Massage News Update - February 2009
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Dear Bodyworkers,
A recent survey conducted in Australia, revealed that massage therapists are the least religious workers. As the study was conducted by Christian Research Association, religious means Christianity and go to Church regularly. The study found that farmers are the most religious folk in the country, meanwhile the “arts and recreation” workers are the least observant. The study found that massage therapists have a disproportionately high connection to “Eastern spiritualities”. Quite true, indeed, and not that it matters, but just an interesting news. The full story here.
In this issue we bring you a range of news on lower back pain, the statistics in Australia, the effectiveness of core training and the unique design of multifidus that contributes to spine stability.
And talking about "Eastern spiritualities", we got a new DVD on TuiNa, directly imported from UK. Please check it out. We also have specials on some of our DVD collection: positional release, myofascial release, and others, great discount but offer only for a limited time. So hurry. Details below.
Fascia is alive! We got a range of new books on fascia, including a new one directly imported from Italy, Fascial Manipulation - Practical Part by Stecco, Anatomy Trains by Tom Myers and the latest fascia research DVD lecture by Robert Schleip. If you are a fan of fascia research, there's an interesting interview with Dr. Schleip talking about fascia, complementary therapy and research, and muscle memory, you can listen it here or read the transcript here. It is worth a listen.
The next thing that will be coming to Sydney are workshops. First, if you are interested in getting a workshop on Lomi Lomi massage, Carrie Rowell, an international teacher from US, will be coming down under in September 2009. Read more details here http://www.terrarosa.com.au/articles/lomi.htm and register your interest.
Notice anything different in this issue? We have remove the "Alert", a therapist reminded us the word Alert can make us uneasy. So now our newsletter from now on is called Massage News Update.
This newsletter is our attempt to bring you what's happening in the latest research and news on massage related issues. We sell massage videos and books so the advert is at the end of this page. Archive of our past news can be found at http://www.massage-research.com/blog/ You can search for and comment on articles. We don't just sell DVDs, we provide you with the latest information. Happy reading and stay healthy… from us at www.terrarosa.com.au
Inside this issue:
Back pain still an issue for over 5 million Australians
Motor Control Exercises Reduce Persistent Lower Back Pain
Exercise underutilized for chronic back and neck pain
Unique multifidus design contributes to spine stability
Best Treatment for TMJ May Be Nothing?
Routine scans for low-back pain do not improve outcomes
Back pain still an issue for over 5 million Australians
A new study by researchers at The George Institute for International Health, Sydney University has found that back pain is a reoccurring problem for five million Australians. According to lead author, Professor Chris Maher, Director of Musculoskeletal Research at The George Institute, “After an episode of back pain resolves, one in four people will experience a recurrence within one year. This explains why around 25% of the Australian population suffers from back pain at any one time.”
Low back pain is the most prevalent and costly musculoskeletal condition in Australia, estimated to cost up to $1billion per annum with indirect costs exceeding $8billion. It is also the most common health condition causing older Australians to be absent from the labour force.
According to Professor Maher, patients and clinicians need to shift their focus to prevention. “We tend to treat the pain when it’s there, but when you recover, patients rarely take steps to prevent the problem from returning. People understand the message about lifting correctly but heavy lifting is only one of the risk factors for developing back pain. What many people do not understand is that some of the risk factors for back pain are also the risk factors for other chronic diseases like heart disease. My advice is that people should take a similar approach to back health, as they do for heart health – eating right, exercise and a healthy lifestyle is definitely good for your heart, and also your spine,” he added.
“Good, previous research has shown participation in an exercise program after the original episode of low back pain is highly effective in preventing recurrence. Those in the exercise group had half the rate of recurrence of the control group. Other studies have indicated that strengthening muscles and developing fitness show some benefit in avoiding recurring back pain. Mental stress also increases the risk of back pain so including stress management in a health promotion approach would be a sensible way to reduce your chances of back pain. Just paying attention to lifting correctly is probably not enough, a holistic approach is really best.”
Motor Control Exercises Reduce Persistent Lower Back Pain
Motor control exercises, when performed in conjunction with other forms of manual therapy, can significantly reduce pain and disability in patients with persistent low back pain, according to a new systematic review published in the January issue of Physical Therapy (PTJ). In addition to feeling less pain, patients performing these types of exercises are able to be more physically active and experience positive effects over a longer period of time than those who receive other treatments, according to researchers.
