Dana Madigan, DC, MPH; Jerrilyn Cambron, LMT, DC, PhD; Ann Blair Kennedy, LMT, DrPH; Kaley Burns, BS; Jennifer Dexheimer, LMT, BS

Introduction: Volunteerism among physicians, nurses, and other healthcare professionals has been described in the literature. To our knowledge, there is currently no published literature regarding the volunteerism of massage therapists.
Objective: The aim of this study was to describe the volunteerism activities, motivations, and barriers for massage therapists.

Methods: Practicing massage therapists in the United States that were recruited through MassageNet, a practice-based research network, to take a survey containing questions regarding volunteerism. Participants took a survey containing questions regarding professional, volunteerism, and personal characteristics. Specific volunteerism questions addressed if volunteering was massage or non-massage related, motivations, barriers, and their primary role including direct service, administrative/organizational, or fundraising. This was intended to serve as a preliminary assessment using a small sample of therapists and is not representative of the massage therapy profession.

Results: Of the 96 massage therapists that completed the survey, in the past year 27 participated in only massage related volunteering, 12 participated in only non-massage related volunteering, 37 participated in both massage and non-massage related volunteering, and 20 did not volunteer. The most commonly reported motivations for volunteering include the enjoyment of the activity (67.7%), desire to contribute to betterment of society (59.4%), and desire to give back to society (56.3%). The most commonly reported barriers for volunteering include not having enough time (62.5%), organizational restrictions (38.5%), and personal health concerns (20.8%). For those who participated in massage-related volunteering, the most commonly reported settings included social and community service groups (40.6%), hospital, clinic or healthcare organization (37.5%), and health research or education organizations (34.4%). The most common population specified was cancer patients (15.6%). Of the 64 participants who participated in massage related volunteering, the majority engaged primarily in direct service volunteering (46.9%).

Conclusion: The majority of massage therapists surveyed participated in volunteer work during the past year, primarily with social and community groups in a direct service role. Service is important to various sectors of the massage community; therefore recognizing the benefits and barriers to volunteerism for massage therapists may enhance participation and impact the profession positively.

Oral & Poster Abstract from the 2016 International Massage Therapy Research Conference. International Journal of Therapeutic Massage and Bodywork. 2016; 9(2): 9-27.

Cathy Meryanos, LMT

Background & Objectives: There is limited access to healthcare in rural Ghana and virtually no rehabilitative services available. This situation presents a unique opportunity to utilize chair massage in addressing women’s health in rural Ghana, particularly when it comes to muscle pain and fatigue from heavy labor. The objective of this case report is to determine the results of chair massage as a strategy to reduce neck, shoulder, and back pain, while increase range of motion.

Case Presentation: The patient is a 63-year-old Ghanaian female, who was struck by a public transport van while carrying a 30-50 pound load on her head, 2 years prior to the massage. The accident resulted in a broken right humerus and soft tissue pain. A traditional medicine practitioner set the bone, however there was no post-accident rehabilitation available. At the time of referral, she presented complaints of shoulder, elbow, and wrist pain. In addition, she was unable to raise her right hand to her mouth for food intake.

Results: The results of this case report include an increase in range of motion, as well as, elimination of pain in the right shoulder, elbow, and hand. A visual assessment showed an approximate ROM increase within the range of 45-65 degrees in the right arm and 10 degrees in the 4th and 5th fingers. There was also a decrease in muscle hypertonicity in the thoracic and cervical areas, and a profound increase in quality of life for the patient.
Discussion: This case report illustrates how therapeutic chair massage was utilized to address a common health concern for one woman in rural Ghana. It also demonstrates pre-existing musculoskeletal disorders and pain may be eliminated with massage intervention. Massage therapy may be important to ameliorating certain types of health problems in remote rural villages in low income countries.

Alyssa Hofmann

Background: Fetal Alcohol Spectrum Disorder (FASD) a term used for a wide array of growth, mental, and physical problems that can occur to a baby if the mother drinks while pregnant.

Symptoms can include smaller physical features and stature, poor coordination, hyperactivity, and difficulty with attention span and communication. There is currently no specific treatment for FASD; however parents may seek medical care from a variety of specialists, medications, behavior and educational therapy, and/or complimentary therapies such as massage.

Objectives: To determine the effects of Swedish massage on the behavior of a two year old boy with physician suspected FASD.
Case Presentation: The patient is a two year old boy small in stature, with abnormal facial features, chronic ear problems, and developmental difficulties who regularly works with hearing and speech specialists. According to the guardian, the child’s mother had admitted to drinking throughout her pregnancy. The child’s physician suspects FASD, but he is currently on a waitlist for additional testing by a specialist.

Methods: The patient was given ten approximately 30minute Swedish massage treatments. Palpation, postural assessment, and muscle testing was conducted by the therapist. Subjective measures of behavior and emotional levels were collected from both the patient and the guardian.
These measures included the FACES Rating Scale and behavioral questions inquiring about interactions with others, distraction during tasks, and toe walking. Assessments were primarily collected before the first treatment, after the fifth treatment, after the last treatment, and one week later.

Results: The therapist noticed a decrease in hypertonicity in the child’s bilateral Tricep Surae group and increased strength in the Tibialis Anterior muscles. Decreased behavioral outcomes included toe walking, throwing of toys, aggressive behavior, getting over emotional, and fidgeting during mealtime. However, taking toys away from others and mimicking bad behavior remained the same. The FACES Rating scale responses were unreliable and only served to help the child reflect and improve communication.

Conclusion: The findings from this case study demonstrate the possibility of massage as a treatment to assist with improving behavior problems in a 2 year old with FASD; however, additional larger scale research with more standardized assessments needs to be conducted.

Susan G. Salvo, MEd, LMT, BCTMB

Purpose: Student satisfaction is one of the five pillars of quality online education. In 2015, nineteen percent of massage schools offered online courses for their entry-level programs. If trends in massage education follow colleges and universities, this number will increase. The purpose of this study was to gain a deeper understanding of how students perceive their online educational experiences. Educators and administrators are interested in this topic as satisfied students are more likely to achieve academic success, less likely to drop out, and more likely re-enroll in future online courses.

Methods: Studies, reports, and textbooks were obtained using scholarly databases. Keywords used during searches were online, distance, learning, education, student, perception, attitude, university. Inclusion criteria were participants must be students of higher education and must have completed at least one online course. Publication dates must be prior to January 2000. Studies that examined faculty perceptions were excluded. Data gathered from 34 sources were used during analysis.

Results: Students cited flexibility and convenience as primary reasons why they choose online courses. Learning management systems (LMSs) were important to online course implementation. The most valued LMS features were uploading assignments and utilizing digital resources such library databases. The least valued feature were discussion boards. Students had a strong preference for courses that were well-organized. One consistent finding was students felt there was a lack of teacher presence, inadequate teacher feedback and time intervals between student inquiry and teacher response were excessive. These experiences produced feelings of anxiety among online learners.

Conclusion: Students enjoyed their online learning experiences overall. Teacher presence was an important contributing factor that improved student satisfaction. Teachers help create substantial learning experiences for students learning online by stimulating and directing discussions, asking probing questions, clarifying misconceptions, and emphasizing key concepts.

Oral & Poster Abstract from the 2016 International Massage Therapy Research Conference. International Journal of Therapeutic Massage and Bodywork. 2016; 9(2): 9-27.

Rosi Goldsmith, BA, LMT, DAFNS

Introduction: Parkinson’s Disease (PD) is a progressive neurodegenerative disorder, with symptoms of rigidity, tremor, postural instability and bradykinesia. Sleep disorders, fatigue, emotional issues, and cognitive changes are some non-motor symptoms (NMS) which negatively impact Quality of Life (QoL).

Objective: Research done within various populations using massage, focused exercise, mind-body practices, and imagined movement have shown benefits to associated brain areas, emotional issues, and/or motor symptoms implicated in Parkinson’s. No previous studies have investigated these combined therapies for PD patients. This study asks whether a multi-modal program could affect PD symptoms.

Case Presentation: A 63 year old male with PD 5 years post-diagnosis, was taking Sinemet. Patient identified goals of pain relief, improved mobility, slowing of PD progression, and symptom control. Initial assessment showed moderately stooped posture; mild to moderate rigidity of neck and major joints; bilateral pain at shoulders; and impaired balance.

Methods: Fifty-six bodywork sessions over eight months included: Massage, Ortho-Bionomy; mindfulness and interoceptive awareness training; and neurological exercises including single leg stand and vertical eye saccades. A home program was developed from clinical practices, with adapted yoga, meditation, and mental rehearsal of his exercise/yoga routine. Joint range of motion (ROM), balance, and eye saccades were assessed clinically throughout the study. Pain, motor and NMS, and QoL were assessed by validated instruments: Visual Analog Scale (VAS), Non-Motor Symptom Scale (NMSS), PD Quality of Life-39 (PDQ-39), Modified PDQoL (PDQoL), and Unified Parkinson’s Disease Rating Scale (UPDRS).

Results: ROM, balance, and eye saccades improved based on clinical assessments. VAS of pain showed a decrease from 7/10 to 4.5/10. PDQ-39 showed an 11.5% overall improvement, with the largest subscale improvement in Activities of Daily Living (ADL) (33%). PDQoL demonstrated notable subscale improvements of Emotional Functioning (12.5%) and Parkinsonian Symptoms (21.6%). NMSS showed a 26% overall improvement, with specific domain improvement in Sleep/Fatigue (10%). UPDRS showed notable improvements in Motor Examination (15%). Patient reported he could often calm “off” symptoms of fatigue, tremors, and RLS by meditation and exercise/yoga mental rehearsal, resulting in improved sleep, confidence and self-satisfaction.

Implications: Multiple therapies and medication changes may have introduced confounding variables; and variations in Parkinson’s symptoms and massage clinical practice make it hard to reproduce. The possibility of benefits to QoL and NMS suggests a controlled study using multiple evidence-based modalities, including bodywork, might be worthwhile.
Oral & Poster Abstract from the 2016 International Massage Therapy Research Conference. International Journal of Therapeutic Massage and Bodywork. 2016; 9(2): 9-27.

Tara McManaway, M.Div. C.A.G.S., LMT, LCPC, ALPS

Introduction: Trauma is, by definition, unspeakable and unbearable. Trauma interferes with language and the fight/flight response. Counseling and mental health treatments for trauma may incorporate embodied practices, including massage therapy and movement. A review of available literature across disciplines was conducted to investigate evidence of benefit of this integration. Body-oriented therapy needs to be defined, evidence supported practices for use in trauma work identified, and supervision and ethical considerations for body-oriented practitioners developed.

Objectives: (1) Identify evidence-supported practices that may be effective in trauma work. (2) Identify preliminary best practices utilizing body-oriented therapy. (3) Identify supervision and ethical considerations for body-oriented practitioners.

Methods: A review was conducted of available books, journal articles, dissertations, reviews and research articles from 1996-2015 accessing databases and collections available through Johns Hopkins University Catalyst —including but not limited to publications from mental health, psychology, psychiatry, neuropsychology, neuroscience, massage therapy, public health, epidemiology, and trauma. 158 publications were identified and reviewed for basic supporting science; treatment effectiveness specific to trauma symptomology; preliminary evidence; current best practices; and ethical and supervision considerations in body-oriented trauma-informed care.

Results: The review indicated that body-oriented therapies may be categorized into no-touch or near-touch therapies, movement therapies, and touch therapies. Pilot studies with torture, trauma, and sexual abuse survivors, as well as other findings, although limited, suggest that body-oriented therapy may play a unique role in the path toward embodiment for trauma survivors. Ethical and supervision issues were identified and guidelines developed based on best practices to date.

Conclusion: Body-oriented therapies show promise in helping reconnect the body sensations with emotions, reduce anxiety, improve restorative sleep, and help clients create and repair functioning connections to body awareness and emotional control that were damaged during trauma. A number of supervision considerations need to be addressed when working ethically with vulnerable populations of trauma survivors.

Oral & Poster Abstract from the 2016 International Massage Therapy Research Conference. International Journal of Therapeutic Massage and Bodywork. 2016; 9(2): 9-27.

Nicole Gnadt, LMT

Objective: To determine if Myofascial release, Swedish massage, Neuromuscular therapy, and frictions performed local to affected bilateral chest; combined with pain free stretch and strengthen exercises has an impact on pain, itch, anxiety, range of motion, sensory of the skin, and nerve pain in a chronic burned victim. The goal is to decrease adhesions, hypertonicity, improve tissue elasticity in the client’s bilateral chest area, and restore range of motion to the bilateral glenohumeral joints.

