Past Practitioner Case Report Contest
Comparing the Effects of Rest and Massage on Return to Homeostasis Following Submaximal Aerobic Exercise
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.
Dynamic Angular Petrissage (DAP); A Novel Therapeutic Approach for Axillary Web Syndrome
Silver Award Winner
Paul Lewis, NCBTMB, RMT, CDT
Background/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.
Bowenwork for Migraine – Is it all in the Head?
Bronze Award Winner
Sandra Gustafson, MHS, BSN, RN
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.
Contralateral Treatment for Centrally Sensitized Chronic Shoulder Pain” A Case Report
Rosie Goldsmith, BA, LMT, DAFNS
Background/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 injuryinduced 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.
Therapeutic Scraping for the Treatment of Chronic Overuse Injury of the Shoulder of CrossFit Athlete
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.
Zen Shiatsu: A Viable Intervention for Stress Reduction in Children with Autism Spectrum Disorder
Gold Award Winner
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.
The Use of Massage Therapy to Relieve Chronic Low Back Pain
Silver Award Winner
Backround/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.
Case Report on Exploration of Massage, Bodywork and Mind-Body Interventions for Parkinson’s Disease
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.
Keywords: Parkinson Disease; Pulse Oximetry; Massage; Parasympathetic Nervous System; Meditation.
Assessing the Effectiveness of Massage Therapy for Bilateral Cleft Lip Reconstruction Scars
Gold Award Winner
Background/Objective: Bilateral cleft lips occur when the bones that form the upper lip fail to fuse at birth. Surgical reconstruction creates scars, which may lead to the following impairments; adhesions, decreased oral range of motion, decreased strength of orbicularis oris muscle, and asymmetry of oral region leading to poor self-esteem. The purpose of this case study is to determine the effectiveness of massage therapy in its ability to improve these impairments.
Methods: A 5 week treatment plan consisting of fascial release, kneading and intraoral techniques. Subjective information was assessed on two scales; restriction of scar and clients attitudes and acceptance of scar. Objective information was cataloged through photographs, palpatory evaluation and a self-created “Pen Test”.
Results: Results included increase range of motion and strength, decrease restrictions (palpable and subjective) and increase symmetry. Client’s perceived confidence of scar and its appearance increased.
Conclusion: The evidence suggests that massage therapy helped with the impairments associated with scars formed by bilateral cleft lip reconstruction.
Eight Week Chair Massage Intervention for Client with Severe Atopic Dermatitis
Atopic Dermatitis (AD) is a chronic skin condition affecting an estimated 17.8 million Americans1. It is characterized by itching, an inflamed rash, excessive dryness or scaling. AD usually has an early childhood onset. Symptoms are persistent, lasting 14 days or longer, and are typically accompanied by asthma or allergic rhinitis or hay fever. The causes of AD are not fully understood but are thought to be a combination of genetics, environment, and immunological factors. Stress also plays a role in the development and exacerbation of dermatological symptoms 2,3 and there is an established link between psychological and dermatological disorders 4,5,6. Massage therapy has been shown to reduce stress levels in recipients 7,8,9,10 and a study of children with atopic dermatitis produced symptom improvement over a 5 week intervention period 11. Our investigative team hypothesized that regular chair massage might reduce symptoms in a 32 year old client who has suffered AD since infancy. An eight week chair massage intervention was performed. Twice weekly half hour chair massages were given alternately by two licensed massage therapists (LMTs). The LMTs followed the same massage protocol. The client maintained a journal in which she recorded the severity of both AD symptoms and her stress level using a 5 point numerical scale. Client also kept a daily photographic record of her AD symptoms. While twice weekly massage may have reduced redness and facilitated the relaxation response in the client, there was no noticeable improvement of symptoms as reported by client.
The Effects of Massage Therapy after Decompression and Fusion Surgery of the Lumbar Spine: A Case Study
Bronze Award Winner
Background: Spinal fusion and decompression surgery of the lumbar spine are common procedures for problems such as disc herniations. Various studies for postoperative interventions have been conducted however no massage therapy studies have been completed. The objective of this study is to determine if massage therapy is beneficial to treat pain and dysfunction associated with lumber spinal decompression and fusion surgery.