Motor control exercise, also known as specific stabilization or Core exercise, is a new form of exercise for back pain that has gained the attention of researchers and health practitioners over the past decade. The exercise focuses on regaining control of the trunk muscles, also known as the transversus abdominis and multifidus, which support and control the spine. Previous studies of patients with low back pain have shown they are unable to properly control these muscles. Through motor control exercise, patients are taught how to isolate and “switch on” these muscles and then incorporate these movements into their normal activities.
“Although the exercises seemed promising, until now we did not have clear evidence on whether or not they were more effective,” according to researcher Luciana G Macedo, PT, MSc, a PhD student at The George Institute for International Health, Sydney University, Australia.
The report in PTJ systematically reviewed and then summarized 14 randomized, controlled trials, evaluating the effectiveness of motor control exercises for persistent, low back pain. An abstract of the study can be found on the PTJ Web site.
Exercise underutilized for chronic back and neck pain
Exercise is commonly used to improve physical function, decrease symptoms and minimize disability caused by chronic low back or neck pain. Numerous randomized trials and clinical practice guidelines have supported this practice, and studies suggest that individually tailored, supervised exercise programs are associated with the best outcomes.
Nevertheless, there is a lack of knowledge about exercise prescription, including who is prescribing it, who is getting it and what type of exercise is being prescribed. A new study, funded by the National Institutes of Health, examined these questions and found that exercise may be underutilized for chronic back and neck pain. The study was published in the February issue of Arthritis Care & Research.
Led by Timothy S. Carey and Janet K. Freburger of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, researchers conducted a telephone survey of almost 700 individuals with chronic back or neck pain who saw a physician, chiropractor and/or physical therapist (PT) during the previous 12 months. They asked participants whether they were prescribed exercise, the amount of supervision received, and the type, duration and frequency of the prescribed exercise.
“Less than 50 percent of the subjects in our sample were prescribed exercise, one of the few moderately effective therapies for the highly disabling illness of chronic back and neck pain,” the authors state. The type of provider seen played a major role in whether participants received a prescription. Of those who received exercise prescription, 46 percent received the prescription from a PT (Physiotherapist), 27 percent from a physician, and 21 percent from a chiropractor. The authors note that these findings agree with previous studies that have found that “who you see is what you get.”
Although most of the 700 participants had seen a physician, only 14 percent were prescribed exercise. Some of those who were not prescribed exercise by a physician, however, were likely referred to a PT who did prescribe exercise. Not surprisingly, Pts were the most likely to prescribe exercise, although about a third of those who saw a PT did not receive an exercise prescription.
For those who were prescribed exercise, the type of provider seen determined the amount of supervision and, to some extent, the types of exercises prescribed. Pts were more likely to provide supervision and prescribe stretching and strengthening exercises, practices which follow current guidelines and lead to better outcomes.
“Considering current evidence on the efficacy of exercise, these findings demonstrate that exercise is being underutilized as a treatment for chronic back and neck pain,” the authors state. They note that none of the hypothesized health-related characteristics, such as pain or weakness in the extremities, hypothesized whether an individual was prescribed exercise and that providers’ decisions to prescribe exercise did not appear to be influenced by the degree of impairment. However, women, people with a higher education level and those receiving worker’s compensation were more likely to be prescribed exercise. This may be because women and more educated individuals are more likely to be active participants in their care and those with worker’s compensation are frequently injured on the job and treated with the goal of returning to work.
“Although exercise prescription provided by PTs appears to be the most in line with current guidelines, there is much room for improvement by all types of providers who prescribe exercise for patients with chronic back and neck pain,” the authors note. They suggest that future studies should explore barriers to prescription of exercise treatments, such as practitioner knowledge, organizational aspects of the practice, and poor reimbursement for exercise instruction compared with other types of treatment.
Unique multifidus design contributes to spine stability
The novel design of a deep muscle along the spinal column called the multifidus muscle may in fact be key to spinal support and a healthy back, according to researchers at the University of California, San Diego School of Medicine. Their findings about the potentially important “scaffolding” role of this poorly understood muscle has been published on line in advance of the January issue of the Journal of Bone and Joint Surgery.