Case Selection: A Caucasian male, age thirty, with no history of illness nor use of other therapies, who has a chronic third-fourth degree burn to his bilateral chest and the right side of his neck. The client has a full thickness graft in the form of an oval shape to the middle section of his throat and normal skin grafts to his bilateral chest and the right side of his neck.

Methods: Seven 60-minute treatments were conducted, twice a week. Prior to each treatment, 30-minutes of assessments were collected, including the McGill pain questionnaire, state trait anxiety form, and active/passive range of motion tests. Resisted muscle testing, pec contractor test, a two-point discrimination test, and a modified nerve pain test were done prior to the first treatment and after the seventh treatment. The 60-minute massage treatment consisted of Myofascial release, Neuromuscular therapy, Swedish massage and Cross Fiber frictions. Homecare recommended included the use of a stretch and strengthen exercise with a moisturizer.

Results: The client had a significant increase in nerve pain and skin sensation to his chest bilaterally. Upper/middle trapezius strength increased, as well as range of motion of his bilateral glenohumeral joints. The client had a significant decrease in the McGill pain score and itch with use of certain massage techniques. Following the seventh treatment, the pec contracture test was negative but no difference was found in state trait anxiety.

Conclusion: Massage was beneficial in reducing itching and pain levels, as well as increasing overall range of motion, nerve pain and skin sensation in a third-fourth degree chronic burned victim.

Rachel Benbow, LMT, BA, MLIS

Introduction: Children with Autism Spectrum Disorder (ASD) often have an underdeveloped or dysfunctional proprioceptive system, leading to significant motor skill delays and increased anxiety. There is not enough clinical research to indicate the efficacy of massage therapy on proprioceptive dysfunction in children with ASD, but if shown effective, massage therapy could offer a new intervention for this issue.

Objective: The objective of this case report is to describe changes in the proprioceptive abilities of a child with ASD after the application of 8 massage therapy sessions over a four week period.

Case Presentation: The subject of the case report was a 5 year old Caucasian female client with mid to high functioning autism and proprioceptive dysfunction. The client’s proprioceptive dysfunction impairs gross motor planning and execution, creating gross motor developmental delays.

Intervention: Eight 40 minute massage therapy sessions, consisting of Swedish massage and foot reflexology, were administered twice a week over four weeks. The Swedish massage protocol utilized strokes stimulating to muscle spindle proprioceptive neurons. The foot reflexology focused on reflex points specific to the nervous system. Improvements in proprioceptive abilities were monitored through pre and post-massage testing activities that included single foot balancing, jumping rope, back-and-forth ball bouncing, and independent ball dribbling.

Interpretation: The client displayed improvement in proprioceptive testing tasks at a much faster rate than her usual learning curve. Proprioceptive progress was demonstrated by gains in gross motor skills pertaining to postural control, overall body coordination, and use of force.
Implications: Although positive results were achieved within this case study, more extensive studies are needed to support the efficacy of massage therapy on proprioceptive dysfunction in children with ASD. Further research is needed to determine which intervention in this case study, Swedish massage, foot reflexology, or the combination of the two, is responsible for the observed changes.

Oral & Poster Abstract from the 2016 International Massage Therapy Research Conference. International Journal of Therapeutic Massage and Bodywork. 2016; 9(2): 9-27.

Rosi Goldsmith, BA, LMT, DAFNS

Introduction: Shoulder pain is the third most common musculoskeletal condition, with high social-economic costs. Contralateral inhibition (CI) has been used to treat a limb affected by stroke and to prevent unilateral overuse sports injuries, but is not well researched for pain treatment. This is the first such case report on CI for disabling shoulder pain.

Case Presentation: The patient was a married, 45 year old, right-handed male, with a 3-year history of right shoulder pain following a traumatic injury. The slightest touch or use of his right arm exacerbated the pain for days and interfered with all aspects of his daily life. Previous treatment included surgery, psychotherapy, pain management training, physical therapy, and chiropractic. He took analgesics, and wore an advanced transcutaneous electrical nerve stimulation (TENS) unit for approximately 2 hours daily.

Methods: The practitioner identified the most painful tissues in the affected right arm, then applied isometric and very slow isotonic contractions to homologous left arm muscles. The patient’s wife was recruited to assist with daily home exercises. The practitioner applied cross-fiber friction, myofascial release and proprioceptive exercises to the right arm when direct touch became tolerable. The patient recorded VAS pain scales at each session and kept a weekly frequency/duration log of TENS unit use. The practitioner charted verbal narratives on other changes the patient experienced.

Results: Following 12 clinical sessions in 24 weeks, the patient had a 50% VAS reduction in between-session pain, and TENS unit usage dropped from 13-14 hours per week to none. The patient reported improvements in sleep and confidence, as well as resumption of normal home and family activities. He also reported that he was able to return to work for the first time in three years.

Conclusion: Physical therapy research has documented CI with “neurological crossover” effects, but it is not well researched. A prospective study could choose more appropriate rating scales, and determine when CI treatment might be most effective. This case suggests massage therapy may be beneficial for some cases of severe unilateral pain, but additional larger scale studies are needed.

Rosi Goldsmith, BA, LMT, DAFNS

Introduction: Ankle sprains comprise up to 85% of athletic injuries. Most heal without consequences. Chronic ankle sprains, especially in sports, can result in more proximal complaints. A perception of instability and sensorimotor deficits are key symptoms of chronic ankle instability (CAI).

Objective: To note how clinical reasoning and research literacy reframed a clinical focus CAI that improved outcomes and patient satisfaction.

Case Presentation: A 48-year-old athletically-inclined corporation middle manager had a history of sports injuries. After multiple prior treatments, including two knee surgeries, she still experienced restriction in her ability to walk, run, stand, squat, or engage in sports. The patient’s initial complaint was knee pain.

Interventions: Ortho-Bionomy® (O-B) techniques were initially applied to hypertonic, painful muscles around the knee and proximal to it, in 7 sessions over 4 months. The practitioner surveyed the research and found that patient self-report of lower limb instability is an indication of CAI, despite absence of pain at the anteriotalofibular ligament (ATFL). Positive anterior drawer and talar tilt tests suggested a change of focus to the ankle. O-B for ATFL and calcaneofibular ligaments was applied in 3 sessions. Four months later, the patient presented with re-injury, and practitioner found new research recommending massage techniques for CAI sensorimotor deficits. Practitioner assessed ATFL pain by palpation and pinwheel tests, and found diminished sensation and changed frequency, dosage and methods. In 11 half hour sessions over 4 weeks, practitioner used O-B for proximal fibula and hypertonic lower leg muscles plantar fascia massage, ankle isometric and isotonic exercises to increase proprioceptive awareness and improve ankle biomechanics to prevent re-injury.

Results: Following the first 4 months of treatment, the patient reported diminished knee pain, but a perception of instability. The 5th month, with ankle-focused sessions, increased the patient’s perception of stability, but did not prevent re-injury. The last series of treatments 4 months later, the patient reported increased proprioception, “I can be mindful of how I use it”, “Feel close to normal”, “I am excited about getting my body back”, “I just thought it was my knee”, “Now I’m noticing the healing.”
Implications: Massage practitioners may apply clinical reasoning skills, assessments within their scope of practice, and research literacy to target physiological dysfunction that is not immediately obvious or reported by the patient.

Oral & Poster Abstract from the 2016 International Massage Therapy Research Conference. International Journal of Therapeutic Massage and Bodywork. 2016; 9(2): 9-27.

Susan Vaughan Kratz, OTR, CST

Introduction: Cerebellar agenesis is a rare condition in which the brain develops without a cerebellum. Individuals with either congenital or acquired cerebellar agenesis often have significant impaired mobility, and function, sensory motor deficits, speech, and often other cognitive impairments.

Objective: This case reports on the results of using CranioSacral Therapy (CST) to treat an adult female with cerebellar agenesis and other congenital malformations.

Case Presentation: A 22 year-old female with congenital cerebellar agenesis presented to a private therapy clinic for treatment of chronic pain following spinal surgery which occurred 6 years prior. The patient had life-long movement disorder; cerebellar ataxia; neurogenic bowel and bladder dysfunction; and required maximal assistance for walking, standing, and changing position due to pain and lack of strength, balance, and control. The treating therapist noted extreme athetosis of the head, neck, and shoulders and a significant keloid scar along the posterior vertebral surface.

Intervention: Ninety-one, 45-60 minute, CST sessions were conducted over a four-year period with minimal/occasional use of proprioceptive neuromuscular facilitation, myofascial release, scar reduction techniques, and lymphatic drainage. The primary goal was relief of chronic pain, but shifted to a general health and wellness focus when that goal was attained.

Results: Following 18 sessions of CST within the first six months, the primary goals of pain relief were attained. The patient’s mother reported this as “the only therapy she has ever attended where she indicates receiving comfort. She appears motivated to come and I know she feels better and her mood is better.” After 4 years, CST also contributed to marked improvements in functional movement skills and unexpected attainment of fecal continence. The patient’s mother again reported “she has started to be able to go to the bathroom and is now using the toilet and is independent with her bowel control now. It’s a huge impact that we are all very happy about”.

Conclusion: Clinical significance of these outcomes arouses curiosity about the type of stimulation CST provides to the central nervous system and any effect upon neuroplasticity.

Nancy J. Rodgers, BCTMB, Susanne M. Cutshall, APRN, CNS, DNP, Liza J. Dion, BCTMB, Nikol E. Dreyer, BCTMB, Jennifer L. Hauschulz, BCTMB, Crystal R. Ristau, BCTMB, CMT, PMT, Barb S. Thomley, BA, Brent A. Bauer, MD, FACP

The use of complementary and integrative medicine therapies is steadily becoming an integral part of
health care. Massage therapy is increasingly offered to hospitalized patients for various conditions to
assist with the management of common symptoms such as pain, anxiety, and tension. This poster
summarizes a decade of building the massage therapy service at a large tertiary care medical center, from
the early pilot studies and research to the current program offerings, and the hopes and dreams for the
future.

*Rodgers NJ, Cutshall SM, Dion LJ, Dreyer NE, Hauschulz JL, Ristau CR, Thomley BS, Bauer BA. A decade of building massage therapy services at an academic medical center as part of a healing enhancement program. Complement Ther Clin Pract. 2015; 21(1):52-6.

Paul A. Lewis, RMT, CDT; Joan E. Cunningham, PhD

Introduction: Axillary web syndrome (AWS), also called lymphatic cording, typically presents in the weeks after axillary surgery for breast cancer. This painful condition is like-ly angiolymphatic and fibrotic in origin, and restricts upper extremity range of motion (ROM). It has no establised treatment although physical therapy and other approaches have been used to variable effect.

Objective: Swedish massage and specialized passive movement techniques were applied in the case of a young woman with axillary cording, to investigate effectiveness in reducing pain and restricted ROM caused by this condition.

Case Presentation and Methods: A female patient who had recently undergone axillary surgery presented with pain (self-reported as 5 on a scale of 0-10) and restricted use of the ipsilateral up-per extremity. Extent of cording (taut, from axilla to wrist) and flexion at glenohumeral joint (GH; 140 degrees measured by goniometer) were assessed. Therapeutic massage was adminis-tered over two sessions. Methods included dynamic angular petrissage techniques: stretching and relaxing the target tissue by taking the limb through all possible angles of movement while sim-ultaneously and segmentally applying Swedish and non-Swedish (including myofascial, lym-phatic drainage, etc.) techniques to the underlying soft tissue. The cord was considered a struc-ture to be released, rather than a tissue to be torn or broken. The patient practiced prescribed self-care exercises between treatment sessions.

Results: After Session One pain was reduced to 0/10, GH flexion improved to 170 degrees and cording was visibly reduced. After Session Two the cord was only residually apparent, with no ROM restrictions even during hyperextension. Long-term outcome was complete resolution after only two sessions, with no recurrence of AWS.

Conclusions: Pain, restricted flexion and cording were quickly and gently eliminated. The com-bination of massage and movement using dynamic angular petrissage techniques is proposed as an effective, efficient treatment approach for axillary web syndrome.

