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We tried to organise a replay for the Fascia Congress early this month, but unfortunately there is only a few people interested in it. So we have to make the event shown privately, and we enjoyed it. The topics ranging from "hard-core" molecular biology to Anatomy & Biomechanics. Presentations that I found most interesting is by Andry Vleeming and Serge Gracovetsky, PhD. There is an article below excerpted from Science Magazine that describes the congress superbly. If you still want to see the replay, AMT is organizing it in Sydney in March.

We have finished a preliminary report on survey on musculoskeletal injuries among bodyworkers. It is available here (as pdf). If you still have not participate in the survey, please help us spend few minutes to complete it at: http://www.terrarosa.com.au/poll/index.htm

This month' we have interesting news highly related to massage and bodywork: side effect of massage, prevalence to hand demartitis, no relationship between keyboard use and CTS?, strength training on chronic neck pain.

We have a range of new books, a great one is Massage Therapist's Guide to Lower back & Pelvic Pain by Leon Chaitow, new books by Jean-Pierre Barral. Another great collection, if you are into deep tissue & structural work, is Erik Dalton's book and DVDs.

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 little advert is at the end of this page. Archive of our past news is at: http://www.terrarosa.com.au/news.htm We don't just sell DVDs, we provide you with the latest information.

If you do not wish to receive email from us, please reply to this email with subject “Unsubscribe”.

Massage therapists who frequently use essential oils involved in aromatherapy treatments, have higher rates of hand dermatitis than the general population, according to an article in the August issue of The Archives of Dermatology, one of the JAMA/Archives journals. Hand dermatitis (also known as hand eczema) is a skin disorder that causes the hands to develop a rash and become dry and cracked. Hand dermatitis can interfere with social activities and can cause permanent disfigurement, the article states. Currently, there are between 260,000 and 290,000 practicing massage therapists and massage therapy students in the United States. Many massage therapists are exposed to multiple factors known to increase the risk of hand dermatitis, including frequent hand washing, contact with fragrances, dyes, detergents, latex and other irritants and allergens found in massage oils, creams and lotions. The essential oils used in aromatherapy can also cause hand dermatitis.

Glen H. Crawford, M.D., of the University of Pennsylvania Medical Center, Philadelphia, and colleagues investigated the prevalence of hand dermatitis over a 12-month period among 350 massage therapists practicing in Philadelphia. The researchers used a mailed survey that included questions about use of essential oils, lotions, and other products, history of diagnosis of hand dermatitis, and symptoms of hand dermatitis.

The researchers found that the 12-month prevalence of hand dermatitis among the survey respondents was 15 percent by self-reported criteria (respondent had been diagnosed with hand dermatitis) and 23 percent according to symptoms reported. Those who reported using aromatherapy products, massage oils, lotions, or creams, were more than three times as likely to have hand dermatitis, and respondents with a history of dermatitis were more than eight times as likely to have hand dermatitis.

"The prevalence of hand dermatitis in massage therapists is high," the authors write. "Significant independent risk factors include use of aromatherapy products in massage oils, creams, or lotions and history of atopic dermatitis."

"Massage therapists should be aware of the sensitizing potential of their oils and the possibility of personal and client adverse skin reactions. To lower this high prevalence of hand dermatitis in massage therapists, it may be useful to conduct an educational campaign regarding the potential hazards of aromatherapy products," write the researchers.

Side-Effects of Massage Therapy

A recent study published in the Journal of Alternative and Complementary Medicine by Researchers at the National University of Health Sciences, Lombard, IL examined the side effects of massage therapy on 100 clients. The study was conducted at a health clinic at National University of Health Sciences and questioned 100 new and returning massage therapy clients, of which 91 completed all of the survey questions. Type of massage is mostly Swedish (90%), with the other being Deep Tissue & trigger points,

The study was a telephone survey and medical chart review 2–7 days after receiving massage.

Their results showed that overall, 10% of the massage clients experienced some minor discomfort after the massage session; however, 23% experienced unexpected, non-musculoskeletal positive side-effects. The most common complaint was increased discomfort or soreness at a discomfort level of 5 of 10. The majority of clients stated that the discomfort did not affect their “normal activities at home and/or at work,” and that the majority of symptoms started less than 12 hours after the massage and lasted for 36 hours or less. No major side-effects occurred during this study.
In terms of unexpected positive effects, the most common positive side-effects (Table 3) were non-musculoskeletal including improvement in mood and emotional well-being (9.9%), digestive function (5.5%), and respiration (5.5%). The majority of positive benefits began immediately and lasted more than 48 hours. When asked how they would rate their benefit on a scale of 0 (no benefit) to 10 (extreme benefit), all subjects reported an 8.