Methods: Client is a 47-year-old female who underwent spinal decompression and fusion surgery of L4/L5 due to chronic disc herniation symptoms. 7, 30 minute treatments were conducted over 8 weeks. Treatment was conducted on the back, shoulders, posterior hips and posterior legs. Techniques included rocking, shaking, gliding, wringing, stripping, kneading, compression, passive hip range of motion and myofascial release techniques including skin rolling, connective tissue cutting, fascial spreading, C-bowing, and S-bowing. VAS pain scale was recorded before and after every treatment. Hamstring Length Test, Oswestry Disability Index and the Roland-Morris Disability Questionnaire were recorded before and after 8 weeks of treatment.
Results: There was no significant changes in pain. Hamstring length improved (measured in degrees) at first treatment from pre 40 and post 60, left pre 65 and post 70. After the final visit the results were right pre 50 and post 65, left pre 70 and post 75. The Oswestry Disability Index improved 14% from 50% to 36% disability. Roland-Morris Disability decreased 1 point from 3/24 to 2/24.
Conclusions: Massage for pain had short term effects. Massage therapy seemed to lengthen the hamstrings bilaterally. Massage therapy does appear to have positive effects in the reduction of disability. This study is beneficial in beginning to understand the relationship between massage therapy and clients who have undergone spinal decompression and fusion. Further research is warranted. Keywords: Spinal decompression, spinal fusion, massage therapy, lumbar spine
Massage Treatment Improves NTOS Symptoms and Mobility: A Case Study on Neurogenic Thoracic Outlet Syndrome
Silver Award Winner
Neurogenic Thoracic Outlet Syndrome (NTOS) is a neuromuscular condition affecting brachial plexus functionality. Massage therapy serves as a conservative treatment for this condition, but the extent of its benefit is unclear. The objective of this case study is to quantify the effect of massage on key symptoms of NTOS. Eight treatment sessions were administered over a 35-day period, integrating trigger point therapy, stretching, cross fiber friction, myofascial release, manual vibration, and therapeutic touch massage techniques. Treatments induced symptomatic alleviation and improved range of motion over time; massage rendered a 49% decrease in muscle weakness, 45.7% range increase in external shoulder rotation, and a 13.5% improvement in shoulder abduction mobility. Therapy yielded a limited change in muscular spasm severity, frequency, and muscular strength. Results suggest massage is a critical treatment for managing key symptoms of and improving range of motion in NTOS patients.
Keywords: thoracic outlet treatment; brachial plexus compression; neurogenic
Massage Therapy for Lyme Disease
Gold Award Winner
Objective: To study the effects of massage therapy on Lyme disease symptoms of pain, fatigue, and impairment in concentration.
Methods: A 21-year-old college student who had been diagnosed and treated for Lyme disease was recruited. Her pain, fatigue, and impairment in concentration were recorded daily using visual analog scales (VAS). Positive and negative affect were measured before and after each massage therapy session using the Positive and Negative Affect Scale (PANAS). A treatment and withdrawal procedure was developed, consisting of two three-week periods of massage twice per week. A nine-day control period occurred before the massage therapy sessions were applied, as well as a withdrawal between sets, and a nine-day up period. A composite score of pain, fatigue, and impairment in concentration was created. Researchers conducted intake and termination interviews with the client.
Results: Lyme disease symptoms tended to stay the same or increase during non treatment periods, and to decrease during treatment periods. There was an average improvement of -0 .69 points per day in the first massage therapy set, and an improvement of -1.54 points per day during the second set. Control and withdrawal periods showed an average increase in composite scores, 0.38 points per day, 0.74 points per day, and 2.59 points per day.
Conclusions: Massage therapy is a promising treatment for the symptoms associated with Lyme disease. Further research, in the form of more carefully controlled study designs, is needed to validate these effects, and to refine our understanding of massage therapy as a possible treatment of Lyme disease symptoms. Keywords: Lyme disease, massage therapy, prospective, pain, concentration, fatigue, arthritis, quasi-experiment.
