For a while, JMS didn’t have an interesting article for the Science of Therapeutic and Stress Reduction Massage section. We think that this article is very informative and important for therapists who practice stress-reduction massage and, by doing so, greatly contribute to the nation’s health.
The goal of each full-body massage session is to reduce the level of stress and balance the activity of the sympathetic and parasympathetic nervous systems. Therapists go the extra mile while trying to provide the best service: they take continuing education classes, design the therapy room, play soft music, etc. However, one critical component is frequently missed: the client’s positioning on the table and table support.
As you will read below, just placing the client in an ergonomic position, in which gravitational and biomechanical forces cancel each other out, already gives the therapist a great advantage during therapy. Thus, the application of the correctly formulated massage protocol that follows becomes even more efficient. As our readers know, we are not in the business of advertising, but we think that therapists should consider the bodyCushion an important tool for enhancing their therapy.
ROLE OF BODY ERGONOMICS IN STRESS REDUCTION MASSAGE. ROLE OF BODY CUSHION
Does client comfort affect the outcome of a massage treatment? To what extent does client comfort affect the client’s experience of receiving treatment? What is client comfort? How is the client’s comfort achieved?
The answers to these questions require a small crash course in the effect of massage therapy on the function of the autonomic nervous system. According to a world-recognized theory proposed by Professor H. Selye (1955), the chronic accumulation of stress is the first stepping stone in the development of all chronic pathologies in the human body (except, of course, trauma, infection or genetic predisposition).
The main functions of our body are beyond our conscious control, since they are under the control of our autonomic nervous system, which has two divisions: sympathetic and parasympathetic. While the sympathetic or “fight or flight” division of the autonomic nervous system is more active during the day, its parasympathetic or “rest and digest” division is more active during the night. In a healthy body, the interaction of both divisions should equal zero, since they are constantly watching each other, trying to self-adjust their activity and subsequently balance.
The daily events of our performance-demanding lives constantly drive up sympathetic tone, which builds up from day to day, month to month, until the gap between the two systems becomes so large that it triggers a variety of somatic and visceral problems.
The main goal of massage therapy as a preventive measure is to decrease the sympathetic tone to equalize the activity of both systems and maintain the client’s overall health. This is well documented by studies (Barr and Taslitz, 1970; Longworth, 1982).
Therapists try to reinforce this effect of massage therapy by playing music in the background, dimming lights, etc., and I am sure that any additional tool (e.g., aromatherapy) that helps diminish sympathetic tone should be welcomed by therapists.
From this perspective, optimal support of the client’s body on the massage table is a frequently overlooked subject that we think must be considered by therapists who want to optimize the stress-reducing effect of each massage session, help their clients and build their own practices.
DEVELOPING THE CONCEPT OF THE BODY CUSHION
From a young age, I experienced a great deal of pain and tension in my neck and shoulders. I also noticed that different body positions reduced the intensity of my symptoms. In 1970, my girlfriend gave me my first full-body massage. The massage techniques she used were varied and amazing. I marveled that so simple a thing as applying hands to a person’s body could bring so much relief and be so rejuvenating.
In 1974, I built my first massage table in a woodshop class. The table had a beautiful inlaid birch wood top that I didn’t want to cover with foam and vinyl, so I covered it with two sheets of one-inch foam with terry cloth material. Looking back, it is difficult to imagine that I massaged my subjects on this table. There was no accommodation for the face, no support for the head when the subject was face-down.
Sometime around 1983, I went to receive a massage. The decor of the therapist’s massage room was lovely: the color of the walls, the furnishings, the artwork. The therapist had me lie face down. She burned sweet grass as she covered me.
She said, “There you go …” and she asked me a question, “Are you comfortable?” I lied. I lay there, face squished in a slot, thinking, This sucks! … and I don’t think anyone is going to do anything about the discomfort of being on a massage table … Really? This is the way it is, and we just accept that this is the way it is? I vowed to myself I would solve this puzzle.
For two years I struggled with the challenge of designing a table that would afford comfort to clients. After two years of trial and error, I created a stationary table with a rising upper-body half, an adjustable face rest, an adjustable arm shelf that could be moved up or down and was removable. This table cost me about $2,200 to build, and I proudly transported it to a hospital physical therapy clinic to do an in-service manual training.
