The purpose of this section of the Journal of Massage Science is to inform the practitioners about valuable articles that frequently go unnoticed, as well as to point to those authors and publications who present very questionable views in their writings. We do not play politics and we are not associated with any publishing company or professional association. We are a completely independent voice and we promise you direct unbiased reviews based strictly on the science.
If the author of the reviewed article does not agree with our opinion, we will be more than happy to publish his or her response and have a productive discussion over the article’s subject.
At the end of the year we will recognize and reward the author of the most important publication(s) and point to the authors of the most unscientific publication(s). We hope this will help to raise the bar of published materials in massage journals for the benefit of the entire profession.
Massage & Bodywork Magazine
Massage Today
Massage Magazine
Massage Therapy Journal
Massage & Bodywork Magazine
Safely Navigating Injuries. Massage & Bodywork Nov-Dec: 33-34, 2012, by Art Riggs
This short article answers one reader’s question about how to safely work in the SPA setting on clients with acute injuries. The author is completely correct when he states that: “…never work on anyone if you don’t feel confident in the safety of techniques you use”. The article targets those practitioners who work in SPA settings that focus on the stress reduction action of massage, and offers some basic suggestions on how to work safely on these clients.
We would like to add that the best method for working on clients with acute injuries is to learn medical massage, and how it can really help them rather than just use safety precautions to avoid further complications.
When the Pieces Don’t Fit. Massage & Bodywork Nov-Dec: 37-39, 2012, by Douglas Nelson
Without a long discussion this is an excellent article, which everyone in the field must read. Please note the sentence at the end of the article: “When the pieces of the puzzle do not fit, do not force them” (emphasized by JMS). Thank you for the great piece!
Adults With Cerebral Palsy. It’s Not Just A Children’s Condition. Massage & Bodywork Nov-Dec: 37-39, 2012, by Ruth Werner
A great article! It provides readers with important information about cerebral palsy and raises awareness about this debilitating condition. Unfortunately, massage therapy is unable to completely eliminate cerebral palsy but neither can any other modality. However, the massage practitioner can play a very important role in the life of clients with cerebral palsy since massage therapy greatly improves their quality of life.
Your Body’s Comfort. Use All Your Massage Tools. Massage & Bodywork Nov-Dec: 46-47, 2012, by Barb Frye
The article offers a simple exercise that the author called Partner Practice for practitioners to heightened the state of their body awareness. It seems this is a very simple issue but we bet that many practitioners will be surprised how much detachment they have between brain and hands while doing stress-reduction massage. The massage practitioner who practices medical massage is in the state of constant awareness since the client’s body constantly feeds the practitioner’s senses with important information. On the other hand, some practitioners who practice their routine of stress reduction massage frequently will get in a state of mind where brain wanders while the hands are automatically working. This is where practitioners become vulnerable to stress injuries.
Partner Practice exercise discussed in the article is a helpful tool, among others, to restore such a broken connection.
Functional Anatomy. Splenius Capitis. Massage & Bodywork Nov-Dec: 49-50, 2012, by Christy Cael
An informative article that discusses the palpation of the Splenius Capitis Muscle.
Massage Improves Postoperative Experience. Massage & Bodywork Nov-Dec: 52-55, 2012, by Diana L. Thompson
For those practitioners who would like to expand their practice in the hospital setting to provide therapeutic massage after major surgeries as a part of the patient’s rehabilitation, this article provides general guidelines and, what is more important, scientific references from medical journals where the clinical benefits of massage for postoperative patients have been examined and justified.
MS. Easing Symptoms with Informed Massage. Massage & Bodywork Nov-Dec: 56-65, 2012, by Charlotte Michael Versagi
This is a main article in Massage & Bodywork Magazine from the reviewed issue. It is dedicated to Multiple Sclerosis (MS), a very debilitating autoimmune disease that attacks the CNS. The article provides considerable helpful and correct information until it gets to the section that is most important for the practitioners and patients: “Step-by-Step Protocol for MS Technique for lower extremities treatment” using massage.