Well, the implication of this study is very good, that massage is quite safe, and the most complaint we can get is soreness. Therefore if you are applying a deep massage, you should warn your clients that "you might experience soreness on your muscles, less than 12 hours after the massage, and can last up to 2 days"

Adapting to pregnancy played key role in human evolution, study shows

The human spine evolved differently in males and females in order to alleviate back pressure from the weight of carrying a baby, according to research spearheaded at The University of Texas at Austin.

The lumbar differences are documented for the first time in Nature, a scientific journal. The researchers believe the adaptation first appeared at least two million years ago, in the early human ancestor Australopithecus. The male-female difference does not appear in chimpanzees, meaning the evolution to walking upright led to the adaptation.

"Natural selection favored this adaptation because it reduces extra stress on a pregnant female's spine," said University of Texas at Austin anthropologist Liza Shapiro, who conducted the research with graduate student Katherine K. Whitcome, now a post-doctoral fellow at Harvard University. "Without the adaptation, pregnancy would have placed a heavier burden on back muscles, causing considerable pain and fatigue and possibly limiting foraging capacity and the ability to escape from predators." Harvard anthropologist Daniel Lieberman also contributed to the study, which shows the key differences between males and females appear in the lower back, or lumbar portion of the spine.

Human spines have a unique forward curve in the lumbar region, but the curve extends across more vertebrae in females. That helps offset harmful forces that might occur on the spine when pregnant women lean back or hyperextend their spines to balance the weight of the fetus, Shapiro said. The joints between the vertebrae also are larger in females and angled differently than in males to better support the extra weight.

"Any mother can attest to the awkwardness of standing and walking while balancing pregnancy weight in front of the body," Shapiro said. "Yet our research shows their spines have evolved to make pregnancy safer and less painful than it might have been if these adaptations had not occurred."

Research Found No Relationship Between Keyboard Use and Prevalence to Carpal Tunnel Syndrome

Since the advent of the personal computer in the 1980s, massage therapists have seen an increasing number of clients present with carpal tunnel syndrome Now, a new study out of Sweden refutes long-held beliefs about the condition.

Researchers at Hassleholm Hospital found that heavy computer keyboard use is a predictor of lowered risk of carpal tunnel syndrome—not the higher risk many in the health professions have thought it was. Results were published in the November 2007 issue of Arthritis & Rheumatism.

A health status questionnaire was mailed to 2,465 persons of working age (25-65 years) who were randomly selected from the general population of a representative region of Sweden. The questionnaire required the subjects to provide information about the presence and severity of pain, numbness and tingling in each body region, employment history, and work activities, including average time spent using a keyboard during a usual working day. Those reporting recurrent hand numbness or tingling in the median nerve distribution were asked to undergo a physical examination and nerve conduction testing. The prevalence of CTS, defined as symptoms plus abnormal results on nerve conduction tests, was compared between groups of subjects that differed in their intensity of keyboard use, adjusting for age, sex, body mass index, and smoking status.
The results showed that persons who had reported intensive keyboard use on the questionnaire were significantly less likely to be diagnosed as having CTS than were those who had reported little keyboard use, with a prevalence that increased from 2.6% in the highest keyboard use group (

4 hours/day), to 2.9% in the moderate use group (1 to <4 hours/day), 4.9% in the low use group (<1 hour/day), and 5.2% in the no keyboard use at work group.

The researchers concluded that intensive keyboard use appears to be associated with a lower risk of CTS??

- A study conducted at a medical facility in the US among 249 employees described as frequent computer users (mean of 6.4 hours/day at a keyboard) found the prevalence of CTS to be similar to the prevalence previously reported in general population studies, suggesting that intensive computer use was not associated with a higher frequency of CTS.

- A Danish study that examined the relationship between CTS (3 different case definitions) and computer use among

7,000 workers from various workplaces showed that the association with keyboard use was not statistically significant.

- A Swedish study used median nerve conduction tests to compare a group of computer users (82 secretaries) with a group of nonusers (35 nurses) and found no difference in nerve conduction parameters ; however, the study population was small, with only 5 persons having symptoms related to CTS.

-A British population-based study found no association between numbness and tingling in the arm, based on questionnaire response only, and keyboard use (>4 hours in an average working day) among non-manual workers .