The Effects of Massage on Pain, Stiffness and Fatigue Levels Associated with Ankylosing Spondylitis: A Case Study
Gold Award Winner
Rosemary Chunco, LMT, BA, MSc Plano, TX
Objectives: To study the effects of massage on pain, stiffness, and fatigue in a patient recently diagnosed with ankylosing spondylitis (AS).
Methods: A 47-year-old woman with AS diagnosed 11 months earlier received 7 massages across a 28-day period. Her pain, stiffness, and fatigue were recorded using visual analogue scales daily during the study period. Spinal mobility was measured at each massage session with finger-to-floor measurements for both forward and lateral flexion. The client also used a daily journal to supply pertinent information on quality of life.
Results: Improvement was recorded in all dependent variables, with stiffness intensity showing the greatest improvement, to a final value of 0.75 from an initial value of 5. Duration of stiffness also showed improvement, to a final value of 1.2 from an initial value of 3.5. Improvement was also found in general pain (final value: 1; initial value: 4), fatigue (final value: 1.5; initial value 5), and forward and lateral flexion (forward flexion distance final: 4 inches; initial: 6 inches; lateral flexion, left distance: final, 16.5 inches; initial, 21 inches; right distance: final, 16.5 inches; initial, 20.5 inches).
Conclusions: Massage shows promise as a treatment for symptoms associated with AS. Further study is needed to validate these effects and to determine the feasibility of massage as an adjunct to standard care for AS patients with mild-to-moderate symptoms of AS.
Keywords: Ankylosing spondylitis , massage therapy , fatigue , pain This case report was published in IJTMB Vol 4, No 1. Read the full study here.
The Effects of Specific Injury Treatment and Facilitated Stretching on Acromial Clavicular Joint Pain with a Possible Separated Shoulder
Rosalyn Smarr, LMT Dayville, OR
Background: Acromio-clavicular (AC) joint pain is a common complaint in athletes who participate in contact and throwing sports. Soft tissue techniques are commonly incorporated in recovery, but there has been little research on whether or not the use of massage therapy alone can aid full recovery.
Objectives: This case study’s intent was to facilitate a complete recovery of shoulder use.
Methods: The subject of this study was a 17 year old male athlete. The study consisted of nine treatment sessions of Specific Injury Treatment and Facilitated Stretching applied to all muscles related to shoulder movement. Range of motion (ROM) and pain levels were assessed at each session.
Results: The results of the study indicated that the applied treatment was successful in decreasing pain and increasing normal ROM. Directly after injury, the subject modified all physical activity, but by the completion of the treatment subject had unimpeded use of the shoulder.
Conclusion: For this case study participant, massage therapy was helpful in aiding a full recovery from AC joint injury. The first group of muscles addressed did not decrease pain and a change in treatment emphasis was made before positive effects were noted. Keywords: shoulder injuries, contact sports injuries, Proprioceptive Neuromuscular Facilitation, shoulder pain
Treating Chronic Cervical Dystonia with Massage Therapy: a Case Study
Gold Award Winner
Glenda Keller, RMT, BPHE
No abstract available.
Integrating CAM Therapies into a Multidisciplinary Treatment for Glioblastoma Multiforme: Utilizing Reflexology for Pre-intra-arterial Chemotherapy Anxiety and Massage Therapy for Post-intra-arterial Chemotherapy Bed Rest Pain and Muscle Spasm: A Case Study
Silver Award Winner
Anthony Balluff, ARCB, Jeremy E. Miller, NCTMB, Jeffery A. Dusek, PhD
No abstract available.
The Role of Therapeutic Massage and Integrative Medicine for Supporting a Mother Experiencing Infant Loss during her Acute Care Hospital Stay
Mollie M. O’Brien
No abstract available.
Massage Therapy Effects in a Long-Time Prosthetic User with Fibular Hemimelia
Gold Award Winner
Background: Low back pain (LBP) is a common occurrence in lower limb amputees (LLA). Although massage effects for LBP have been widely documented, little research has been conducted regarding massage for LLA. Objectives: This study evaluated the effectiveness of massage therapy to promote activity level, decrease LBP, and improve health-related quality of life (HRQOL) in a long-time prosthetic user.