This protocol misses two critical components of the treatment since the author somehow placed them in contraindications: passive stretching and vibration therapy. She never explained where these restrictions come from or on what scientific basis she makes such strange conclusions, which are now will be disseminated in massage community. Here are quotes from the original article and our review of scientific data that completely refutes the author’s claims:
1. First quote from the article:
“Never stretch the limbs of an MS client. You learned in massage therapy school to stretch your client’s limbs to the point of resistance….Exactly the opposite is true when working with MS client (emphasized by the author). Here’s why: 1) These clients cannot tolerate any form of sympathetic nerve firing which might cause spasms. 2) They might have inadequate physiologic reporting mechanism to sense how far they can stretch. 3) If they have contractures, you can cause harm with even mildly overzealous passive ROM”
This is a problem we observe in many publications when the author does not fully understand the pathophysiology of the disease and draws incorrect practical recommendations, which after being published, became generally accepted among massage practitioners since no one challenges such statements or recommendations.
It seems that the author removes passive stretching from the arsenal of practitioners who work on the MS patient based on the assumption that muscle spasms in patients with MS are the result of the increased activity of sympathetic nervous system or that its stimulation will trigger such spasm. First of all, the muscle spasticity is not an initial symptom of MS; it is a complication of MS. According to Harrisson’s Principle of Internal Medicine, the muscle weakness and sensory abnormalities is observed in 72% of newly diagnosed patients with MS. Yes, during the latter stages of MS spasticity becomes a problem but the author of the article failed to understand that this spasticity is not the result of increased of sympathetic tone but rather damage of autonomic nervous system as a result of demyelination. These are two completely different scenarios.
It seems that the author is not aware that in patients with MS both system: sympathetic and parasympathetic can be similarly affected and modern medicine is not able to make such drastic conclusions as the author did. Here is one of the quotes that illustrates our point:
“Thus various sections of the autonomic nervous system may be involved in MS plaques and the overall prevalence of e.g. sympathetic or parasympathetic nervous system alterations may be difficult to access. “
As many studies show, many patients with MS do not exhibit symptoms of activation of the sympathetic division. Dougall and McLeod (2003) detected the abnormal sympathetic skin response in only half of patients with MS. Thus author’s explanation that “…these clients can’t tolerate any form of sympathetic nerve firing” is overstretching especially if MS is newly diagnosed and there is no spasticity developed yet.
Finally if the author is correct that any form of sympathetic nerve firing is prohibited in patients with MS what about the exercises? According to many studies, patients with MS symptoms greatly benefit from exercise programs (Rietberg et al., 2005; Snook, Motl, 2009), but any exercises require a great increase in sympathetic nerve firing. Someone is wrong here, medical sources or the author of the article. We are giving the readers the chance to decide.
In reality, the clinical fact is very simple: passive stretching is one of the most important tools for the treatment of patients with MS. We may provide numerous studies that support this statement. Here are two examples:
Brar et al., (1991) examined effect of baclofen and the combination of baclofen and passive stretching on patients with MS who suffer from significant spasticity. The authors concluded that stretching when added to the treatment protocol greatly enhanced the beneficial effect of baclofen and reduced level of spasticity.
Also, readers may easily check out Mayo clinic website in regard to treatment strategies of the treatment of MS symptoms:http://www.mayoclinic.com/health/multiple-sclerosis/DS00188/DSECTION=treatments-and-drugs
As you may see the first option mentioned on the Mayo website in regard of spasticity treatment of patients with MS is passive and self-stretching. We think that readers will agree that the Mayo Clinic is a very sophisticated and scientifically oriented source of such information, which the author of the article is somehow missed.
2. Second quote from the article:
“Do not use mechanical muscle vibrators to quiet spasms which can stimulate the sympathetic nervous system; use only your hands”
Electric vibration is a very powerful stimulant. As a matter of fact, the vibratory stimuli are even able to override pain stimuli. However, it seems that author writes about vibration without knowledge of its effect on the body. The vibratory stimulation has a dual effect on the function of the muscles. Yes, the author is correct that vibration increases muscle tension but it happens only after vibratory stimuli is introduced to the skeletal muscle or the massager is constantly moved back and forth along the targeted muscle. However, if the massager stays still for at least one minute especially in the middle of the muscle belly where the motor nerve enters the muscle, the vibration triggers deep muscle relaxation. Many studies confirmed the clinical effectiveness of electric vibration on the spasticity and other motor abnormalities including postural changes in patients with MS (Schuhfried et al., 2005; Diego et al., 2012). It is puzzling why the author missed such clinically important information.