Among complementary treatments of depression, massage plays an important role, but although there are some limited data available on the effects of massage on anxiety and depression, no randomized controlled studies have been performed of massage on inpatients with depression. MUELLER-OERLINGHAUSEN and colleagues from Berlin have described the effects of slow massage on depressed patients. 32 depressed patients were recruited for this study. The randomized cross-over design involved three massage sessions at set times and sessions in two control groups (relaxation and perception) lasting for 60 minutes. Treatments were set 2-3 days apart. Various observable characteristics of depression were measured before and after treatment, both in self-assessment by patients and by independent observers.

Their results showed that patients in both groups showed marked improvements in almost all the variables measured, the effect being more marked in the massage group. After Bonferroni correction for multiple tests, the statistical significance remained stronger for massage in four dimensions (global tenseness, restlessness, depressed mood, neck/shoulder tension). The intensive effect of massage was confirmed by both female and male patients in their answers to open questions.

The authors concluded that low-stroke massage is suitable as an adjuvant acute treatment for patients with depression. Depressed patients are able to recognize the sensory quality of therapeutic touching as a positive stimulus In view of the latent period of many weeks and the only moderate efficacy of antidepressants, the described complementary method should be more often applied in both a hospital and general practice setting.

Cell Biology Meets Rolfing

That is the title of an article in the November issue of Science, a respected Scientific journal describing the Fascia Congress. David Grimm from Science Magazine wrote that "A diverse group of researchers wants to create a new discipline from scratch by bringing together experts in fascia and deep-tissue massage". The journal also dedicated a Story on Robert Schleip as " From Rolfer to Researcher"

Here is an extract of the article in Science:

Peter Huijing was far from enthusiastic when he received an invitation to speak at the Fascia Research Congress. The meeting, held in October 2007, would be the first dedicated to the soft part of the body's connective tissue system--an important but medically neglected organ. It would bring together top scientists from fields as diverse as cell biology and biophysics, but it would also include alternative medicine practitioners, such as chiropractors and deep-tissue manipulators known as Rolfers. "I had a fear of damaging my reputation," says Huijing, a world-renowned biomechanics researcher at Vrije Universiteit in Amsterdam, the Netherlands, who, despite his hesitation, decided to attend. By the time the conference was over, Huijing had agreed to organize the next one.

The conference was the brainchild of Thomas Findley, an M.D.-Ph.D. co-director of research at the VA Medical Center in East Orange, New Jersey. For 30 years, Findley has been studying the science behind rehabilitation medicine; he is also director of research at the Rolf Institute of Structural Integration in Boulder, Colorado, which trains and certifies Rolfers. He became convinced early on that fascia--which weaves its way through the body like a gossamer blanket, cradling organs, ensheathing bones, and providing structural support--plays a key role in how patients respond to treatment. He wanted to learn more, but there were no identifiable fascia researchers.

Frustrated, Findley began e-mailing scientists like Huijing in 2005. He knew that researchers around the world had been studying fascia in some form--MEDLINE references to i t have spiked in the past 3 years--but that they didn't see themselves as part of a coherent field. Huijing, for example, looks at how the body generates force via the interactions between muscles and fascia, but he was unaware of cell biologists who were studying how fascial cells respond to movement. Findley hoped that bringing such scientists together would stimulate new research collaborations and shed light on the mysterious tissue.

Findley also wanted to bring in clinicians, but he knew that M.D.s wouldn't cut it. Some researchers have speculated that fascial anomalies may be responsible for black box disorders like fibromyalgia and lower back pain, yet doctors have traditionally ignored the tissue. Medical books barely mention fascia, and anatomical displays remove it. "It's just not sexy," says Elizabeth Montgomery, a pathologist who specializes in soft tissue at Johns Hopkins University in Baltimore, Maryland.

So Findley turned to the alternative-medicine community. Findley knew that Rolfers and other alternative therapists held fascia in high regard: They believe that rubbing and stretching the tissue brings about the improvements they see in clients.

Yet they don't have the tools or data to prove their claims. "Practitioners want to know the science behind what they're doing," says Findley, "and scientists want to see clinical applications of their work." Combining the two groups to create a new field seemed natural. But as the meeting in Boston revealed, bridging the gap won't be easy.

It was 9:00 in the morning on the first day of the conference, and Paul Standley, a vascular physiologist at the University of Arizona College of Medicine in Phoenix, was describing his work on fibroblasts, the chief type of cell found in fascia. When Standley's team placed the cells on flexible collagen and stretched the collagen in ways that replicated repetitive motion strains on the body, many cells died. But when the team followed the strains by stretching the collagen in ways that approximate techniques like Rolfing, more cells survived. The audience erupted.

