• Making Sense of Medicine by Bob Keller
  


• When one thinks about massage, one imagines lying on a massage table for an hour or so, undressed but covered by a drape, and having the pleasing experience of being rubbed with massage oil by a professional therapist: head and neck, arms and hands, legs and feet, and, of course, your back. The best result of such a classic or Swedish massage is to feel relaxed all over, to be relieved of stress and to feel ready to take on the world.

Classic massage falls into the broad category of soft tissue manipulation, but there are several other ways to work with your muscles and other soft tissues. These have goals other than making you feel temporarily good all over.
Here is a laundry list of some of the more common approaches: deep tissue massage, sports massage, hot stone massage, trigger point, reflexology, craniosacral, zero balancing, Feldenkrais, acupressure, Alexander, Jin Shin Do, Thai massage, neuromuscular, polarity, reiki, Rolfing and even more. These are all effective techniques when applied in the context they address.
What is medical massage?
Of particular interest to me is what’s called medical massage therapy. Medical massage therapy is a broad category that uses soft tissue manipulation to relieve specific medical conditions. In other words, medical massage therapy is outcome-based and is sometimes called clinical massage or treatment massage.
There are now numerous schools that claim to teach medical massage therapy, and even award a certificate. But there is no one set of techniques to be taught nor certified. Rather, whatever techniques a particular therapist uses become medical massage when applied to relieve a specific condition, like low back pain.
Every licensed, professional massage therapist acts in some cases to perform medical massage. That is, anyone who successfully treats specific conditions is free to print up and legitimately display a medical massage certificate.
That said, there are some therapists, myself included, whose practice is focused mainly on medical massage.
Is medical massage new?
Massage has been used as a medical treatment at least as far back as China 5,000 years ago. And as recently as the last few centuries, there are books and papers, often by physicians, explaining the clinical application of massage. Among the most influential practitioners in this area was 20th-century doctor Janet Travell, whose work with trigger points and referred pain fueled an explosion of information in the area of neuromuscular rehabilitation.
An example of medical massage
I don’t usually write much about my own practice in these columns, but the myokinesthetic system I use, MYK for short, is a good example of medical massage therapy.
MYK uses very precise, gentle muscle movement and stimulation to address a wide variety of specific medical conditions. These include migraine headaches, sciatica, carpal tunnel, knee pain, hemorrhoids, tennis elbow, low back pain, plantar fasciitis and many more.
What I do
At every vertebra in your spine, from your head to your tailbone, there emerges a big pair of nerves from your central nervous system that we call the nerve root. The nerve roots branch out to innervate every part of your body: muscles, organs and more. That is to say, every part of your body is hard-wired to your CNS through one or more nerves.
If you visit as a patient, my first priority is to determine which nerve root is primarily responsible for whatever pain or other condition you are experiencing. In order to do this, I listen to your symptoms, perform a posture analysis, do some muscle testing and arrive at a conclusion. If there is more than one nerve root involved, then I will usually prefer to treat the one responsible for your oldest pain.
Next, using very gentle stretch and stimulation, I treat every muscle in your body that’s innervated by that nerve root, and only those muscles. In so doing, a focused neurological signal is sent to that nerve root, and on to the CNS.
The CNS then perceives that there is some imbalance in the signals between the right side and left side of the nerve root, and being determined to enforce balance in your nervous system, it sends signals down to adjust the postures in your body. When balance is achieved, your pain or numbness is generally relieved.
How it works
The effect of MYK treatments is very similar to what your surgeon may do in implanting a nerve root stimulator in your spine. I would love to tell you how and why the NRS works. Alas, however, no one seems to be quite sure why this works. And the same applies to MYK.
MYK has worked in about 80 percent of my cases, and it seems to have an effect better than the NRS. As I understand the research, the NRS generally has the effect of changing pain into numbness, whereas with MYK, I generally expect a return to normal sensation.
Finally
The point of this is to illustrate some differences between medical massage and classic massage. For example, MYK uses no oils nor creams, you are fully dressed, and the treatment is 10 to 20 minutes. In addition, results are achieved through focus on a specific nerve root, while in a classic massage, most of your nerve roots are stimulated randomly, leaving the CNS with no clear direction as to what to do.
I recommend getting a regular classic massage for your general well-being, but if you have specific pains or other conditions, I urge you to consider medical massage.


Bob Keller maintains a holistic practice in Newburyport, MA. 