Methods: The 36- day study consisted of two baseline sessions, seven treatment sessions during which a 50- minute massage protocol was applied to low back muscles and related muscle groups, and two follow-up sessions. Measurements of ambulatory activity level, pain level, and HRQOL were assessed.
Results: The results of this study indicate that pain level decreased, HRQOL increased, and no change occurred in ambulatory activity level measured as step counts per day. In addition, the participant felt less restricted by the condition.
Conclusion: For the case study participant, therapeutic massage facilitated a decrease in pain level as measured using a Visual Analog Scale (VAS) and an augmented HRQOL as determined through the RAND-36 Health Status Inventory (RAND-36 HSI) but failed to increase ambulatory activity level.
Keywords: Lower Limb Amputee (LLA); Manual Therapy; Pedometer; Low back pain (LBP); RAND-36 Health Status Inventory (RAND-36 HSI).
The Effects of Massage Therapy in Treatment of Chronic Plantar Fasciitis
Silver Award Winner
Glenda Keller, RMT, BPHE
The aim of this study is to determine the effectiveness of massage therapy techniques for treatment of chronic plantar fasciitis. Plantar fasciitis is the number one cause of heel pain, however, research in the massage therapy field is not extensive. This study deals with a 51 year-old female with chronic plantar fasciitis. Treatments included 8, 30 minute sessions over 4 weeks using general Swedish massage including trigger point therapy and cross fiber frictions followed by ice massage, myofascial release, and stretching. Subjective testing and VAS pain scale were used to track daily function. Results of the study showed that pain levels decreased on first steps taken in the morning, the amount of participation in high weight bearing activities (Scottish Country Dancing) increased, and pain level post dancing significantly decreased. In Conclusion, massage therapy is shown to be an appropriate method to treat chronic plantar fasciitis although further research is needed.
Keywords: Foot pain, heel pain, myofascial release, cross-fiber frictions
Reduction and Stabilization in Parkinson-related Peripheral Edema with Therapeutic Massage
Robin B. Anderson, LMT, NCTMB, CPT-ACE
Objective: This study considered therapeutic massage as a complementary modality to reduce and stabilize lower extremity edema relating to possible side effects from current medications and bradykinesia in a client with Parkinsonism.
Methods: An 80 year old female client diagnosed with Parkinson’s disease (PD) presented with right lower leg edema causing mild pain, discomfort, restless sleep patterns, and added difficulty in activities of daily living (ADL). Over a six month period, the subject received ten 30 minute weekly to bi-monthly massages in the supine position to the lower extremity using Swedish effleurage, a modified lymphatic drainage stroke, and mild vibration and friction with trigger points. Girth circumference measurements were taken pre and post session to determine any change.
Results: Girth measurements showed a statistically significant decrease and stabilization in the presence of edema, which conveyed into improved restful sleep quality and PD related motor functions in ADL.
Conclusion: The reduction and stabilization in the leg edema enabled palpable access for massage to lower leg musculature. The client currently experiences improved motor function in ADL, pliable musculature that can be exercised to improve balance and coordination and decrease gait shuffling, and an overall positive outlook in the management of Parkinsonism.
Keywords: Neurological disorders, elderly, lower extremity edema, Parkinson’s disease
The Use of Massage Therapy for Long-Term Glycemic Control in a Type 2 Diabetic Client
Sherry A. Robinson-Jackson
The objective of this study is to determine if glycemic control in a type 2 diabetic client continues to improve after Swedish massage treatments cease. For years, complementary and alternative medicine has been utilized for diabetic management. Specifically, massage therapy is effective in lowering glucose levels during a massage. However, knowledge of the long-term effects of massage therapy on fasting blood glucose (FPG) levels will provide a means to improve diabetic management as well as defend against future diabetic cases. Methods involved monitoring FPG levels four weeks prior to massage treatments, during month of massage treatments, and four weeks after massage treatments ceased. The massage treatments entailed one hour Swedish massage sessions administered weekly. Results of this study demonstrated lower fasting glucose levels remained even after treatment ceased. Swedish massage has the potential to sustain lower FPG levels long-term.
