“Prostitution VS. Massage therapy” Are we contributing to the confusion?

20+ years ago when I arrived to Los Angeles, I have obtained the only available at that time license of massage technician. Adding to my bewilderment was fact that my license was listed under adult entertainment category. Neither of the stipulations made much sense. "How could such developed country lump this powerful health related methodology into the adult entertainment category?" Little by little I started to understand that many so-called "massage“ places were nothing else, but illegal whore houses. Having realized this, I still couldn't comprehend in what way licensing massage therapists alongside prostitutes, helps to fight illegal activities or, in general, serve any constructive purpose. From studying the US history I remembered how alcohol prohibition has shown that more Americans got addicted to alcohol, organized crime activities expanded to multi-million dollar operations, killing innocent people, etc. With elimination of prohibition, things changed for the better: less alcoholics, more tax revenue and more education on why not to drink excessively. Not that I am a proponent of legalized prostitution, but by this day I cannot understand why regulating prostitution was given such priority over massage therapy, bouncing it off to the road ditch of marginalization. Why were these memories brought back to life? Because I came across the video that you can see embedded below.
Initially I thought this lady was a hooker. Then I realized she was an actress who did quite a talented humorous impression on “masseuse” whatever “masseuse” means. More than that. This video is a clever take of the stereotype that some general public has of massage: something that make you feel good, with some sexual implication, that although is not always explicit and is officially prohibited, yet nevertheless always present. In itself the suspicion in sexual undertone is only half the problem. The bigger issue is that by perceiving massage as a cover up for sexual favors, such perception denies massage any treatment affect, reducing its healing power to a sort of voodoo. Apparently, out of realization of utter unfairness of such perception for practitioners who put out great deal of honest physical and emotional effort in their work, lately there came a trend that attempts to elevate massage therapist from the abyss of prostitution and voodoo to a lofty heights of science. I am talking about the "evidence based" approach to massage. This approach goes into another extreme and denies all the methods of physical rehabilitation that are not supported by the latest scientific research, thus parting themselves from all hints of voodoo-ism and at the same time ricocheting at such methods as acupuncture, homeopathic medicine, Chinese cupping with all the concepts that go alone with it such as meridians, yin-yang, chi, etc. In its unchanged righteousness it also denies 9/10th of the Western massage protocols, scientifically developed in the previous centuries as long as it lies East of the Atlantic Time zone. If my conjecture about the genesis of "evidence based" trend is true, I am startled by the great discontinuity between the popular believe and the proposed cure. In my view massage therapist should be placed more or less in between those extremes. The country where I came from had many idiotic rules and regulations, but somehow in the field of massage therapy the globally planned economy worked well. Massage therapist over there was neither scientist nor a prostitute, but a medical professional. Like a construction worker who fulfills the orders of architect or structural engineer, a massage therapist worked with the medical doctor, and following his/her treatment plan, provided therapy to patients. Continuing this analogy, a good construction worker has to have a very specific set of skills. These skills are not the skills that allow him to calculate the sheer force or a momentum acting at the edge of a cantilever, or the knowledge of how the future building would fit in the overall city landscape, but nevertheless are highly specific set of skills allowing the construction worker to put the building together. In the same way, massage therapist doesn't have to know the intricacies of biochemistry and cellular level or molecular biology, but there is a set of absolutely pertinent practical skills specific to massage that a therapist has to know extremely well. That is: How to perform step by step protocols that are developed by scientists for massage therapists. Surely there were exceptions out of this rule. There were a number of brilliant researchers and medical doctors who at the same time possessed hands on massage skills. But as a general rule, the reverse wasn't true. I think that such approach would fit even better in the framework of highly compartmental American mentality, where a specialist knows his/her area very well, but feels quite helpless outside it. That's why I feel that making massage therapists to graduate Master and PhD programs, where they would be force fed by hours of anatomy, physiology and pathologies is going to be just as productive as offering PhD programs to construction workers. Therefore I feel that the group that pushes such program requirements does nothing else but promoting some special interests and, if being given a go, would hurt the entire massage field tremendously. In my view the damaged image of massage practitioner should be cleaned up by the collective movement, medical and massage fields toward each other. Once American public stars commonly seeing massage therapist in the hospital setting, the video like the one I offered you above, would stop being done. The much larger involvement of massage therapist in the overall preventive efforts would make our nation much healthier and would free much of taxpayers' money for bigger and better things. During the 1st 10 years of practicing in America I was witnessed significant positive changes in regards of the general public as well as in evolution of medical societies’ views on therapies by means of massage. Thanks to the effort of some individuals, AMTA and ABMP, now we have California state massage therapy certification. It's a very encouraging progress. Using the opportunity would like to thank everyone who has contributed to this certifications. I was and am hopeful that little by little, we will get our desired place in the healthcare system. It was a significant move forward.

