One of the major obstacles to massage practitioners building productive professional relationships with physicians and other health practitioners and establishing a successful referral base is their frequent inability to explain the importance of massage in terms familiar to Western-educated doctors. In other words, we have a communication problem, and until this problem is solved, massage therapy will remain on the outskirts of medicine instead of being an integral part of the treatment of many somatic and visceral disorders.
Here at the Journal of Massage Science, we strongly believe that real scientific information about massage therapy is long overdue and must be introduced to massage practitioners. It is time for the massage industry to rely on scientific data to convey a correctly formulated message to the medical community and clients. In this issue, we are starting a series of publications that will address this exact topic.
Using the world’s best scientific medical and massage sources (please see the caliber of publications this article is based on in the reference list at the end of the article), we will illustrate step by step for our readers how massage therapy affects the healthy and disease-stricken body at the cellular, tissue and body levels by employing a variety of healing factors. Pay attention to this and future articles because they will give you enough scientifically based information to have unique leverage in any professional situation, ranging from interactions with physicians or with fellow colleagues and students to explaining the benefits of the therapy to the client or patient.
Let’s hypothetically consider two scenarios in which two massage practitioners are interviewed by a family physician who is looking to extend their practice and start to offer massage therapy as an integrative part of the standard care provided in the clinic. There are more and more family physicians who are looking for this opportunity. This is a great chance for the massage practitioner, because he or she will be guaranteed a very busy practice, and frequently the office will do the billing and communicate with insurance companies.
During the interview, the first practitioner explains his scope of work and justifies the necessary expertise by stressing his ability to balance the body’s energy and normalize the flow of the ‘Qi’ through the patient’s body.
The second practitioner bases her expertise on the fact that the therapy she uses changes the bioelectricity in the soft tissue and consequently the entire patient’s body by generating piezoelectrical potentials and streaming potentials as two major healing factors. As you may agree, these are quite different ways of explaining the healing impact of massage therapy.
The massage practitioner who works in his or her private clinic and would like to build up a referral base among local physicians will face a similar situation if he or she doesn’t have the ability to clearly explain the benefits of the therapy using scientific terminology of Western medicine.
LOCAL HEALING MECHANISMS OF MASSAGE THERAPY
Massage therapy is a way to deliver mechanical stimuli to the body, and all local and reflex healing effects of massage therapy are outcomes of this process. Diagram 1 summarizes the scientifically proven local effects of massage therapy on the human body. This diagram does not include the reflex mechanisms of massage therapy and its impact on the central nervous system. These topics demand a separate discussion. From issue to issue, we will cover each segment of this diagram until our readers have a completely unique understanding of the local healing impact of massage therapy on the human body. To replay the diagram, please click at the beginning of the sliding bar (blue line) located just below the diagram.
In this issue of our Journal, we will discuss an effect that is mostly unknown to practitioners. That is the ability of massage to alter and enhance cellular function in the soft tissue. This effect is called cellular stimulation. We guarantee our readers that at this point you may find this critically important information only in our Journal. We will start the discussion of cellular stimulation by massage therapy with the phenomenon of piezoelectricity, its impact on the body and its role in massage therapy.
PHENOMENON OF PIEZOELECTRICITY
Let’s start with the basic definition. Piezoelectricity is the ability of inorganic and organic matter to generate electrical potentials in response to pure mechanical deformation without application of any external electric or magnetic field. In other words, inorganic or organic matter has an inner ability to generate independent electricity in response to its simple mechanical deformation.
The phenomenon of piezoelectricity was discovered by two French physicists, the brothers Curie, in 1880 (Williams, 1974). The diagram below re-creates their experiment (to see the diagram, please push the play button). The authors tested the behavior of a quartz crystal when mechanical force was applied to it at different angles. If force was applied along the main axis of the quartz crystal, its increase eventually crushed the specimen. However, when the authors applied force at an angle (black arrow in the diagram) to the main axis, it created a combination of vertical mechanical compression and shear deformation within the quartz crystal. Such a combination of two mechanical factors deformed the atomic structure of the quartz in a way that electric potentials with opposite polarities were formed and were detected on the opposite sides of the quartz crystal.
For many decades after its discovery, the phenomenon of piezoelectricity was considered a unique feature attributed solely to inorganic matter. The situation dramatically changed in the middle of the 20th century.
In 1957, two Japanese scientists, E. Fukada, MD, and I. Yasuda, MD, discovered the existence of piezoelectricity in human bone. This is a very important issue for our further discussion, and we will use Diagram 3, which recreates the initial experiment on the human bone conducted in Japan.