This table did afford more comfort than a typical flat table, but I was soon challenged to provide comfort for a client with breast augmentations. She had been in an automobile accident and had been referred into my practice to be treated for whiplash. To make her comfortable, I started to use sheets of foam of different densities, layered and built up to support her bony structures. This worked! She reported complete comfort and was able to relax during prone treatment. No guarding. No protective muscle tension!
After about a month, I realized that I could devise a similar support for the pelvis, allowing ventral space for the abdominal organs, bladder and male genitalia. I also realized that this approach allowed a distinct relief and decompression of my own lumbar spine.
Soon, my clients started to give me rave reviews, and this encouraged me to use the device more and more. I began to realize that because my clients were so relaxed, my work became easier and more beneficial for them. Muscle groups were more easily palpated. Mobilizations and stretches were supported and more easily achieved. My simple device works as a neutralizer of the gravitational and biomechanical forces that exert pressure on a body lying flat on the table.
This little device I had contrived became so popular that I spent considerable time cutting foam sheets with an electric turkey knife and sewing vinyl coverings on a borrowed sewing machine. This took place in the kitchen of my tiny cottage in Ashland, Oregon, the place in which I practiced massage.
I finally, simply, named it bodyCushion™. Generally speaking, the BodyCushion System consists of different-sized foam blocks with special openings. Placing these blocks under the client’s body allows the therapist to achieve the best ergonomic position during the entire massage session.
SCIENTIFIC STUDY OF THE BODY CUSHION
Since our device afforded such a marked improvement in anatomical support with resultant comfort for my clients, I embraced a mission of challenging the status quo by educating others about the importance of positioning and sharing the profound improvements in the treatment outcomes. To do so, I decided to participate in the American Back Society meeting in San Francisco, demonstrating the bodyCushion™ in a booth in the exhibit area. Across the aisle was a company that advertised a device to test muscle tension using electromyography (EMG). After some time of watching me and others demonstrating in our booth, a Dr. Vinitzky from the EMG booth came over to discuss the possibility of doing an EMG study with the bodyCushion™, comparing the positioning effects produced by a regular massage table vs. the effects produced by the bodyCushion™ placed on top of a massage table.
We agreed to engage in a study with the results to be published in medical journals. After the formal agreement was prepared and signed by each party, the study got underway. After some two weeks had passed, I got a call from Dr. Vinitzky:
“Hello, Tom. I have some very exciting news for you!”
“Oh, is the study finished already?” I asked with surprise.
“Oh, no, no, Tom. We just beginning in the first phase of the study. We are testing the subjects for muscle tension while seated and standing and then we test them laying on the regular massage table. What we’re finding is that when we test the subjects who are on the regular massage table, the tension levels are going up!
I had assumed that because they are lying down, the tension would go somewhat down, but that’s not the case. The tension is increasing on the flat table. At first we thought maybe something wasn’t right with our testing, or device itself so we tested again, and sure enough: the tension rises on the flat table! I just had to call you to let you know. I’m going to continue this phase of the study and I call you next week with more findings.”
About a week later, Dr. Vinitzky called again:
“Tom, more news! Now we’re finding that the longer the subjects are on the flat table, the higher readings of muscle tension! We now know that the tension increases the longer your clients lie on the flat table!”
The EMG study, authored by Dr. Jeffrey R. Cram and Dr. Itamar Vinitzky (1994), was published in October 1994 in the Journal of Myofascial Therapy. The study compared sEMG readings as a result of brief massages given to two groups of subjects. Both groups were positioned prone, but on different surfaces. Subjects from one group lay on a flat massage table and subjects from the other group lay on a massage table with a bodyCushion™.
The study found that massages given to subjects lying on the bodyCushion™ placed on top of a massage table produced lower levels of Resting (client is on the table) and Dynamic (after massage session was over) EMG activity, compared to subjects who received a massage on a standard massage table. Fig. 2 illustrates the level of resting muscle tension in clients who were positioned on the table with the bodyCushion system placed on top of it and on the regular massage table.
