From Vox:

By Julia Belluz

Millions of back patients are floundering in a medical system that isn’t equipped to help them. They’re pushed toward intrusive, addictive, expensive interventions that often fail or can even harm them, and away from things like yoga or psychotherapy, which actually seem to help. Meanwhile, Americans and their doctors have come to expect cures for everything — and back pain is one of those nearly universal ailments with no cure. Patients and taxpayers wind up paying the price for this failure, both in dollars and in health.

More and more people are seeking out alternative therapies for back pain. While yoga, massage, and acupuncture have been around for a long time, there was little high-quality research out there to understand their effects, and doctors often looked down on the practices. But over the past decade, that’s changed.

… Massage therapists work by manipulating the muscle and soft tissue of the back and body. There are many, many different styles of massage: Swedish, deep tissue, sport, myofascial release, Thai, the list goes on. Massages also vary in how long they last, how much pressure is used, and how frequent sessions are, which makes the evidence for massage pretty difficult to interpret. But there’s good news here: Massage is pretty harmless, and the researchers who study back pain say the approach makes sense from a pain relief perspective.

See the entire (long and detailed) article at vox.com/science-and-health/2017/8/4/15929484/chronic-back-pain-treatment-mainstream-vs-alternative.

“More Mental Floss for the Myofascial Release Brain: Changing Your Story”

From Myofascial Release Blog. (See also the author’s “Let Your Stories Mature and Grow” and “The Good (and Bad) of a Simpler Narrative“.)

By Walter Fritz

[Though fascial massage can feel like the most effective treatment for many people, there are a few different hypotheses about how it actually works — and sometimes conflicting evidence for each. -Jonah W.]

What if I asked you to strip away the story you tell when describing your modality? Could you describe the actions of your hands without the jargon inherent in the story of your modality? It might be pretty hard to do, as it may be hard to separate actual plausible science, anatomy, and physiology from what you were taught as the science that supports the work you use. You have to use something that sounds science-like, but what if you had to change your story? Could you do it and would you even wish to try? You would need something to explain your work, though my explanation seems to get simpler by the year.

Changing one’s story is often viewed as shifty or even indecisive, as if you cannot decide or are trying to cover up something. I disagree. I’ve written extensively about how I moved from a narrative (story) of myofascial release in the traditional, folkloric sense, which credits so-called fascial restrictions as being the cause of most pain as well as the key to the remediation of pain, into a story of simplicity and plausibility. Apparently my story was so compelling it garnered a request to tell it earlier this year at the RMTs of British Columbia Manual Therapy 2016 Conference. The story I now tell and teach is a simple one, one deconstructed from the stories of fascial fantasies. But as a therapist (PT) with over 30 years in practice, I’ve heard literally hundreds of stories on how we are creating change in the body, as well as the cautions as to what will happen if we do not follow the recipe set forth in that line of training’s rulebook.

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From Massage Today:

By Leon Chaitow

Fascia is fashionable. Over the past few years, you may have noticed the increase in conferences, congresses, symposia, workshops, online courses, books and articles that contain the word fascia in their title.

Fascia was, for many years, seen as a sort of second-class tissue, a form of supportive wrapping, a nuisance during dissection, where it obscured the views of pretty muscles and joints. Fascia’s increased visibility, due largely to the series of International Fascia Research Congresses,  has attracted publication of a huge number of serious basic science research papers, as well as an avalanche of clinically related, fascia-related articles. These articles range from a focus on the fascial influences of foam-rolling, kinesiotaping, connective tissue massage, muscle-energy and other stretching techniques, myofascial release, a variety of exercise models (with plyometrics taking the lead), as well as a range of new trademarked approaches, led by the Italian export Fascial Manipulation.

One of the surprising features resulting from current fascia research (and there is an awful lot of it) is how little our increased understanding of fascia’s functions has changed what manual therapists actually do – or need to do. Rather, I believe, greater fascial awareness and understanding helps most therapists to do what they already do, more effectively, rather than having to relearn their skills.

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From Runners World:

By Kelly Bastone

Research finally reveals just what massages can — and can’t — do for runners.

There is good reason massage therapists are part of an elite runner’s entourage. And why the lines for a postrace massage seemingly extend for miles. A rubdown — even a deep, intense one — feels great. Runners report that massages help lessen muscle tension and improve range of motion, while also making them feel relaxed and rewarded for their hard efforts.