"It's rare to see such enthusiasm at a conference," says Grinnell, a cell biologist at the University of Texas (UT) Southwestern Medical Center in Dallas. "I was really struck by it." The audience was composed mostly of alternative-medicine practitioners--chiropractors, massage therapists, and Rolfers--who signed up in droves when Findley first advertised the meeting in the fall of 2006. Within 5 months, the 500-seat venue at Harvard Medical School had sold out.

The scientists took more convincing. In addition to Findley's aggressive e-mail campaign, a 51-year-old graduate student named Robert Schleip traveled to labs around the world looking for plenary speakers. Some, like Grinnell, saw the conference as an opportunity to learn from other basic researchers. "I never realized my work on cell mechanics related to tissue mechanics until I heard about this meeting," he says. But others, like Huijing, were turned off at first: "I had never heard of things like Rolfing before," he says. "I didn't see the relevance." In the end, 58 scientists signed up for the meeting--along with 51 M.D.s. Most of them took the podium, whereas the practitioners filled the seats.

Clapping aside, many of the practitioners struggled with the science. Findley was adamant that the talks not be "watered down," and intricate presentations on the first day pulled no punches. Cell biologists spoke about how fascial cells alter gene expression in response to force, while biomechanics researchers detailed how interactions between fascial cells and the extracellular matrix contribute to whole body mobility. By the afternoon, the auditorium was noticeably emptier. "My frontal lobe was tired," says Briah Anson, a St. Paul, Minnesota-based Rolfer.

For their part, the scientists had some problems connecting with the clinicians. Huijing's fears of stigma seemed to be borne out when he interacted with one group of attendees. "They started talking about aura," he says. "I don't want my name associated with that." And Giulio Gabbiani, a cell biologist at the University of Geneva in Switzerland who studies connective tissue and wound healing, acknowledged difficulty discussing some concepts with the practitioners. "It's like we were talking two different languages," he says.

All of this prompts Wallace Sampson to question whether putting the two camps together is a good idea. "Fascia is a legitimate target of study, but a field like this has to be generated organically," says the alternative-medicine skeptic and professor emeritus at Stanford University in Palo Alto, California. "You have to do the basic science and see what evolves. You can't force the clinical side."

By the second day of the conference, things began to gel. A clinician-scientist panel fostered a dialogue between the two groups, and a networking lunch sparked new collaborations. "I heard clinicians talking about how manipulating fascial stiffness was key to their interventions," says UT Southwestern's Grinnell. Now he plans to study the cell biological basis of stiffness and how it might contribute to wound repair and scarring. Huijing says he also learned new things from the alternative therapists--and he found that he had something to teach them as well. Establishing fascia research as a legitimate field, he says, will guarantee that these interactions continue.

Findley knows it won't be easy. First, he'll need to attract more scientists. Publishing fascia research in top journals would help. He'll also need to cultivate a stable source of funding. Through the Rolf Institute, Findley has helped establish the Ida P. Rolf Research Foundation (named after the institute's founder), which is raising funds in hopes of awarding $200,000 in grants per year in 2 to 3 years. That's still a pittance compared to the millions NIH can provide, and NCCAM's Khalsa says he likes what he saw at the meeting. "There's a lot of potential here," he says.

But Findley's greatest challenge will be keeping everyone happy. Practitioners want to see more of their own up on the podium, and scientists want assurances that everything will remain respectable.

It's a tightrope Huijing looks forward to walking in 2009 when he puts together the next conference, to be held in Amsterdam. Huijing plans to give a larger spotlight to practitioners and to explore even more of the basic science. He's adding days, and he's reserved an auditorium for 1000 people--twice the size of the room at this year's event. "I have a feeling it could be very big," he says.

Strength Training Of Neck Muscles Relieves Chronic Pain

Neck pain has been steadily increasing over the past two decades and is now second to back pain, the most common musculoskeletal disorder. Women are more likely than men to suffer from persistent neck pain, in particular those who engage in repetitive tasks such as working at a computer keyboard. Previous studies have shown conflicting results as to whether or not exercise can effectively treat neck pain, but there has not been enough high-quality research in this area to draw firm conclusions. A new study on women with neck pain found that specific strength training exercises led to significant prolonged relief of neck muscle pain, while general fitness training resulted in only a small amount of pain reduction.

Led by Gisela Sjøgaard and Lars L. Andersen of the National Research Centre for the Working Environment in Copenhagen, Denmark, researchers conducted a randomized controlled trial for which they recruited 94 women from seven workplaces in Copenhagen between September 2005 and March 2006. The work tasks performed by the women consisted of assembly line work and office work, with 79 percent of the participants using a keyboard for more than three-quarters of their working time.