“The differences in sEMG levels appear to reflect different ergonomic effects of the body support system versus the standard massage table. The body support system seems to better facilitate normalized gamma motor (and therefore muscle) function, thus providing better support to the shoulder and upper back than the standard massage table”
Cram and Vinitzky (1994)
Such a profound effect of the bodyCushion on muscle tension is the result of the ergonomic support itself, and as a consequence, this support decreases the level of sympathetic activity.
Another finding reported in the article was the presence of “…significant asymmetrical sEMG recordings” in those clients who were prone on the regular massage table. It means that positioning on the regular table without ergonomic support creates an imbalance between various muscle groups, and they start to exhibit different levels of muscle tension while the client is supposed to be completely relaxed. This fact to a significant degree ruins the therapists’ efforts to reduce muscle tension and balance the interaction between muscle groups. As soon as clients were placed on the Body Cushion, the entire Resting Muscle EMG activity synchronized.
“There is a gentle art to the use of pillows and cushions during massage procedure. These biomechanical aids support the body while it lies prone on an otherwise flat surface. This appears to help ‘relax’ muscles.”
Cram and Vinitzky (1994)
Finally, the completely unexpected finding was the detection of dynamic activity in the muscles after the session in clients who were massaged with and without ergonomic support. Fig. 3 illustrates this finding. On the left side of the graph, you may see the levels of Dynamic EMG in the trapezius muscle before and after massage performed on the BodyCushion placed on the massage table. The right side of the graph illustrates the level of Dynamic EMG in the trapezius muscle before and after massage session conducted on the regular massage table.
This amazing data indicates that desynchronization of the muscle activity while the client is positioned on the table without ergonomic support increases the level of Dynamic EMG after the session is over. Thus, instead of the treatment completely decreasing muscle activity and balancing both divisions of the autonomic nervous system, the lack of ergonomic support during the treatment didn’t trigger complete muscle relaxation despite the correct efforts of the therapist.
“The main finding of this study is that massages using a body support system for subjects yielded lower levels of sEMG activation post-massage than did the same treatment on a standard massage table.”
Cram and Vinitzky (1994)
Thus, the study results proved that ergonomic support offered to the head, shoulders, rib cage, lower spine and pelvis is a critical component of a therapeutic massage session. Use of the bodyCushion allows the therapist to achieve a baseline effect of muscle relaxation, and it multiplies several times over the outcomes of treatment conducted by therapists. It helps you to build up a healthy and thriving practice.
We follow all the products offered in the industry, and we can guarantee that the bodyCushion™ effectively reduces the client’s muscle tension simply by positioning the client on an ergonomic surface. The important effect of our product is supported by hard scientific data. “When a massage practitioner uses proper ergonomic support for his prone-lying client, he may more effectively reduce and normalize the client’s muscle activity in the neck, shoulder, and upper back regions.” Cram and Vinitzky (1994)
These EMG results clearly mirrored what I and others have been feeling in our bodies every time we had a massage on a flat table. We simply accept this discomfort as part of receiving a massage treatment! It is evidently, unreasonably, thought that this is just the way it is … Now we have proof that it doesn’t need to be any longer.
REFERENCES
- Barr JS, Taslitz N. The influence of back massage on autonomic functions. Phys Ther. 1970;50(12):1679-1691. doi:10.1093/ptj/50.12.1679
- Cram JR, Vinitzky I. Massage: a surface EMG comparison of the effects of a body cushion versus a standard massage table. J Myofascial Ther. 1994;1(3):13-17.
- Longworth JCD. Psychophysiological effects of slow stroke back massage in normotensive females. Adv Nurs Sci. 1982;4(4):44-61. doi:10.1097/00012272-198207000-00006
- Selye H. Stress and disease. Science. 1955;122(3171):625-631. doi:10.1126/science.122.3171.625
ABOUT THE AUTHOR
Tom Owens
Tom Owens, founder of Body Support Systems, has been engaged in the pursuit of therapeutic orthopedic positioning for more than 30 years. He has explored, examined, researched, and tested various aspects of positioning as a singular career pursuit since 1984, and it has been said that no one knows more about orthopedic positioning. Tom was licensed as a Massage Therapist in 1985.
Category: Stress Reduction Massage
Tags: JMS 2016 Issue #4