• By Susan Lacke
• ​

From timing and tips to talking and--er, tooting, a massage therapist answers your questions.
There’s no question that regular massage can benefit a triathlete--studies have shown massage can increase flexibility, speed recovery, and prevent injury. But the massage itself still poses questions--some too awkward to ask. Is a massage supposed to be this painful? When is the best time to schedule a massage? Should I wear underwear? What happens if I fart?
John Sanders and Robin Wooten, triathletes and owners of Next Level Massage Education, have heard them all (and more). Their answers to questions about massage from readers:
What is the difference between a massage for relaxation and a sport massage?
A relaxation massage tends to be more superficial, non-specific, connective and flowing. A sports massage, on the other hand, is vigorous and involves the use of multiple modalities, which could include relaxing Swedish-type massage techniques. Sports massage is more stimulating and at times needs to match the intensity of the athlete. It can be sport-specific and should be added as part of an athlete’s regular training schedule.
The pressure isn’t deep enough, but I don’t want to insult my massage therapist. What should I do?
Communication between client and therapist is essential to provide the best therapeutic massage possible. A professional massage therapist should not be offended by a client who asks them for deeper work or to move a little left or right. If they do get offended, then find another therapist.
Is there such a thing as too much pressure, or should I take as much as I can stand?
Yes. A therapeutic massage can at times be intense, but, it should never be painful. A painful massage is counterproductive.
What should I do if I get ticklish during a massage?
Communicate with your therapist. The therapist will adjust their touch/technique to help diminish the sensation.
Why do I sometimes get a headache after a massage?
While uncommon, massage does effect vascular circulation which for some could elcit a headache. Also, excessive pressure on the sinus cavity from being face down in the face rest could bring on a headache. Anytime you feel excessive congestion, which is quite common, turn your head to the side to help you breathe. Communicate with your therapist if your face rest is uncomfortable because it’s angled too low or too high.
Is it normal to bruise once in a while after a session?
No, not from a sport maintenance massage. If the treatment consists of structural integration techniques, then yes, bruising may occur due to the intensity of this type of work.
Does it make a massage more effective if I don’t wear underwear (or do wear underwear)?
If the athlete is in need of a relaxing massage, being completely undressed can allow the therapist to address all areas of tissue without the need of working through the sheet. This does not make the massage more effective, however. A professional, knowledgeable sports massage therapist can work through clothing or sheets and still be effective. If the client is more comfortable wearing underwear, then they should, as this will help them relax on the table and not worry about being exposed. If the athlete is going to be stretched extensively, then wearing underwear/shorts/sports bra can allow the massage therapist to be unencumbered by a sheet while draping their athlete. Communicate with your therapist prior to the session to determine what you should wear to meet your needs and wants.
I farted during a massage. I was so embarrassed, but I pretended like nothing happened. Should I have said something?
An “excuse me” would be nice! The last time this happened, I asked my client, “what else did you have with your broccoli last night?” We both laughed! In the massage world, this is called “a release.” It’s going to happen. And yes, there may be giggles.
Sometimes I fall asleep on the table. Does that make things difficult for the therapist?
No, not at all. As a matter of fact, it can be construed as an act of trust. When your client is so comfortable and trusting of you, they fall asleep on the table, this is considered a huge compliment--they have completely given themselves to their therapist. A client who talks during their entire massage session is not reaping the rewards of the complete healing process the therapist is attempting to provide.
As far as the triathlete, they can often be injured and/or completely stressed out due to a rigorous training schedule. Sometimes the athlete needs a break from therapeutic work and receive a relaxing put-me-to-sleep massage.
I like my massage therapist, but she’s very chatty. How do I let her know I’d rather not talk?
Communicate with them. Let them know you prefer a quiet session. Let the therapist know you are not trying to be rude by not answering or engaging in their conversation, you just want to completely be in the moment of your therapy session. Your therapist will understand, and if they don’t, find another therapist.
I’ve never had a massage before. Should I schedule one before my race next week?
Yes. However, it is very important you let your therapist know you have never received a session before and you do not want to receive an overly intense massage. Schedule the massage three days before your race, request moderate pressure, nothing specific, full body, with some stretching. And communicate! Do not allow them to go to deep or too intense. Be sure to schedule your post-race massage one or two days after your race.
Is there ever a circumstance or injury where massage could make things worse instead of better?
Yes, there are contraindications when a massage should not be performed: an acute injury, an opened wound, when an athlete is feverish, to name a few. First duty of a massage therapist is to cause no harm. If in doubt, communicate with your therapist.
How far out before a race should I schedule a massage?
Hopefully the athlete has incorporated maintenance and rehabilitative massage into their training calendar. Most receive pre-race massage three days before race day and post-race two days after.  Two to three days beforehand allows an athlete’s body to receive moderate to intense massage therapy which should not inhibit performance, and, hopefully increase performance. All athletes’ bodies are different, so knowing your body will help you determine how close to race day you should receive bodywork.
I’m never sure about gratuities. How much should I tip?
Gratuity is an act of gratitude, it is never a requirement to tip. If you are a gracious receiver of an awesome massage 15-20% is a standard percentage. The ultimate gratuity is not gratuity, but re-booking the next massage.
Why does my therapist always tell me to drink lots of water after the massage is over?
There is an overused myth in the massage world which expresses massage therapy releases toxins. Massage therapists ask clients to drink plenty of water to help flush out these toxins. However, there is no clinical research to provide evidence that massage therapy releases toxins. That being said, massage therapy does generate heat. This heat can create a sensation of thirst, so, drinking water will help quench this thirst, plus, drinking water is good for the body.