Mariusz P. Furmanek, Kamil Mustafa, Michal Pawlowski, Grzegorz Juras

Background: Swedish massage (in Europe also known as classic massage) is one of the common treatments that are used to provide optimal start and readiness of athletes. Kinesthetic differentiation (KD) is ability of an individual to assume the demanded muscle forces in order to optimize the required motor tasks (its economy and precision). There is no evidence how Swedish massage influences the kinesthetic differentiation. This issue is definitely worth exploring, taking into account the concept of a reflex-nervous activity of massage and the role of the kinesthetic differentiation in the structure of motor coordination.

Purpose: The main objective of the study was to evaluate the impact of the Swedish massage on the kinesthetic differentiation through measurements of maximal force grip and required partial force grip under static conditions.

Methods: Thirty participants took part in this investigation (17 women and 13 men). The subjects were (mean ±sd): age: 22.2 ±1.09 years old, height: 173.2 ±8.91 cm, and weight: 68.5 ±13.48 kg. The assessment consisted of two kinesthetic differentiation (hand grip force) tests conducted on the dominant (DH) and non-dominant hand (NDH). The first test reflected the natural state of KD, while the second one was expected to reflect the impact of the 15-minute hand and forearm Swedish massage. These tests were done within 1 minute after the completion of massage. The procedure consisted of thirteen trials for each extremity. The first three were done for 100% of the participants’ capabilities, which allowed to assess the participants’ maximum force (Fmax), next five trials were done using 50% of maximum force (50% of Fmax), and in the last five trials, the participants tried to use only 50% of their previous force (1/2 of 50%). Base on the model forces the absolute force production error (FPE) expressed in percentage was calculated for 50% (FPE_50%) and 25% (FPE_ 25%).

Results: The 2-way repeated measure analysis of variance ANOVA did not reveal any statistically significant changes in maximal force grip and kinesthetic differentiation between pre- and post-massage intervention in both dominant and non-dominant hand. Correlations showed strong relationship between pre- and post-massage for maximum force (r = 0.92, p = 0.01 for DH, and r = 0.94, p = 0.01 for NDH), and only for the FPE_50% (r = 0.67, p = 0.01 for DH, and r = 0.71, p = 0.01 for NDH).

Conclusions: The results obtained indicated that the application of the Swedish massage (for 15 minutes in hand and forearm muscles) did not affect the kinesthetic differentiation in this particular young adults group.

Reference: Mustafa K, Furmanek M.P, Knapik A, Bacik B, Juras G. The impact of the Swedish massage on the kinesthetic differentiation in healthy individuals. International journal of therapeutic massage & bodywork. 2015, 8(1), 2-11.

Virginia S. Cowen, Ph.D., L.M.T., Lillian Pliner, M.D. , Robin Streit, L.M.T. , Nadine Jenkins, Ph.D., Bijal Parikh

Introduction: Non-pharmacological interventions like massage can play an important role in helping cancer patients manage cancer and cancer treatment-related symptoms. Many studies on massage for cancer patients have illustrated the positive impact, but it is unclear whether massage is routinely made available at cancer centers. The purpose of this project was to analyze if, where, and how massage was incorporated into cancer care in the Newark/New York City metropolitan area.

Methods: A mixed-methods analysis combined a content analysis of web-based information with a telephone survey. Cancer centers within a 50 mile radius of the Rutgers Biomedical and Health Sciences Campus were chosen for review.

Results: Approximately half of the centers in the sample (40, 51.3%) offered massage therapy onsite for cancer patients undergoing treatment. An array of different massage modalities were offered to cancer patients including Reiki, reflexology, and Therapeutic Touch. Swedish mas-sage, aromatherapy, manual lymphatic drainage and neuromuscular massage were also refer-enced. Thirty minute massages were the most frequently described length with treatments rang-ing from 10 to 90 minutes. None of the centers billed insurance companies directly for massage therapy. Eighteen centers (23.1%) employed or contracted with a licensed massage therapist. Pa-tients had the choice to seek massage on their own, with only 5 centers (6.4%) requiring approval of a physician. Massage treatment was recorded in the patient’s medical record in only 11 centers (14.1%).

Discussion: Findings reveal massage is only made available on-site at half the oncology centers in the Newark/New York City metropolitan area. Centers that did offer massage provided thera-pists credentialing to treat cancer patients. Since most massage services were free or paid out-of-pocket by patients, this suggests the impact of massage for cancer and cancer treatment-related symptoms is not stimulating recognition of massage as a viable supportive treatment by insurance companies.

Ronald J. Kettering, DHSc, MBA; Joan S. Leafman, PhD; Lisa A. Wallace, PhD; Jerrilyn A. Cambron, PhD, DC

Introduction: Massage therapists must have the necessary knowledge and skills to evaluate avail-able research to make effective clinical decisions. However, the extent to which the attitudes of massage therapists towards the value of using evidence in patient care, and their confidence in their ability to implement evidence-based practice (EBP) is lacking in the body of available evi-dence.

Purpose: This study explored the perceptions of the clinical value of EBP among members of the Florida State Massage Therapy Association (FSMTA) and their confidence in implementing it in practice.

Methods: Members (n=498) completed a secure online survey related to beliefs and attitudes about EBP and met the research inclusion criteria. This study used univariate non-parametric sta-tistics to analyze demographic and EBP variables.

Results: The findings suggest participants perceived EBP as an important aspect of practicing massage therapy. Statistically significant findings included: Positive belief in the importance of critical appraisals (68.0%, n=259) and belief that EBP can improve patient care outcomes (66.4%, n=253). However, there remains a need among massage therapists to develop confidence in using EBP to optimize clinical outcomes. The belief that EBP is difficult to utilize in clinical practice was significantly negative (93.2%, n=355). Confidence in using evidence to answer clinical questions (52.8%, n=201) and confidence in the ability to overcome EBP implementation barriers (52.0%, n=198) were low.

Conclusion: This study described important EBP and confidence attributes of the population of FSMTA members, and provided important foundational data that can be used to help in the de-velopment of future massage therapy research literacy programs and clinical application policies.

Keywords: evidence-based practice, massage, research, methodology, outcomes, education, training, standards
Conflict of Interest: The authors declare that there are no conflicts of interest.

Natalia Jaramillo, BA; Rika Meyer, PhD; Lauren Conn, BA; Jeffrey I. Gold, PhD

Introduction: Integrated health interventions, such as massage are becoming more frequently used in pain management of palliative care patients (Mansky et al., 2006; Klick et al., 2010). However, there is limited research examining the effectiveness of massage in the reduction of pain among this population of patient.

Objective: The objective of this pilot study was to assess whether massage reduced pain intensity in children, adolescents and young adults receiving palliative care.

Methods: We examined 11 palliative care patients at Children’s Hospital Los Angeles (6 female; Ages 1-20; M=15.18, SD=5.74). Massage therapists completed a thirty-minute Swedish massage on each patient. Patients aged 8 and above were asked to self-report their pain intensity before the massage, at present, and in the past week n = 10 (Visual Analogue Scales (VAS) and (FAC-ES Pain Scale-Revised, Hicks et al., 2001). Parents and nurses were asked open-ended questions about the overall effect of massage on the patient.

Results: Mean scores of pain decrease pre- (M=3.25) to post-treatment (M=.50). Patients mean score of pain also decreased from past week (M=4.57) to after massage (M=.57). However, paired sample t-tests were not significant for pain intensity of patients before and after massage (t(7)=2.11, p=.07) and pain in the past week and after massage (t(6)=2.37, p=.06). Analysis of pilot data suggests that massage may be effective in reducing self-reported pain intensity in chil-dren, adolescents and young adults on the palliative care service. Qualitative data from parents and nurses also demonstrated that massage was beneficial in increasing relaxation and providing comfort to patients.

Conclusion: The study provides preliminary evidence supporting the effects of massage and its role in decreasing pain intensity and offering therapeutic value to children adolescents and young adults receiving palliative care. Further investigation is needed with a larger sample to assess pain reduction and other potential benefits.

Jeffrey Forman, PhD, NCTMB*, Michael E. Rogers, PhD, FACSM
Mikalea Bunyan, MEd 
Nicole L. Rogers, PhD
Jeremy A. Patterson, PhD, FACSM,*De Anza College; Wichita State University

Reduced flexibility and balance are associated with aging and increased fall risk. The purpose of this study was to determine the effects a single active muscle therapy treatment on ankle flexibility and balance in adults aged 50-65 years.

Method: Thirty-one volunteers (26 women, 5 men; 58.5 + 4.6 yrs; ; 84.6 + 22.7 kg; 166.1 + 8.2 cm; mean + SD) had their balance measured with the FDA-approved Sway Balance TM mobile application (Sway Medical, Tulsa, OK) which uses the built-in tri-axial accelerometer within an iPhone or iPod Touch to measure postural sway. Participants held the device against the chest while standing with feet together, in tandem, and on one foot for 10 sec each. Sway measures from each stance were compiled into a single score with 100 being perfect (no sway). In addition, ankle dorsi and plantar flexion flexibility were measured using a digital inclinometer. Participants then underwent a 2.5 min warm-up massage to each foot, ankle, and lower leg, a 2.5 min stripping massage (7/10 on a verbal pressure scale) on each tibialis anterior muscle while eccentrically resisting an elastic resistance band, and a similar 2.5 min massage with resistance on the gastrocnemius/soleus groups. After the 15-min massage intervention, balance and flexibility measures were repeated. Results: Balance scores increased (p = 0.024) 4.8% (pre: 83.0 + 15.0; post: 87.0 + 11.0). All measures of flexibility improved (p < 0.001). There was a 15.4% increase in dorsiflexion, 9.6% increase in plantar flexion, and 12.5% increase in overall ankle ROM. Conclusions: Results indicate that combining eccentric resistance with massage improves balance and ankle flexibillity in adults aged 50-65 yrs immediately post-intervention. Future research is needed to determine the effects in older populations, long term effects of this treatment, effects of multiple treatments, and the effects on fall incidence.

Ling Tsui, Arianna Robin

Introduction: Massage therapy (MT) is a common intervention used in patients with chronic pain. Although most literature on the effects of MT focuses on adults, existing studies on
pediatric MT have shown decreases in pain and distress immediately after each treatment. This study examined the overall benefits of massage in pediatric patients with chronic pain across 4 treatments.

Methods: Fifty-one participants (74.5% female and 23.5% male; ages 5 to 19; Mage= 15, SD=
3.21) from an urban children’s hospital-based pediatric pain clinic, completed a survey pre- and post-massage and self-reported a variety of critical outcomes. Anxiety, comfort, relaxation, and calmness was assessed using a 10-cm Visual Analog Scales (VAS) ranging from 0 (strongly
disagree) to 10 (strongly agree); pain intensity was evaluated using the Faces Pain Scale-Revised (FPS-R) (Hicks et al., 2001); and sleepiness was assessed with the Epworth Sleepiness Scale (Johns,1991).

Results: Results revealed significant changes in comfort (F(3,42)=5.89, p=.02), relaxation
(F(3,54)=6.27, p=.00), and calmness (F(3,45)=2.18, p=.00), indicating that MT is effective in increasing comfort, relaxation and calmness in patients across time. Although significant
changes in pain were found from pre- to post- within each treatment, no significant changes in anxiety, pain VAS, Pain FPS-R, sleepiness across treatments were reported over time, suggesting that MT’s effect in reducing anxiety, pain and sleepiness is temporary, as opposed to long-lasting improvements.

Conclusion: Future studies should 1) include a larger sample, 2) provide greater than 4 sessions to examine the ongoing cumulative effects of MT versus the acute pain relief, and 3) continue to investigate the effectiveness of MT alone and in combination with other integrative health
interventions. Integrated health interventions are critical in the management of patients with chronic health conditions.

Andre Farasyn, PhD, PT, DO; R Meeusen, PhD

Objective: To investigate (1) the pressure pain thresholds [PPTs] with respect to muscles related to low back pain [LBP] and to a muscle unrelated to lower back region, and (2) to explore the effect of Deep cross‐friction massage sessions [roptrotherapy] on PPTs, pain sensitivity and disability.

Methods: 65 consecutive patients with subacute non‐specific LBP were allocated in this clinical trial. The primary outcome measures were the PPTs measured with the aid of a mechanical FISCHER algometer of levels L1, L3, and L5 of the Erector spinae and the Gluteus maximus. The middle of the left Triceps brachii was chosen as a neutral measuring point unrelated to LBP. Additionally, pain rating (VAS) and disability variables (ODI) were examined. In order to establish reference values, 64 healthy subjects [control group] were examined with respect to similar PPTs.

