During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and well thought out information and decision-making outcomes. I am happy to share some of their assignments for you to enjoy.
The goal of this research paper is to better understand the trend in massage toward evidence-based treatment, and to better understand how to find, and use, research in my practice as a massage therapist.
To begin, one must look at what type of research is even out there to be found, read, interpreted, analyzed and implemented in their own practice. From a culmination different articles, it is known in the research world that there are several different types of research. First, there is historical/archival research, which would include journals, articles, videos, etc., that show examples of different types of modalities and their consequences or findings. Secondly, there is quantitative research, which includes research findings from surveys, clinical trials or medical trials. These will be more of a controlled study requiring precise measurement. Thirdly, qualitative research is more of an exploratory type of research where one examines another person's perception, satisfaction or opinion on a subject. Fourthly, there is mxied quantitative and qualitative research where qualitative findings are used to help the quantitative findings.
It is hard to say in a black or white manner which types of research are valid or not. At some point, it will be up to the viewer to make their own determination of one's researches validity. For me, I often trust sources with medical backgrounds who cite their references for me to look into further. And then, I must determine if I trust those references that the original post mentioned.
Research for the profession of massage therapy can range from individual blogs or websites where they talk about energy healing or Reiki all the way to Rolfing where structural integration helps those with serious postural deviations. In order to determine which type of research is valid, I believe that it somewhat depends on the modality one is interested in. If one is interested in pregnancy massage, it would be helpful to research pregnancy-related medical sites/books/articles instead of, or in addition to, just looking at a mommy's blog on the internet where she talks about her personal experiences. I believe that all forms of "research" for findings are helpful to at least give one the opportunity to decipher for themselves about what aspects of the research do they believe in and, more importantly, want to try on their own clients.
In general, however, all massage therapists should be on the look-out and have a burning desire to be educated on the latest findings or reports in the practice of massage, regardless if one is doing heated stone massage or craniosacral therapy. Any new idea or findings have the potential to be important in the advancement of massage therapy, therefore, each massage therapist should want to learn about any new ideas or theories about bodywork and to be aware of the finding's validity. Finding sources of up-to-date information and research is extremely important for any massage therapist because, in a way, it would be malpractice not to! If there are updated or improved ideas, techniques, or modalities, and if an LMT does not acknowledge or try to incorporate better techniques, they could be harming their patients, or at least not serving them to the best of their ability.
The criteria that I use to determine if the information is valid and correct would mostly be to see where the references were made. For me, I trust sites like the American Massage Therapy Association, or Massage Therapy Foundation, scientific journals, or experienced practitioners who have years of experience and case studies where their main goal is to present information and research on different types of massage therapy modalities and their results.
I also like to find new ideas or research and then research it further on my own, adding my own ideas and eventually practicing the idea to see how it works in real life. The world of massage therapy, inside the world of evidence-based medicine, one must at least consider new ideas, theories, and practices in the massage therapy community. Most people trust and rely on evidence-based medical research; however, there are some things that an MRI or Xray cannot find, which leads us to the remaining part of this research paper.
The remaining part of this paper is dedicated to the statement that:
Fascia can be stretched to release adhesions
To begin, let's understand what fascia is. Fascia is a thin sheath of fibrous tissue enclosing a muscle or other organ. It is a continuous structure, like a woven sweater, inside our bodies, that runs from head to toe. When there is trauma, inflammatory responses from overuse or daily wear and tear, or surgical procedures, the fascia has the potential to form tight restrictions, or adhesions, in the body. These adhesions, or muscle knots, cause great pain, discomfort, lack of mobility, and other health related problems. Because fascia surrounds and attaches to all structures in our bodies, when one area of the body experiences tightness, that pain can radiate to another part of the body, causing wide-spread pain, affecting our flexibility and stability. Once fascia is stretched too far, pulled or torn, the fibers of the fascia are no longer parallel, flexible, or elastic. When there is a collection of too many knots, or trigger points, one may be diagnosed with Myofascial Pain Syndrome or Fibromyalgia. Massage therapists, among other body practitioners with well-trained techniques, may have the ability to help reduce these adhesions by gently stretching this fascia in the body.
Massage therapists, with proper training and practice, may have the ability to use certain strokes to stretch the fascia in someone's body. They are essentially getting hold of the tissue and moving the underlying structures, which may be able to somewhat change the consistency of the tissue. By using different techniques, they have the potential to gently stretch the fascia in opposite directions while using a sustained pressure to decrease pain and increase range of motion, or improve flexibility.