When pain, no gain

According to Wikepedia the origin of the expression "No pain,  no gain" goes back as far as the second century A.C.  At that time though it was referring to spiritual rather than physical activity - unless a person endures some spiritual search or suffering - he or she won't achieve any spiritual gain. 

In America this expression was revamped and became and exercise motto that promises greater value rewards for the price of hard and even painful work. Under this conception competitive athletes are required to endure pain and pressure to achieve professional excellence.

The motto expresses the belief that solid large muscle is the result of training hard and suffering sore muscles repeatedly, implying that those who avoid pain will never reach a professional level as athlete.  Beneficial pain refers to that resulting from tearing microscopic muscle fibers, which will be rebuilt more densely, making a bigger muscle.

It came into prominence after 1982 when actress Jane Fonda began to produce a series of aerobic workout videos. In these videos, Fonda would use "No pain, no gain" catch phrases for the concept of working out past the point of experiencing muscle aches.  This catch phrase is perfect for marketing because it encapsulate a simple concept and, enforced in memory, rolls off the tongue as a nursery rhyme.

As we all know everything genius is simple.  Unfortunately the reverse is not always true.  Pain in this case usually leads to serious re-strain and re-sprain traumas and, at times, could end athlete's career.  Pain is a signal of the body on the existence of injury, disorders or dysfunction. A phenomenon of skeletal muscular injuries disorders or dysfunctions always manifested as elevated resting tone of muscles, which then be transmitted to tendons, ligaments and other tissues. Described muscular conditions, should be viewed as a precondition to significant muscles or ligaments tears that, at times, require surgeries.  Besides, when athletes suffer from pain and tension in muscles and, in some cases also in fascia, they cannot perform to the best of their physiological potential.

Because of this, or maybe because the words pain and gain that rhyme so well in English, and don't rhyme in other languages, the motto perhaps didn't stick in other countries.  Well I can bravely say this for the Russian language where the word "pain" sounds like bol` and  the word "gain" like priobretat`.

In any case coming from Russia the concept of "No pain, no gain," when it was introduced to me, seemed quite foreign.  This introduction has occurred in a quite peculiar way.

When I arrived to the US, I was hired by a physical therapy company as a staff trainer, to teach Russian Medical massage methodology. Since the primary goal of this methodology, from its inception, was treatment of patients, one of its major emphases was placed on avoiding traumas. Therefore medical massage always starts with very light pressure and in inhibitory regime.

This regime allows for gradual increase in pain threshold, which in turn permits gradual increase of pressure without activating of the pain analyzing system. 

When a therapist continues to provide massage while pain analyzing system is activated, it is likely that not only a therapist is going to reach his/her treatment goal, but also would aggravate client's condition.  For detail please read the article Reaction vs. Aggravation.
If you ever be asked by healthcare professionals to explain scientific part of what you are doing you are welcome to give these references. They will be acceptable and scientifically sounds.  

Most of the physical therapists, physical therapists assistant, and physical therapy aides, who have had  worked for this company, had no problem with this approach. However, there were some who objected.  Specifically I remember one heavy set, tall, muscular physical therapist who looked like a line-backer.  At the moment my English was quite rusty but I remember him referring to Medical Massage approach something not manly.  He was the first one who familiarized me with "No pain, no gain" motto and its application to massage therapy, promoting vigorous pressure.  According to him Americans were tough people and were ready to endure pain to reach results.  There were also other who insisted that pain sensation after treatment as a positive reaction.

Luckily this company used to employ more than 120 physical therapists, and most was following my teaching to avoid activating pain analyzing system and traumatizing clients.  Faster and more sustained results were achieved almost in all cases. I am very happy to say that the "line-backer," due to clinical outcome, changed his mind in regards “no pain, no gain“ and started following protocols everyone used successfully.

I remember how, while participating with fibromyalgia support group, I listened to one well known rheumatologist, who deeply doubted the effectiveness of deep tissue massage on human body.  As a proof of his position he showed me the list of 200 of his patients, who incurred fibromyalgia after receiving deep tissue massage.  

