Blood Flow Within Active Myofascial Trigger Points Following Massage

AWARD TYPE: Research Grants

Albert Moraska, PhD
University of Colorado at Denver
Aurora, CO
$30,000

Myofascial pain syndromes are associated with a high percentage of chronic pain disorders and are characterized by the presence of myofascial trigger points (MTrPs). Massage therapy has been shown to be effective at alleviating myofascial pain presenting as back pain or tension-type headache and specifically reduce point tenderness associated with MTrPs. However, mechanisms by which massage therapy exerts an effect are poorly understood. The MTrP is a tightly contacted nodule within skeletal muscle and research evidence suggests it impedes blood flow, subsequently causing tissue distress and production of pain evoking chemicals. The purpose of this research study is to investigate blood flow at the MTrP following massage to provide inroads into a mechanism of action for massage in the treatment of myofascial pain and MTrPs. Research subjects with myofascial pain expressed as tension-type headache and an active MTrP in the upper trapezius muscle will be randomly assigned to receive trigger point release massage or a control treatment at the MTrP. Interstitial fluid within the MTrP will be collected before and after massage from which markers to assess blood flow will be determined.


Blood Flow Within Active Myofascial Trigger Points Following Massage

AWARD TYPE: Research Grants

Albert Moraska, PhD
University of Colorado at Denver
Aurora, CO
$30,000

Myofascial pain syndromes are associated with a high percentage of chronic pain disorders and are characterized by the presence of myofascial trigger points (MTrPs). Massage therapy has been shown to be effective at alleviating myofascial pain presenting as back pain or tension-type headache and specifically reduce point tenderness associated with MTrPs. However, mechanisms by which massage therapy exerts an effect are poorly understood. The MTrP is a tightly contacted nodule within skeletal muscle and research evidence suggests it impedes blood flow, subsequently causing tissue distress and production of pain evoking chemicals. The purpose of this research study is to investigate blood flow at the MTrP following massage to provide inroads into a mechanism of action for massage in the treatment of myofascial pain and MTrPs. Research subjects with myofascial pain expressed as tension-type headache and an active MTrP in the upper trapezius muscle will be randomly assigned to receive trigger point release massage or a control treatment at the MTrP. Interstitial fluid within the MTrP will be collected before and after massage from which markers to assess blood flow will be determined.


Bowenwork for Migraine – Is it all in the Head?

AWARD TYPE: Case Report Contest
AWARD TYPE: Practitioner

Bronze Award Winner
Sandra Gustafson, MHS, BSN, RN
Bodega Bay, CA

Description: This case report described one migraineur’s response to Bowenwork (gentle, soft-tissue bodywork technique) for reducing migraine occurrence and pain, pharmaceutical analgesic consumption, and improving her health-related quality of life, wellbeing and activities of daily living.  The client, a 66 year-old Caucasian female, had a history of debilitating migraines since childhood and severe neck pain resulting from 2 motor vehicle accidents sustained as an adult.  She reported experiencing severe migraine and neck pain 3 – 4 times a week, and taking up to 10 tablets of Ibuprofen 200mg per day, placing ice-packs on her neck and lying in a quiet, dark space until her symptoms abated.  She had previously sought medical and pharmaceutical treatment, chiropractic, massage and other bodywork techniques to relieve her condition.

Method: The case-study reports on the client’s responses to receiving fourteen Bowenwork sessions, weekly to two-weekly, over a 4-month period, using the self-reporting Measure Yourself Medical Outcome Profile version 2 to evaluate clinically meaningful changes. 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 which varied from neck and jaw pain to middle and lower back pain.

Results: During the 4-months of receiving Bowenwork, the client progressively reported decreased migraine and neck pain; and by session 14, no further migraine, neck or jaw pain, nor medication use; and increased quality of life, daily activities and wellbeing, for 10 months thereafter, and continues to be migraine-free at the time of this report.

Conclusion: Bowenwork had a positive effect for one client and may offer non-pharmaceutical relief for migraineurs.  Further research on larger populations is indicated.


