Massage News

We are back this month with more evidence based studies. So keep reading for lots of goodies, and at the end you will be given a quiz. If you got it all correct, you can treat yourself a good massage, how about that?

Few months ago we brought you the statistics of musculoskeletal injuries among massage therapist in Canada http://www.terrarosa.com.au/articles/july07.htm And there is another article in this issue by the same researchers that examine the posture of students when they give massage on a table and a chair. Again it highlights the importance of posture when working.

And we are still conducting a survey on musculoskeletal injury among bodyworkers in Australia. If you haven't completed your survey yet, please help us. Just need few more participants until next month (November). And will present the results in December. As a reward for participating, you will have a chance to win one of the two Massage DVDs (Lymphatic Drainage by Sean Riehl, and Stone massage by Meade Steadman) each worth $70. To get a chance to win a lovely DVD simply follow this link and complete our simple online survey http://www.terrarosa.com.au/poll/index.htm Winners will be drawn in end of November.

We will be at the ATMS National Massage Conference at Sydney Olympic Park 27 and 28 October 2007. Give us a visit if you are there.

We got a whole lots of new DVDs and books this month. Our oriental bodywork collection now grows with more great DVDs on Tai Chi (from Real Bodywork, promise this is a great one), QiGong massage, and more. Also stretching by Brad Walker, and the famous palpation yellow book by Leon Chaitow. Check them out.

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

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

Even Sham Acupuncture Eases Low Back Pain

A couple of months ago we brought you an article on the prevalence of massage therapist to RSI especially the wrist. Now the same group from Faculty of Kinesiology at the University of New Brunswick, Canada presented another study on the muscular and postural load of massage therapists. Their study was published recently in Journal of Manipulative and Physiological Therapeutics.

The study was performed on twelve senior female massage therapy students from the Atlantic College of Therapeutic Massage (New Brunswick, Canada).

Each massage therapist was asked to perform separate 10-minute on-site massages on a client using a massage chair and massage table. The order of condition (table and chair) was randomized. Each massage therapist had a 5-minute break between massages while the condition was switched. The massage table was adjusted to the proper height for each therapist, and the massage chair was adjusted for both the proper height for the therapist and the comfort of the client. The therapists applied 14 different techniques in a sequence of 14 set periods, with each one being either 30 or 60 seconds long. Instructions of the massage protocol were provided on an audio tape to cue the therapist to the details of the next period (ie, the technique to be used, the duration of the technique, the area of the back [quadrants] to be massaged, and direction of the technique motion). The techniques chosen were to replicate the fundamental modalities used during a relaxation massage over fully clothed client most commonly used in an on-site setting. The 10-minute period also reflects a typical on-site massage session.

They then determined the activation of muscles using electromyography collected from 8 upper extremity muscles. Integrated electromyography was used to compare activation between the 14 massage techniques used. Eight electromagnetic motion capture sensors were attached: the head, trunk, and upper arm, forearm, and hand bilaterally to track segment kinematics and determine total time spent in different postures.

Their major findings are:

- Massages performed with client in the chair required greater anterior deltoid muscular activity.

- Massages performed with client on the table required greater erector spinae muscular activity.

- Both the chair and table massages resulted in non-neutral trunk flexion postures for greater than 30% of the massage time, which significantly increases the risk of low back injury.

- The table massages required a significantly longer percentage of time (~50%) in a non-neutral posture and consequently a larger injury risk.

- Both the chair and table massages resulted in severe wrist postures for greater than 80% of the massage time, which places the wrist at risk of injury.

- Therapists adopted trunk and wrist postures that would increase the risk of upper extremity injury while using either the massage chair or table.

Although the study examined posture for students of massage which may have less experience, this study again highlighted the importance of posture for bodyworkers. For the work to have a great longevity and fun as well, look after your body.

