Gold Award Winner
Conway, South Carolina
Thank you to Massage Warehouse for for their generous gift to our gold case report winner!
Background and Objectives: There is limited access to healthcare in rural Ghana and virtually no rehabilitative services available. This case study presents a unique opportunity to utilize chair massage in addressing women’s health in rural Africa, particularly when it comes to muscle pain and fatigue from heavy labor. The objective of this study is to determine the results of chair massage as a strategy to reduce neck, shoulder, and back pain and 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. The accident resulted in a broken right humerus and soft tissue pain. A traditional medicine practitioner set the bone. 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 study include an increase in range of motion, as well as diminished pain in the right shoulder, elbow, and hand. 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 study illustrates how therapeutic chair massage was utilized to address a common health concern for one woman in rural Africa. It also demonstrates pre-exiting myoskeletal issues 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.
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.
Rosie Goldsmith, BA, LMT, DAFNS
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.
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.
Silver Award Winner
Paul Lewis, NCBTMB, RMT, CDT
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.
Gold Award Winner
Portia Resnick, MA, ATC, LMT
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.
Rosi Goldsmith from Portland, OR
Background- Parkinson’s Disease (PD) is a disabling, neurodegenerative movement disorder, affecting over 1.5 million Americans. Non-motor symptoms (NMS) and quality of life (QoL) have increasingly become a focus of PD research over the last 10 years.
Objectives- To explore what contributions massage therapy could make to this focus as part of a multi-modal approach to PD treatment.
Methods- A 63 year old male, diagnosed with PD for 5 years, was seen for 56 sessions of 45-90 min. over 36 weeks. Validated, widely accepted Parkinson’s rating scales were administered at study onset, three intermediate points, and conclusion to track motor and NMS and QoL changes, and were supplemented by clinical assessments, narrative reports, medication records, and pain rating scales.
As a proxy measure for parasympathetic response, a fingertip pulse-oximeter monitored heart rate during bodywork interventions of Swedish massage, acupressure, myofascial release and Ortho-Bionomy®. Neurologically targeted exercises and exercises for posture, balance and coordination were developed to complement a home program of yoga routine, mindfulness practice, and meditation.
Results- Posture, gait and balance showed clinical improvements. Overall, graphs of QoL and NMS showed no worsening, or modest gains, but no trend emerged for motor symptoms. Symptoms worsened significantly after adverse life events. A surprising discovery was that sustained massage compressions along paraspinal muscles consistently calmed restless leg syndrome and initiated an overall parasympathetic response. Patient reported sometimes being able to calm tremors and restore normal movement by meditation and mental rehearsal of his yoga routine at home.
Conclusions- These results cannot be attributed to massage alone, considering the multi-modal approach, and medication changes. Although the patient attributes his symptom stabilization to a supportive therapeutic massage relationship, this hypothesis was not investigated. More research may be productive.
Silver Award Winner
Laura Allen from Rutherfordton, NC
Backround and Objective- To enable the subject to cut down on pain medication, currently prescribed at 7.5 mg of Percocet (acetaminophen and oxycodone) 4 times per day, through the help of massage therapy. The subject states he does not like to take it that frequently because it makes him feel lethargic and disoriented. 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. He has multiple diagnoses of osteoarthritis, scoliosis, spinal stenosis, and degenerative disc disease.
Methods- The massage used was a combination of Swedish strokes (effleurage, petrissage, and 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.
Results- 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. Conclusion: The success of this intervention for this subject suggests that massage therapy can be an effective intervention for chronic low back pain.
Gold Award Winner
Angela Burke from Boulder, CO
Objective- Autism Spectrum Disorder (ASD) is a developmental disability that manifests as impairments in social interaction, communication and behavior. The objective of this study is to determine if Zen Shiatsu can reduce short and long-term stress levels in a child with ASD.
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 designed for children with Autism, the client indicated his stress level before each session, as well as afterward. 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- Based on the 5-point pictorial stress scale, the client indicated that stress levels decreased 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.
Conclusion- Zen Shiatsu, a form of Traditional Chinese Medicine, has the potential to be a viable treatment for stress reduction in children with Autism Spectrum Disorder, therefore improving overall quality of life.