Comparing the Effects of Rest and Massage on Return to Homeostasis Following Submaximal Aerobic Exercise

AWARD TYPE: Case Report Contest
AWARD TYPE: Practitioner

Gold Award Winner
Portia Resnick, MA, ATC, LMT
Honolulu, HI

Background: Post-exercise massage can be utilized to help promote recovery 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 and parasympathetic activity.

Objectives: The purpose of this case study was to compare the effects of massage recovery and resting recovery on a subject’s heart rate variability (HRV) and selected metabolic effects following a submaximal exercise session.

Methods: One healthy 24-year old female performed submaximal treadmill exercise prior to resting or massage recovery sessions.  Metabolic data and HRV were evaluated for two 10-minute intervals after each of two 30-minute recovery sessions, either resting or massage.

Results: Heart rate returned to below resting levels more quickly with massage recovery. Heart rate variability showed a more immediate shift to the parasympathetic state and ventilations per minute decreased following 30 minutes of massage recovery. After 60 minutes of resting recovery levels of HRV and ventilation approached those found after 30 minutes of massage recovery.

Conclusion: Massage immediately following submaximal exercise lead to lowered heart rate more quickly than resting alone.  Massage during recovery showed a decrease in sympathetic control and an increase in parasympathetic tone.  A greater relaxation response was seen with massage recovery as evidenced by the VE*VO2-1 response.


Contralateral Treatment for Centrally Sensitized Chronic Shoulder Pain” A Case Report

AWARD TYPE: Case Report Contest
AWARD TYPE: Practitioner

Honorable Mention
Rosie Goldsmith, BA, LMT, DAFNS
Portland, OF

Background and Objectives: Severe chronic pain affects up to 100 million Americans. Central sensitization (CS) of pain is where there is an increased pain responsiveness of the central nervous system to slightest touch or movement. Acute musculoskeletal injury induced pain may develop into CS pain. Contralateral manual therapy and exercise of the opposite arm has been shown to stimulate muscles and pain signaling of an affected limb. This case report investigates whether contralateral inhibitory exercise techniques can be effective to treat a patient with central sensitization of chronic shoulder pain.

Methods: The patient, a 45 year old man with a history of 3 years post-injury severe chronic right shoulder pain, showed all the signs of central sensitization. He was assessed for range of motion and pain. His pain contraindicated direct touch. Over a course of 12 sessions spanning 24 weeks, Visual Analogue Scales were used for pain, and the patient kept a log of the use of his need to wear a transcutaneous electrical nerve stimulation (TENS) unit to interrupt the pain signaling. Part way through the series practitioner obtained informed consent and recruited patient’s wife to assist with exercises at home. Practitioner lightly palpated to find the most painful sites on the right shoulder, then used slow resisted range of motion, or concentric isotonic contractions to homologous muscles and tendons of the left arm.

Results: Patient had a substantial reduction in pain, improvements in sleep and confidence. He was able to resume normal activities in his home and family, and return to work for the first time in three years.

Conclusion: This case report showed a beneficial effect of contralateral massage and exercise treatment for centrally sensitized pain. It merits further study under controlled conditions.


Dynamic Angular Petrissage (DAP); A Novel Therapeutic Approach for Axillary Web Syndrome

AWARD TYPE: Case Report Contest
AWARD TYPE: Practitioner

Silver Award Winner
Paul Lewis, NCBTMB, RMT, CDT
Mississauga, Ontario

Background and objectives: Axillary web syndrome (AWS), also called lymphatic cording, typically presents in the weeks after axillary surgery for breast cancer. This painful condition is likely angiolymphatic in origin. It restricts use of the upper extremity, and has no established treatment although physical therapy and other approaches have been used to variable effect. We applied therapeutic massage techniques using Dynamic Angular Petrissage (DAP) with the aim of quickly but gently reducing upper extremity pain and improving range of motion in the case of a young woman with AWS.

Methods: Patient assessment included self-report of pain (5 on a scale of 0-10), extent of flexion of the glenohumeral (GH) joint (140 degrees by goniometer), and visual and physical determination of extent of cording (taut, from axilla to wrist). She received two therapeutic massage sessions including the DAP approach: passive manipulations of the involved joint through all possible angles of movement, lengthening and shortening the target muscle(s) while simultaneously adapting petrissage techniques to the condition of the underlying soft tissue. The cord was considered part of the arm structure restricting motion, rather than a tissue to be torn or broken. Specified home care exercises were also used by the patient.

