical massage is!
JMS: Tell us about your work as an educator. What are the major difficulties and your personal achievements while working with future therapists?
L.F.C. Perez: As an educator, the major difficulty for me is the short time massage therapists spend in school to get enough hours to get their license, and the curriculum in many schools is not friendly to science-based clinical aspects of massage therapy. For example, I see that in a number of schools the medical massage part of the curriculum is dedicated to the medical billing for the insurance rather than training in Medical Massage!
Thus, I started to separate my classes into information for the therapists to get their licenses and presented massage science in completely different segments. I think that we need dramatically change our approach to initial massage therapy education and license requirements to redirect both into clinical aspects of massage therapy using already available massage and medical science rather than personal opinions. At the same time, the medical community needs to embrace Medical Massage but first, we need to be able to present science-based data correctly. I started to teach Medical Massage in the USA in 2007 and during all these years I only had one nurse and one PT Assistant in my classes!
Thus, I see my major goal is spreading massage science, and educating a new generation of massage therapists in effective Medical Massage practice while teaching them how to integrate Medical Massage therapy into the already established health care system.
Getting a recognition Diplom for winning Case of the Month in the Journal of Massage Science’s International Competition is my most important professional achievement which gives me support and leverage in my work and achieving my goals! Thank you very much to everyone who cast their vote, Science of Massage Institute, and Dr. Ross Turchaninov!
Category: Person of the Month
Tags: 2022 Issue #1