The harvested bone was placed in a holder, and the electrodes of an amplifier were attached to the opposite surfaces of the bone to record the possible generation of electric potentials. After that, the authors applied mechanical pressure to the opposite end of the bone. As you may see in part ‘a’ of the diagram, the application of pressure triggers tension (or stretch) on one side of the bone while the opposite side becomes compressed.
At the moment of pressure application, Dr. Fukada and Dr. Yasuda were able to register negative electrical potentials on the compressed side of the bone. These potentials returned to zero as soon as the further increase of pressure ceased, but the initial pressure was still maintained. At the moment pressure was released and the bone came back to its original form, the authors registered positive electric potentials on the tensed surface of the bone.
Why was this discovery so important? Imagine that every step you take causes constant deformation of each bone in your body and, as a result of these deformations, your bones are able to independently generate electricity, without input from the central nervous system. This electric potential becomes one of the major factors in supporting the proper function of the skeletal system and, as you will see below, in maintaining the physiological balance in the function of soft tissue and even inner organs.
Dr. Fukada and Dr. Yasuda also showed that the application of external electric current of different polarities to the bone has completely opposite impacts on its function. If a positive electric current was applied to the bone, it caused its resorption (i.e., weakening), while application of the electric current with negative polarity stimulated bone growth and remodeling. This discovery became the foundation for a very effective medical treatment of delayed fracture healing.
For our discussion, it is important to find out what happened after the initial publication of Fukada and Yasuda. After the original paper was published in 1957 and scientists around the world agreed on its importance, it was immediately accepted that the inorganic component of the bone, called apatite, was responsible for the generation of the piezoelectrical potentials in the bone.
As we know, bones are composed of two major parts: the organic part, represented by the collagen fibers, and the mineral part (Ca, P, etc.), which forms apatite (see Diagram 4).
The organic part gives the bone elasticity, while the inorganic part gives the bone its firmness and stability. Since piezoelectricity had been attributed to inorganic matter ever since the Curie brothers’ discovery, it was obvious to everyone that apatite was directly responsible for this phenomenon.
Everything went upside down when, in 1962, two American scientists, R.O. Becker, MD, and C.A. Bassett, MD, published their paper showing that collagen fibers, or the organic part of the bone, are directly responsible for piezoelectrical potentials generated by the bone. This study sent shock waves through the world’s medical community because if the collagen fibers in the bone were able to generate electric potentials, the collagen fibers in other tissues and organs would be able to do exactly the same. As we know, collagen is a major framework material for the organs and soft tissue and it is everywhere in our body.
After Dr. Becker and Dr. Bassett’s original publication, scientists rushed to examine the possibility of piezoelectricity in other tissues. The results were astonishing. It was found that elastin in the skin (Shamos and Lavine, 1967), collagen in tendons (Anderson and Eriksson, 1968), collagen in ligaments (Fukada and Hara, 1969), actin and myosin in skeletal muscles (Fukada and Ueda, 1970), and even some individual amino acids (Vasilescu et al., 1970) and DNA molecules (Fukada, 1982) exhibited piezoelectrical properties. All of this allowed Dr. M.H. Shamos and Dr. L.S. Lavine to conclude that “piezoelectricity is a property of most, if not all, tissue in the plant and animal kingdoms”.
MASSAGE THERAPY AND PIEZOELECTRICITY
As we now know, all organs and tissues in our body exhibit piezoelectric properties, but what theoretical and practical value does this information have for the practitioners and massage therapy profession in general? Why do we spend time even discussing this matter in our massage Journal? Here are the answers to these questions.
The seemingly theoretical concept of piezoelectricity has great clinical value for the massage practitioners. Massage therapy is a way to deliver mechanical stimuli to the soft tissue and one of its great clinical outcomes is the generation of piezoelectrical potentials in the massaged area.
Let me, as an example, briefly review the impact of massage therapy strokes on collagen. As mentioned above, collagen fibers are the most important and abundant fibers in our body. They form the structural frame of all organs and tissue and are a major repair material used to restore tissue after any trauma or inflammation.
Each collagen molecule is a strong dipole, i.e., it has two oppositely charged ends (see Diagram 5). The head is the bigger part, and it has a slightly larger positive charge while the tail is smaller and it has a slightly smaller negative charge. Thus, the overall charge of each collagen molecule is positive.
Collagen molecules unite together to form different anatomical structures (tendons, ligaments, bones, structural frame of the inner organs, etc.). All collagen molecules in combination with other electrically active proteins generate the so-called fixed electric charge of each organ and tissue.
Thus, the fixed electric charge is a cumulative charge of all electrically active molecules in the area. Even under normal conditions this charge constantly changes as a result of the individual person’s physical activity, diet, level of stress, etc. Despite these constant fluctuations, changes in the fixed electric charge stay within the physiological range assigned to this particular tissue.
