Massage News Alert - November 2007
G'day Bodyworkers,
This has been a busy month, so the "editorial" is a bit long. Hope won't make you too bored to continue reading. But briefly there are several activities and news we can report this month:
- We have finalized our survey on musculoskeletal injury among bodyworkers in Australia. The results are available in the article below. Thanks to our participants. As promised we draw two winners for 2 DVDs. They are Elizabeth Frayne from Lindfield, NSW, and Luke McMahon from Kangaroo Point, QLD. Congratulations. Your DVD is on its way.
- We were at the ATMS National Massage Conference at Sydney Olympic Park 27 and 28 October 2007. Thanks for those who visited us and give us supports. We had a chance to meet new therapists and also ATMS executives. Mainly Bill Pearson and Allan Hudson who gave us a great support.
- Last month at the Harvard Campus, Boston, there was the First Fascia Conference. This is an exciting new field where therapists meet and discuss with clinical scientists. The brief summary of the papers are available on the Conference's website: http://www.fascia2007.com/.
In youTube there are several interview, including the organiser Dr. Thomas Findley on the congress http://www.youtube.com/watch?v=N8rKSmIk2FI.
Robert Schelip on background of his research http://www.youtube.com/watch?v=y01_bpLMpqU.
A full report on the congress is available at this website:
http://www.massagetherapypractice.com/Text/1194801314375-5938/pC/1171750496218-4054/
In Australia, the replay of the conference will be on 4-5 Dec at RMIT in Melbourne. Worth to see and hear the latest in research
There is a couple of issues in the news:
- Can massage cause injury? Except for one dodgy report by Today Tonight last year which was rebutted by ATMS http://www.atms.com.au/PDFS/Massage.pdf we don't hear much about injury caused by massaging muscles or sort tissue. However a new report that said massage can cause of injury to the spinal accessory nerve. Nothing to be too worried, but we need to be alarm as well. Full article below
- A new study from Sydney University published that spinal manipulation do not have significant effect on patients with lower back pain. This report caused upset for chiros, physios, and even massage therapists. Well, let's hear the full story first below. We maybe able to see some light from it.
There are few new things on our website
- We have a new page with links to our therapists http://www.terrarosa.com.au/articles/therapists.htm
If you want your site to be listed, let us know, send us your site with a brief description and we are happy to make links to your site for free. (Other site you have to pay) A reciprocal link will be great. After all, Google's "hit" is based on how many webpage link to your site and vice versa.
- Have a look at our bargain page and you'll be surprised what you can find: Anatomy Trains video by Tom Myers, Myofascial Release by John Barnes and more. This is a used DVD and only 1 copy is available for each title. So the one who pay first, get it, be quick.
- We have new DVDs and books by Kit Laughlin on the effective Contract-Relax Stretching, also our oriental bodywork collection grows with more great DVDs on Short Yang-style Tai Chi (from Real Bodywork), Chen-Style Tai Chi, QiGong massage, and more. Check them out.
That's it for this month, Christmas coming soon.. Hope your business will grow more and more..
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.
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Happy reading and stay healthy… from us at www.terrarosa.com.au
Inside this issue:
Bodyworkers' Prevalence to Injury
Could massage cause nerve injury?
Complementary Therapies Help Patients Recover After Heart Surgery
Spinal manipulation does not have beneficial effect on acute lower back pain
Expensive Trainer Running Shoes Are A Waste Of Money
Muscle Patterns in Women may be linked to at risk positioning for ACL tears
We have finally compiled enough data for the survey on musculoskeletal injuries among massage therapist in Australia. We have 55 respondents, although not a big sample but will give us a rough idea on how we rate ourselves. Thanks to those who have completed the survey.