I assured him that deep tissue massage has nothing to do with sudden application of vigorous pressure and told him about the value of introductory massage, gradual increase of pressure as application of the Gate control theory and four strategies for deep tissue massage.  I also told him about massage therapists who neglected such careful and gradual approach, professing immediate vigorous pressure and who, most likely, inflicted trauma  and caused incurring fibromyalgia in his patients.  Subsequently, he referred me many fibromyalgia clients allowing me to help them managing their symptoms.

Contemplating about the differences in deep tissue massage approach, I am remembering one of my students.  He was of Chinese nationality, immigrant from Vietnam, who came to my school, sharing with me his life story.  He told me that he was considered a "black sheep" in his family for his inability to learn.  He also shared with me his dream of healing people with his hands. 

I accepted him to my school and noticed that despite being slightly uncoordinated, due to overexcitement, he had quite capable hands.  In general, he was a very eager to learn student.  After graduating he was accepted to one of the famous spas and started his quick rise to prominence.  However, apparently not being satisfied with what he knew, he took some extra courses.  He was taught, as he was explaining me, the version of deep tissue massage that emphasizes vigorous pressure as in "No pain, no gain."  Despite my objections, he insisted on this method that he thought was superior.  Unfortunately this lead to many clients being traumatized and him being eventually fired from the spa and, of course, it is to no surprise of mine.

Vigorous pressure,  persisted while pain analyzing system is activated causes development of myositis, tendinitis, microscopic tears of soft tissue, development of trigger points and many other pathologies.

In retrospect I can rephrase the "No pain, no gain" motto as "When pain, no gain."

Dear colleagues,

This blog contains a few links to the important information.  For 40 years I'm practicing scientifically developed massage protocols and all offered information is based upon real scientific data, related to the science of massage.

I know, that there is new trend out there ”show me the references.” Many times people request these references, just for the sake of requesting for they don't know what to do with them.

Most of my references are in Russian.  However, below I'd like to offer some Western references in English from the books of Dr. Ross Turchaninov. While writing these books, he undertook  a truly titanic work on collecting and verifying them.  Both Dr. Turchaninov and I are trained and practice medical massage as it was proposed by Prof. Sherback, therefore references that he offered are applicable for articles I provided the links above.  Again, I included only small portion of his references, those that I checked myself. 

Thinking back though at my entire career, during the last 20 years at the US many times I have presented to medical doctors, physical therapists, doctors of chiropractic medicine.  No one ever asked me for references. I guess the material I presented sounded scientifically enough.

As for me - references do not provide treatment.  Our hands do.

And  while we are on the topic of hands ... If you visit out fan page at 

http://www.facebook.com/FreeInstructionalandSelfMassageLessons  you will find many free lessons, including almost 4 hours hands-on performances: ”Orthopedic massage physical therapy aide program Part1"