There is "drama" about this fascia release in the massage therapy community. There are studies out there that suggest fascia cannot be stretched. Instead, massage therapists may only have the ability to affect the nervous system, through manual touch, which can create changes in the body that help their clients feel at ease. Massage therapists seek to change the quality of the fascia, perhaps not necessarily stretch it out.
The study on Fascial Plasticity by Dr. Schleip in the Journal of Bodywork and Movement Therapies in 2003, has given thought and rise to new ideas surrounding this relatively new topic. The investigation about the nervous system, Ruffini and Pacini corpuscles, and mechanoreceptors in regards to fascial release is very interesting. It may not be just a manual touch that "releases" an adhesion, but perhaps because the central nervous system doesn't activate a single muscle, rather it activates groups of motor units, it would make sense that manual touch would release parts of the muscle tissue, instead of the whole muscle. 3 Therefore, this release may lower the firing rate of a few motor units by stimulating "intra-fascial mechanoreceptors, which then causes a reduction in the level of muscle activation of specific groups or motor units." (5, Greg Lehman).
Some believe that the work done on fascia is too intense, causing pain for the client. Others believe it is the ultimate cure for chronic pain in the human body. Since there is such a wide range of opinion on stretching of the fascia, it is my belief that it is up to the individual massage therapist and their individual client to meet on a similar page so the client is not going to have a negative outcome from the potentially painful and "abusive" therapy. There are numerous continuing education courses, classes or seminars, etc., that help massage therapists learn more and understand fascia work to even better serve their clients.
For example, the Fascial Therapy Continuing Education program is a comprehensive program that helps keep therapists current and up-to-date in this work, and it helps to advance their knowledge and skills. It takes time and working on many bodies to feel and know what to look for when searching for fascial adhesions. Once a therapist has been trained and has had opportunities to practice their skills, they have a great advantage over other practitioners to perhaps try to remodel fascia and help get it back to functioning properly.
There are different methods that massage therapists can use to help fascial adhesions. For example, Myofascial Release Treatments are typically performed directly on the skin, without oils or creams. "This helps the therapist to accurately detect fascial restrictions and apply the appropriate amount of sustained pressure to facilitate release of the fascia," (1, John F. Barnes, PT). Through soft-tissue massage, connective tissue massage, trigger point therapy, and Rolfing, a client has the potential to experience great relief from the tightness and pain.
There may be implications of fascial stretching. Fascia does have the potential to stretch too far and cause micro-tears. Anyone off the street may not be knowledgeable enough about this type of practice and should not perform fascial stretching massage techniques due to its highly sensitive implications that could arise. If one wants to perform fascial stretching to release adhesions, one must have education and training on the different techniques used.
In addition to manual therapies for reducing pain or releasing adhesions in the fascial system, one may want to also consider that no matter how much bodywork is performed, as long as the client is not moving properly in daily activities and exercises, using poor posture, or repeating poor muscle movements repeatedly, the fascia may never truly come to an ease, or find relief. From the findings on this topic, it is clear that massage therapies can be a supplement to other body practices that aid in relieving fascial body pains. There are some modalities such as ART, or Active Release Technique, that helps the soft tissues of the body by specifically targeting and correcting adhesions and scar tissues. ART is just one example of other therapies that aren't necessarily massage, but do offer very similar techniques and knowledge.
In retrospect, there may not be a way of knowing if stretching fascia can release adhesions since a medical practitioner would have to see deep into someone's layers of muscle (while being massaged) and somehow track or clearly provide evidence that stretching the fascia releases adhesions. This is a very difficult topic of research because it is nearly impossible to truly see the immediate results and lasting results of fascia stretching. The information from the Pain Science website provided a neutral-based stance on the topic, talking about Ida Rolf and other people who have carved the way in myofascial release techniques; however, any case studies, journals or articles that were found lacked any scientific or evidence-based information to confidently say whether or not stretching fascia releases adhesions.
For me personally, and why I was drawn to this topic, is because I would like to incorporate myofascial release techniques in my future practice. I feel as though fascial stretching research and findings will continue to grow and advance the ability for therapists to get to the root of people's chronic pain problems. If a massage therapist can give relaxation and stress relief to their clients, then that is great! But if the therapist can also help reduce, and perhaps rid, their client's pain problems, wouldn't that be the ultimate success story? In a world of prescription pills and drugs to "cure" all human problems, where there are doctors for all body parts, it is interesting to think that there are no Doctors of Muscles. Massage Therapists, in my opinion, have the potential to be doctors of muscles and truly help people's pain problems.
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