A bit on the demography of our massage therapists
The results, Musculoskeletal injuries due to massage:
Lower back Pain:
15% says the pain is affecting their work
Neck Pain:
16% says the pain is affecting their work
Shoulder Pain:
22% says the pain is affecting their work
Thumb & Wrist Pain:
42% says the pain is affecting their work
The big implication is, yes we are highly prevalence to muscular injuries especially the thumb and wrist (42%), Neck pain (29%), Shoulder pain (25%), and lower back pain (20%). The result is comparable to our colleagues in Canada (http://www.terrarosa.com.au/articles/july07.htm), but thumb & wrist is still the biggest problem. 36% of us are seeking medical treatment, and 60% is using alternative treatment. Among the most popular alt. treatment are: massage (60%), acupuncture (27%), osteopath/chiro (18%), Yoga & Pilates (6%).
A full report is due end of the year. if you still want to help us with the survey, few additional data will be valuable you can still complete the survey at http://www.terrarosa.com.au/poll/index.htm
According to researchers at Mayo Clinic, a potential complication can arise from massage, resulting in a local compression nerve injury in the shoulder area. Their report examines the clinical and electromyography (EMG) issues related to spinal accessory nerve injury caused by massage. The spinal accessory nerve is a small nerve traveling in the back side of the upper shoulder area that is vulnerable to injury from local compression. Spinal accessory nerve injury is not common, but is known to occur as a complication of surgical procedures or trauma in the upper shoulder region. Massage, it should be noted, has not been previously recognized as a cause of injury to the spinal accessory nerve.
Illustrative of such an injury is a case in which a healthy 38-year-old Arizona woman received a massage and experienced left shoulder pain. The pain persisted following the massage, and she experienced difficulty lifting her arm. Special tests for evaluating nerve and muscle function, called EMG studies, confirmed injury to the spinal accessory nerve. Magnetic resonance imaging (MRI) revealed evidence of swelling in the upper shoulder area. This swelling was specifically in the trapezius muscle, which is supplied by the spinal accessory nerve.
The patient underwent physical therapy and gradually improved over six weeks. However, two years later, the patient still experiences persistent mild left shoulder pain and weakness.
Senior author of the study, Mark Ross, M.D., Department of Neurology at Mayo Clinic in Arizona advises, "People should tell their massage therapists if they experience pain during massage. Although nerve injury is not a common complication of massage, clients and therapists should be aware of the potential risk."
Dr. Mark Ross, said there are no data or studies on how often massage
might cause nerve injury. "Our report is the first to call attention
to this relationship and we are making additional reviews to learn
more about how often it may occur."
It's possible, Ross said, that "some people with unexplained nerve
pain or injury may have a complication of massage that is not
recognized."
Dr. Ross also advises that massage therapists avoid applying excessive focal pressure to the neck and shoulder area.
Sara Schrader, M.D., also Department of Neurology, Mayo Clinic, co-author of the report, notes, "Those experiencing pain or shoulder weakness after massage may benefit from a visit to their physician to find out if nerve damage is the cause of their symptoms. Their physician can determine if EMG testing is necessary and what would be the most appropriate treatment."
Complete findings and results of the study were presented at the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) 54th Annual Meeting in Phoenix in October.
http://www.mayoclinic.org
In an article published by the British Society of Rheumatology in 2003, E. Ernst review the safety of massage therapy. based on published literature, all articles reporting adverse effects of any type of massage therapy were retrieved. Adverse effects relating to massage oil or ice were excluded. No language restrictions were applied. Data were extracted and evaluated according to predefined criteria.
Sixteen case reports of adverse effects and four case series were found. The majority of adverse effects were associated with exotic types of manual massage or massage delivered by laymen, while massage therapists were rarely implicated. The reported adverse events include cerebrovascular accidents, displacement of a ureteral stent, embolization of a kidney, haematoma, leg ulcers, nerve damage, posterior interosseous syndrome, pseudoaneurism, pulmonary embolism, ruptured uterus, strangulation of neck, thyrotoxicosis and various pain syndromes. In the majority of these instances, there can be little doubt about a cause–effect relationship. Serious adverse effects were associated mostly with strong massage techniques other than ‘Swedish’ massage.
The author concluded that massage is not entirely risk free. However, serious adverse events are probably true rarities.