Results: The mean PPT values of the erector spinae and the gluteus maximus of the LBP group were significantly lower in comparison to the PPT values of the healthy group. The correlation between having LBP and PPT was highest at the L3 level of the erector spinae [r=0.73, P< 0.001]. The ODI and VAS decreased significantly after the 1^st roptrotherapy session by more than 50% and 25% after the second roptrotherapy session. At baseline, the PPTs of the erector spinae levels increased after the 3 roptrotherapy sessions, yielding a situation in which the patients no longer had back complaints, while the neutral triceps brachii remained unchanged over the entire time.

Conclusion: The results of this study demonstrate that patients with nLBP treated 3 times weekly with deep cross-friction massage, or roptrotherapy, had increased PPTs at the nLBP-related M.

Erector spinae L1, L3, and L5 and M. Gluteus maximus levels and is probably responsible for the healing effect on local muscle tenderness. The 3-month follow-up results revealed that the PPT values of the non-treated and neutral Triceps brachii remained unchanged, while the PPT of the most highly nLBP related Erector spinae and Gluteus maximus levels increased in such way that the PPT values became similar to those of healthy subjects. Deep friction therapy of those muscle hardenings may desensitize central neural structures involved in pain perception and is not meaningfully influenced by the possible release of endogenous opioid hormones.

The hypothesis that non-specific LBP is primarily a myofascial pain syndrome caused by local injured muscular, structures within the thoracolumbar spine and buttock should be supported.

Reference: FarasynA, MeeusenR. Effect of Roptrotherapy on pressure pain thresholds in patients with subacute non-specific low back pain. Journal of Musculoskeletal Pain, 2007; 15:41-53.

Lisa Dion

Background: Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. This poster summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center.

Methods: A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course has three components in its educational experience: online learning, classroom study, and a 25-hour shadowing experience. The in-classroom study portion includes an entire day in the simulation center.

Results: The hospital-based massage therapy course addresses the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course has indicated key learning opportunities and additional content that is needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment.

Conclusions: The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This poster provides an example of the initial steps in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment.

Portia B. Resnik, MA, ATC, LMT

Introduction: Post-exercise massage can be utilized to help promote recovery from exercise on the cellular level as well as systemically by increasing parasympathetic activity. No studies to date have been done to assess the effects of massage on post-exercise metabolic changes, includ-ing excess post-exercise oxygen consumption (EPOC). The purpose of this study was to compare the effects of massage recovery and resting recovery on a subject’s heart rate variability and selected metabolic effects following a submaximal treadmill exercise session.

Methods: One healthy 24 year-old female subject performed 30-minutes of submaximal tread-mill exercise prior to resting or massage recovery sessions. Metabolic data was collected throughout the exercise sessions and at three 10-minute intervals post-exercise. Heart rate varia-bility was evaluated for 10-minutes after each of two 30-minute recovery sessions, either resting or massage.

Results: Heart rate returned to below resting levels (73 bpm) with 30 and 60 minutes of massage recovery (72 bpm and 63 bpm respectively) compared to 30 and 60 minutes of resting recovery (77 bpm and 74 bpm respectively). Heart rate variability data showed a more immediate shift to the parasympathetic state following 30-minutes of massage (1.152 LF/HF ratio) versus the 30 minute resting recovery (6.91 LF/HF ratio). It took 60-minutes of resting recovery to reach simi-lar heart rate variability levels (1.216 LF/HF) found after 30 minutes of massage. Ventilations after 30 minutes of massage recovery averaged 7.1BPM compared to 17.9BPM after 30 minutes of resting recovery.

Discussion: No differences in EPOC were observed through either the resting or massage recov-ery based on the metabolic data collected. Massage can be used to help an athlete shift into para-sympathetic activity more quickly than rest alone following a submaximal exercise session.

Reference: Resnik P. Comparing the Effects of Rest and Massage Following Submaximal Aero-bic Exercise. Int J Ther Massage Bodywork. 2015: In Review.

Robin Gawronski, LMT; Kristy Ruiz, LMT; Amanda Sonk, LMT; Travis Duffey, MS, LMT

Introduction: Although Massage Therapy (MT) is a less common treatment modality offered in inpatient pediatric hospital settings, research has shown that patients with severe burn injuries benefit from MT by having a decrease in pain, anxiety, and itching (Parlak Gürol et al., 2010). Research has also shown that when utilized prior to painful procedures, MT can lessen a patient’s non-verbal pain and stress response, as well as facilitate dressing changes (Hernandez-Reif et al., 2001).

Objective: We present the case of a 13-year old male who was admitted to the hospital after a self-inflicted flame burn, covering 83% of his total body surface area. This case study will demonstrate the benefits of including MT as part of an interdisciplinary burn team in order to improve range of motion (ROM), appearance of scarring, and decrease pain and anxiety over the course of treatment.

Methods: The patient received MT up to 10 times per week for sessions lasting from 30 minutes to two hours in individual or co-treat sessions with OT/PT to assist with increasing ROM and to decreasing pain and anxiety. ROM was recorded to demonstrate changes in pliability, and pic-tures were taken throughout his course in order to demonstrate changes in appearance of burn scars. Anxiety reduction was evidenced through changes in non-verbal indicators and heart rate values recorded using hospital monitors. Additionally, pain scales and verbal reports of itching were recorded throughout treatment.

Results: Throughout his admission, the patient displayed positive responses to MT including a decreased heart rate, reduced itchiness, improved appearance and increased pliability of burn scars, and verbalized decrease in pain scale rating.

Conclusion: MT can be an integral part of the treatment course for severe burn sufferers. This case demonstrates the value of including MT throughout a patient’s recovery to promote im-proved outcomes.

Edward Cho, BA, BS; Marie Lee, BS; Rika Meyer, PhD

Background: Familial Mediterranean Fever (FMF) is an autosomal recessive disease characterized by intractable pain due to serosal inflammation and sporadic recurring fevers. Little research currently exists on alternative, non-pharmacological interventions for pain management of FMF.

Purpose: In this case report, we examine the effect of acupuncture and massage on chronic pain associated with FMF in 2 pediatric patients.

Methods: Patient #1, an 11 year old Hispanic male, and patient #2, an 8 year old Caucasian fe-male, are FMF patients with diagnoses of chronic pain. Patients received 6 weeks of therapy (ac-upuncture and/or massage) followed by a 4-week treatment gap. Patient #1 received acupuncture followed by massage, and patient #2 received massage only. Each treatment included a 30-min pre-test and a 10-min post-test. Surveys assessed pain, physical health, and psychosocial health per the Pediatric Quality of Life Inventory™ (PedsQL), Brief Pain Inventory (BPI), Visual Ana-logue Scales (VAS), and FACES Pain Scale.

Results: Both patients showed immediate improvements in VAS and FACES pain measures fol-lowing treatment with a total or near total relief of pain observed in the majority of recorded in-stances where patients presented with pain. Physical health scores showed a slight worsening in patient #1, but a moderate improvement in patient #2. BPI pain severity scores slightly worsened for patient #1 but improved for patient #2, while BPI pain interference scores slightly improved for patient #1 and slightly worsened for patient #2.

Conclusions: Acupuncture and massage may be a promising palliative treatment for chronic pain associated with FMF. However, findings are limited due to small sample size and lack of baseline data (week 1 pre-test data) for patient #2. Future research should conduct a larger RCT on acupuncture and massage for pediatric FMF patients and other chronic pain conditions such as fibromyalgia, systemic lupus erythematosus, rheumatoid arthritis, etc.

Tammy Brockman, MS, ATC/L, LMT, CLT; Stacey Powell, LMT

Introduction: “Stringhalt” is a horse condition that causes one or both hind legs to spasm when walking or trotting. The condition is thought to be related to a neurological cause from plant tox-icity or peripheral nerve injury. The prognosis is poor and the horse’s performance and quality of life can be affected. Treatment has included surgically cutting the digital extensors, with varied results and additional problems.

Case Presentation: The case study is a 12 year old Akhal-Teke horse of excellent pedigree. In 2011, she was caught in barbed wire overnight and sustained lacerations to the bone. Shortly after the injury the horse was placed in an inadequate stall for several months and was unable to walk or run, developing stringhalt. Currently, her condition is aggravated by stress and dietary changes and alleviated by certain types of massage (myofascial, acupressure, trigger point re-lease). The incidence of stringhalt is every 3-5 minutes, with more frequent and severe symptoms on the right. The horse is unable to run or back up.

Methods: Six 1 to 1-1/2 hour bi-weekly treatments were performed. The treatments consisted of myofascial release at the cervical, sacrum, and iliums; acupressure of the bladder meridian in-cluding c-spine, t-spine, L-spine, and hamstring; and trigger point release of the iliacus.

Results: After 6 treatments, the horse was seen running and standing in a position that promotes hip extension. She has not been able to do either since the injury. The frequency and severity of the spasms have decreased to every 10-20 minutes. The horse’s owners report that her disposi-tion and quality of life are much improved.

Discussion: The results suggest that myofascial release, acupressure, and trigger point therapy may be utilized to provide a positive treatment outcome in the case of stringhalt. However, please note that the scope of practice varies by state and special training is needed to work with the equine population.

Sandra Gustafson, MHS, BSN, RN

Introduction: This study aimed to review and assess one migraineur’s response to Bowenwork (gentle, soft-tissue bodywork technique) for reducing migraine occurrence and pain, pharmaceu-tical analgesic consumption, and improving the client’s health-related quality of life (HRQoL), wellbeing and activities of daily living (ADLs). Migraine is a complex neurological disorder characterized by episodic, neurogenic, cerebrovascular inflammation and hypersensitization of brain-tissues and the central nervous system,causing severe pain and debility. Conventional treatments vary greatly and are often pharmaceutically based. Research literature points mostly to pharmaceutical prophylactic and symptomatic treatments, a few non-pharmaceutical,
complementary and alternative medicine (CAM) approaches, massage and bodywork studies, and no studies on Bowenwork for migraine intervention.

Participant: A 66 year-old Caucasian female with a history of debilitating migraine since child-hood, and severe neck pain resulting from 2 motor vehicle accidents (MVA) sustained as an adult.

Methodology: A descriptive observational case-report of one client’s responses to receiving four-teen Bowenwork sessions, weekly to two-weekly, over a 4-month period, using the self-reporting Measure Yourself Medical Outcome Profile version 2 (MYMOP2) to evaluate clinically mean-ingful changes. In previous studies involving participants with chronic pain conditions, MYMOP2 was considered a reliable and valid assessment tool. Prior to each Bowenwork
session, data were recorded to track changes in migraine and neck pain occurrences, medication use, daily functional ability and general sense of wellbeing. Specific Bowenwork procedures were applied in each session, to address the client’s symptoms.

Results: Over 4-months of receiving Bowenwork, the client progressively reported decreased migraine and neck pain; and by session 14, no further migraine, neck pain nor medication use, and increased ADLs and wellbeing, for 10 months thereafter.

Conclusion: Although limited to a single-person, this case-report suggests that Bowenwork may offer nonpharmaceutical migraine and pain relief for migraineurs, however further research on larger populations is indicated.

Reference: Gustafson S. “Migraine – Is It All In the Head?” A Case Report on Bowenwork for Migraine Relief. Int J Ther Massage Bodywork. 2015: In Review.

Laura Allen

Abstract
A 53-year old male, formerly employed as a construction worker, was referred for massage therapy for treatment of debilitating low back pain. He has pain in all areas of the back; although he sometimes experiences cervical pain and/or thoracic pain, he reports the majority of his pain is in the lumbar area. His objective for treatment is to cut down on pain medication, acetaminophen and oxycodone (Percocet), currently prescribed at 7.5 mg 4 times daily. The subject states he does not like to take it that frequently because it makes him feel lethargic and disoriented. The massage used was a combination of Swedish strokes (effleurage, petrissage, friction), muscle stripping, and myofascial release, techniques chosen based on the practitioner’s 14 years of experience in working with clients who are in pain. A treatment plan of 6 weekly visits was agreed upon with re-evaluation after the sixth visit. The subject is dependent on only his disability income and is unable to commit to more frequent visits. Progress was measured using the Oswestry Low Back Pain Scale and by subjective statements on his decreased pain level and decreased need for medication, and positive effects on his activities of daily living. The massage therapy intervention was so successful that the subject switched to monthly maintenance care after four sessions instead of six as originally planned. The success of this intervention for this subject suggests that massage therapy can be an effective intervention for chronic low back pain.