Even Sham Acupuncture Eases Low Back Pain

A recent study from Germany compared real acupuncture with sham acupuncture and conventional therapy for therapy in patients with chronic low back pain. The study is a double blinded randomized controlled trial conducted in Germany involving 1162 patients aged 18 to 86 years with a history of chronic low back pain for a mean of 8 years. Patients underwent ten 30-minute sessions, generally 2 sessions per week, of verum (real) acupuncture according to principles of traditional Chinese medicine; sham acupuncture consisting of superficial needling at non-acupuncture points; or conventional therapy, a combination of drugs, physical therapy, and exercise.

Patient response rate (defined as a 33 percent improvement in pain or a 12 percent improvement in functional ability) was checked after six months of treatment. Response rates were: verum group, 47.6 percent; sham group, 44.2 percent; conventional group, 27.4 percent.

Almost half of patients in the acupuncture groups (both real and sham) experienced clinically relevant improvement in pain intensity or back-specific disability without having recourse to concomitant therapies. Only one-fourth of the patients receiving conventional therapy, consisting of a multimodal combination of pharmacologic and nonpharmacologic treatments, responded to treatment. Acupuncture, regardless of the technique, was significantly more effective than conventional therapy at all follow-up points.

The authors said "The superiority of both forms of acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals, or processing of pain signals by the central nervous system and that is stronger than the action mechanism of conventional therapy. Nevertheless, the effectiveness of acupuncture cannot be attributed merely to a placebo effect because there is no reason to believe that the action mechanism of conventional therapy is the result solely of the placebo effect. Nor can the conditions of a randomized trial be responsible for the unexpected success because the same success rates after 3 and 6 months were measured under conditions of everyday practice. Nevertheless, the effectiveness of sham acupuncture suggest that a discussion is called for about the necessary depth of insertion of acupuncture needles."

"Acupuncture gives physicians a promising and effective treatment option for chronic low back pain, with few adverse effects or contraindications. The improvements in all primary and secondary outcome measures (in the study) were significant and lasted long after completion of treatment," they said.

The findings are published in the Sept. 24 issue of the journal Archives of Internal Medicine.

Continuing from last month's article, we bring you summaries of what research (based on clinical trials) has found on the best treatment for musculoskeletal injuries. This come from a book called Evidence Based Sports Medicine. A wonderful book, that takes on the Evidence based medicine concept, that prescribed treatment should be based on results best found from clinical trials. Still not sure if we can (or want to) apply the same concept in massage.

If you are interested in the findings of clinical trials on particular conditions, you can try PEDro http://www.pedro.fhs.usyd.edu.au/ PEDro is the Physiotherapy Evidence Database from the University of Sydney and free to use. It has been developed to give rapid access to bibliographic details and abstracts of randomised controlled trials, systematic reviews and evidence-based clinical practice guidelines in physiotherapy.

While there are case by case studies on the success of massage (and other manual therapy) in treatment of various conditions (as we have reported monthly) when it comes to review of major conditions such as back pain, headache etc. the evidence of manual therapies are not great. Here are some examples:

The authors found no rigorous evidence that manual therapies have a positive effect in the evolution of Tension Type Headache.

No recommendations for practice can be made at this time because the effectiveness of massage for neck pain remains uncertain. Pilot studies are needed to characterize massage treatment (frequency, duration, number of sessions, and massage technique) and establish the optimal treatment to be used in subsequent larger trials that examine the effect of massage as either a stand-alone treatment or part of a multimodal intervention.

- The clinical effectiveness of therapeutic massage for musculoskeletal pain: a systematic review doi:10.1016/j.physio.2006.02.008

The available evidence is inconclusive. A combination of inadequate sample sizes, low methodological quality and insufficient Therapeutic Massage dosing is likely to have contributed to the confused evidence base.

Results did not produce any rigorous evidence that some manual therapies have an effect beyond placebo in treatment of Myofascial Pain Syndrome.

The notion that chiropractic or massage are effective interventions for pain control has not been demonstrated convincingly through rigorous clinical trials.

It appears that massage therapy may be effective for orthopaedic patients with low back problems and potentially beneficial for patients with other orthopaedic problems.

The effectiveness of spinal manual therapy on non-specific neck pain remains inconclusive.