​What to Do When Your Green Thumb Has ArthritisThese 11 professional tips will help you enjoy gardening (relatively) pain-free

• 
  By Leslie Land

I am mostly unbothered by the signs of my advancing age: Finding a wrinkle here or a gray hair there disturbs me not a jot. But last spring the osteoarthritis that I’ve had in my hands for more than a decade stopped being a minor annoyance and became quite literally a major pain, especially when I’m in the garden.
Simple tasks like weeding and deadheading had always been meditations that freed and quieted my mind. Then suddenly they were the opposite. My mind was pretty much tied up to the noise of my thumbs hurting.

Knowing I wasn’t alone didn’t help; the majority of women over 50 have this kind of arthritis. And the longer you live, the more likely it is that you’re in for it. (Men are somewhat less likely to be cripplingly afflicted, but plenty of them suffer nevertheless.)
Arthritis in the hips and knees is usually more debilitating, so it’s not surprising those joints get a lot more notice from the medical community and the media. But speaking as a gardener with only the one variety, I am here to tell you that is bad enough.
There are orthopedists who specialize in hand conditions, therapists without number and no shortage of soothing drugs, both prescription and OTC, but for me the biggest relief came through behavior modification. By the end of last summer, I was able to care for the garden almost as well as I had done before, and although my doctor and therapist both deserve some credit, I’m convinced more of it goes to me, because I (mostly) followed this simple, at-home program.

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A Behavior Modification Guide to Hand Preservation 
Drugs can help ease some of the pain of arthritis, but doctors, therapists and sufferers all agree that the best “treatment” is less of the kind of use that aggravates the condition. Since no use isn’t possible for avid gardeners, I’ve come up with a number of solutions and work-arounds that I’m listing below.