Complementary Therapies Help Patients Recover After Heart Surgery
While the report on nerve injury due to massage is from Mayo Clinic, another Mayo Clinic study shows that massage therapy decreases pain levels for patients after heart surgery. During a five-month period in 2005, 58 patients undergoing surgery participated in a pilot study to examine the effect of massage on pain after surgery. Of the 30 who received massage, the mean pain scores were less than 1 on a scale of 1 to 10, with 10 as the most painful. Before the massage therapy, these patients rated their pain at an average of 3 on a 10-point scale.
In the control group of 28, pain levels remained the same over the same period, according to findings published in Complementary Therapies in Clinical Practice.
Mayo Clinic's cardiovascular surgery group began looking at complementary therapies in 2004. "In surveys, we started to hear from patients that tension, stress, pain and anxiety hampered their recovery," says Susanne Cutshall, a registered nurse in Mayo Clinic¡¦s cardiovascular surgery group and lead author of the study.
A team of nurses, surgeons, anesthesiologists, pharmacists and hospital administrators listened to patients' concerns, searched the literature and visited other hospitals. The result was the Healing Enhancement Program for cardiac surgery patients. It offers massage, music and guided imagery. The program combines evidence-based conventional care and evidence-based complementary and alternative medicine (CAM), Cutshall says.
"Our goal was to look at the patient's mind, body and spirit experience," Cutshall says. "We knew long ago that our patients had stress and pain, but it had been seen as a normal part of the process. Today, patients speak up more, and we recognize it's not enough to fix the heart; we have to treat the whole patient. These therapies don't take the place of medications but are seen as an important addition that makes a difference to patients."
As team members examined potential complementary therapies, they discovered little information specific to helping heart surgery patients, particularly after surgery. Therefore, they used the following criteria to incorporate methods that had been studied for complementary therapies in general: previous studies documented good results, the therapy coincided specifically to concerns of patients needing heart surgery, and the method could be used with relative ease and low risk for the patient. Based on their research, the team created pilot studies and research protocols for massage therapy, music therapy and guided imagery for patients, as well as stress education classes for patients and family members.
Music therapy
The team bought CD players for each room and a selection of CDs. The team endorsed relaxation music based on numerous studies that show music's positive effects on hospital patients. In addition, the team began a partnership with Chip Davis, founder and leader of the 18th century-style classical rock group Mannheim Steamroller, to include Ambient Therapy: specially created relaxation music combined with nature sounds for patients at Mayo. A randomized controlled trial is under way.
Guided imagery
This complementary health method teaches patients to use their imaginations -- along with music and spoken messages -- to help guide them through recovery. Using a stress- and wellness-trained nurse, patients were instructed about stress management and given a portable CD player and imagery CDs. This pilot didn't show a significant decrease in pain and anxiety, possibly because, in the pilot phase, there was limited time prior to surgery to explain this method to patients and encourage them to practice it, Cutshall says. However, guided imagery CDs are now distributed to patients when they are informed of the need for surgery, so they can use them prior to surgery, she says.
Stress education classes
The team partnered with the Mayo Clinic Patient Education Center to offer pilot stress management skill classes to inpatients and their family members. The classes work well because patients often are in the hospital for several days following surgery, Cutshall says. Classes are conducted twice a week on the cardiac surgery units.
"These services are outside the realm of what surgeons are typically taught in medical school; we tend to always want to see the evidence," says Thoralf Sundt, M.D., co-author and a cardiovascular surgeon at Mayo Clinic. "But we quickly could see the benefits to patients and that's the bottom line for us. We see this as looking out for all the needs of our patients."
As a result of the pilot study, Mayo now has a full-time massage therapist available for patients after heart surgery, and a larger, randomized study is under way.
ScienceDaily 5 November 2007. 20 November 2007 <http://www.sciencedaily.com /releases/2007/10/071031134336.htm>
Spinal manipulation does not have beneficial effect on acute lower back pain
A study published recently in the prestigious British journal The Lancet, questions the need for expensive and potentially risky treatments commonly used to combat acute low back pain. They found that paracetamol and gentle exercise is just as effective. Neither diclofenac (a commonly prescribed NSAID) nor spinal manipulation provided clinically useful effects with regard to the time to recovery.