Well, most review said the effectiveness is inconclusive. But that doesn't mean that what we are doing is of no use, but we should also question how the studies are conducted. Most of them are because there are inadequate number of high quality studies. In clinical trials, there need to be so-called randomized, double blinded, controlled, and study. Conducting clinical study needs at least the following:

- participants, which should be equally across physical conditions, so that the effect of treatment is not due to the physical condition of the participants.

- control, that means some of the participants will not get any treatment. Some studies also use a placebo, that means getting a treatment but not the real one.

- randomized, meaning that the participants are randomly assigned to a type of treatment.

- double-blinded, meaning that both the patient and therapist do not know the type of treatment they will get.

There are so many conditions that can vary as well, so a good trial should involve a large number of participants, and it is expensive to run such trial. Well, luckily in the US there is The Touch research institute http://www6.miami.edu/touch-research/ which conducted many studies devoted solely to the study of touch and its application in science and medicine.

But we should also be reminded that massage and other bodyworks are personal, depend on both the therapist and the patient, and it is not a prescription that can be equally applied to everyone. But we should also take light on what the study has found and may give us more knowledge and understanding on how things are working.

Ankle Sprains

- External ankle support prevents ankle injuries, at least in athletes with previous injuries

- It is not clear whether high-top shoes reduces the risk of ankle sprains

- Balance training (using balance board) improves ensorimotor control in athletes with previous injuries, and also prevents ankle sprains.

- Athletes with sprained ankle should complete supervised rehab, incl. 6-10 week program of balance training exercise

Plantar Fasciitis

- Plantar Fasciitis is an overuse injury, not associated with trauma

- Symptoms due to microtears at the tendon insertion, sue to tendon strain during the take-off phase of walking, not the impact phase

- The conditions is unusual in adolescents and elderly - alternative causes of heel pain should be sought in these populations

- Most patients (85%) will improve regardless the form of therapy

- There is limited evidence for most forms of treatment

- Heel pads are not recommended for treatment of plantar fasciitis, but may benefit patients with heel pain due to contusion.

- Give rest and stretching an adequate trial before more aggressive therapies

- Cortisteroid injections provide only short-term relief, and can involve a risk of tendon rupture

- Surgery should be considers only a last resort

Ice Treatment in soft tissue injury

- The basic premise for applying ice is to cool skin and deep tissue temperature to a therapeutic level

- The degree of cooling depend on the mode, duration & frequency of ice application

- Compression bandages & dressing may lessen the cooling effect, compromising the effectiveness of ice treatment

- Ice can be applied safely in acute & rehabilitative phases

- Little evidence shows that addition of ice to compression has significant effect

- Preliminary evidence shows that ice is superior than no treatment, heat & contrast therapy (repeated alternate warm & cold bath) in minimising pain & swelling after injury

- Preliminary evidence shows that ice can be safely and effectively combined with therapeutic exercise during rehab.

No Evidence That Insoles Prevent General Back Pain

There is strong evidence that using insoles does not prevent people from getting non-specific back pain, and there is insufficient evidence to say whether or not they help solve existing low-back pain, a Cochrane Systematic Review has found. Some people have suggested that insoles in shoes (orthotics) might help by absorbing shock, keeping the foot more stable as it touches the ground and helping the person's walking action to become more stable and fluent.

A team of Cochrane Researchers searched the international literature for relevant studies and found six randomised controlled trials that met their inclusion criteria. These involved over 2300 participants. The researchers came to two main conclusions:

1. there is strong evidence that the use of insoles does not prevent back pain in someone who does not have it already, and,

2. there is limited evidence that using insoles may reduce back pain in people who have pain -- but it may also shift the pain from the back to the legs.

"We do need some good studies of the effect of insoles on existing or recurrent back pain, so that we can make recommendations with a greater sense of certainty," says lead researcher Dr Tali Sahar who works at the Department of Family Practice at the Hebrew University, Jerusalem, Israel.

http://www.sciencedaily.com/releases/2007/10/071016195925.htm

New Guidelines Issued For Treating Low-back Pain

The American College of Physicians (ACP) and the American Pain Society (APS) just released joint guidelines on diagnosing and treating low back pain. Although targeted for medical practitioner, it is interesting and useful for us to understand and know what sort of recommendation that is currently available.