Patricia Rogers

Introduction: Functional constipation, one of the most common somatic complaints encountered by practitioners, both negatively affects quality of life and leads to increased healthcare costs. Craniosacral therapy (CST) is a form of bodywork that addresses micro strain patterns which accumulate to create macro dysfunction. The core physiological intent of CST is to free restrictions in the cranial membrane and the dural tube to enhance central nervous system function. CST can elicit the release the somatic memories and residual effects of past injuries and negative experiences.

Objective: There is a paucity of data in the literature on the use of CST in the treatment of somatic complaints such as gastrointestinal distress. This case report highlights the effect of CST on functional constipation in a trauma survivor.

Case Presentation: A 49-year-old, Caucasion female with a history of childhood abuse and domestic violence presented with a chief complaint of difficulty with elimination. She was treated with CST twice per week for four weeks and once per week for four weeks. The Constipation Assessment Scale (CAS) rates the severity of constipation on a scale of 0-16, with 16 being most severe. The CAS was administered before the start of treatment and again at four and eight weeks.

Results: After eight weeks, a reduction in the severity of constipation was noted. The initial CAS score of 8 was reduced to 5 at four weeks and 2 at eight weeks.

Conclusion: CST facilitated the release of adverse mechanical strain patterns associated with somatic memories. Constipation decreased in severity. In this case study, CST was a useful tool in the treatment of constipation, underscoring the need for further evidence-based research in the use of CST to treat somatic complaints.

Renee Stenbjorn

Purpose: Investigate the use of myofascial massage therapy as treatment for longstanding contractures.

Introduction: Contractures develop when the soft tissues in the muscle and surrounding fascia are replaced by inelastic, fibrotic tissue, making it hard to stretch the area and prevent normal movement1.
Contractures are a concern for patients with strokes, spinal cord injuries and other debilitating diseases. Severely limited range of motion inhibits many activities of daily living. The usual care for contractures include surgery, medication, braces and botulinum toxin2.

Prevalence: The prevalence of contractures varies widely among patient population. The prevalence of contractures among Multiple Sclerosis patients was found to 56%3. In one study, contractures were a complication for 73% of stroke survivors at the one year mark4.

Methods: Subject was 23 year-old male massage student with history of contractures of the left arm and wrist since age six, when he suffered three left arm injuries over a one year period.

A series of six myofascial massages was applied over the course of two months, focusing on eliminating fascial adhesions and restrictions. Direct fascial strokes were applied including compartment separation, fascial wringing and spreading, cross fiber friction, muscle energy techniques and compression of myofascial trigger points. Approximately 80% of the strokes were applied to anterior and posterior forearm, with the balance applied to upper arm and pectoral regions.

Results: Range of motion increased from severely limited supination, starting at approximately 70 degrees, to normal range of 182 degrees following the last massage5. Other measures focus on daily living, such as an ability to play the banjo without pain, have more fluid movements while massaging and more successfully complete small tasks such as using the brakes on his bike & open doorknobs.

This significant result warrants a more thorough investigation of massage therapy as a treatment for contractures.
1: http://www.nlm.nih.gov/medlineplus/ency/article/003185.htm
2. Farmer, SE. Contractures in orthopedic and neurological conditions. Disability and rehabilitation. 2001 Sep 10;23(13):549-58.
3. Hoang PD, Gandevia SC and Herbert RD. Prevalence of joint contractures and muscle weakness in people with multiple sclerosis. Disability and Rehabilitation. 2013 Nov 18. [Epub ahead of print].
4. Sackley C, Brittle N, Patel S, Ellins J, Scott M, Wright C and Dewey ME. The prevalence of joint contractures, pressure sores, painful shoulder, other pain, falls, and depression in the year after a severely disabling stroke. Stroke. 2008 Dec;39(12):3329-34.
5. Measured with Goniometer Pro app for iPad.

Diane Mastnardo

Introduction: Patients on dialysis can experience pain caused by muscle cramping that may result in shortened treatment times that have been linked to worse outcomes. 1,2 It is estimated that up to 88% of dialysis patients experience cramping and one study reported that 15% of patients with shortened treatment cited muscle cramping as reason.3 Over the past ten years research studies using massage in cancer patients have shown decreases in pain, inflammation and feelings of anxiety.4 Although there is limited evidence available about massage in dialysis patients, it may be an effective treatment modality for hemodialysis-related lower extremity cramping.

Aim: To determine the effectiveness of intradialytic massage on the frequency of cramping among hemodialysis patients prone to lower extremity cramping.

Methods: Our study protocol, approved by the Institutional Review Board at MetroHealth Medical Center included a 2- month training period during which licensed massage therapists were trained in massage techniques and tested for inter-therapist consistency. 32 (16 intervention, 16 control) hemodialysis patients with frequent lower extremity cramps, were enrolled in our study. Frequent cramping during dialysis treatments was defined as 1 or more episodes of lower extremity cramps during or after dialysis over the previous 2 weeks. The intervention group received a 20 minute massage of the lower extremities during each treatment (3 times per week) for 2 weeks. The control group received usual care by dialysis center staff.

Results: Patient reported cramping at home decreased by 2.5 in the intervention group compared to 0.3 in the control group (p = 0.005) and patient reported cramping during dialysis decreased by 1.6 in the intervention group compared to 0.9 in the control group (p = 0.44)

Conclusion: Intradialytic massage appears to be an effective way to address muscle cramping. Larger studies with longer duration should be conducted to test for similar results.

Katie Stewart, LMT, RCST, Margaret Love, PhD, Gaza Bruckner, PhD,
Kevin Pearce, PhD, and William G. Elder, PhD
University of Kentucky- Department of Family and Community Medicine

Introduction: Few NIH funded studies give community massage therapists the opportunity to become study personnel. A recent NIH/NCCAM funded study investigating Chronic Low Back Pain (CLBP) recruited, trained, and utilized community licensed massage therapists (LMTs) as study personnel.

Objective: Determine whether health-related outcomes for CLBP improve when patients are referred from primary care to clinical massage therapy (CMT) or progressive muscle relaxation therapy. Massage practice driven study objectives included: a) Identify challenges and solutions to recruiting and retaining ample community LMTs, b) Develop a practice informed protocol reflecting real world CMT, c) Identify challenges and solutions to utilizing LMT descriptors, assessment, and treatment notes as data, and d) Determine the extent to which community LMTs comply to rigorous research methodology in their clinical practices as study personnel.

Methods: Eligible LMTs in urban and rural Kentucky counties were identified through licensure board records, professional organizations, and personal contact opportunities. Interested LMTs completed 6 hours of research and Human Subjects Protection training and agreed to comply with a study protocol reflecting CMT as practiced. Once trained, study LMTs were matched with study participants to provide and document up to 10 massage therapy sessions per participant.

Results: Utilizing prominent massage therapy community members proved invaluable to recruitment and protocol development. LMT recruitment challenges included lack of interest, low number of available rural LMTs, busy clinic schedules, and compensation. Ethics CE credits encouraged LMT interest. A total of 28 Kentucky LMTs with 5-32 years experience completed study training. N=127 CLBP patients consented to participate (n=104 for CMT). Twenty-three LMTs provided 1-10 treatments for 91 study participants. Treatment documentation was provided by LMTs for 95% of treatments provided.

Conclusion: When recruitment, retention, and protocol compliance challenges are met, community LMTs are valuable study personnel for practice based research reflecting real world CMT practice.

Angela Burke 

Objective: To present research data representing short and long-term stress reduction in a child with an Autism Spectrum Disorder using Zen Shiatsu as a complementary and alternative treatment.

Methods: A seven year old male with a diagnosis of Autism was given twenty-minute Zen Shiatsu sessions weekly for six consecutive weeks.  Using a 5-point stress scale that utilized facial expressions with corresponding stress values, the client indicated his stress level prior to the session, as well as afterwards.  Measurement comparing the levels demonstrated a decrease in stress within the twenty minute period.  In addition, the parent was given the PEDS QL 4.0 Young Child Questionnaire to determine the child’s HRQoL (Health Related Quality of Life) prior to the six-week Zen Shiatsu treatment to establish a baseline.  The parent completed the same questionnaire after the six weeks of sessions to compare results.

Results:  Stress levels decreased in the client after receiving Zen Shiatsu after all six sessions.  The PEDS QL 4.0 showed higher HRQoL scores in all domains, indicating that the child’s overall quality of life improved within the six weeks of receiving Zen Shiatsu.

Conclusions:  Zen Shiatsu, a form of Traditional Chinese Medicine, has the potential to be a viable treatment for stress reduction in children with Autism Spectrum Disorders, therefore improving overall quality of life.

Key Words: Zen Shiatsu, Autism Spectrum Disorder, Traditional Chinese Medicine, Stress Reduction

Susan Davis RN, BHSc, MClSc, RMT
Southern Cross University Lismore, NSW Australia- Masters Research Project

Introduction: Sleep problems and pain are widely experienced in the general population. Research has shown a relationship between chronic pain and poor sleep and between no pain and sleep. This research aims to investigate the relationship of mild pain and sleep problems.

Methods: Sixty seven (67) patients from an established remedial massage centre completed questionnaires. The majority (79%) of the respondents were female. The questionnaire was a combination of three aspects: general demographics and alcohol consumption; an edited version of the Brief Pain Index; and the 12 question MOS Sleep Scale (revised). Sleep results were produced from the MOS software that compared the participants to the large population (mainly USA) recorded to date. Pain was reported as a 0-10 score (10 being the most pain). Those individuals scoring over 7 were excluded from the survey. The age range was from 20-85 years. Correlational analyses were then made using Microsoft Excel, ANOVA.

Results: The overall results showed a small, but insignificant relationship. Isolating the female results produced a significant relationship, with coincidental movements of pain experience and sleep problems. This outcome is in line with previous studies on chronic pain and serious sleep problems. In the female group (n = 53), 59% fell below the average of 50 set by the MOS Sleep Problem Index (below 50 indicating sleep problems). 41% showed mild pain experience. Correlational analysis showed that increases in pain coincided with decreases in sleep quality. Correlation was r = 0.41 with a p value < 0.05 indicating a statistical significant result.

Conclusions: Although only a small study with limited detail in the questionnaires, it is concluded that the results encourage the need for further research. This research shows that there may be a progressive line of pain before the development of chronic problems that could be detection through the inclusion of sleep assessment in mild pain patients and vice versa. This has important implications for the ongoing treatment of mild pain and the methods of practice for professions that deal with mild pain such as massage therapists.

Renee Stenbjorn, BS, LMT
Director of Education, Albuquerque School of Massage Therapy

Background: Fibromyalgia is a syndrome characterized by pain-producing musculoskeletal changes and Central Nervous System sensitization to pain. Most patients live with chronic pain and additional symptoms such as anxiety, depression, and irritable bowel syndrome. Several studies have revealed the effectiveness of massage therapy for fibromyalgia. Swedish and myofascial massage techniques have found to be mildly successful in reducing symptoms. This pilot study will focus on the use of the Fascial Abrasion Technique tool (FAT-tool), a myofascial massage tool for treatment of fibromyalgia pain. The FAT-tool has been anecdotally reported to decrease fibromyalgia pain. This study will evaluate the effects on pain immediately after a treatment and, as a follow up, three days later.

Methods: Five clients, all diagnosed with fibromyalgia and currently under doctor’s care, were each seen for one half-hour session. Due to the short treatment time, the body region treated was limited to an area between the occiput and the elbow. The client and therapist determined which segment of the region of the body would be treated at the appointment. Using a Visual Analog Scale (0 – 10 scale), each client reported their current pain levels in general and in the specific treatment area before their treatment, immediately after and again three days later. The treatment focus was myofascial therapy. The tissue was warmed with effleurage strokes and myofascial dysfunction of the region was treated with the Fascial Abrasion Therapy Tool (FAT-tool). Each session lasted approximately 20 minutes.

Results: After one short treatment session, 4 out of 5 fibromyalgia patients reported a significant reduction in pain. The average pain level before the treatment was 7, immediately after the session, the average was reduced to 3.6. There was no decrease in the average general pain three days after the treatment session.

