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.