Yet despite massage’s popularity and positive reputation, there’s been little scientific evidence to support why athletes feel so good when they hop off the table. “It can be hard to merge basic science with alternative medicine,” says Justin Crane, Ph.D., a McMaster University researcher who conducted some of the first objective studies on massage in 2012. Practitioners say massage relieves muscle soreness, promotes circulation, flushes toxins and lactic acid from the body, and eases joint strain — claims supported by centuries of anecdotal evidence from China, Sweden, and around the globe. But science hadn’t confirmed just what massage actually achieves — until now. Recent research has sorted out what’s true and what’s not.

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From American Journal of Sports Medicine, and see also “RICE: The End of an Ice Age” at Stone Athletic Medicine:

By Gabe Mirkin

When I wrote my best-selling Sportsmedicine Book in 1978, I coined the term RICE (Rest, Ice, Compression, Elevation) for the treatment of athletic injuries. Ice has been a standard treatment for injuries and sore muscles because it helps to relieve pain caused by injured tissue. Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.

In a recent study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage (The American Journal of Sports Medicine, June 2013). A summary of 22 scientific articles found almost no evidence that ice and compression hastened healing over the use of compression alone, although ice plus exercise may marginally help to heal ankle sprains (The American Journal of Sports Medicine, January, 2004).

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From Psychology Today:

by Rick Chillot

Touch is the first sense we acquire and the secret weapon in many a successful relationship. Here’s how to regain fluency in your first language.

You’re in a crowded subway car on a Tuesday morning, or perhaps on a city bus. Still-sleepy commuters, lulled by vibrations, remain hushed, yet silently broadcast their thoughts. A toddler in his stroller looks warily at his fellow passengers, brows stitched with concern. He turns to Mom for reassurance, reaching out a small hand. She quietly takes it, squeezes, and releases. He relaxes, smiles, turns away — then back to Mom. She takes his hand again: squeeze and release. A twenty-something in a skirt and blazer sits stiffly, a leather-bound portfolio on her lap. She repeatedly pushes a few blonde wisps off her face, then touches her neck, her subconscious movements both revealing and relieving her anxiety about her 9 a.m. interview. A couple propped against a pole shares messages of affection; she rubs his arms with her hands, he nuzzles his face in her hair. A middle-aged woman, squished into a corner, assuredly bumps the young man beside her with some elbow and hip. The message is clear; he instantly adjusts to make room.

Probing our ability to communicate nonverbally is hardly a new psychological tack; researchers have long documented the complex emotions and desires that our posture, motions, and expressions reveal. Yet until recently, the idea that people can impart and interpret emotional content via another nonverbal modality — touch — seemed iffy, even to researchers, such as DePauw University psychologist Matthew Hertenstein, who study it. In 2009, he demonstrated that we have an innate ability to decode emotions via touch alone. In a series of studies, Hertenstein had volunteers attempt to communicate a list of emotions to a blindfolded stranger solely through touch. Many participants were apprehensive about the experiment. “This is a touch-phobic society,” he says. “We’re not used to touching strangers, or even our friends, necessarily.”

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From Nature:

Mice have ‘massage neurons’: Nerve cells that detect gentle touch in mice are a hit with cats too.

Picture the expression on your cat’s face when you stroke it. What makes it so happy? The answer lies in a particular type of sensory neuron that responds to pleasant stroking, say scientists at the California Institute of Technology in Pasadena. The neurons, identified in mice, are similar to certain human neurons, which could explain why we enjoy a massage too.

Stroking skin produces a pleasurable sensation in many mammals, including humans, but until now, it was unclear which neurons detected that stimulus. It is easier to measure responses to pain than to pleasure, so neuroscientists have in general focused their attention on noxious stimulation.

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From massage-stlouis.com:

By Alice (?)

When Ida Rolf began putting her hands and elbows on people’s skin and applying pressure, creating a slow, sustained stretch, she imagined that she was stretching fascial sheets. Generations of manual therapists have followed her thinking, accepting this explanation to account for the changes felt in tissue tension beneath their hands and the sensations experienced by those who receive this type of therapy.

Ideas change over time

Much of manual therapy has grown largely out of anecdotal experience and tradition. Without the means to directly observe or measure what happened inside of the body, explanations for results had to be created from the “outside” and have largely been guesswork. As manual therapy has moved forward, an interest in understanding exactly how touch affects the body has led to a growing interest in research. With research has come the realization that many explanations of the past are not supported by evidence and are sometimes contradicted by evidence. Science-minded manual therapists have learned to adapt to this information, dropping outdated hypotheses and unsupported claims. While some have found it disconcerting to have cherished notions disproved, others have embraced knowledge and have adapted their conceptual models to fit what is known. They may continue to use modalities that have produced desired results but their understanding of how that comes about changes to fit the evidence.