Conclusions: This study shows that myofascial therapies may be very effective in the treatment of fibromyalgia pain and should be further investigated. The clients responded favorably to myofascial treatment with the FAT-tool, demonstrating the effectiveness of this method of myofascial work in short-term pain relief. Further studies could investigate the effectiveness of long-term myofascial treatment on overall pain levels of fibromyalgia patients.

Robin Sarah Streit, BA, LMT, NCTMB

Introduction: Neurogenic thoracic outlet syndrome (NTOS) is a neuromuscular condition affecting brachial plexus functionality due to compression in the thoracic cavity. NTOS is characterized by paresthesia, pain, muscle fatigue and muscle spasms, restricting mobility in the upper extremity.

Objective: The objective of this study is to quantify the viability of massage therapy as a treatment for NTOS.

Method: A 24-year-old female was diagnosed with NTOS following a motor vehicle accident. Eight 75-minute massage therapy sessions were administered over a 35-day period. Myofascial release addressed fascial restrictions in the upper trapezius and levator scapulae, involving deep stripping from the muscles’ origin to insertion. Sustained compression was applied to release the trigger points found at the insertion of the levator scapulae and origin of subscapularis. Gentle passive stretching addressed hypertonicity of the scalene and sternocleidomastoid muscles. Pre and post treatment assessments measured symptomatic intensity and range of motion.

Results: Massage therapy rendered a 49% decrease in muscle fatigue, 45.7% increase in external shoulder rotation, and a 13.5% improvement in shoulder abduction. Therapy yielded a limited change in muscular spasm severity, frequency, and muscular strength.

Conclusion: Results suggest massage is a useful treatment for NTOS patients by managing primary symptoms and improving mobility in the affected area.

Nicole Riou
Grant MacEwan University, Edmonton, AB, Canada

Introduction: Essential tremor (ET) is a neurological disorder resulting in rhythmical shaking of part of the body. The condition is known to have an inheritable tendency and can present in more than one family member, known as familial tremor. Treatment of the disorder is commonly by way of prescription medication. ET is progressive and in its mildest form can be sensed internally and/or observed when performing simple motor skills or activities of daily living.

Objective: To evaluate the effects of massage therapy on the severity of ET using an activity-based rating scale pre and post treatment.

Methods: The study period included five consecutive weekly sessions. The subject, a 63-year old female, indicated her hands and head as the primary areas affected by ET. The treatment aim was to reduce sympathetic nervous system firing; therefore the massage techniques implemented were relaxation-based. Methods included Swedish massage, hydrotherapy, myofascial release, diaphragmatic breathing, remedial exercise education and affirmative symptom management recommendations. Comparison drawings of an Archimedes spiral pre and post treatment provided an objective, visual representation of tremor intensity affecting fine motor control. Goniometric measurements were taken to mark changes in cervical range of motion.

Results: Tremor severity decreased after each session; demonstrated by improved fine motor manipulation skills. The client also reported an increased functionality in cervical range, which was documented during the first and last visits.

Conclusion: The results suggest that tremors, symptomatic to ET, can be eased through initiatives that encourage a parasympathetic response. Massage therapy has shown to be a valuable method of treatment for ET. Tremor severity can present in an irregular pattern due to subjective individual triggers; therefore further controlled research is required to lessen the variability between subjects and to validate these findings.

Susan Davis RN, BHSc, MClSc, RMT
Southern Cross University Lismore, NSW Australia- Masters Research Project

Introduction: Sleep problems and pain are widely experienced in the general population. Research has shown a relationship between chronic pain and poor sleep and between no pain and sleep. This research aims to investigate the relationship of mild pain and sleep problems.

Methods: Sixty seven (67) patients from an established remedial massage centre completed questionnaires. The majority (79%) of the respondents were female. The questionnaire was a combination of three aspects: general demographics and alcohol consumption; an edited version of the Brief Pain Index; and the 12 question MOS Sleep Scale (revised). Sleep results were produced from the MOS software that compared the participants to the large population (mainly USA) recorded to date. Pain was reported as a 0-10 score (10 being the most pain). Those individuals scoring over 7 were excluded from the survey. The age range was from 20-85 years. Correlational analyses were then made using Microsoft Excel, ANOVA.

Results: The overall results showed a small, but insignificant relationship. Isolating the female results produced a significant relationship, with coincidental movements of pain experience and sleep problems. This outcome is in line with previous studies on chronic pain and serious sleep problems. In the female group (n = 53), 59% fell below the average of 50 set by the MOS Sleep Problem Index (below 50 indicating sleep problems). 41% showed mild pain experience. Correlational analysis showed that increases in pain coincided with decreases in sleep quality. Correlation was r = 0.41 with a p value < 0.05 indicating a statistical significant result.

Conclusions: Although only a small study with limited detail in the questionnaires, it is concluded that the results encourage the need for further research. This research shows that there may be a progressive line of pain before the development of chronic problems that could be detection through the inclusion of sleep assessment in mild pain patients and vice versa. This has important implications for the ongoing treatment of mild pain and the methods of practice for professions that deal with mild pain such as massage therapists.

Renee Stenbjorn, BS, LMT
Director of Education, Albuquerque School of Massage Therapy

Background: Fibromyalgia is a syndrome characterized by pain-producing musculoskeletal changes and Central Nervous System sensitization to pain. Most patients live with chronic pain and additional symptoms such as anxiety, depression, and irritable bowel syndrome. Several studies have revealed the effectiveness of massage therapy for fibromyalgia. Swedish and myofascial massage techniques have found to be mildly successful in reducing symptoms. This pilot study will focus on the use of the Fascial Abrasion Technique tool (FAT-tool), a myofascial massage tool for treatment of fibromyalgia pain. The FAT-tool has been anecdotally reported to decrease fibromyalgia pain. This study will evaluate the effects on pain immediately after a treatment and, as a follow up, three days later.

Methods: Five clients, all diagnosed with fibromyalgia and currently under doctor’s care, were each seen for one half-hour session. Due to the short treatment time, the body region treated was limited to an area between the occiput and the elbow. The client and therapist determined which segment of the region of the body would be treated at the appointment. Using a Visual Analog Scale (0 – 10 scale), each client reported their current pain levels in general and in the specific treatment area before their treatment, immediately after and again three days later. The treatment focus was myofascial therapy. The tissue was warmed with effleurage strokes and myofascial dysfunction of the region was treated with the Fascial Abrasion Therapy Tool (FAT-tool). Each session lasted approximately 20 minutes.

Results: After one short treatment session, 4 out of 5 fibromyalgia patients reported a significant reduction in pain. The average pain level before the treatment was 7, immediately after the session, the average was reduced to 3.6. There was no decrease in the average general pain three days after the treatment session.

Conclusions: This study shows that myofascial therapies may be very effective in the treatment of fibromyalgia pain and should be further investigated. The clients responded favorably to myofascial treatment with the FAT-tool, demonstrating the effectiveness of this method of myofascial work in short-term pain relief. Further studies could investigate the effectiveness of long-term myofascial treatment on overall pain levels of fibromyalgia patients.

Robin Sarah Streit, BA, LMT, NCTMB

Introduction: Neurogenic thoracic outlet syndrome (NTOS) is a neuromuscular condition affecting brachial plexus functionality due to compression in the thoracic cavity. NTOS is characterized by paresthesia, pain, muscle fatigue and muscle spasms, restricting mobility in the upper extremity.

Objective: The objective of this study is to quantify the viability of massage therapy as a treatment for NTOS.

Method: A 24-year-old female was diagnosed with NTOS following a motor vehicle accident. Eight 75-minute massage therapy sessions were administered over a 35-day period. Myofascial release addressed fascial restrictions in the upper trapezius and levator scapulae, involving deep stripping from the muscles’ origin to insertion. Sustained compression was applied to release the trigger points found at the insertion of the levator scapulae and origin of subscapularis. Gentle passive stretching addressed hypertonicity of the scalene and sternocleidomastoid muscles. Pre and post treatment assessments measured symptomatic intensity and range of motion.

Results: Massage therapy rendered a 49% decrease in muscle fatigue, 45.7% increase in external shoulder rotation, and a 13.5% improvement in shoulder abduction. Therapy yielded a limited change in muscular spasm severity, frequency, and muscular strength.

Conclusion: Results suggest massage is a useful treatment for NTOS patients by managing primary symptoms and improving mobility in the affected area.

Nicole Riou
Grant MacEwan University, Edmonton, AB, Canada

Introduction: Essential tremor (ET) is a neurological disorder resulting in rhythmical shaking of part of the body. The condition is known to have an inheritable tendency and can present in more than one family member, known as familial tremor. Treatment of the disorder is commonly by way of prescription medication. ET is progressive and in its mildest form can be sensed internally and/or observed when performing simple motor skills or activities of daily living.

Objective: To evaluate the effects of massage therapy on the severity of ET using an activity-based rating scale pre and post treatment.

Methods: The study period included five consecutive weekly sessions. The subject, a 63-year old female, indicated her hands and head as the primary areas affected by ET. The treatment aim was to reduce sympathetic nervous system firing; therefore the massage techniques implemented were relaxation-based. Methods included Swedish massage, hydrotherapy, myofascial release, diaphragmatic breathing, remedial exercise education and affirmative symptom management recommendations. Comparison drawings of an Archimedes spiral pre and post treatment provided an objective, visual representation of tremor intensity affecting fine motor control. Goniometric measurements were taken to mark changes in cervical range of motion.

Results: Tremor severity decreased after each session; demonstrated by improved fine motor manipulation skills. The client also reported an increased functionality in cervical range, which was documented during the first and last visits.

Conclusion: The results suggest that tremors, symptomatic to ET, can be eased through initiatives that encourage a parasympathetic response. Massage therapy has shown to be a valuable method of treatment for ET. Tremor severity can present in an irregular pattern due to subjective individual triggers; therefore further controlled research is required to lessen the variability between subjects and to validate these findings.

John Balletto, LMT, CKTP
Center for Muscular Therapy, Inc.

Introduction: Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disorder. KinesioTaping (KT) is a rehabilitative intervention that uses a unique, patented, medical grade elastic tape specifically designed for treating muscular problems and reducing lymphedema. There was no reported use of KinesioTaping for management of RA symptoms in the current literature.

Objective: To study the combined effects of massage therapy and KT on RA symptoms of pain, swelling, restricted range of motion and performing endurance in the right arm of a 59 year-old, female professional oboeist.

Results: The addition of KT applications to massage sessions provided a reduction of joint pain (from 8 to 4 on a 10-point scale) within the first three applications. Relief duration extended from 24-48 hours to 4-5 days. Extent of practice time increased to 40 minutes per session after KT application 1. By the fourth KT application, practice time increased to 60 minutes per session; by KT application 9, two 60-minute practice sessions per day.

Implications: Complementing traditional massage applications with KT appears to yield positive result in pain reduction, functional mobility, and duration affect. Further investigation with additional outcome measures is indicated.

Beth Barberree, MA, BA, MT

Introduction: Injured soft tissue structures can become hypertonic and develop adhesions. Although a client may experience discogenic nerve root compression, interventions that lengthen soft tissue structures could minimize nerve root irritation and reduce symptoms.

Objective: Evaluate whether Massage Therapy decreases anesthesia in a client with cervical nerve impingement.

Case Presentation: Treatment began in April 2005 and at present continues every few months for symptom management. A 28 year old nurse presented with intermittent left hand anesthesia, specifically digits I and II. Medical imaging indicated disc herniation impinging the C6 nerve root as the source. Symptoms were present since neck injury occurred in July 2004. Although the pain was manageable, symptoms of anesthesia were of primary concern. The initial treatment plan was one 30 or 60 minute session every 3 to 4 days for 3 weeks. An exhaustive search for a ‘numbness scale’ was not successful, so client description in terms of percentage was utilized to describe symptoms, with 100% indicating no feeling, 50% moderate and 0% asymptomatic. The client reported on symptoms before and after each treatment. Eight treatments over 3 weeks were delivered, focusing on lengthening soft tissue structures that could be compressing cervical joint space and trigger points mimicking left arm neuralgia.

Interpretation: A decrease in symptoms pre to post treatment occurred each session. Gradual recurrence of symptoms occurred as early as the next day and up to one week post treatment. Prior to his last session, the client reported no numbness whatsoever in digit II and digit I symptoms at half of prior treatment levels.

Implications: Based on this case, Massage Therapy seems to be a promising option for managing symptoms of anesthesia due to disc compression. Further investigation of similar cases, integrating more robust measurement tools, is necessary.