Keywords: Swedish massage, type 2 diabetes, stress management, fasting blood glucose level
Orthopedic Massage Protocol for Post-ACL Reconstruction Patellofemoral Pain Syndrome
Gold Award Winner
The intent of this study is to determine the effectiveness of orthopedic massage in the rehabilitation of post anterior cruciate ligament (ACL) reconstruction patellofemoral pain syndrome (PFPS). The primary complications following surgical repair of the ACL and classified as PFPS are hamstring flexion contracture and quadriceps weakness, leading to patellofemoral dysfunction and retropatellar pain. Treatment included lymphatic drainage, myofascial release, neuromuscular therapy including trigger point release, muscle energy technique and cross-fiber friction. Orthopedic physical assessment tests were used to track effectiveness of massage as well as subjective reporting on pain level and function. Results of this study showed a decrease in pain levels, hamstring flexion contracture, and lateral tracking of the patella. Orthopedic massage was determined to be an effective complementary therapy in the treatment of PFPS.
Clinical Reasoning in Massage Therapy
Silver Award Winner
Clinical reasoning has long been a valuable tool for healthcare practitioners, but has been under-researched in the field of massage therapy. Case studies have been a useful method for exploring the clinical reasoning process in various fields of manual therapy, and can provide a model for similar research in massage therapy. A challenging diagnostic case study concerning a client with low back pain serves as a guideline for examining the clinical reasoning process. Methods include self-reflective questions pertaining to beliefs about health problems; beliefs about the mechanisms of pain; the medical conditions that could explain the pain; knowledge of the client’s anatomy; consideration of treatment options; observations made during treatment; extent of experience treating similar problems; and the ability to recognize clinical patterns. Such questions resulted in a differential diagnosis, which explained the low back pain of the aforementioned client and led to a satisfactory treatment resolution. This study serves as an example of the value of clinical reasoning in the field of massage therapy, and the need for expanded research into its methods and applications. Such research will hopefully lead to greater respect for the clinical reasoning process of massage therapists from other members of the healthcare profession.
The Role of Massage Therapy and Bodywork in the Treatment of a Client Diagnosed with Dissociate Identity Disorder
Bronze Award Winner
Objective: The study describes an effective massage therapy/bodywork session format and protocol for a client with the diagnosis of Dissociative Identity Disorder (DID). The study covers a 3 and a 1/2 year time period from April 2004 through September 2007. Skills and guidelines found necessary for effective treatment were reviewed.
Methods: Client received weekly massage therapy for 1 and a 1/2 hours per session. Client concurrently received weekly psychotherapy sessions from a psychologist trained to treat severe trauma. Massage therapy sessions consisted of three segments: opening to a stated intention, bodywork which fell into three categories (muscular/physical discomfort, “healing process”, and restorative), and closing for grounding and sharing feedback. Massage therapist maintained written notes of sessions which documented intention, bodywork modality, observations of client during treatment (presence, grounding, emotional states), and client feedback.
Results: Treatment outcomes are presented from three perspectives: the client, psychotherapist and massage therapist. Client made significant progress in remaining reconnected to her body, and developing appropriate interpersonal relationships.
Conclusion: Massage therapy/bodywork was effective for this client with the diagnosis of Dissociative Identity Disorder. Client and psychotherapist stated that massage therapy/bodywork expedited client’s healing process. It is important to work in partnership with a psychotherapist and meet together with the client on a regular basis. This study supports the literature that an integrated mind-body approach is effective for treating severe trauma.
Massage as Conservative Treatment for Chronic Exertional Compartment Syndrome
Background: Chronic exertional compartment syndrome (CECS) has been recognized as a condition for the past sixty years. The most common site of occurrence is the anterior compartment of the leg. Patients with CECS are instructed to modify their activity level or undergo surgery to manage the symptoms of this condition.
Objectives: This study examines massage as a conservative treatment option for an individual exhibiting the symptoms of CECS.
Methods: The 52-day study consisted of two baseline sessions, two follow-up sessions, 11 treatment sessions during which a 20-minute massage protocol was applied to each leg with the goal of increasing functionality and decreasing symptoms, and three functional assessments. Measurements of limb girth, temperature, and range of motion, and a Likert scale were recorded before and after each treatment session.