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By Greg Lehman. Originally posted at greglehman.ca, now only online at archive.org. See a response by Andreo Spina.

Purpose: Fascia is everywhere, provides a fantastic structural support for the body and has the ability to transmit force from force generating muscles. But we as therapists tend to get ahead of ourselves and make statements about treatments and the body’s function that I am not sure make sense and haven’t made sense for the past decade that I’ve questioned it.

The fascial treatment fallacy.

Fascia is laid out everywhere in the body… we can even use some sharp scissors to dissect it in such a way to create lines of fascia that show how muscles that follow a limb or the trunk are connected. We can even give these lines names and call them trains. I think this stuff is really neat. But then we go and suggest that we can actually influence that line with our hands or some tool. Without a doubt I would support the idea that strength training tensions this connective tissue and we would expect adaptations in the fascia. Super, nothing new there. But then we might get in trouble with what we say we can and should do with manual therapy. Two examples…

Two examples of things I wish were true but probably aren’t when it comes to fascia therapy

1. If we “rub, pin, release, contact, shear or roll-out” fascia while pressing our digits/utensils against the skin we can somehow modify fascia.

We also assume that if we palpate the skin we can find “restrictions, adhesions or scar tissue” in the fascia. As if the normal response to activities of daily living or strength training is to build “restrictions, adhesions or scar tissue” in this important connective tissue. Why do we think that rubbing through skin will somehow make fascia change? How is this even possible? Does mechanotransduction work this way? Mechanotransduction is typically meant to refer to how the forces produced within body (e.g strength training) might yield some biological changes in tissues.

But rubbing on skin and hoping that this is influencing fascia is not the same as strength training. No one would suggest that if you rub a muscle it will hypertrophy and become stronger. Yet, we postulate a theory of mechanotransduction to influence fascia that no one would even consider if we applied it to muscle. And what is more responsive to change? Muscle or fascial connective tissue? Why muscle of course. So the more responsive tissue to mechanotranduction would not get stronger after your rub it but fascia, the less responsive soft tissue, will naturally warp and bend to your genius hand wishes. Makes sense to me.

2. If you have pain in one part of the body you have to follow that fascial line/link/chain/train and treat the whole thing.

Lets forget about the questionable possibility of even influencing the mechanical properties of fascia with your hands (if you talk neural properties of the nervous system I will listen) lets just look at the idea that everything is connected and you need to treat that bloody chain. I have two biomechanical questions/issues with this:

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From Time Magazine

by Maia Szalavitz

The word massage alone elicits deep relaxation and stress relief, and now a new study sheds light on how deep touch works to ease pain and promote healing in sore muscles.

Researchers at McMaster University in Canada found that massage affects the activity of certain genes, directly reducing inflammation in muscles — the same result you’d get by taking aspirin or ibuprofen — and boosting their ability to recover from exercise.

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From wired.com/playbook/2012/01/more-evidence-supports-barefoot-running

If you’re a runner, start striking with your forefoot. And wear those goofy minimalist shoes while you’re at it. Your body will thank you.

Those are the findings of a pair of studies by Daniel Lieberman, a professor of human evolutionary biology at Harvard University. He found runners who use a forefoot strike face a significantly lower risk of repetitive stress injuries, and barely there running shoes produce more efficient movement than conventional kicks.

The two studies, published this month in the journal Medicine & Science in Sports & Exercise, come less than two years after Lieberman’s earlier work found runners wearing minimalist shoes put less force into the ground, therefore less force on their bodies, when striking the ground with their forefoot versus their rearfoot.

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“A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain: A Randomized, Controlled Trial,” by Daniel C. Cherkin, et al., Annals of Internal Medicine 155(1), pp. 1-9. Read online at annals.org/article.aspx?articleid=747008. See also a detailed follow-up study “Structural Integration as an Adjunct to Outpatient Rehabilitation for Chronic Nonspecific Low Back Pain: A Randomized Pilot Clinical Trial” at ncbi.nlm.nih.gov/pmc/articles/PMC4405211.

“Massage is one of the most popular complementary and alternative medical therapies for neck and back pain, conditions that account for more than one third of the more than 100 million annual visits to massage therapists in the United States. Almost all massage therapists in the United States use Swedish massage techniques aimed at relaxation, but only a minority take courses in such techniques as structural massage for treatment of chronic low back pain. Recent reviews have found limited evidence that massage is an effective treatment of chronic back pain, and no studies have compared relaxation massage with structural massage, which focuses on correcting soft-tissue abnormalities. We therefore conducted a trial to determine whether relaxation massage reduces pain and improves function in patients with chronic low back pain and compared relaxation and structural massage for treating this condition…”

Read the rest at annals.org. Read about my own work at structuralintegrationniagara.com, and my personal experience in a short bio How I came to Rolfing.