Results: After a 1.5 hour session using DAP, pain was reduced to 0/10 and flexion was improved to 170 degrees. The cord was visibly reduced. Following a second 0.5 hour DAP treatment the cord was only residually apparent, with no restrictions 4 even during hyperextension. Long-term outcome was complete resolution with no recurrence.

Conclusion: The techniques of DAP are simple for the trained therapist to apply. We propose that DAP may be an efficient, comfortable and effective approach to treating axillary web syndrome.


Impact of Massage Therapy on Spasticity in People with Multiple Sclerosis

AWARD TYPE: Research Grants

Deborah Backus, PT, PhD
Shepherd Center, Atlanta, GA
$29, 998

The purpose of this pilot study is to assess the effectiveness of massage therapy for decreasing fatigue, pain, and spasticity in people with multiple sclerosis, in order to improve their health perception and quality of life. Participants will receive a standardized routine of massage therapy by a licensed massage therapist one time a week for 6 weeks. Measures of fatigue (primary outcome measure), and pain, spasticity, and quality of life (secondary outcome measures) will be collected before and immediately after the completion of the 6-week intervention phase.

Click here to view Dr. Backus and her research featured on CBS-WTAJ in central PA.

Click here to view another story that features Dr. Backus and her research.


Impact of Massage Therapy on Spasticity in People with Multiple Sclerosis

AWARD TYPE: Research Grants

Deborah Backus, PT, PhD
Shepherd Center, Atlanta, GA
$29, 998

The purpose of this pilot study is to assess the effectiveness of massage therapy for decreasing fatigue, pain, and spasticity in people with multiple sclerosis, in order to improve their health perception and quality of life. Participants will receive a standardized routine of massage therapy by a licensed massage therapist one time a week for 6 weeks. Measures of fatigue (primary outcome measure), and pain, spasticity, and quality of life (secondary outcome measures) will be collected before and immediately after the completion of the 6-week intervention phase.

Click here to view Dr. Backus and her research featured on CBS-WTAJ in central PA.

Click here to view another story that features Dr. Backus and her research.


Massage for Survivors of Human Trafficking

AWARD TYPE: Community Service Grants

Willie Martin
New Orleans Community Outreach, New Orleans, LA
$4,000

New Orleans Community Outreach is a non-profit organization that provides access to programs and services offered by the New Orleans Healing Center to the under served in the community.The grant will be used to provide massage to women in Louisiana who are survivors of human trafficking. After years of exploitation, this population has developed a negative association with physical contact and we are working to change that. Since starting the program in September, massage therapists have been meeting regularly with these women and providing massage while talking about different techniques for relaxation. The women live at Eden House, a residential home in New Orleans that provides two years of housing for the women as they rebuild their lives.


Massage Therapy Treatment and Outcomes for a Patient with Parkinson’s Disease

AWARD TYPE: Case Report Contest
AWARD TYPE: Student

Gold Winner
Youlanda Casciaro
MacEwan University
Edmonton, AB, Canada

Abstract

Background: Parkinson’s Disease (PD) is a complex neurological disorder. The root cause is unknown, and while treatment with pharmacotherapy is successful, eventually the effectiveness of the medications wears off. The disease is progressive and eventually results in severe disability. Symptoms are well-documented, with the most recognizable manifestations being resting tremor, bradykinesia, and rigidity.
Objective: To determine if massage therapy can produce favourable outcomes with respect to the severity of rigidity and tremor in a patient with PD. Methods A 63-year-old female patient with idiopathic, long-standing, Hoehn-Yahr Stage four PD was treated with massage therapy five times over the course of six weeks. A SPES/SCOPA Motor Impairments rating scale was used to measure rigidity and tremor pre- and post-treatment, to gauge treatment effectiveness. The massage treatments consisted of deep longitudinal stroking, muscle squeezing techniques, passive range of motion movements, and general relaxation techniques to encourage a soothing environment while promoting a decrease in muscular tone and hyperactivity.
Results: The results obtained indicated that massage therapy treatment had a positive effect on reducing resting and postural tremor in a patient with long-standing PD. The treatment was also effective to temporarily reduce rigidity during treatment, but did not produce a lasting effect.
Conclusion:
MASSAGE TREATMENT & OUTCOMES FOR A PATIENT WITH PD 4
Further study is required; however, the results of this case were consistent with the limited research available on the subject of massage therapy and Parkinson’s Disease, in that positive change with respect to resting tremor – and to a lesser degree, rigidity – were achieved with focused, intentional treatment.