Conclusion:
1. Passive stretching is a critical component of the massage treatment of patients with MS. This therapy must be conducted within the patient’s comfort level without activation of any uncomfortable sensations. The practitioner must teach the patient to do self-stretch, especially before and especially after the exercises.
2. The practitioner must use the electric massager with semisoft contact area or use a towel. The massager should be placed in the middle of the muscle bellies of muscles which exhibit symptoms of spasticity. Never move the massager and stay in the same spot to use inhibitory effect of electric vibration.
Brar SP, Smith MB, Nelson LM, Franklin GM, Cobble ND. Evaluation of treatment protocols on minimal to moderate spasticity in multiple sclerosis.Archives of Physica Medicine and Rehabilitation, 1991 Mar;72(3):186-9.
Diego A., Hernandez C., Molina Rueda F., Cano de la Cuerda R. Effects of vibrotherapy on postural control, functionality and fatigue in multiple sclerosis patients. A randomized clinical trial. Nurologia, 2012 Apr;27(3):143-53.
McDougall A.J., McLeod J.G. “Autonomic nervous system function in multiple sclerosis”. Journal of the Neurological Sciences, vol. 215, no. 1-2, pp. 79-85, 2003.
Merkelbach S., Haansen C-A., Hemmer, B., Koehler B., Konig N.H., Ziemssen T. Multiple sclerosis and the autonomic nervous system. Journal of Neurology, February 2006, Volume 253, Issue 1, supplement, pp i21-i25.
Rietberg MB, Brooks D, Uitdehaag BM, Kwakkel G. Exercise therapy for multiple sclerosis. Cochrane Database of Systematic Reviews, 2005 Jan 25;(1):CD003980.
Schuhfried O., Mittermaier C., Jovanovic T., Pieber K, Peternostro-Sluga T.Effects of whole-body vibration in patients with multiple sclerosis: a pilot study.Clinical Rehabilitation, 2005 Dec;19(8):834-42.
Snook EM, Motl RW. Effect of exercise training on walking mobility in multiple sclerosis: a meta-analysis. Neurorehabilitation and Neural Repair, 2009 Feb;23(2):108-16.
Human Movement. An Introduction to Therapeutic Kinesiology. Massage & Bodywork Nov-Dec: 70-77, 2012, by Mary Ann Foster
A very good introduction to kinesiology presented from the massage therapy perspective.
Restoring Smooth Movement. How Active Release Technique Can Help Athletes and All Your Clients. Massage & Bodywork Nov-Dec: 94-97, 2012, by Yael Grauer
The subject of the article is the so-called Active Release Technique (ART). The article also discusses the Graston Technique despite that, according to the article, this modality is not within the scope of the massage therapists’ practice. We do not want readers to think that we are criticizing ART. We cannot do that since the article does not provide any idea what ART is all about. This piece is a great example of what we hate about some massage publications. It is simply a promotion piece.
If ART is so great why does the author not explain the mechanism of its innovative power? What makes it so unique and effective compared to Myofascial Release? From the article, we learned that myofascial release was its original name but since this name was already taken, the author changed it to an easier name to sell, namely ART.
If the article is a simple promotion piece without any scientific justification to its claims, it treats readers poorly. If the author is unable or afraid to say more, she should not write such an article at the first place.
The portion of the article’s title that ART will “Help ALL Your Clients” is a very sad sell pitch.
Delivering Care for Delivery Workers. Massage & Bodywork Nov-Dec: 106-109, 2012, by Whitney Lowe
The author has a very helpful column that looks at the somatic abnormalities the practitioner may encounter in the therapy room from the point of occupational hazards associated with the type of work that patients may do. It is a great help for the practitioners since simple questions during the initial interview: i.e., “What do you do for living?” should direct the practitioner’s thoughts in a correct diagnostic direction and help during further evaluation of the client’s tissues.