REFERENCES

Bodhise PB, Dejoie M, Brandon Z, Simpkins S, Ballas SK. Non-pharmacologic management of sickle cell pain. Hematology, Jun;9(3):235-7, 2004
Dubrovsky V.I., Dubrovsky, N.M. Massage Manual. 'Chuvashia', Cheboksari, 1995
Fernandez-de-las-Penas C, Cleland JA, Cuadrado ML, Pareja JA. Predictor variables for identifying patients with chronic tension-type headache who are likely to achieve short-term success with muscle trigger point therapy. Cephalalgia, Mar;28(3):264-75, 2008
Garvey TA, Marks MR, Wiesel SW. A prospective, randomized, double-blind evaluation of trigger-point injection therapy for low-back pain. Spine (Phila Pa 1976), Sep;14(9):962-4, 1989
Huldicka O., Broqwn M.D. Physical forces and angiogenesis. In: Mechanoreception by vascular walls. Edited by G.M. Rubani. 'Futura Publishing Company, Inc.' Mount Kisko, NY 1983
Krogh A. The Anatomy and Physiology of Capillaries. 'Yale University Press', New Haven, 1929
Kuprivan W. Physical Therapy for Sports. "W.B. Sandesr Co", Philadelphia, 1995
Kurz W, Wittlinger G, Litmanovitch YI, Romanoff H, Pfeifer Y, Tal E, Sulman FG. Effect of manual lymph drainage massage on urinary excretion of neurohormones and minerals in chronic lymphedema. Angiology, Oct;29(10):764-72 1978
Lakin G.F. Biomatria. 'Medicina', Moscow, 1990
Lather I., Bevan J.A. Stretch-dependent myogenic tone in isolated blood vessel. In: Mechanoreception by vascular walls. Edited by G.M. Rubani. 'Futura Publishing Company, Inc.' Mount Kisko, NY 1983
Montanez-Aguilera FJ, Valtuena-Gimeno N, Pecos-Martin D, Arnau-Masanet R, Barrios-Pitarque C, Bosch-Morell F. Changes in a patient with neck pain after application of ischemic compression as a trigger point therapy. J Back Musculoskelet Rehabil., 23(2):101-4, 2010
Morhenn VB. Firm stroking of human skin leads to vasodilation possibly due to the release of substance P. J Dermatol Sci., Feb;22(2):138-44, 2000
Otsuki A, Fujita E, Ikegawa S, Kuno-Mizumura M. Muscle Oxygenation and Fascicle Length During Passive Muscle Stretching in Ballet-Trained Subjects. Int J Sports Med., 2011
Pick F. Verhandlungen des Kongress fuer Innere Medizine. XX, Weibaden, 1907
Smith JD, Davies N, Willis AI, Sumpio BE, Zilla P. Cyclic stretch induces the expression of vascular endothelial growth factor in vascular smooth muscle cells.Endothelium, 8(1):41-8, 2001
Von Mosiengeil Uber Massage, deren Technik Wirkung und Indikationen. Arch. F Klin, Chiurgie, 19:2-4, 1876
Wakim K.G. Martin G.M., Terrier J.C., Elkins E.C., Krusen F.N. The effect of Massage on the Circulation in Normal and Paralyzed Extremities. Arch Phys Med, Mar, 135-144, 1949
Yang W, Chen J, Zhou L. Effects of shear stress on intracellular calcium change and histamine release in rat basophilic leukemia (RBL-2H3) cells. Environ Pathol Toxicol Oncol, 28(3):223-30, 2009

Cafarelli E., Sim J., Carolan B., Liebesman J. Massage and Short Term Recovery From Muscle Fatigue. Int J Sports Med, 1990, 11:474-478.

Cheung, K., Hume1 P.A., Maxwell L. Delayed Onset Muscle Soreness Treatment Strategies and Performance Factors. Sports Med, 2003; 33 (2): 145-164.

Cleak M.J., Eston R.G. Muscle soreness, swelling, stiffness and strength loss after intense eccentric exercise. Br. J. Sports Med, 1992, 26(4): 267-272.

deVries H.A. Quantitative EMG investigation of the spasm theory of muscle pain. Am J Phys Med, 1966; 45:119-134.

Drews T., Kreider R.B., Drinkard B., Cortes C.W., Lester C., Somma C.T., Shall L.M., Woodhouse M. Effects of Postevent Massage on Repeated Ultra-Endurance Cycling. Int J Sports Med, 11:407, 1990.

Ganong W.F. Review of Medical Physiology. 'Lange', Norwalk, Connecticut, 2009.

Gulick D.T., Kemura I.F. Delayed onset muscle soreness: what is it and how do we treat it? J. Sports Rehab, 1996, 5: 234-243.

Hough T. Ergographic studies in muscular soreness. Am J Physiol, 1902; 7:76-92.

Lin WH. The effects of massage, stretch and meloxicam on delayed onset muscle soreness. Taoyuan: National College of Physical Education and Sports, 1999.

Reynolds G. Phys Ed: Does Massage Help After Exercise? New York Times, 2010, June 2.

Sharkey B.J., Gaskill S.E. Sport Physiology For Coaches. Human Kinetics. Windsor, Champaign, Ill. 2006.

Rodenberg J.B., Steenbeek D., Schiereck P., Bar P.R. Warm-up, Stretching and Massage Diminish Harmful Effects of Eccentric Exercises. Inter J Sports Med, 1994, 15:414-419.

Smith L.L. Acute inflammation: the underlying mechanism in delayed onset of muscle soreness. Med Sci Sports Exerc, 1991, 23(5):542-551.

Smith L.L., Keating M.N., Holbert D., Spratt D.S., McCammon M.R., Smith S.S., Israel R.G. The Effect of Athletic Massage on Delayed Onset Muscle Soreness. Creatine Kinase and Neutrophil Count. J. Orthop Sports Phys Ther, 1994, 19(2):93-99.