The recommendations, published in the Oct. 2, 2007, issue of Annals of Internal Medicine, include an algorithm to guide clinicians in obtaining and interpreting information during the first patient visit and place patients into one of three general categories: 1. Nonspecific low back pain (85% of patients fall in this category) 2. Back pain potentially associated with spinal conditions, such as spinal stenosis, sciatica, vertebral compression fracture 3. Back pain potentially associated with another specific cause, such as cancer.

The first recommendation says that clinicians should not routinely order imaging or other diagnostic tests such as X-rays, CAT scans, and MRIs, for patients with nonspecific low back pain. They should reserve these tests for patients who have severe or progressive neurologic deficits or suspected underlying conditions, such as cancer or infection.

And the recommendation that is related to our work is:

"Patients who prefer not to take medication can benefit from non-drug treatments, such as acupuncture, spinal manipulations and massage therapy. None, however, are proven to be more effective than others to warrant recommendation as first-line therapy."

For the full guideline read: http://www.acponline.org/clinical/guidelines/?hp

Quiz

Now that you have read all the materials, we want to give you some quiz. Take your time, no cheating, no Google. The answer is at the end of this page.

(1) With regard to the anatomy of elbow (choose two that are correct):

a. The posterior interosseous nerve has roots in cervical nerves C7 and C8

b. The extensor carpi radialis brevis is supplied by the median nerve

c. The working poistion of th eforearm is a position of extension & supination

d. The extensor carpi radialias brevis lies deep to the extensor carpi ladialis longus

e. The extensor carpi radialis inserts into the second metacarpal

(2) Which is the most important risk factor for ankle sprains?

A. A history of previous sprain

B. Gender

C. Joint Laxity

D. Short Achilles Tendon

E. Rear Foot valgus

(3) Which statement is currently available evidence for the effectiveness of balance training in preventing ankle sprain?

A. No evidence yet to support the effectiveness of balance training to prevent ankle sprain.

B. There is evidence showing that balance training reduces risk of ankle sprains in athletes with previous injury

C. The preventive effect of balance training have been clearly documented, both for athletes with no prior injury and athletes with previous injury

(4) Plantar fasciitis is an uncommon heel pain in which of the following:

A. Ten year old athlete

B. Twenty-year old long distance runner

C. Thirty year old obese female

D. Forty year old factory worker

(5) Which of the following therapies increases the potential for rupture if the plantar fascia?

A. stretching of plantar fascia

B. Night splints

C. Cortistreroid injection

D. Casting

(6) Following current best evidence, an athlete with a 7 day old knee medial ligament strain should:

A. Not applied ice

B. Apply ice, for longer duration

C. Apply ice, with compression

D. Apply ice with intermittent exercise

E. Apply ice with elevation

(7) Which of the following statement is true?

A. Icing before exercise can prevent injury

B. Ice and compression should not be applied simultaneously

C. Ice should always be applied over a compressive bandage to minimise skin burns

D. Intermittent ice treatments may minimise skin burns

E. Contrast therapy is more effective than ice alone in decreasing swelling.

(8) Which of the following statements is FALSE?

A. Deep tissue temperatures can be reduced faster to therapeutic level in athletes with lower percentage of body fat

B. Icing may facilitate therapeutic exercise

C. Decreasing secondary hypoxic injury is the most important physiological effect in acute injury management

D. Icing is only effective when applied immediately after injury

E. the magnitude of skin temperature reduction depends on the mode of icing

(9) Factors linked to development of Chronic back pain include

A. genetic disposition

B. Pyschoscocial issue

C. Smoking

D. Dietary habits

E. Hypertension

Even Sham Acupuncture Eases Low Back Pain

Even Sham Acupuncture Eases Low Back Pain

New Books

New DVDs