“The multifidus muscle was formerly thought to be relatively unimportant based on its fairly small size,” said Richard L. Lieber, Ph.D. “Our research shows that it’s actually the strongest muscle in the back because of its unique design. It’s like a long, skinny pencil packed with millions of tiny fibers.”
The researchers discovered that the multifidus has a unique packing design consisting of short fibers arranged within rods, and that these fibers are stiffer than any other in the body. Using laser diffraction methods that they developed to measure muscle internal properties during back surgery, they demonstrated that the multifidus’ unique design serves a critical function as a stabilizer of the lumbar spine. These findings could have implications for surgery, according to Steven R. Garfin, M.D.
“It is important to identify what each individual muscle does, and this is just a start, showing that the multifidus contributes significantly to spinal stabilization,” said Garfin. “The more we know about what muscles do, the better we can devise therapeutic interventions such as physical therapy to target specific muscles.”
Garfin explained that currently surgery to treat spinal disorders could actually disrupt the multifidus muscle, which could lead to decreased stabilization and lower back pain. Minimally invasive spine surgery techniques strive to minimize surgical trauma to these muscles in order to best preserve their function. The lower back, or lumbar spine, can be vulnerable to many pain-causing injuries or disorders because the lumbar vertebrae carry the most body weight and are subject to the most force and stress along the spine. Muscular instability is a risk factor in many injuries and consequent chronic lower back pain, according to Lieber. “The multifidus back muscle keeps us vertical and takes pressure off the discs,” said Lieber. “When muscle function is poor due to back problems, support is lost.”
He explained that many muscles get weaker as they are extended. But the researchers discovered that, unlike all other muscles, the multifidus actually becomes stronger as it lengthens, when the spine flexes. “The length of the sarcomere—the structure within the muscle cell where filaments overlap to produce the movements required for muscle contraction—is shorter in the multifidus than in any other muscle cell,” explained study’s first author Samuel R. Ward, P.T., Ph.D. “But as it gets longer, for instance as a person leans forward, the multifidus actually strengthens.”
http://www.ejbjs.org/cgi/content/abstract/91/1/176
Best Treatment for TMJ May Be Nothing?
TMJ or temporomandibular disorders represent a wider class of head pain problems that can involve this pesky joint, the muscles involved in chewing, and related head and neck muscles and bones. But too often, experts say, patients fail to have the problem examined in a comprehensive way and undergo costly and sometimes irreversible therapies that may do little or nothing to relieve their symptoms. As scientists at the National Institute of Dental and Craniofacial Research wrote recently, “Less is often best in treating TMJ disorders.”
TMJ problems were originally thought to stem from dental malocclusion — upper and lower teeth misalignment — and improper jaw position. That prompted a focus on replacing missing teeth and fitting patients with braces to realign their teeth and change how the jaws come together. But later studies revealed that malocclusion itself was an infrequent cause of facial pain and other temporomandibular symptoms. Rather, as the Boston specialists wrote recently in The New England Journal of Medicine “the cause is now considered multifactorial, with biologic, behavioral, environmental, social, emotional and cognitive factors, alone or in combination, contributing to the development of signs and symptoms of temporomandibular disorders.” According to the American Academy of Orofacial Pain, the disorder “usually involves more than one symptom and rarely has a single cause.”
Among the “mechanical” causes that are now recognized as distorting the function of the TMJ are congenital or developmental abnormalities of the jaw; displacement of the disc between the jaw bones; inflammation or arthritis that causes the joint to degenerate; traumatic injury to the joint (sometimes just from opening the mouth too wide); tumors; infection; and excessive laxity or tightness of the joint.
But the most common TMJ problem is known as myofascial pain disorder, a neuromuscular problem of the chewing muscles characterized by a dull, aching pain in and around the ear that may radiate to the side or back of the head or down the neck. Someone with this disorder may have tender jaw muscles, hear clicking or popping noises in the jaw, or have difficulty opening or closing the mouth. Simple acts like chewing, talking excessively or yawning can make the symptoms worse. Jaw-irritating habits, like clenching the teeth or jaw, tooth grinding at night, biting the lips or fingernails, chewing gum or chewing on a pencil, can make the problem worse or longer lasting. Psychological factors also often play a role, especially depression, anxiety or stress.
