Archives for posts with tag: massage

Specificity of Treatment

Training, conditioning and rehabilitation are all designed to correct the dysfunctions we create through the rest of our daily activities. All “corrective exercises” should take the patient/client to the neural edge of their ability. This does not mean that they are to be destroyed and rebuilt via the session, but it should let them succeed in the exercise while still challenging them.

A common exercise that I see prescribed that has potential to be beneficial by strengthening the deep musculature of the spine including the multifidus is the bird-dog. However, most practitioners use the same exercise with everyone with no modification for what the patient/client is capable of doing.

As soon as one of the legs is moved, the multifidi must start contracting to stabilize the torso to prevent rotation. However, most individuals are instructed on performing full hip extension. This is where the problem occurs: the fully extended knee offers too much resistance so the lumbar spine compensates by recruiting the lumbar paraspinals (erector spinae) which also create lumbar extension. Often, these individuals demonstrate curving in the low back that is wrongly attributed to weakness of the transverse abdominis.

Try working within your patient’s ability with the toe-drag hip extension. The patient only extends their leg posteriorly as far as they can without losing neutral spine. Whenever they can fully extend the leg with the toe touching the ground, then progress to actually lifting the leg while maintaining neutral pelvis.

I often joke that as we are becoming Doctors (of Physical Therapy, of Occupational Therapy, of Athletic training), we are becoming more like Doctors (of Medicine) in that many are taking a hands-off approach to patient care. Oddly, some chiropractors are taking a hands-off approach in using adjusting tools such as the Activator Methods International or computerized adjusting equipment from Sigma Instruments. (This is especially ironic since “chiro” is Latin for “of the hands”.)

While physical touch can have many positive influences from a rehabilitative stand point, it can also improve psychological and emotional well-being:

Manual therapies have been shown to decrease anxiety, tension and depression in active populations(1). The results have actually shown a greater reduction in psychological complaints than running. Improving psychological well-being may influence physical pain by decreasing central sensitivity or how the brain interprets peripheral input.

Massage may also create multi-system releases in tension. Interventions have been shown to decrease pulse rate which is under autonomic control(2). These individuals also reported decreased anxiety while demonstrating decreased output of cortisol in their urine and saliva (decreased adrenal activity).

Eating disorders such as bulimia are also psychological in nature. Manual therapy has been shown to be an effective intervention in decreasing anxiety and depression associated with disordered eating which can also help control the disorder eating itself(3).

On the opposite end of the spectrum are aggression issues. These may be hormonally or psychologically induced issues. Manual therapy has also been shown to decrease anxiety and aggression in adolescents via positive affects on mood(4).

Often, these results are thought to be associated with traditional massage therapy practice of 60 to 90-minute sessions. However, results can be seen with as little as 10-minutes(5). Elderly patients noted a psychological state of relaxation after the interventions of kneading from the occiput to the sacrum.

Even if manual therapy is not a strong suit, touch can be incorporated into treatment in several ways. Stabilizing touch during therapeutic exercises may have the same affect. Facilitating touch on the muscle that should be contracting is another approach.

REFERENCES
1. Weinberg R, Jackson A, Kolodny K, The relationship of massage and exercise to mood enhancement. Sports Psychologist 1988;2:202-211.
2. Field T, Grizzle N, Scafidi F, Schanberg S. Massage and relaxation therapies’ effects on depressed adolescent mothers. Adolescence 1996;31:903-911
3. Field T, Schanberg S, Kuhn C. Bulimic adolescents benefit from massage therapy. Adolescence 1998;33:555-563.
4. Diego MA, Field T, Hernandez-Reif M, et al. Aggressive adolescents benefit from massage therapy. Adolescence 2002;37:597-607.
5. Frazier J, Kerr J. Psychophysiological effect of back massage on elderly institutionalized patients, Journal of Advanced Nursing 1993;18:238-245

Myofascial Release

Did you know there are grades (degrees) of Myofascial release?

Grade I
Technique is applied with no tension through the tissue and it is on slack

Grade II
Technique is applied with minimal tension, typically with the tissue in neutral position

Grade III
Technique is applied with the tissue on stretch (passive)

Grade IV
Technique is applied as the tissue is stretch via a concentric contraction of the tissue’s antagonist (active)

Grade V
Technique is applied as the tissue concentrically contracts

[Image shows grade III MFR to cervico-pectoral fascia to improve left cervical rotation as well as right scapular depression/retraction]

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