Working with the Sacroiliac Joints. Massage & Bodywork Nov-Dec: 114-117, 2012, by Til Luchau
A very good and informative article on SI joint dysfunction. We agree with the author when he said that The SI joint dysfunction is more likely responsible for greater than 15-21% of lower-back pain than commonly believed.
Massage Today
The Missing Link: A New Paradigm for Soft Tissue Therapy. Massage TodayOctober, 2012, Vol. 12, Issue 10, by Don McCann, MA, LMT, LMHC, CSETT
Overall, the article is correct on many levels, but what bothers us is that the author promotes its main subject as a silver lining for everything. He sees that all abnormalities of the musculoskeletal system are the results of distortion between the cranium and the anterior/posterior rotation of the iliums and tipped sacrum. Let us quote:
“Since approximately 95 percent of musculoskeletal pain is due to the body collapsing further into the core distortion pattern over time, it is unfortunate that none of the other techniques is able to effectively release this distortion.”
We would like readers to pause for a second and imagine that 95% of musculoskeletal problems have only one simple explanation as a distortion between the cranium and the anterior/posterior rotation of the iliums and tipped sacrum. On top of that, the author writes such nonsense in a way that it seems that it is a well-established medical fact. Forget about bulging disk, osteoarthritis of the knee, carpal tunnel, tendinitis, pronator muscle syndrome, subluxated ribs etc. All of these and hundreds of other pathologies are simply the result of distortion between the cranium and the anterior/posterior rotation of the iliums and tipped sacrum or they are conveniently placed in the 5% that is not mentioned in the article.
Does the condition mentioned in the article exist? Definitely, and more than likely the author’s treatment could help some clients. However, why do you need to justify the importance of one approach with such ridiculous claims while in the process of doing so derides anything else (Neuromuscular Therapy, Connective Tissue Massage, Myofascial Release etc.) as a treatment option? Is it just personal ego or attempts to fill up a classroom with enough students? We think that the author fails to understand the importance of promoting an integrative approachto the somatic rehabilitation when the patient is the center of the therapy rather than what the practitioner knows or is comfortable with. The article presents a one-sided approach and contributes to the further fragmentation of an already fragmented profession, which is detrimental for the industry, the practitioners and, more important, for the patients.
Understanding the Difference Between Clinical and Spa Massage. Massage Today October, 2012, Vol. 12, Issue 10, by Christy Schumacher, NCTMB
The author gives the readers a clear differentiation between spa and clinical (medical) massage. This article is especially helpful for new massage graduates who are trying to find their own place in the industry.
The Peroneals: Anatomy and Function. Massage Today November, 2012, Vol. 12, Issue 11, by Nicole Nelson
This is a very good article on the anatomy, physiology of the peroneal muscles and treatment options when pain and tension developed there. The author is correct with the recommended treatment protocol. The only critical information missed in the article is the very important fact that if the patient did not suffer a previous injury, the main reason for tension and pain in the peroneal muscles is mild irritation of the spinal nerve in the lower back or sciatic nerve in the gluteal area.
Tissue Density Restoration Massage for Restless Leg Syndrome. Massage Today December, 2012, Vol. 12, Issue 12, by Linda LePelley, RN, NMT
We have already reviewed the article (see Issue #3 2012, JMS) by the same author who promoted Tissue Density Restoration (TDR) massage as a solution to the treatment of Osteoarthritis. She based her treatment on the fact that “crusted” and mineralized tissue around the affected joint is made from the fat tissue, and the massage therapist can melt them away and cure Osteoarthritis. It is difficult to imagine such writing comes from a registered nurse but this lack of scientific data in many massage publications is a sad reality.
After successfully solving the problem with Osteoarthritis and put orthopedic surgeons out of work since there is no further need for joint decompression, cleaning or replacement, the author moved on to new disorders. Now the main topic is Restless Leg Syndrome (RLS). Again we learned that patients with this abnormality developed plaques in the soft tissue that are 60% fat. Apparently, the author detected with her unique palpation skills the plaques in the soft tissue that no one was able to detect before despite that numerous studies have been performed to examine the origin of RLS including studies on cadavers.