The overwhelming majority of people with TMJ symptoms are women. Women represent up to 90 percent of patients who seek treatment, Dr. Leonard B. Kaban, chief of oral and maxillofacial surgery at the Massachusetts General Hospital in Boston, said in an interview. Most patients are middle-age adults, he and two dental specialists, Dr. Steven J. Scrivani and Dr. David A. Keith, wrote in the journal article.
Resting the jaw is the most important therapy. Stop harmful chewing and biting habits, avoid opening your mouth wide while yawning or laughing (holding a fist under the chin helps), and temporarily eat only soft foods like yogurt, soup, fish, cottage cheese and well-cooked, mashed or pureed vegetables and fruit. It also helps to apply heat to the side of the face and to take a nonsteroidal anti-inflammatory medication, for up to two weeks. Other self-care measures suggested by the orofacial academy include not leaning on or sleeping on the jaw and not playing wind, brass or string instruments that stress, strain or thrust back the jaw.
Physical therapy to retrain positioning of the spine, head, jaw and tongue can be helpful, as can heat treatments with ultrasound and short-wave diathermy. Stress management and relaxation techniques like massage, yoga, biofeedback, cognitive therapy and counseling to achieve a less frenetic work pace are also helpful, according to the findings of a national conference on pain management.
If you clench or grind your teeth, you can be fitted with a mouth guard that is inserted like a retainer or removable denture, especially at night, to prevent this joint-damaging behavior. But Dr. Kaban cautioned against embarking on “any expensive, irreversible treatment” before a thorough diagnosis is completed and simple, reversible therapies have been tried and found wanting.
There is no good evidence supporting a harmful effect of exercise on joints in the setting of normal joints and regular exercise, according to a review of studies published in this month’s issue of the Journal of Anatomy.
Exercise is an extremely popular leisure-time activity in many countries. In contrast, however, the lay press and community perception is also that exercise is potentially deleterious to one’s joints, in particular those of the lower extremities.
Researchers from Boston, USA, and Ainring, Germany, reviewed existing studies on the relationship between regular exercise and osteoarthritis (OA) and concluded that in the absence of existing joint injury there is no increased risk of OA from exercise.
“We found that in elite athletes where there was more likelihood of obtaining sports injuries, there was an increased risk of OA in the damaged joints, but in most people vigorous, low-impact exercise is beneficial for both it’s physical and mental benefits,” said lead researcher David Hunter MD PhD, New England Baptist Hospital. “The largest modifiable risk factor for knee OA is body weight, such that each additional kilogram of body mass increases the compressive load over the knee by roughly 4kg”. One might surmise therefore that exercise to reduce body-weight, where necessary, could in fact reduce the risk of OA, rather than increase it.
Routine scans for low-back pain do not improve outcomes
Physicians should not immediately order routine scans for low-back pain unless they observe features of a serious underlying condition, researchers in the Oregon Evidence-Based Practice Center at Oregon Health & Science University report. Their findings are published in a recent edition of the The Lancet.
The regular use of radiography, MRI or CT scans in patients with low-back pain but no indication of a significant underlying condition does not improve their outcome, the researchers report.
“Our study shows that performing routine X-rays or MRIs for patients with low-back pain does not lead to improved pain, function or anxiety level, and there were even some trends toward worse outcomes,” said Roger Chou, M.D., lead author; scientific director of the Oregon Evidence-Based Practice Center at OHSU; and associate professor of medical informatics and clinical epidemiology, and medicine (general internal medicine and geriatrics) in the OHSU School of Medicine.
“Clinicians may think they are helping patients by doing routine X-rays or MRIs, but these diagnostic tests increase medical costs, can result in unnecessary surgeries or other invasive procedures, and may cause patients to stop being active — probably the best thing for back health — because they are worried about common findings such as degenerated discs or arthritis, not understanding that these are very weakly associated with back pain.”
To reach this conclusion, Chou and colleagues conducted a meta-analysis of randomized controlled trials that compared immediate back imaging — using one of the three scanning types above — with usual clinical care that does not involve immediate imaging. Six trials covering more than 1,800 patients were included, reporting a range of outcomes including pain and function, quality of life, mental health, overall patient-reported improvement, and patient satisfaction. The analysis found no significant differences between immediate imaging and usual clinical care. The authors say that the results are most applicable to acute or sub-acute low-back pain of the type assessed in a primary care setting with the patient’s family doctor.