Sydney-Smith M., Quigley, B. Delayed onset muscle soreness: evidence of connective tissue damage, liquid peroxidation and altered renal function after exercise. Report to Australian Sports Comission's Applied Sport Research, Canberra: Australian Sports Commission, 1992:77.

Wiltshire EV, Poitras V, Pak M, Hong T, Rayner J, Tschakovsky ME. Massage impairs postexercise muscle blood flow and "lactic acid" removal. Med Sci Sports Exerc, 2010 Jun; 42(6):1062-71.

Wenous J.Z., Brilla L.R., Morrison M.D. Effect of Massage on Delayed Onset Muscle Soreness. Med Sci Sports Exerc, 1990, 22:S34.

Unexpected usefulness of certain massage protocols

Several weeks ago, I received a 53 years old male client who was suffering from what was introduced to me as sciatic nerve neuralgia. He had reported all classical symptoms of this disorder, including pain in the buttocks with irradiating to the leg. This wasn't his first episode; during the last five years the pain was on and off. The MRI examinations showed, 4mm disc bulging on the level of L4-L5, and 5 mm disc bulging on the level of L5-S1. When I asked him slightly to bent forward, he could do it without experiencing increase in pain intensity. 
 
During these five years of suffering through the pain, he tried many different therapies including epidural injections with no real progress. 

As usual in such cases I started palpating lower back area, buttocks, hamstring muscles, investigating for tension within muscles and fascia, discovering trigger points, etc. 

There was much indication that Piriformis Muscle Syndrome could be responsible for all the difficult clinical picture. However when I have investigated gluteus muscles by slight compressions, especially area of sacrotuberous ligament, my client immediately complained on experiencing intense irradiating pain in penis and testicles. The pain was disappearing once I was stopping the compression. 

I have immediately checked the tension in hamstring muscles. Their resting tone was noticeably high alone with the apparent limitation in range of motion and containment of numerous trigger points. I told him that these muscular syndromes, if addressed appropriately and in detail, would not only help him alleviate pain and limitation in the range of motion, but also can increase his erection during intercourse. 

The client, who happened to be a urologist, immediately asked me about how I deduced him having the erectile dysfunction. 

I explained him that the clinical symptoms he experienced often caused by chronic lower back disorders, which also cause hamstring muscles tension. Hamstring muscles tension, is transmitted to sacrotuberous ligament, resulting in irritation of pudendal nerve. Since pudendal nerve provides innervation to sex organs its irritation produces pain in penis and testicles, and diminishes one's ability to maintain erection. Therefore my treatment that included releasing tensions in muscles and addressing trigger points could have improved his sexual potentials. 

After six treatments all clinical symptoms of sciatic nerve neuralgia were almost gone, but I have continued providing massage treatment, including trigger point therapy to hamstring muscles, paying special attention to gluteus muscles, and area of sacrotuberous ligament. 

With decreased pain, my client could report feelings of warm sensation in penis, and was amazed at how his erectile potential has improved. 

Altogether I've provided this doctor with 14 treatments, on the basis of three-times a week. Treatment included, connective tissue massage/fascia release, muscular mobilization, trigger point therapy, as well as post-isometric relaxation techniques. This step by step protocol I present on my instructional DVD#1 

In fact he was so impressed with the result that he referred to me three of his patients, who had suffered similar symptoms. 

As of today my urologist client is discharged. We are staying in touch. He feels great, and happy and this is a source of great pride and joy for me. His patients - all three of them are improving, including improvement of their sexual potential. This is another example of how appropriately applied medical massage protocol makes a huge difference in difficult cases compromised health manifested by complex clinical symptoms.

Clinical incidences could be educational

Recently I had a rather stormy discussion in one of the user groups regarding my article "Body cells carry emotional memories.” This theory doesn’t have existing scientific explanation, only a working hypothesis. But this hypothesis has such a frequent support in everyday clinical experience that I felt it cannot be ignored. Turning around the discussion in my head I remembered the incident that perfectly fit as the supportive argument for this hypothesis. 