Despite that modern medicine associates RLS with many different causes: it is a symptom of peripheral neuropathy, it is caused by hyperreflexia, it is result of deficit or inability to metabolize iron or changes in dopamine metabolism, the author on her own detected some mystical plaque “engulfs and traps nerves, which when irritated, begin to twitch”. As readers may see, Linda LePelley, RN, NMT is on a cutting edge of science in regard to RLS since she bases her assumptions on one critical piece of knowledge: “as all my work indicated.” Is such ‘scientific’ approach supposed to completely disarm any possible critic?
Here is another great quote from her article:
“Take note of the area at the medial aspect of the knee. It often forms a large, sensitive plaque within which nerves are engulfed and irritated. Much of your time may be spent here, carefully massaging crusted-over nerves, which feel like large, firm strands and bands.”
If before writing the article, the author simply bothered to open any anatomy textbook she will find that in the medial aspect of the knee there is no major nerves she felt encrusted that needed to be massaged. The common peroneal nerve is in on the lateral aspect of the knee and the tibial nerve is located deeply on the posterior aspect of the knee.
So what plaques did author feel since in these areas the tissue density were present? We think it is time to enlighten the author about these dense areas she felt and called plaques. RLS is a disorder of central or peripheral nervous system and as a result of inappropriate innervation of the tissues the connective tissue zones (CTZ) are formed in the superficial and deep fascia. One of the major symptoms of CTZs formation is hardening of the fibrotic bridges that connect the superficial fascia to the skin and these bridges are passing through subcutaneous fat making subcutaneous tissue harder since it is now ‘glued’ between superficial fascia and skin. This is the real cause of tissue density that the author palpated. The CTZs are consequence of the RLS rather that is cause. Instead of inventing a new pathology, which exists only in the author’s imagination and on the pages of Massage Today, the author should open any textbook on Connective Tissue Massage and she would be able to find a very simple explanation of her palpatory finding.
Yes, in the article the author mentioned that her research in medical literature did not show that any plaques exist as abnormality in the soft tissues but this fact did not stop her anyway. We constantly ask ourselves this question: Why are articles like this one printed in massage publications? Why do some authors think that it is acceptable to feed readers such nonsense and, what is more important, why is such nonsense published? It still puzzled us.
The treatment which is called TDR offered in the article as a solution to RLS is very basic. At the same time the combination of other modalities (e.g., connective tissue massage, PIR, vibration therapy, etc) is a much more effective clinical tool.
A Chronicle of a Kyphotic Tennis Player. Massage Today December, 2012, Vol. 12, Issue 12, by Nicole Nelson
The article describes a fictional tennis player with pain and weakness in the right arm and wrist joint and explains the nature of her symptoms by the fact that she has “kyphotic posture + suspect anatomy + poor biomechanics + repetition of movements” and describes potential treatment. We completely agree with such a theoretical arrangement but we would like to add that the patient may have similar symptoms if her anterior scalene or pectoralis minor muscle entraps the brachial plexus. In these cases, the proposed treatment is useless. We would like the readers to remember that.
Learning to Train the Myofascial System. Understanding Tibial Fractures and Medial Tibial Stress Syndrome. Massage Today by Debbie Roberts, LMT
Good and informative article on the subject of tibial fractures, treatment options and prevention.
Massage Magazine
Swell. Fascia as Sponge. Massage Magazine November, 198:52-55, 2012, by Thomas Myers
A great article!
Massage Therapy Journal
Calming the Tremors. Massage Therapy Journal Winter, V. 51(4): 90, 2012, by Nicole Riou
This short article is a contribution by the reader who used massage to calm the client’s Essential Tremor (ET). We think that Nicole Riou deserves a lot of credit especially since she decided to address this abnormality using massage therapy since generally massage is not the first treatment option for patients with ET.
We would like to emphasize to the readers that massage therapy should be used as initial treatment option for patients with ET, and if it is ineffective, the patient may use other treatment modalities. The article greatly illustrated this fact.
Stretching the Lower Back. Massage Therapy Journal Winter, V. 51(4): 17-22, 2012, by Joseph E. Muscolino, DC
A great article! As usual, Dr. Muscolino wrote a very good and informative piece.
Category: Good Apples, Bad Apples