From Running Times:

By Julia Lucas

You’ve got this injury you just can’t shake. You take time off. You ice and stretch and do all the right things but you’re still limping home. You spend too much time trying to articulate your particular brand of hurt to those loved ones who still put up with you. You follow referrals to physical therapists and massage therapists and you’d go to an aromatherapist if it’d help you run again, but nothing does. You diagnose yourself on WebMD: You’re a structurally flawed human being for whom recovery is impossible.

DON’T GIVE UP YET! The answer may be right under your fingertips. About 2mm under your fingertips, to be precise. Under your skin, encasing your body and webbing its way through your insides like spider webs, is fascia. Fascia is made up primarily of densely packed collagen fibers that create a full body system of sheets, chords and bags that wrap, divide and permeate every one of your muscles, bones, nerves, blood vessels and organs. Every bit of you is encased in it. You’re protected by fascia, connected by fascia and kept in taut human shape by fascia.

Why didn’t anyone mention fascia earlier? Because not many people know that much about it. Fascia’s messy stuff. It’s hard to study. It’s so expansive and intertwined it resists the medical standard of being cut up and named for textbook illustrations. Besides that, its function is tricky, more subtle than that of the other systems. For the majority of medical history it’s been assumed that bones were our frame, muscles the motor, and fascia just packaging.

In fact, the convention in med-school dissections has been to remove as much of the fascia as possible in order to see what was underneath, the important stuff. That framed Illustration hanging in your doctor’s office of the red-muscled, wide-eyed human body is a body with its fascia cut away; it’s not what you look like inside, but it’s a lot neater and easier to study and it’s the way doctors have long been taught to look at you. Until recently, that is.

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from www.prweb.com/releases/2011/04/prweb5272954.htm

New Book, “Figuring Out Fibromyalgia,” Offers Scientific Evidence on Cause of Fibromyalgia Pain

Ginevra Liptan, M.D., who developed fibromyalgia while a medical student at Tufts University School of Medicine, shows in her new book, “Figuring Out Fibromyalgia: Current Science and the Most Effective Treatments” (Visceral Books 2011), scientific evidence that dysfunction in the fascia, the connective tissue surrounding the muscle, causes the muscle pain in fibromyalgia. The book provides state-of-the-art understanding of the role of fascia in fibromyalgia muscle pain and its effective treatment. Dr. Liptan is also the founder and medical director of The Frida Center for Fibromyalgia in Portland, Oregon. On National Fibromyalgia Awareness Day, May 12, the Frida Center will be hosting its grand opening, with an appearance and book signing with Dr. Liptan.

Until recently, the role of fascia has been ignored. Many doctors may not even be familiar with the fascia because it is barely mentioned in medical textbooks. Dr. Liptan, who developed fibromyalgia while a medical student at Tufts University School of Medicine, found pain relief with manual therapy directed at the fascia. Her personal experience with myofascial release therapy led her to suspect fascia as the source of pain in fibromyalgia. As an associate professor at Oregon Health & Science University, she is currently directing a study comparing myofascial release to traditional massage for fibromyalgia. She has published several papers on the subject, including “Fascia: A missing link in our understanding of the pathology of fibromyalgia.”

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From University of Manchester:

Scientists have discovered how tendons – the fibrous tissue that connects muscle to bone – become damaged through injury or the ageing process in what could lead to new treatments for people with tendon problems.

The University of Manchester team, working with colleagues at Glasgow University, have been investigating ‘adhesions’, which are a build up of unwanted fibrous tissue on internal organs that have been damaged as a result of surgery or injury.

Adhesions cause organs to stick together and are extremely painful and distressing for patients, who often have to undergo surgery and rehabilitation. The estimated cost of adhesions to the NHS is £100 million each year.

In this study, published in the journal PLoS One, the researchers wanted to understand how tendon adhesions form, so examined the surface of healthy tendons and discovered that they are covered by a thin layer of skin.

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From Get Healthy:

By Angela Shawn-Chi Lu

Sitting in a hallway of the Cortiva Massage Therapy Center in downtown Chicago, Jennifer Kaminski appeared ebullient – ready to take on anything in fact.

Few would guess she had just spent an hour in a dimly lit room, relaxing on her back, in almost complete silence, while a therapist stroked her muscles. Massages, however, have become a routine part of her life for stress reduction and relaxation.