This one lady (let’s call her Ann just to preserve her anonymity) was referred to me by her primary care physician. Eleven years prior to this referral took place, after giving birth to a beautiful baby girl, Ann developed clinical depression, frequent episodes of anxieties, muscular pains and aches and sleep disorders. As her health was declining she was diagnosed with postpartum depression. During all this years, she received clinical psychological and pharmacological treatments. Nothing was working and symptoms were getting worse. 

The referring physician, requested to provide her with medical stress management massage. During the first session, as I was attempting to massage her right side upper back, shoulder area, and pectoralis muscles, she sprang out and with convulsive movement deflected my hand away from her. To my inquiry about the reason for such reaction she was quite vague. But having been familiar with similar behavior before in my practice and suspected an emotional trauma, similar to the one I described in my article "Body cells carry emotional memories." 

Because my touch didn't cause her to sprang out and deflecting my hand when I was massaging the other parts of her body, I have convinced her to allow me to massage her right side upper back, shoulder area, and pectoralis muscles. Also I have advised to her to release any emotions, if she'd experience any at the time of massage, including crying if she'll have felt like it. And so she did cry it out. 

Eventually, after the fifth treatment, she told me what caused this anxiety. Actually, all these years she didn't realize that it was poisoning her life. During the treatments, and the related emotional releases what was deeply plunged in her subconscious mind, somehow came out and became obvious.
 
The story went back to the incident that happened while she was in her early teens between her and her boyfriend who was two years her senior. It was what was supposes to be their first sexual encounter. In the moment of truth the boyfriend saw her thirteen year old breasts. The gentleman that he was, he sneered at them, pushed her against her chest, and told her that she needs to grow up before he would yield his manhood to her undeveloped femininity. When she start crying, he had pushed her few additional times, including area of right side upper back, shoulder area, and pectoralis muscles. Thus these regions became bookmarks of emotional scars. Surely, in the moment of tight dramatic tension, these were the chain of events that left a heavy emotional scar to all her life. Although Ann is quite a beautiful woman, happily married and looks spectacular for her age, somewhere in the depth of her subconscious mind the burn of this rejection haunted her all her life. She complained that during intimate moments with her husband, she always felt tormented, whenever the action was coming to her breast region. 

I said and recommend to her since all this incident got conscious realization just to get rid of it. I also stated that her ex-boyfriend was not only rude and stupid, but most likely had some serious emotional problem himself. At that moment she started laughing as well, because as she explained the person, who used to be that boyfriend of hers, indeed today has some serious psychological problem. 

We were laughing together for some time, especially Ann who seemingly couldn't stop. I have no doubts in my mind that this laugh was her additional emotional release and a cure, because the next five times we've met she had no more problems with me massaging pectoralis and as she admitted, first time in all her life she fully enjoyed the intimate moment with her husband. 

As many stories like this accumulated over my more than 40 year old practice, I can all but shrug when I hear how someone, with the righteousness of scientific purist, denies the connection between body regions somehow linked with emotional traumas. While purists like these wait another fifty years until such connection would be proven by the official Western science, many therapists could help very many suffering people armed with only working hypothesis and a bit of common sense. 

Common concept: Massage therapy /chiropractic procedure

Back in 1987 one Russian neurologist, the specialist in sports medicine, has invited me to participate in a pilot experiment for chiropractic medicine educational program. He was hired by Medical College at city of RAMAT GAN at Israel to develop and to supervise this program for further approval by the Department of Education. At the time I was already experienced medical massage practitioner but knew little about chiropractic medicine. 

This offer was too good to refuse: free education, flexible schedule, and the opportunity to learn x-rays readings from a well known neurologist, an expert in x-ray readings. 

He knew how to extract real and useful data from x-ray shadows. To teach chiropractic adjustments techniques college hired one American chiropractor, and one from UK. In my opinion both of these doctors, where quite knowledgeable in spinal pathologies. They thought us that facet joint subluxations is the main cause of back pain. Thus elimination subluxations through adjustments practically restores the normal function, such as no pain, normal functional activities conditions, etc. 

At the time both of them have thought us, that main cause and preconditions for facet joint subluxations are myofascial dysfunctions, which are tensions within muscles and fascia. When I asked in which way adjustments addresses this soft tissue dysfunctions, they had no answer to that. Indeed there could not be such an answer, because dysfunctions originated on the level of soft tissue could only be addressed on that level. 

Approximately at this same time the “new” Manual therapy theory came about. This theory stated that facet joint maneuvers - a modality similar to adjustment techniques - is the ultimate “remedy” thus eliminating the need to address soft tissue by means of massage. This approach had a devastating effect on the entire medical massage therapy field in Europe, and, of course, has proven that adjustment only, do not lead to sustainable results. 