Therapeutic Scraping for the Treatment of Chronic Overuse Injury of the Shoulder of CrossFit Athlete

AWARD TYPE: Case Report Contest
AWARD TYPE: Practitioner

Honorable Mention
Stacey Meek
Louisburg, NC

Background: CrossFit is an exercise regimen of constantly varied (CV), functional movements (FM) performed at high intensity (@HI) in a communal environment and often includes the use of Olympic weightlifting techniques and gymnastic maneuvers to build muscle and increase cardiovascular endurance. The three Olympic lifts are the Clean, Jerk, and Snatch. All of these lifts require rotation of the shoulder under heavy load and CrossFit requires that these lifts be performed with speed, thus putting significantly more strain on the rotator cuff muscles than non-weight-bearing exercises.

Objective: This case study will test the effects of consistent, focused therapeutic scraping on a CrossFit athlete with chronic overuse injury to the right shoulder resulting in limited range of motion and, therefore, limited progress in training.

Method: This study spanned 5 weeks in which the client was assessed and treated every 7 days for 30-40 minutes with goniometric measurements of internal rotation in the right shoulder recorded at the beginning and end of each session. The client was treated with therapeutic scraping (TS). He was also encouraged to train as he normally would in between sessions and report improvements or concerns with his mobility.

Results: The degree of internal rotation of the right shoulder increased directly following each treatment and decreased during the 7 days between treatments. The client reports significant improvement in mobility; the speed and fluidity in his Olympic lifts (primarily the Clean and Jerk) has improved greatly; and he also reports achieving personal records where progression had been difficult prior to starting treatment.

Conclusion: For this athlete, consistent, focused therapeutic scraping (TS) has proven to improve range of motion, decrease pain, decrease recovery time post-workout, and improve performance.


Touching Pain: Massage Therapy Techniques To Support Adaptive Body Awareness for Self-Management of Chronic Pain Related to Spondylosthesis

AWARD TYPE: Case Report Contest
AWARD TYPE: Student

Honorable Mention
Krina Patel
Cortiva Institute
Boston, MA

Abstract
Background: Massage therapy techniques increase body awareness. Body awareness can be adaptive or maladaptive. Adaptive body awareness is shown to have a positive effect in the acceptance and management of chronic pain. Spondylolisthesis is a structural condition often accompanied with chronic pain.
Purpose: The present report investigates the efficacy of massage therapy techniques in enhancing and sustaining adaptive body awareness for the self-management of chronic pain related to Spondylolisthesis. Participant:  A 57-year-old female initially diagnosed with congenital spinal abnormality by a physician and subsequently with both congenital and degenerative Spondylolisthesis by a chiropractor presents with chronic low and upper back pain and frequent episodes of intense pain in these same areas usually brought on by physical activity. Client is familiar with general massage and acupuncture treatments.
Intervention: Therapeutic massage with the clear goal of increasing adaptive body awareness was introduced during a 4-week period. Five treatment sessions, each 45 minutes in duration used a treatment protocol that included diaphragmatic 4 breathing, various massage techniques in a ‘massage flow’ to relieve muscle tension and recommended home care. Verbal instructions encouraging patient to experience body awareness and sensations of muscles relaxing during massage were integral to the protocol.
Results: Client recorded a decrease in intense pain episodes between treatments, decrease in use of pain medication, no perceptible change in intensity of pain episodes and a better understanding of how to manage her chronic pain.
Conclusion: Patient feedback and therapist observation suggest that therapeutic massage with the clear goal of enhancing and sustaining adaptive body awareness through a treatment protocol carried out as a touch based dialogue between client and therapist may decrease pain-related anxiety and avoidance and increase capacity to accept and manage pain. This in turn may improve functioning and overall sense of wellness.