The Sydney University researchers, led by Mark Hancock from the University of Sydney Back Pain Research Group, followed 240 patients suffering from acute low back pain from their first visit to their GP through to recovery.
Australians suffering from lower back pain may spend more than a billion dollars a year trying to find relief. Some of the more expensive forms of treatment are by chiropractors and physiotherapists, while over the counter anti-inflammatory drugs are often the first thing sufferers reach for when pain occurs. But there has been concern over the side effects of some non-steroidal anti-inflammatory drugs. Earlier this year one brand of an osteoarthritis drug, which has since been deregistered in Australia, was linked to serious liver side effects, while gastroenterologists have raised concerns about the damage anti-inflammatory drugs can do to the stomach and bowel.
Current guidelines for the treatment of acute low back pain recommend that GPs provide advice (to remain active, avoid bed rest etc) and paracetamol as the first line of care. Non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac and spinal manipulation are then recommended as second line management options.
'It is therefore particularly important to establish the efficacy of using NSAIDs in view of recent concerns about potential adverse with these drugs,' said Mark. Although lumbar spinal manipulation is also associated with adverse events, the main concern we have in this area is the requirement of referral and extra expense for this treatment.
Mark Hancock and his team studied 240 patients suffering with acute lower back pain. All had been given paracetamol and advice from their GP. They were then randomly divided into four groups. Some were given placebo therapy and placebo drugs. Others were given anti-inflammatory drugs, or spinal manipulative therapy, or both.
Spinal manipulative therapy was done by 15 physiotherapists, in 13 private clinics in Sydney, who had a minimum qualification of a graduate diploma in manipulative therapy, and who regularly used spinal manipulative therapy in their clinical practice. Participants allocated to spinal manipulative therapy had treatment two or three times per week (at the physiotherapist's discretion) to a maximum of 12 treatments over 4 weeks. If the participant recovered before the end of the 4 weeks, spinal manipulative therapy was stopped. Patients had spinal manipulative therapy according to a treatment algorithm developed by the researchers on the basis of views of expert clinicians and researchers. The algorithm permitted the use of mobilisation or high velocity thrust procedures, which aimed to produce motion at the joints of the lumbar spine, thoracic spine, sacroiliac joint, pelvis, and hip.
The primary outcome was the number of days to recovery.
The study concluded that spinal manipulative therapy and non-steroidal anti-inflammatory drugs don't necessarily lead to faster recovery from acute lower back pain.
Mark said that, we therefore concluded that patients with acute low back pain should be treated according to international guidelines without diclofenac or spinal manipulation, staying reasonably active is actually good for acute lower back pain.
Well, does that mean massage and other type of bodywork is not useful? You know better how many people who will feel much relieve from getting massage or other bodyworks. And if we do not build a stronger Core muscles, then taking paracetamol and staying active won't do much help as well for the recurring back pain. But unfortunately this is how 'evidence-based' medicine works.
http://www.abc.net.au/worldtoday/content/2007/s2086582.htm
http://www.usyd.edu.au/news/84.html?newsstoryid=2043
Expensive trainers are not worth the money, finds a small study published ahead of print in the British Journal of Sports Medicine. Cheap and moderately priced running shoes are just as good, if not better, in terms of cushioning impact and overall comfort, it concludes.
The research findings are based on a comparison of nine pairs of trainers, bought from three different manufacturers, in three different price ranges. The cheapest pairs were priced at £40 to £45, with the moderate range costing £60 to £65. The three most expensive pairs cost £70 to £75. The 43 participants were not told how much any of the shoes cost.
Plantar pressure - the force produced by the impact of the sole hitting the ground - was recorded in eight different areas of the sole, using a special device (Pedar) attached to the shoes. Different models performed differently for different areas of the foot. But, overall, there were no major differences among the shoes, irrespective of brand or price.