“I’d rather do this than take a pill,” said Kaminski, associate dean of the business school at Robert Morris University in Chicago. “It’s not just some fluff, downtown spa. They’re actually doing something for your muscles. I always see this as a doctor’s visit.”

Clients such as Kaminski, massage therapists, statistics and studies are all now attesting to the benefits and growth of the massage therapy industry.

Recent research has suggested that massage therapy can effectively alleviate cancer-related pain, boost the immune system, lower blood pressure and stress levels, reduce headache frequency and ease alcohol withdrawal symptoms, among many other things.

Just one session of massage can decrease levels of cortisol, a stress hormone, and increase the number of white blood cells, according to a study released in fall by researchers at Cedars-Sinai Medical Center in Los Angeles in The Journal of Alternative and Complementary Medicine.

It’s also a lucrative profession. Last month, Bloomberg Businessweek ranked massage therapy one of its top 10 careers for 2011. U.S. News and World Report named massage therapy one of the 50 best careers.

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from money.usnews.com/money/careers/articles/2010/12/06/best-careers-2011-massage-therapist:

“Best Careers 2011: Massage Therapist”

As one of the 50 Best Careers of 2011, this should have strong growth over the next decade

By Alexis Grant

The rundown:

Massage therapists may be good with their hands, but most also have a knack for business. You’re likely to work for yourself, and your success depends largely on how many clients you bring in, so you’ll need to market yourself well and develop a rapport with repeat customers. Many massage therapists work part time in several locations, including spas, hospitals, cruise ships, and sports centers.

Massage therapy uses touch to treat injuries, sooth tired or overworked muscles, reduce stress, and promote general health. Treatment comes in many varieties, including Swedish massage, deep-tissue massage, reflexology, and sports massage, and most therapists specialize in one or more. In most states, massage therapists need a license to practice.

The outlook:

As massage therapy becomes more popular, employment is expected to grow faster than average—19 percent between 2008 and 2018, according to the Labor Department. Although this industry certainly hasn’t been spared the wrath of the recession, more spas and massage clinic franchises are popping up to meet increased demand for massage services, creating new openings for therapists. Massage therapists held about 122,400 jobs in 2008, and more than half were self-employed. Many more practice massage therapy as a secondary source of income.

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From New York Times:

By Austin Considine

[Read about my Rolfing work at structuralintegrationniagara.com.]

A FORMER dancer of 14 years, Anna Zahn is in touch with her body. To gain more flexibility, and to counteract some of the strain from dancing, she has tried a number of remedies: Reiki, acupuncture, yoga.

But she still felt tight, her body tense. So she started getting Rolfed — a kind of deep-tissue bodywork that can be so intense that some jokingly liken it to masochism.

“It’s not going to massage and lighting aromatherapy candles,” said Ms. Zahn, a 20-year-old student at New York University, who gets a Rolfing treatment every week or so. “It’s tough to go to these sessions. It’s painful, very painful, emotionally and physically. But you feel such a relief when you leave that it’s just the most amazing feeling.”

Others are feeling it, too. Popular in the 1970s, Rolfing once evoked hairy-chested, New Age types seeking alternative therapies — perhaps most famously spoofed in the 1977 football movie “Semi-Tough,” starring Burt Reynolds and Kris Kristofferson.

But today, Rolfing is experiencing something of a resurgence, especially among younger city dwellers for whom the novelty of yoga has worn off, and who are now seeking more intense ways to relieve the stresses of modern life.

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From New York Times:

By Roni Caryn Rabin

Does a good massage do more than just relax your muscles? To find out, researchers at Cedars-Sinai Medical Center in Los Angeles recruited 53 healthy adults and randomly assigned 29 of them to a 45-minute session of deep-tissue Swedish massage and the other 24 to a session of light massage.

All of the subjects were fitted with intravenous catheters so blood samples could be taken immediately before the massage and up to an hour afterward.

To their surprise, the researchers, sponsored by the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health, found that a single session of massage caused biological changes.

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From Suite 101:

By Noreen Kassem

Can’t touch your toes with your fingertips? A lack of trunk muscle flexibility may be a sign of artery stiffness and heart disease. Here is why stretching is important.

Muscle flexibility is usually a sign of physical fitness; however, new studies indicate there may also be a correlation between core trunk muscle flexibility and artery wall stiffness. Stretching may be more important in preventing cardiovascular disease than previously thought and should be a part of exercise regimens, particularly for diabetics and other high risk individuals.

(See also Artery and Vein Stiffness Relieved by Stretching Test [2010] and Benefits of stretching along the artery [2008].)

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