The situation changes dramatically if the soft tissue or inner organ has been traumatized or has developed inflammation, etc. The fixed electric charge within the affected area immediately changes its normal value as a result of the pathological process. Diagram 6 describes this process and the healing mechanism the massage therapy employs to normalize electrophysiology in the affected soft tissue. We will discuss the issue of streaming potentials in the next issue of the Journal of Massage Science.
As we now know, any inflammation or trauma of the soft tissue increases the positive fixed electric charge and the collagen fibers are one of the major contributors to this process (see Diagram 7). Swelling, rupture and twisting of the normal collagen fibers (see #1 in the diagram) greatly contribute to the increase of the positive fixed charge in the soft tissue (see #2 in the diagram). The healing process after initial trauma or inflammation is always accompanied by the slow restoration of the fixed electric charge in the affected area.
During the massage, external mechanical stimuli in the form of the repeated application of massage strokes deform the collagen molecules (see #3 in the diagram) and generate piezoelectricity, which increases the negative fixed electric charge. As we discussed above, the negative electric charge has the greatest impact on the proliferation, growth and regeneration of the tissue (see #4 in the diagram).
Also, the increase of the negative charge in the affected area is the critical factor in the correct alignment of the pro-collagen fibers before their maturation into the fully developed collagen fibers. The delay of this process slows the local healing. Thus, the restoration of the fixed electric charge is a critically important process in reducing the tension in the soft tissue and eliminating the physical and even mental stress. At the same time, it is an equally important component in speeding up the healing process.
The concept of piezoelectricity gives the practitioners a lot of important clinical tools to apply therapy correctly and optimize the outcomes of the treatment. For example, the study conducted by Shamos and Lavine in 1967 showed that human skin exhibits the largest piezoelectrical potentials if the mechanical stimuli are applied at a 45-degree angle. This is a very important practical recommendation, as the massage practitioner needs to generate the greatest number of piezoelectrical potentials during the treatment.
Let’s compare the common application of effleurage and friction strokes with the application of the same strokes using a 45-degree angle. The video below presents the application of both techniques.
If the practitioner wants to optimize performance and enhance the healing potential of the therapy, he or she simply needs to change the angle of the applied strokes, and this factor alone, even without learning additional massage techniques, will greatly help the practitioner build up a successful practice.
Modern technology allowed scientists to measure the piezoelectrical properties even within a single collagen fiber. In a recent study, Minary-Jolandan and Yu (2009) showed that a single collagen fiber is able to generate a piezoelectric coefficient of 1 pm V(-1) and the summation of piezoelectrical charges generated by each collagen fiber allows the entire tendon to generate electric potential up to tens of millivolts, depending upon the size of the tendon. The authors of this study strongly reinforced the previously mentioned publication of Shamos and Lavine, who found that only shear deformation of the collagen fibers triggers the piezoelectrical effect. Thus, the angle of the application of the pressure during the massage strokes (45 degrees is the most preferable) is a critical factor in the generation of the piezoelectricity and normalization of the electrophysiological properties of the soft tissue.
A very important article for massage practitioners was published in 1977 by one of the most respected scientific authorities in the field of bioelectricity, Professor B. Lipinski, MD. Using his experimental data he formulated the theory which links the therapeutic effect of soft tissue manipulations, acupuncture, Hatha Yoga and the action of negatively charged air ions with piezoelectrical properties of the biological tissue.
According to this theory, proteins, mucopolysaccharides, nucleic acids, etc., which compose all tissues of our body, are able to generate piezoelectricity. Thus, these substances have the ability to transfer the externally applied mechanical energy (e.g., by massage strokes) into electric energy inside the soft tissue.
The author showed that stimulation of the soft tissue in special areas of the body produces an electric current. This piezoelectrically induced current activates the healing processes in the stimulated area, and it is able to flow “towards the internal organs along the semiconductive channels of biological micromolecules”.
I would like the readers to pause for a second and fully comprehend the theoretical and practical value of this information for the entire massage therapy profession. Imagine that every time you apply mechanical pressure to the soft tissue in the form of massage strokes, you actively produce an electric current in these tissues, and it has enormous healing potential on the cellular, tissue and organ levels. This electric current is able to travel to distant parts of the body, including the inner organs, and normalize their function.
The healing impact of the massage treatment is directly correlated with the total amount of piezoelectrical potentials the practitioner generates during the therapy. If the practitioner doesn’t use correct tools and tips (e.g., angle of the strokes, speed of the strokes, greater variety of massage techniques, etc.), he or she greatly diminishes the healing outcomes of the treatment and undermines his or her efforts and practice.
TALE OF TWO PRACTITIONERS
Now let’s come back to the hypothetical case of two massage practitioners we discussed at the beginning of the article, who are being interviewed for potential work in the family practice medical office.