Participants first answered a questionnaire about their pain and then underwent a clinical exam to confirm a diagnosis of trapezius myalgia (muscle pain in the trapezius muscle). Participants were assigned to three intervention groups: those who did supervised specific strength training (SST) exercises for the neck and shoulder muscles, those who did high-intensity general fitness training (GFT) on a bicycle ergometer, and a control group that received health counseling but no physical training. Both exercise groups worked out for 20 minutes three times a week for 10 weeks.

The specific strength training (SST) group, performed supervised high-intensity specific strength training locally for the neck and shoulder muscles with 5 different dumbbell exercises (1-arm row, shoulder abduction, shoulder elevation, reverse flies, and upright row). During the intervention period the training load was progressively increased according to the principle of periodization and progressive overload . The strengthening exercises were performed in a conventional manner using consecutive concentric and eccentric muscle contractions, i.e., raising and lowering the pair of dumbbells in a controlled manner without pause or breaks, and each set typically lasted 25-35 seconds. Three of the 5 different exercises with 3 sets per exercise were performed during each training session in an alternating manner, with shoulder elevation being the only exercise that was performed during each session.

The results showed that the GFT group showed a small decrease in neck muscle pain only immediately after exercise, while the SST group showed a marked decrease in pain over a prolonged training period and with a lasting effect after the training ended. "Thus specific strength training locally of the neck and shoulder muscles is the most beneficial treatment in women with chronic neck muscle pain," the authors state.

The study also showed that the reduction in pain occurred gradually in the SST group, with trapezius muscle pain gradually decreasing as muscle strength increased. Although the GFT decreased the pain only temporarily, the authors note that even minor decreases in pain may be enough motivation to overcome barriers to exercise, and the resulting increase in fitness may benefit overall long-term health.

The authors state that the marked reduction in pain in the SST group is of "major clinical importance." They conclude: "Based on the present results, supervised high-intensity dynamic strength training of the painful muscle 3 times a week for 20 minutes should be recommended in the treatment of trapezius myalgia."

Journal article: "Effect of Two Contrasting Types of Physical Exercise on Chronic Neck Muscle Pain," Lars L. Andersen, Michael Kjær, Karen Søgaard, Lone Hansen, Ann I. Kryger, Gisela Sjøgaard, Arthritis Care & Research, January 2008; 59:1; pp. 84-91.

Massage May Help Ease Pain And Anxiety After Surgery

Many patients still experience pain following major surgery despite the availability of pain-relieving medications, according to background information in the article. Pain may be under-treated because patients fear becoming dependent on medications, are concerned about side effects, believe that they should endure pain without complaining or worry about bothering nurses. Physicians and nurses may administer ineffective doses of pain relievers because of personal biases, cultural attitudes or a lack of knowledge.

Allison R. Mitchinson, M.P.H., N.C.T.M.B., of the Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, Mich., and colleagues conducted a randomized controlled trial involving 605 veterans (average age 64) undergoing major surgery (chest or abdominal operations) between 2003 and 2005. Patients were randomly assigned to one of three groups for the five days following surgery: 203 received routine care; 200 received a daily 20-minute back massage; and 202 received 20 minutes of individual attention each day from a massage therapist, but no massage. "The purpose of this group was to assess the effect of emotional support independent of massage," the authors write. Patients were asked daily to rate the intensity and unpleasantness of their pain, plus their level of anxiety, on scales of one to 10.

"Compared with the control group, patients in the massage group experienced short-term (preintervention vs. postintervention) decreases in pain intensity, pain unpleasantness and anxiety," the authors write. "In addition, patients in the massage group experienced a faster rate of decrease in pain intensity and unpleasantness during the first four postoperative days compared with the control group." There were no differences in long-term anxiety, length of hospital stay or the amount of pain-relieving medications used among the three groups.

"The effectiveness of massage in reducing both the intensity and unpleasantness of pain suggests that it may act through more than one mechanism," the authors write. "Massage may ameliorate suffering by helping to relieve the anxiety that so effectively synergizes with pain to create distress." It could also generate mood-boosting endorphins or create a competing sensation that blocks pain, they note.

"Historically, massage was a common experience for post-surgical patients," the authors write. "As health care systems have become more complex and administrative demands on nursing time have increased, the tradition of nurse-administered massage has been largely lost. With the recent emphasis on assessing pain as the fifth vital sign tempered by renewed concerns for patient safety, it is time to reintegrate the use of effective and less dangerous approaches to relieve patient distress."