I have complained about it to the Russian neurologist, who like myself, had witnessed the destruction of Russian Medical Massage field. He agreed with me, but explained that these chiropractors where hired, before him, and program was already approved and not much he could do. 

I'm not regretting completing this program, since I have learned some very viable stuff but I know and knew then, that without quality soft tissue mobilizations it is impossible to reach and sustain results such as less pain, a greater range of motion, a sensation of well-being, etc. 

We, as massage therapists, have to educate chiropractors in regard to massage related concepts, and capabilities to reduce tension in muscles and fascia, to address trigger points, to manage side effects of stress, etc.

From my observation when treating people with painful orthopedic disorders, it is practically impossible to reach sustained results if stress management massage is not incorporated in the treatment. Stress side effects can initiate painful disorders, worsen a condition, and then, if not managed, prevent obtaining sustain results.

Chiropractic procedure is also about obtaining results. But chiropractic results are different than achieved by massage therapist. As a result: they need us and we need them. The best for clients and patients if we work together having one concept, massage therapy and adjustment.

One can say that for years we already has been working in chiropractic offices. Yet this is not the same as having a common concept? Usually when chiropractors hire massage therapists they instruct them on how massage should be performed. For example "to press hard and strong." The point here is that chiropractors are not trained in massage therapy and don't really understand the importance of performing massage before adjustments, of post-adjustments of trigger point therapy, and other techniques. 

To have a common concept is to educate and to convince on the importance of reducing the size of lymphedemas, releasing the tensions in fascia and muscle, eliminating trigger points by ischemic compression before adjustment, as well as on the importance of continuing to provide orthopedic massage after a successful adjustment/elimination of subluxation. 

I believe that soon enough more and more hospitals will start massage programs and it will make us recognizable methodology of treatment. 

Chiropractors are out of hospital services, and will have much greater interest to work with us, because work in the hospital based settings would command their respect. In any case on the common concept - we have to educate doctors of chiropractic medicine. Soft tissue mobilization by means of massage is different discipline, requiring expertise. The chiropractors must be informed that it is practically impossible to reach sustained results if stress management massage is not incorporated in the treatment. Stress side effects can initiate painful disorders, worsen a condition, and then, if not managed, prevent obtaining sustain results in cases of painful skeleton muscular disorders.

Increase in blood supply triggered by massage

The existence of Vasomotor Reflexes /increase of blood supply triggered by massage therapy was originally shown by Prof. Zabludovsky (1913) who used a plethsymograph to register the phenomenon. 

10 years ago I have repeated the same protocol at Beverly vascular laboratory. Pulse Volume Recording (PVR) Photopletismograph and Termography were used to compare arterial blood circulation. The largest changes were registered in PVR. What is important about this study is that all measurements were conducted in the lower extremity opposite to the massaged one. 

Let's review the data from one of the subjects. The original value of PVR in the lower right extremity of the subject was 0.73. I have provided massage to the subject for 15 minutes and the PVR almost immediately started to climb. At the end of 15 minutes PVR on the lower extremity was 1.22. Thus arterial blood perfusion was almost doubled compared to the previous value of 0.73. I have stopped procedure but, PVR continued to climb, and at the end of the second hour it was 1.63. It means if we provide massage to people who suffer from extremity fractures, or after surgeries on extremities, by massaging the extremity not affected by surgery or fracture, you are significantly stimulating the healing process, preventing self infections, reducing the duration of hospitalization and days of disability. A clinical prove is necessary. Otherwise any theory, however beautiful it might seem, will remain just that and die as such. The other side of this statement is also true. i.e. It doesn't really matter if the theory was established 100 years ago. Al long as it is proved clinically - it is good. 

What separates a good therapist from a great one?

A sense of touch is a demarcation line that sets apart a good therapist and a great one. The greater therapist being the one who constantly delivers better results. In order to be able to deliver better results, it is very important to understand physiological effect of massage on human body. In the following clip hopefully would answer these questions.  The definition of massage

What is this simple approach to massage therapy and how is it different from other approaches?