We got special discount for this month. Myofascial Release, Positional Release, Esalen massage, Shiatsu, Acupressure massage & Sport and Remedial Massage. Only until 22 Feb or while stock lasts. http://www.terrarosa.com.au/special.htm
Errol Dexter Lynch presents a step by step video on how to do and improve your Tui Na massage. Filmed in China and England, with never seen before footage and many treatment demonstrations. This DVD Student to Master has been 6 years in the making, taking you through the process from student to master. Includes: Practical massage demonstrations, Fundamental hand techniques for tuina, sports massage, and sports injuries, Related therapies (cupping, heat lamps and traction), An insight into Chinese culture and uses of tuina in Chinese hospitals, Interviews and testimonials
This DVD provides a lecture on the recent scientific discoveries of fascia. Get informed with the latest scientific exploration of fascia and its manipulation. Rather than being a mere passive packing organ, it has become increasingly clear that the fascia plays an important role in myofascial force generation, in tissue stiffness regulation, in pain generation and in proprioception. Robert Schleip an international expert on fascial research as well as a highly experienced bodyworker presents this lecture in a DVD format.
Get creative, a series of face painting DVD will lighten your work. Animal, Masquerade, Halloween Classics, Horror, Holidays & Seasons. Each DVD shows how to paint eight different full-face designs.
Waiting Room DVD - The benefits of massage
Educate your clients while they wait in your clinic with this looping promotional DVD! This 12 minutes loop is beautifully filmed and discusses the benefits of massage, and the latest research on massage. It includes a subtitled version so you can play it silently if you choose. Presented in a widescreen format to fit modern flat-screen televisions. A must for a professional clinic. EXTRAS: This DVD also includes 3 short videos: Mastering Massage (7 min.), Fascia (3 min.), The Nervous System (3 min.) PLUS 90 minutes of sample clips from 27 of the Real Bodywork massage DVDs, which can also play in a loop. Total: 127 mins.
Another great Yoga DVD from real Bodywork, Explore deep relaxation, rejuvenation and healing by experiencing restorative yoga. In this style of yoga, each pose is held for several minutes supported by blankets, allowing the nervous system to completely quiet and return to a state of balance, while gently stretching and opening the body. A total of over 4 hours of yoga practice!
Fascial Manipulation - Practical Part by Luigi Stecco & Carla Stecco
Welcome to an exciting new field in musculoskeletal therapy: the fascinating world of fascia. This manual provides practical techniques to facilitate the treatment of the fascia. It describes the topographical location of all the points, the respective movement tests and the modality of treatment for each point. In order to manipulate the fascia it is essential to know the exact location of the points, to perform the movement examinations correctly and to position the patient appropriately for each treatment. This new book just recently published is specially imported from Italy.
The famous Anatomy Trains is now available in a brand new second edition, includes numerous updates including important new findings in recent fascial research, photos of the Anatomy Trains myofascial meridians dissected, new appendices on Structural Integration protocols based on the Anatomy Trains concept, and a comparison of the myofascial meridians with the meridians of acupuncture. The entire book is now in full color, including all new artwork. The new edition also benefits from new web links and includes an interactive DVD-ROM with animations of the Anatomy Trains lines, fascial release techniques, and dissection videos.
Modalities for Bodywork and Massage
Gain a better understanding of the top modalities in massage practice with expert insight and a balanced, user-friendly approach! This current, consistently organized resource distills a wealth of information on 21 popular massage modalities into easy-to-read overviews detailing the essential principles behind each therapy. Leading experts lend years of valuable knowledge and experience across a wide spectrum of massage modalities including triggr points, neuromuscular therapy, prenatal, myofascial release, shiatsu, craniosacral, reflexology, and more. A companion DVD demonstrates proper techniques for 7 top modalities with over 100 minutes of detailed video footage.
The Myofascial Release Manual - 4th Edition
The Myofascial Release Manual is now available in a completely updated and comprehensive Fourth Edition. The "bible" of gentle myofascial release and stretch, continuing the tradition that started over 20 years ago and with a new focus on the current terminology regarding each technique. Carol J. Manheim has taken years of knowledge and expertise and incorporated them with the actual intent and result of the myofascial release treatment techniques to bring to the pages essential information for clinician in search of basic information or wanting to refine more experienced skills of these manual therapy techniques.