Results: There was no change in limb girth or foot and toe temperatures, decreased neutral angle, decreased exertional pain, and increased time until onset of symptoms in the case study participant. Also, the participant feels less restricted by his condition.
Conclusion: For the study participant, therapeutic massage has the potential to increase functionality and decrease symptoms of CECS.
The Effectiveness of Massage Therapy on Postpartum Nondiscogenic Sciatica
Background/Objectives: To determine the efficacy of massage therapy in addressing postpartum hip, leg and low back pain.
Methods: A 37-year-old female subject reported chronic pain in right hip and lower back following pregnancy. 8 sessions of trigger point and neuromuscular therapy were performed over a 4 week period. Treatments lasted 45 minutes of structured protocol addressing TFL, QL, Piriformis Gluteus Medius and Gluteus Minimus, and iliolumbar ligament. Beginning with the third week of treatment, subject experienced a significant reduction in pain and anxiety and a concomitant increase in ease of daily activity.
Results: Patient reported significant decrease in pain and anxiety surrounding the performance of daily activities and care taking and by the time of this report had begun to engage in exercise with confidence and ease.
Conclusions: Massage therapy is efficacious in addressing the presenting condition. Future research should address the integration of manual therapeutics in mitigating postpartum pain of nondiscogenic origin.
Massage Therapy Techniques as Pain Management for Erythromelalgia
Erythromelalgia is characterized by temperature-dependent redness, pain, and warmth in one or more extremities. It may be a primary disease or occur secondarily to underlying illnesses (Mehle, 1990). It is a rare, chronic, and debilitating condition often resistant to treatment as directed by medical professionals. Patients often seek alternative methods to control the painful symptoms from erythromelalgia. This treatment case report describes the application of massage therapy for a patient diagnosed with erythromelalgia as a method for pain relief and to improve its side effects and symptoms. Massage therapy treatments took place over the course of eight weeks and were typically one hour in duration, depending on the comfort level of the patient on the given day. This treatment time included an assessment before and after the session to gauge changes in present symptoms. Pain and discomfort were rated on an intensity scale, and activities planned or that took place between treatments were recorded. Homecare was also advised in order to maintain the work done during the massage therapy treatment.
The massage therapy treatment for the patient who suffers with erythromelalgia proved to provide temporary relief from symptoms during the treatment time itself. On several occasions, the symptoms returned hours, or sometimes moments after the session was complete. The longer term positive benefits lasted upwards of three days after treatment and included an increase in relaxation, decreased anxiety, and improved sleep. All of which are important components to lessen emotional stress often experienced by chronic pain sufferers. At no time during massage therapy treatments did the patient experience severe episodes of erythromelalgia symptoms. Introducing massage therapy in addition to the treatment recommended by his or her doctor, a patient diagnosed with erythromelalgia may experience personal benefits to help manage pain, lessen stress, and decrease anxiety that is caused by the debilitating symptoms of erythromelalgia.
The Use of Lymphatic Facilitation with Anterior Cruciate Ligament (ACL) Reconstruction Rehabilitation
Objective: To explore the effectiveness of lymphatic facilitation in the rehabilitation program of an ACL reconstruction.
Methods: A 20-year-old female gymnast in a rehabilitation program to an ACL reconstruction surgery of her right knee. 30 minute massage therapy sessions were administered by two LMPs 1-2 times per week totaling 19 sessions over a 12 week period. Sessions consisted of lymphatic facilitation, scar mobilization, and basic sports massage. The gymnast also received physical therapy from the athletic trainers and followed a rehabilitation program which included strengthening, neuromuscular, and cardiovascular exercises.
Results: Final measurements of the knee showed a decrease in the circumference at the patella of .5 inches, at the proximal edge of the patella of .375 inches, and no change 3 inches proximal to the patella.
Conclusions: Lymphatic facilitation is beneficial in reducing edema from an ACL reconstruction surgery. Further research should concentrate on a larger-scale study with control groups to determine the level of effectiveness compared to athletes that do not receive lymphatic facilitation as part of their rehabilitation program.