Our lives are full of events that are connected by cause and effect. For instance, if we lift and release an object it's going to fall down. Gravity existed long time before Galileo and Newton described its behavior quantitatively. Millenniums before their time, knowing nothing about gravity beyond its cause and effect relation, military engineers created machines that catapulted rocks over the wall of besieged cities. Today, you can rarely find a person who's not familiar with the force of gravity and Newton's laws. 

Yet to a large degree, the nature of gravity is still a mystery. We understand much more about it now, but there is always one more "why" to which no one has an answer. After all said and done, gravity is just that. However, this doesn't preclude us from counting on gravity to be there for us every time and to use its cause and effect relation to our advantage. 

Electro-magnetic force is another example of such natural phenomenon. The magnetic field is produced by the motion of electric charges. Conversely, the movement of the magnetic field causes electrical current. The nature of these phenomena is very complex and like gravity, not very well understood. Yet this does not preclude us from generating electricity by rotating magnets on electrical stations. 

Going back to the massage business... science can explain many things, but it cannot explain everything. It can measure and record a detailed cause and effect relation that guides practitioners in the field. It can tell us which manipulations need to be done, and in which sequence these manipulations need to be performed, in order to achieve the desired effect. 

As paradoxical as it may sound, in order to achieve sustainable results, a "complete understanding" is not necessary. For example, if a client suffers from the negative effects of stress, a massage therapist should have a clear understanding of the abnormalities caused by stress. It's not necessary to understand the problem on the molecular, atomic or subatomic levels. However, it is very important to understand that stress causes arteries to contract, resulting in other negative side effects such as an increase in heart rate, a rise in blood pressure, an increase in blood sugar levels, etc. 

But it's not important to understand the exact triggering mechanism of such contractions, or the neuron chemistry which allows the transfer of such signals from the brain to the arteries. In other words, each problem has to be dealt with on its own level of abstraction. It is much more important for a massage therapist to know which of the scientifically developed protocols for stress management to apply and to be able to perform them masterfully. 

We must remember that scientists and massage therapists possessing expertise in different fields.

The bottom line is: massage therapy is about results and massage therapist is the one who delivers it.

The scientific community has given massage serious consideration only in the last 100 years.

As a therapeutic tool massage has been known and used since ancient times. The scientific community has given it serious consideration only in the last 100 years. Within this time, scientists have discovered many important factors that links massage with the treatment of multiple diseases. Most of these works are written in a very complex way and a massage practitioner can have a hard time extracting their practical benefits. 

Thus, although there are many ingenious protocols that allow massage to have a pinpointed affect on many different ailments, for all practical purposes that are not accessible to massage therapist. Also, among variety of approaches to training and massage therapy protocols for hands on implementations, only those methods proved themselves in clinical trial that deliver results: such as less pain, improved range of motions, less sides effects of stress, etc.

I believe that scientists and researches should not only develop advanced methods of treatment, but also have a duty to present it in a simplifies way, adjusted to the average level of theoretical understanding indigenous to the majority of therapists in the massage field. 

This approach of leaving complex and intricate details out of the picture and leaving only essential, easily understood and easily implemented information, I call "the simple approach." I will offer a more detailed explanation of what I consider simple approach to massage therapy in the next post.

Medical Massage is not a remedy for all diseases. Yet it is so powerful, that for the sake of one's well-being, it cannot be ignored.

Massage therapy is not a remedy for all diseases. Yet it is so powerful, that for the sake of one's well-being, it cannot be ignored. We cannot rely on "feel good" sensations only. To achieve the best results, treatment strategies and underlying concepts have to be understood and step-by-step protocols should be followed to the letter. Only in this way, massage therapy methodology contributes to human health in a dramatic way. The simplicity of massage is learned by discipline, desire, dedication, and acceptance of the mission. 

Hippocrates, the Father of Medicine, once said, "The doctor must be experienced in many modalities but especially in massage. Massage can cause tight joints to relax and loose ones to become stable." 

Thousands of years have passed. Today we have much additional scientific data, clinical outcomes and experience regarding the power of massage therapy. It is not limited to the treatment of support and movement systems only. I hope that my blogs will contribute to your inspiration, passion and love of this wonderful treatment method. I believe in simple approach to therapy by means of massage. 

I also know, that without home self-massage program, it would be difficult to sustain results in cases of painful back and limp disorders, stress related illnesses such as essential hypertension, tension headaches, anxieties, sleep disorders, major depressive disorders etc. Subsequently, I will try to share my knowledge in a practical way that, in some way, could contribute to your well-being.