Katie Stewart, LMT, RCST, Margaret Love, PhD, Gaza Bruckner, PhD,
Kevin Pearce, PhD, and William G. Elder, PhD
University of Kentucky- Department of Family and Community Medicine

Introduction: Few NIH funded studies give community massage therapists the opportunity to become study personnel. A recent NIH/NCCAM funded study investigating Chronic Low Back Pain (CLBP) recruited, trained, and utilized community licensed massage therapists (LMTs) as study personnel.

Objective: Determine whether health-related outcomes for CLBP improve when patients are referred from primary care to clinical massage therapy (CMT) or progressive muscle relaxation therapy. Massage practice driven study objectives included: a) Identify challenges and solutions to recruiting and retaining ample community LMTs, b) Develop a practice informed protocol reflecting real world CMT, c) Identify challenges and solutions to utilizing LMT descriptors, assessment, and treatment notes as data, and d) Determine the extent to which community LMTs comply to rigorous research methodology in their clinical practices as study personnel.

Methods: Eligible LMTs in urban and rural Kentucky counties were identified through licensure board records, professional organizations, and personal contact opportunities. Interested LMTs completed 6 hours of research and Human Subjects Protection training and agreed to comply with a study protocol reflecting CMT as practiced. Once trained, study LMTs were matched with study participants to provide and document up to 10 massage therapy sessions per participant.

Results: Utilizing prominent massage therapy community members proved invaluable to recruitment and protocol development. LMT recruitment challenges included lack of interest, low number of available rural LMTs, busy clinic schedules, and compensation. Ethics CE credits encouraged LMT interest. A total of 28 Kentucky LMTs with 5-32 years experience completed study training. N=127 CLBP patients consented to participate (n=104 for CMT). Twenty-three LMTs provided 1-10 treatments for 91 study participants. Treatment documentation was provided by LMTs for 95% of treatments provided.

Conclusion: When recruitment, retention, and protocol compliance challenges are met, community LMTs are valuable study personnel for practice based research reflecting real world CMT practice.

Jerrilyn Cambron, LMT, DC, MPH, PhD,
Jennifer Dexheimer, LMT, BS,
Dana Madigan, BS,
Nicole Brod, BS,
Tracy Walton, LMT, MS
National University of Health Sciences

Introduction: No known research exists on the type or amount of information collected by massage therapists regarding clients’ past medical history.

Purpose: The purpose of this IRB-approved study was to determine whether massage therapists collect health history from their clients, what conditions are inquired about, and what conditions are thought to be frequently encountered in practice.

Methods: Massage Therapists were recruited through the MassageNet practice-based research network and a massage news release. This survey was conducted online using SurveyMonkey. The questions inquired about (1) collection of health histories in various practice settings, (2) frequency of collection of information regarding 26 different medical conditions, (3) occurrence of these conditions within their client population, and (4) interest in further education related to these conditions.

Results: A total of 130 therapists responded to survey questions. All therapists reported taking some form of medical history when working in the following settings: client’s home/office, gym/fitness facility/sports organization, massage clinic or office, other healthcare clinic/office, and spa/salon/resort. However, 15% of those working onsite/event massage (10 of 65) and 6% of those working at a hospital/hospice/nursing home (2 of 32) reported not taking any health history prior to the massage. Of the 26 listed conditions, the most common conditions that therapists always inquired about included: heart disease, hypertension, and diabetes mellitus. Over 80% of all responding therapists have seen at least one client with fibromyalgia, asthma, hypertension, and breast cancer. When asked about interest in further education, the most common of the 26 conditions included fibromyalgia and spinal cord injury.

Conclusion: The majority of massage therapists collect health histories regardless of their practice setting and report knowing that their clients have various medical conditions. Interest in further education was not limited to the primary care conditions confronting most therapists.

Kim Goral, Meghan Thomason, & Christopher A. Moyer, PhD
University of Wisconsin – Stout

Introduction: Massage therapy (MT) reduces anxiety, but how it produces this effect is not known. We theorized that MT relaxes and lengthens an anxious recipient’s muscles and connective tissues enough to produce a pattern of peripheral nervous system feedback that is incompatible with a state of high anxiety, and that the relaxation of the muscles and connective tissues will be able to be assessed by precise measurement of a recipient’s stature.

Methods: We conducted a pair of clinical case studies, in which two participants diagnosed with anxiety disorders each received a series of 60‐minute sessions of full‐body MT administered by trained massage therapists. Assessments of stature and state anxiety were made immediately before and after each MT session.

Results: Participants’ stature increased (mean increases of 12 and 9 mms) and state anxiety decreased (mean decreases of 10.6 and 14.8 points on the state portion of the State‐Trait Anxiety Inventory) in response to MT sessions. In both cases increased stature was strongly and consistently predictive of lower state anxiety (rs = ‐.73 and ‐.74).

Conclusions: These uniform results are consistent with the theory that MT reduces anxiety by relaxing and lengthening muscles and connective tissues to produce a pattern of peripheral nervous system feedback that is incompatible with a state of high anxiety.

Alicia Recore, PhD
St. Peter’s Hospital, Albany, NY

Introduction: An eighteen month project providing massage services to acute and chronic care patients was conducted at St. Peter’s Hospital inAlbany,New York. Funded by an anonymous donor, it was a collaboration between the hospital and the local Center for Natural Wellness School of Massage Therapy.

Objective: The purpose was to evaluate the impact of these services on patients’ symptoms during short and long term stays.

Method: Acute and chronic patients were referred to contracted Licensed Massage Therapists by staff on the Oncology, Stroke/Orthopedic, Rehabilitation, Pulmonary, Cardiac, Ante/Postpartum and Dialysis units. Acute care patients received up to three consecutive 30 minute sessions per week. One to two sessions per patient per week, (six sessions maximum) were offered to patients with chronic disease related symptoms and projected stays of up to two months.

Results: Pre/post measures gauging clinical benefit and patient satisfaction were documented on 625 sessions, involving 268 acute care patients. Clinical Care Unit Coordinators were surveyed on perceived benefit to both patients and staff.

Positive outcomes for acute patients included 70% pain reduction; 53% anxiety reduction; 65% heart rate reduction; 64% blood pressure reduction; 51% respiration rate reduction. Patient Reported Satisfaction scores indicated that over 57% felt massage to be very beneficial in relieving pain/anxiety, improving sleep/mood, and increasing comfort; 100% of all respondents said they would recommend it for other patients. The Coordinators also reported beneficial outcomes, recommending continuation of the program.

While long term evaluation for chronic patients could not be consistently measured due to barriers, the following significant outcomes were recorded for 11 patients over 40 sessions:

Rehabilitation (3): 80% decreased pain; over time significant decrease in depression reported

Oncology (2): 67% decreased pain; 67% decreased anxiety

Complicated Cardiac (5): 90% decreased pain, 47% decreased anxiety; 75% – 95% decreased blood pressure and heart/respiration rates

Dialysis (1): 60% decreased pain, 80% decreased anxiety

In addition to Cardiac patients, 50% of all other patients showed decreased blood pressure and heart/respiration rates; sleep status shifted from awake to drowsy/asleep.

As massage later became integrated into the Labor and Delivery Unit per physicians’ and patients’ requests, outcomes indicated intervals between contractions decreasing by minutes (69%) with duration of contractions increasing by seconds (69%). Progression of labor quickened with patients showing marked physical signs of transition (100%).

Conclusion: The program has since been incorporated into the hospital’s Complementary Therapy Department where it continues to be highly successful six years running.

Sarah Weaver, MFA, M.Om, L. Ac., NCTMB,
Sarah Gottfried, B.A., NCTM
Louise Delagran, MA, MEd
Michele Maiers, D.C., MPH
Roni Evans, D.C., MS
Northwestern Health Sciences University

Introduction: Northwestern Health Sciences University (NWHSU) is a multidisciplinary university that educates professionals in massage therapy, chiropractic, and acupuncture and Oriental medicine. In 2007, NWHSU in collaboration with the University of Minnesota received a grant from the National Center for Complementary and Alternative Medicine (R-25AT003582). The purpose of the grant was to integrate research into NWHSU’s academic curricula and enhance students’ research literacy.

Purpose: The purpose of this presentation is to describe a new course introducing massage therapy students to health care research in the context of an evidence-informed practice (EIP) model. This model emphasizes the tripartite relationship between client presentation, clinical experience, and evidence from scientific research.

Methods: A multidisciplinary team of educators and clinicians was assembled to meet the unique learning needs of massage therapy students. The ADDIE (Analysis, Design, Develop, Implement, Evaluate) model of instructional design was used. An initial analysis of student and faculty views of research was performed, as well as an assessment of the existing massage therapy curriculum, and the COMTA research competencies. A 1-credit, course was designed based on 8 broad EIP competencies adopted by NWHSU. Teaching strategies include classroom and online strategies. Lesson plans emphasize practical application of concepts introduced in online learning modules and focus on the specific needs of massage therapy students. Assessment includes online quizzes, online discussions, written exercises and in- class exams. A competency based survey assessing self reported EIP skills and behaviors is given at the beginning and end of each course.

Results: A new course, “Foundations of Evidence Informed Practice for Massage Therapy” was implemented in the final trimester of the massage therapy curriculum. It has been administered to 7 cohorts, reaching over 100 massage therapy students. Recent assessments indicate students believe it is important to be able to use research in massage therapy practice. Results of the surveys show general increases in student self-reported EIP skills and behaviors (e.g. discussing research with others, accessing summary resources, applying the EIP model). Challenges have included the low-credit load, and placement of the course at the end of the massage therapy program.

Conclusion: Despite some challenges, overall, we feel the implementation of the new course has been successful. Students are gaining important research-related skills that will enable them to participate responsibly and more fully in the health care system. Ideally, the foundational related principles related to “evidence-informed practice” would be offered early, and consistently throughout the entire massage therapy curricula. NWHSU faculty are working towards this goal.

Christopher A. Moyer, PhD, Lacey Seefeldt, Eric S. Mann, & Lauren M. Jackley
University of Wisconsin – Stout

Introduction: It is frequently asserted that massage therapy (MT) reduces cortisol levels, and that this mechanism is the cause of MT benefits including relief from anxiety, depression, and pain, but reviews of MT research are not in agreement on the existence or magnitude of such a cortisol reduction effect, or the likelihood that it plays such a causative role.

Objectives: Completion of a definitive quantitative review of MT’s effect on cortisol.

Methods: After first performing a comprehensive literature search and retrieval, we use rigorous and conventional meta‐analytic methods for calculating between‐groups effect sizes. As a point of comparison, we also replicate an unconventional approach taken by other reviewers, in which MT recipients’ within‐group cortisol reductions are quantified as a percentage of change, despite the fact that this introduces numerous confounds not addressed by the first approach.

Results: Resultant between‐groups effect sizes are almost all small (ds = 0.05 to 0.30) and nonsignificant. The lone exception is MT’s multiple‐dose effect in children, which is larger (d = 0.52) and statistically significant, but which is based on only three studies and vulnerable to the file‐drawer effect. Within‐group percentage reductions of cortisol in MT recipients are generally smaller than those found by other reviewers, and are generally inconsistent with the more rigorous between‐groups results, which illustrates the unsuitability of this unconventional approach to assessment of treatment effects.

Conclusion: MT’s effect on cortisol is generally very small and, in most cases, not statistically distinguishable from zero. As such, it cannot be the cause of MT’s well established and statistically larger beneficial effects on anxiety, depression, and pain. We conclude that other causal mechanisms, which are still to be identified, must be responsible for MT’s clinical benefits.

Jerrilyn Cambron, LMT, DC, MPH, PhD,
Jennifer Dexheimer, LMT, BS,
Dana Madigan, BS
Nicole Brod, BS
National University of Health Sciences

Introduction: There are still questions regarding who seeks massage, why massage is sought, and what effects are experienced post-massage.

Purpose: The purpose of this IRB-approved study was to describe the treatment characteristics of Illinois massage therapists and their clients’ perceived outcomes of care.

Methods: All Illinois massage therapists enrolled in the MassageNet practice-based research network who previously indicated interest in research participation were approached regarding this study. Each therapist, up to a total of 50, was asked to participate and if interested was asked to approach 20 consecutive clients. Before and after the massage, the clients were asked about their pain and stress levels. Immediately after the massage and 24 hours later the clients were asked to indicate any change in certain physical, mental, or emotional functions. The therapists were also asked to complete questions regarding the type and duration of the massage.