In fact, plantar pressure was lower in the cheap to moderately priced shoes, although this difference was not statistically significant. Runners were also asked to rate the comfort of the shoes from "least" to "most comfortable imaginable," using a validated graded scale. Comfort ratings varied considerably, but there were no obvious differences among the shoes. And price was no indicator of comfort score. Running produces sizeable shock waves to the bones of the foot, which radiate to other bones in the body. The force of the impact increases with speed and distance, say the authors. Consequently, runners are prone to knee pain, stress fractures, muscle tears and osteoarthritis. The type of cushioning in the soles of running shoes aims to prevent this damage, with expensive trainers deemed to be the most effective.
Research suggests that training programs for females to restore balance between hamstring and quadriceps muscles to better support knee joints could help reduce the disproportionately high number of ACL tears in female athletes.
A new study shows that the amount of preparatory muscle action in the muscles spanning the knee joint prior to landings is associated with knee positions that are considered at risk for ACL rupture, said Riann Palmieri-Smith, lead author and assistant professor at the University of Michigan Division of Kinesiology.
The ACL is one of the four major ligaments of the knee, and women are 2-8 times more likely to tear this ligament than men are while playing the same sport, said Palmieri-Smith.
The research suggests that training programs which promote balanced activity of the inner (medial) and outer (lateral) thigh muscles might help protect the ACL. This preparatory muscle action helps to control the relationship of the shank relative to the thigh. When the shin bone is positioned outward compared to the thigh bone, it results in a knock-kneed posture, Palmieri-Smith said. This position is referred to as knee valgus, and increased knee valgus (more knock kneed) has been shown to be linked to ACL injury risk, said Palmieri-Smith.
Think of a person who jumps and lands with knock knees (knees turned in) as opposed to a person who lands with minimal or no side-to-side angle at the knee (thigh and shank aligned). The person who lands with their knees turned in too much appears, based on previous research, to be more likely to tear their ACL.
The study showed that when women are preparing to land from a jump they tend to activate the muscles of the outer (lateral) thigh more than the muscles of their inner (medial) thigh, and that this pattern of muscle activity was associated with a larger valgus knee angle, Palmieri-Smith said. The results of the study are important because as scientists establish a relationship between preparatory muscle activity and at risk ACL knee positions, they may be able to develop training regimens to help train muscles to behave differently and better support the knees. "The question is can we train these muscles to be more balanced, to really lower valgus knee angle" We want to restore lateral and medial balance," Palmieri-Smith said.
ACL injuries have long lasting and damaging affects in both the short and long term, Palmieri-Smith said. Evidence suggests that up to 70 percent of successfully treated ACL tears will develop osteoarthritis within five to 14 years.
In the study, researchers fitted 11 women and 10 men with electrodes to monitor muscle activity and markers to monitor knee joint position while they jumped on a force platform that collected ground reaction force data.
http://www.sciencedaily.com/releases/2007/09/070918172318.htm
Pain management, soreness, injury recovery, control of headaches or migraines, and general wellness are the top reasons clients seek massage therapy, according to the results of an annual US survey that measures consumers' use of massage. More people get massage therapy for medical purposes than for relaxation, according to a survey conducted on behalf of the American Massage Therapy Association (AMTA). The survey results, released to MASSAGE Magazine in October also showed that baby boomers have more massages than younger consumers and turn more often to massage for medical reasons.
Also among the results:
• Thirty percent of all people who received a massage in the last five years got it for medical reasons, compared to 22 percent who sought relaxation and 13 percent for a simple indulgence.
• Almost one-third (32 percent) of Americans say they’ve used massage therapy at least one time for pain relief – just behind those who have turned to chiropractic (38 percent) and physical therapy (44 percent).
• Respondents aged 45 to 64 have had an average of almost 7 massages during the past 12 months, while those aged 18 to 44 have had an average of five.
• Among those who have had a massage in the past five years, boomers have had an average of just under 20 massages compared to an average of about 10 for those aged 18 to 44.
http://www.massagemag.com/News/2007/October/National-Survey-Measures-Massage-Use.php