1. Think of your pain-free hands as money in the bank. Then realize that everything you do with them has a “use cost.” Even things that normally don’t hurt, like petting the cat or smoothing a planting bed, are putting at least a small strain on your joints, thus subtracting from your account.
2. Give yourself a daily allowance. If you spend a bunch of hand use making a pie, you’ll have less for picking peas. When I’m planning to do a lot of cooking for an evening party, I harvest the food and herbs and cut and arrange the flowers on the previous day. On party day, I ignore the garden, upping the chances I can cook all day and still hold my fork without wincing when dinnertime comes around.
3. Sort tasks between “must be done” and “must be done by me.” Only I can make the artistic decisions called for in hydrangea pruning. And my delicate touch is essential for successful transfer of sweet pea seedlings from starter pot to waiting trench. But just about anybody can dig the trench the seedlings will go into, just as almost anyone can deadhead the daffodils, turn the compost and carry seedlings to the garden from the car.
4. Delegate as much as possible. This brings us to the unpleasant realization that there is not always a delegatee just waiting around to be used. Keep a list of non-urgent tasks ready to whip out whenever some unsuspecting friend offers to lend a hand. And if those kinds of friends are in short supply at critical times …
5. Hire help. Paying somebody to do garden tasks is very difficult. Even if finding the dollars is easy, finding the right helper is not. The local teenager looking for pocket money is a myth, butcraigslist.org, taskrabbit.com and Work Wanted sections of local papers are likely places to find affordable part-timers. (Most newspaper classified sections are more extensive online than in print, so don’t forget to check the Internet.) Bulletin boards at supermarkets are another place to look for signs or post your own. As usual when hiring strangers, check references and be wary.
6. “Preheat” your hands. Don’t leap right into the cold garden without doing this. Warm joints move more smoothly than cold ones, and joints that start out at body temperature chill quickly outdoors, especially in early spring and late fall. This step can be as simple as a five-minute soak in hot water (wear thin rubber gloves) or as elaborate as using a hot wax machine. There are dozens of models available through online beauty outlets, on Amazon, and both new and used on eBay.
7. Ration hand use by kitchen timer, not specific task. Work in the garden is open-ended almost by definition. I can be weeding the bed by the driveway, firmly committed to cleaning up just that one bed for today. But then if I turn my head to the side, there are some very untidy zinnias that really should be deadheaded. Next thing I know it’s 3:30, and my hands are killing me. Remember, this method works only if you stop working when the bell goes off. It may seem too obvious to mention, but I can testify that time limits are very easy to ignore if your hands don’t hurt yet.
8. Use your whole hand (or both hands) to pick things up. We tend to grab for things with just our fingers, but doing that requires a pinching motion, which stresses the joints. Then you have to press tightly to keep your grip on whatever, stressing them even more. Once I started paying attention, I was amazed at how often I did just that, moving empty flowerpots without putting a supporting hand underneath, using my fingertips to carry one last planting stake, grabbing a trowel that was just out of reach instead moving toward it and picking it up with my whole hand. Although breaking this habit is difficult because it’s so useful, it does get easier over time and even partial success is worthwhile. I’d give my current efforts about a C minus. But even that is making a big difference.
9. Keep your tools sharp. This also helps mega in the kitchen. Well-honed cutting edges take far less hand pressure to do their work. There are also many garden implements designed to be easier for arthritic hands to use. Actual helpfulness varies considerably; my hands are small, for instance, while many “ergonomic” handles are larger than usual.
10. Use a voice recorder, not pencil and paper. If you (like me) are a person most comfortable with the written word, get a recording device that transcribes words to text and can store photographs as well. I use my iPhone, and I’ll bet other smartphones can do this, too.
11. Sit still and bathe your hands in the sunshine. Find a spot to just enjoy the place without worrying about work to be done. Emotional stress-reduction is also part of the program. And what’s the point of all your hard work if you forget to just sit in the garden and bask in its beauty?

© Twin Cities Public Television - 2016. All rights reserved.

​Should You Try Massage for Back Pain?How a rubdown compares with other treatments like physical therapy and acupuncture
By Consumer Reports


A soothing massage might feel relaxing, but could it have real health benefits, too? Documented in early Egyptian tomb paintings and Chinese writings from as far back as 2700 B.C., massage involves a range of techniques for rubbing the body to relieve muscle tension and pain. For example, Swedish massage employs long strokes and kneading movements, and deep tissue massage uses focused, intense pressure in tight or painful areas.
Today, Americans are increasingly turning to massage. According to the National Center for Health Statistics, the proportion of Americans who got massage therapy increased by 38% between 2002 and 2012. Users typically seek out a trained massage therapist (not a medical doctor) and can spend anywhere from $40 to $250 or more per hour, depending on where they live, the type of massage, and the setting. (Expect to pay more at a fancy spa.)
Does It Work?“Limited research suggests that massage therapy might ease lower back pain—a condition that affects eight in 10 adults at some point in their lives,” says Consumer Reports chief medical adviser Marvin M. Lipman, M.D. For example, a 2015 review of 25 small to midsized clinical trials conducted by researchers with the independent Cochrane Library. It found that among people with lower back pain lasting more than four weeks, massage provided better relief than either no treatment or a "placebo" treatment—such as lightly touching the skin.
Massage therapy also appeared to relieve discomfort better, on average, than treatments like acupuncture, traction, and relaxation exercises. Most important, when compared to no treatment or a placebo treatment, massage improved functions such as walking ability, sleep, and other important components of daily life.
The studies reviewed were small (124 people, on average), notes Andrea Furlan, M.D., Ph.D., the review’s lead author and a scientist at the Institute for Work & Health in Toronto. “I really believe massage is effective,” she says, “but we need bigger and better-designed clinical trials before we can be sure.”
So, how might massage ease discomfort? Scientists haven’t pinpointed a mechanism, but they think it might stimulate nerves that mute pain signals. Another theory suggests that massage may trigger the release of pain-reducing hormones called endorphins.
Research suggests that massage may have benefits beyond pain relief. For instance, a 2010 analysis of 17 clinical trials found that it may help relieve depression.
“Trying massage for back pain probably won’t hurt, and might help,” says Lipman. But if you try it, tell your practitioner beforehand about medical conditions you have and medicine you take. Massage isn’t appropriate for everyone. People taking blood thinners, such as warfarin (Coumadin or generic), for example, should avoid deep tissue massage because intense pressure could cause bruising.