Results: Twenty-eight massage therapists and 379 clients participated. The most common form of massage included in therapy sessions was Swedish. The majority of clients were female with an average age of 53. Immediately after massage, clients reported a downward trend in levels of both pain (3.7 to 1.6 out of 10) and stress (3.5 to 1.5 out of 10). Physical, mental, and emotional improvements were reported immediately after and 24 hours after massage, with the greatest improvements being muscle tension (99%, 89% respectively), relaxation (96%, 81%), and serenity/peace (93%, 81%). Additional non-musculoskeletal improvements included circulation (67%, 48%), ability to breathe (53%, 39%), and digestion (30%, 29%). A minimal number of clients reported aspects that worsened after massage, with the most common being physical in nature.

Conclusion: Clients overwhelmingly reported improvements in their physical, mental, and emotional well-being. These improvements were noted immediately after the massage as well as 24 hours later. Few aspects were found to have worsened.

Dr. Wanda I. Bonet-Gascot, PhD
Quality Massage and Wellness Research

Attention deficit-hyperactivity disorder (ADD/ADHD) is the most commonly diagnosed behavioral disorder of childhood, estimated to affect between 3% and 5% of school aged children. The core symptoms of ADD/ADHD include inattention, hyperactivity and impulsivity. In 2003, The Touch Research Institute published the study based on observation: Massage Therapy improves mood and behavior of students with ADD/ADHD, showing that relaxation and massage techniques reduce anxiety and activity levels in children and adolescents.

The purpose of this case report is to determine if massage techniques improves the behavior of a third grade boy, which was recommended by his teacher to receive ADD/ADHD medical attention. The boy was a candidate to take behavioral medicated drugs. The teacher indicated symptoms of inattention, and hyperactivity and low grades.

The boy received 20 minutes massage including head, neck, and hands / 4 times a week for 8 weeks. After each massage session, a basic questionnaire was answered by the boy. His behavior was observed by his mother, and teacher.

After the 8 week treatment, the teacher indicated a significant improvement in his student behavior and grades. The boy reported improvement in his quality of life and self esteem. The mother of the boy reported satisfaction and mental peace about the fact that his son’s behavior improved without the need of medications. The boy’s behavior was monitored after the eight weeks, and he received massages periodically.

Based on the results of this case report, massage is recommended for kids with ADD/ADHD for behavioral improvement. There are additional implications of this case report: 1) the foundation to conduct further research studies on this topic; 2) massage therapy not only beneficial the receiver also offers satisfaction and reduce stress to caregivers.

Michael Hamm, LMP, CCST
Cortiva Seattle

The focus of the project was to examine the effects of massage on cancer recovery and chemotherapy-induced peripheral neuropathy. The purpose of working with an individual with these conditions was to see if weekly mini-reflexology sessions, stretching and massage would relieve the symptoms. Before each session, an evaluation of the client’s state was made, with documentation of the clients’ progression. I researched cancer and the prescribed treatments to learn how these treatments affected the body. I recorded my findings with SOAP notes and also graphed my clients progresses over a four week period. I tracked the progress of my clients four chief complaints: the restriction of movement she felt upon rising, level of flexibility, numbness, and pain my client was experiencing in her feet and legs. After four weeks my client did show improvement in all areas. It has been about eight months since last working with my client for these specific conditions, some of her symptoms have returned and she is currently evaluating her continued medicinal treatments to see if they are the cause of her discomfort. I feel that if I had begun treatment with her sooner that some of her symptoms would not have been so severe. I hope that with continued treatments my client will have sustained improvement of her symptoms.

Robin Streit, L.M.T., Virginia S. Cowen, Ph.D.

Introduction: Massage therapy is one of the most common non-conventional therapies for ortho-pedic conditions and is within the scope of many providers. Physical therapists, occupational therapists, and chiropractors frequently receive insurance reimbursement for manual therapy, but it is unclear how the insurance policies factor the provider’s qualifications into payment. This study aims to understand general insurance reimbursement guidelines for massage therapy, spe-cifically as it pertains to the providers, techniques, and covered conditions.

Methods: A list of US health insurance companies was generated from A.M. Best’s online data-base. All of the companies with policies (n=26) available in more than one eastern state were chosen for review. Each carrier’s website was searched for policy information with terms “mas-sage therapy” and “manual therapy.” Information about massage techniques, providers, condi-tions, and practice guidelines was coded and analyzed using descriptive statistics.

Results: All cases offered massage therapy administered by a massage therapist through a dis-counted rate program. Most companies covered massage, but the extent of coverage was limited to plan type. Reimbursable techniques included Swedish, manual lymphatic drainage, mobiliza-tion, myofascial release and traction. In most cases, chiropractors, physical therapists, and occu-pational therapists could bill for massage services directly. Few cases required massage therapists to be employed and/or supervised by a doctor. Reimbursement was typically limited to 15 minute increments, covered as one part of a comprehensive rehabilitation plan, and needed to be medically necessary (prescribed by a doctor). Massage was commonly covered for
neuromusculoskeletal conditions.

Discussion: US health insurance policies tend to cover massage, but limit reimbursement to doc-tors. The strict practice guidelines appear to disregard laws governing massage therapists. Future research should specifically compare the guidelines, laws, and findings across states to identify inconsistencies. . Coverage inclusion will heighten acceptance by other health care professionals and strengthen the profession’s contribution to the healthcare system.

JoEllen Sefton, PhD, ATC, CMT,
Ceren Yarar,
Jack Berry
Auburn University

Objectives: Falls are a leading contributor to death/injury in older persons. Clinical evidence suggests massage therapy (MT) may influence balance. A non-pharmacological intervention for balance could enhance seniors quality of life. Understanding the long-term effects of MT on balance is vital for developing safe, effective MT treatment protocols.

Purpose: investigate the long-term effects full-body MT on postural control and nervous system measures in healthy, older adults.

Methods: Thirty-five healthy volunteers (19 male and 16 female; ages 62.9±4.6 years) participated. The treatment group received a 60-minute, full-body MT treatment for 6 weeks; the control group rested quietly. Testing sessions took place the 1st, 6th and 7th weeks. Outcome measures: Pre-treatment; immediate post, 20 min. post, and 60 min post-treatment center of pressure (COP) measures [rectangular and effective areas, average velocity (Vavg)]; and motoneuron pool excitability measures: Hmax/Mmax, paired reflex depression (PRD), and recurrent inhibition (RI) during single and double leg stance with eyes-open and closed.

Results: A 2×4 ANCOVA revealed significant treatment effects for COP measures in eyes-open double-legged (rectangular: F1,33= 10.3, p£ 0.01; effective: F1,33= 7.2, p= 0.01; Vavg: F1,33= 7.54, p£ 0.01) , eyes-closed double-legged (rectangular F1,33= 9.59, p= £; effective F1,33= 10.6, p£ 0.01; Vavg: F1,33= 5.15, p£ 0.05), and eyes open single-legged stance (effective: F1,33= 5.47, p£ 0.05; Vavg= F1,33= 6.56, p= 0.01) 7 weeks post-MT in treatment group. A significant treatment effect was found for the Hmax/Mmax ratio (F1, 33= 11.4; p£ 0.05), with a lower mean in the treatment group (treatment x= 0.19±0.02; control x= 0.30±0.02).

Conclusion: Long-term MT may improve static and functional balance for up to a week after treatments have ceased. Reduced Hmax/Mmax ratio suggests inhibition of motoneuron pool excitability which may have a direct influence on muscle activity, which suggests a physiological mechanism for improved ability to maintain upright stance.

John Balletto, LMT, CKTP
Center for Muscular Therapy, Inc.

Introduction: Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disorder. KinesioTaping (KT) is a rehabilitative intervention that uses a unique, patented, medical grade elastic tape specifically designed for treating muscular problems and reducing lymphedema. There was no reported use of KinesioTaping for management of RA symptoms in the current literature.

Objective: To study the combined effects of massage therapy and KT on RA symptoms of pain, swelling, restricted range of motion and performing endurance in the right arm of a 59 year-old, female professional oboeist.

Results: The addition of KT applications to massage sessions provided a reduction of joint pain (from 8 to 4 on a 10-point scale) within the first three applications. Relief duration extended from 24-48 hours to 4-5 days. Extent of practice time increased to 40 minutes per session after KT application 1. By the fourth KT application, practice time increased to 60 minutes per session; by KT application 9, two 60-minute practice sessions per day.

Implications: Complementing traditional massage applications with KT appears to yield positive result in pain reduction, functional mobility, and duration affect. Further investigation with additional outcome measures is indicated.

Cary A Brown, PhD; Geoff Bostick, PhD; Leisa Bellmore, CST

Introduction: Difficulty falling asleep is a common problem for persons living with pain.
Research demonstrates that disrupted sleep will, in turn, exacerbate the chronic pain problem.
The evidence-base for a range of pragmatic, non-pharmacological sleep interventions that can
potentially be incorporated into pain management programs is growing. However, strategies that
are controlled by the patient and are congruent with the self-management model favored by
most pain services are not yet well researched. This study looks at the outcome of teaching
adults with enduring musculoskeletal pain a standardized, pre-bedtime, self-administered
Shiatsu hand massage (SHM) intervention to promote sleep onset.

Method: A range of standardized sleep-related self-report tools and objective sleep actigraphy
(recorded for 5-7 nights) were used to collect baseline data. Participants were then taught
pre-bedtime self-administered SHM in one-to-one sessions. They also received two follow-up
phone calls to offer support and clarification if needed. The assessment battery and 5-7 nights
of actigraphy data were collected again at 2 weeks and 8 weeks post-SHM training.

Results: Twelve persons with diverse musculoskeletal pain experiences participated. Data
collected at baseline, 2 week and 8 week follow-up periods revealed no apparent changes in
actigraphy scores. Treatment fidelity dropped off at 8 week follow-up. A trend toward improved
self-reported sleep latency (time to fall asleep) and sleep duration (time spent asleep) emerged.
A number of participants reported they were more concerned with increasing their period of
unbroken sleep as opposed to their total sleep time. None of the participants reported adverse
effects of the intervention.

Conclusion: Preliminary findings of a low-cost, pragmatic, patient-controlled intervention are
promising. Further study of self-administered SHM to determine the potential mechanism(s) at
play, with greater control of treatment fidelity, and to investigate its use during nighttime
awakenings in addition to pre-bedtime, are particularly indicated.

Support: Canadian CAM Research Fund (CCRF)

Reference: Brown CA, Bostick G, Bellmore L, Kumanayaka D. Hand self-Shiatsu for sleep problems in persons with chronic pain: a pilot study. J Integr Med 2014 Mar 12(1):94-101.

Rebecca S. Massmann, LMT

Introduction: Myofascial unwinding (MU) describes involuntary movement and sensations in the body occurring in response to a practitioner’s touch, or through self-induction. Anecdotal ac-counts of the MU experience exist, however there is a paucity of literature examining the experi-ence of MU for the recipient.

Purpose: The aim of this study was to generate a rich description of recipients’ MU experience.

Methods: Naturalistic inquiry and descriptive content analysis guided the research. Data was col-lected through semi-structured interviews. The purposive sample consisted of eight highly expe-rienced practitioners of manual therapies, who were also experienced recipients of MU.

Findings: The findings portray the essential features of the MU experience:
• Pre-conditions for the MU experience include feeling safe in order to let go, working with a trusted practitioner, and trusting oneself in the process
• The practitioner-recipient relationship influences the MU experience
• The lived experience of MU can include a wide range of physiological responses, emo-tional expression, mental processes, and transpersonal experiences
• The impact of the MU experience for recipients is highly individualized and multi-dimensional. Outcomes reflected in this study demonstrated that MU supports the body’s ability to heal and prevent injuries, process traumatic events, support the aging process, improve physiological function, manage emotions, and affect changes in personal belief systems and patterns of behavior.

Implications: The use of an empathic practitioner and the body-centered approach to MU, along with the multi-dimensional experience, and psychophysiological responses to MU suggest that it may be effective as an intervention in trauma recovery.

Conclusion: Myofascial unwinding is a process that is centered in trusting the inherent wisdom of the body to inform the psychophysiological, psychosocial, and/or transpersonal levels necessary to promote a greater state of ease for the recipient.