After reading this article, who do you think will have the advantage during the interview: the first practitioner, who described his work as a way to enhance healing through the balance of body energy, removing energy blocks and normalizing the flow of ‘Qi’, or the second practitioner, who described her work as stimulation of the healing process by normalizing fixed electric charge, generating piezoelectricity and enhancing the maturation of collagen fibers?
Ironically, both practitioners described the same process, but they used strikingly different language. While talking to the physician, the first practitioner used the 5000-year-old language of Oriental health practitioners, while the second practitioner used the 21st-century scientific explanation of the same phenomenon.
This is a great example of how massage practitioners routinely undermine their work in the eyes of the medical community and clients. If you would like to be successful in this profession, you must be familiar with modern terminology and current scientific theories and be able to explain your work in a way that makes sense.
I would like the readers to understand the article’s goal correctly. It in no way undermines the achievement of the Oriental thinkers and health practitioners. Using great observation skills and intuitive minds they were able to discover long ago the same processes in the body we just now are able to understand. They were greatly ahead of us.
Five thousand years ago no one knew about electricity in general and bioelectricity in particular. This is why people called it ‘Qi’ or healing energy, but it is unacceptable in the 21st century to describe the therapy to a Western-educated physician, client or patient using ancient figurative language filled with metaphors. This is not a way to build up a practice in Western society.
It doesn’t matter what type of bodywork you are practicing or teaching – Swedish massage, acupressure, neuromuscular therapy, or reflexology – you are not in any case affecting the flow of some mystical healing energy. This is a complete fairy tale and scientific nonsense. Instead, your treatment triggers a chain of electrophysiological changes in the soft tissue and the entire patient’s body.
Unfortunately for the entire profession, these changes were incorrectly labeled as healing body energy. This 5000-year-old term deprived massage therapy of its scientific basis, and we need to change it as soon as possible in school curricula, in certification exams and even in the publications where it is a very common subject. Please educate clients, colleagues, students or other health practitioners on this fundamental matter.
I am perfectly aware that many practitioners will continue to use this concept because it is very difficult to change an already established system of beliefs. However, our Journal addresses this article to practitioners who are ready to open their minds, embrace the science in massage therapy and learn and practice its application.
A successful massage therapy practice relies on two major pillars: the spiritual-psychological aspect of massage therapy and its scientific foundation. While the first aspect is very well developed and greatly reinforced in massage education and literature, the modern scientific understanding is lagging behind, and must be changed for the benefit of the profession and health of the clients. Thus, the goal of this and our future articles on this subject is to give the practitioners a clear scientific understanding of the healing impact of the massage therapy. Mastering this knowledge is an effective way to build up a flourishing practice and, at the same time, it will help the further development of the entire massage therapy profession.
REFERENCES
- Anderson JC, Eriksson C. Electrical properties of wet collagen. Nature. 1968;218:166-168. doi:10.1038/218166a0
- Becker RO, Selden G. The Body Electric. William Morrow; 1985.
- Fukada E. Piezoelectricity of biological materials. In: Lipinski B, ed. Electronic Conduction and Mechanoelectrical Transduction in Biological Materials. Marcel Dekker; 1982:125-127.
- Fukada E, Hara K. Piezoelectric effect in blood vessel walls. J Phys Soc Jpn. 1969;26:777-780. doi:10.1143/JPSJ.26.777
- Fukada E, Ueda H. Piezoelectric effect of bone. Jpn J Appl Phys. 1970;9:844. doi:10.1143/JJAP.9.844
- Fukada E, Yasuda I. On the piezoelectric effect of bone. J Phys Soc Jpn. 1957;12:1158-1162. doi:10.1143/JPSJ.12.1158
- Lipinski B. Biological significance of piezoelectricity in relation to acupuncture, hatha yoga, osteopathic medicine, and action of air ions. Med Hypotheses. 1977;3(1):9-12. doi:10.1016/0306-9877(77)90045-7
- Minary-Jolandan M, Yu MF. Nanoscale characterization of isolated individual type I collagen fibrils: polarization and piezoelectricity. Nanotechnology. 2009;20(8):085706. doi:10.1088/0957-4484/20/8/085706
- Shamos MH, Lavine LS. Piezoelectricity as a fundamental property of biological tissues. Nature. 1967;213:267-269. doi:10.1038/213267a0
- Vasilescu D, Cornillon R, Mallet G. Piezoelectric resonances in amino acids. Nature. 1970;225:635. doi:10.1038/225635a0
- Williams WS. Sources of piezoelectricity in tendon and bone. CRC Crit Rev Bioeng. 1974;2(1):95-118.
Category: Stress Reduction Massage
Tags: JMS 2010 Issue #1
