Zen Shiatsu: A Viable Intervention for Stress Reduction in Children with Autism Spectrum Disorder


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.

Utilizing Chair Massage to Address One Woman’s Health in Ghana, West Africa: A Case Report


Gold Award Winner 
Cathy Meryanos
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.

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


Honorable Mention
Krina Patel
Cortiva Institute
Boston, MA

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.

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


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.

The Use of Massage to Increase the Performance of a Brazilian Jiu-Jitsu Athlete by Increasing Range


Alta Schwab
Center for Neurosomatic Studies – Clearwater, Florida


Background: Brazilian Jiu-Jitsu is a modern combat martial art that utilizes joint locks to force an
opponent into submission. It is a high intensity combat sport that places unique stresses on the
body leading to atypical injuries and muscular imbalance, a possible predictor of injury. Athletes
with a history of low back pain have significant reductions in hip range of motion, and
maximum hip flexibility is necessary to perform optimally.

Participant: 40-year-old Caucasian male Jiu-Jitsu black belt presenting with restricted range of
motion in the right shoulder and both hips as well as left SI joint and posterior gluteal pain
Diagnosis: Herniated L4-5 disc with no other notable health issues
Purpose: To discover if the utilization of massage can increase the performance of a BJJ athlete
by increasing range of motion and decreasing pain.

Intervention: The practitioner a 25 year old female within 3 months of the end of her third
semester of a three-semester, 18-month program at the Center for Neurosomatic Studies
(CNS). Biweekly targeted, deep-tissue massage treatments were performed for five weeks. The
results were tracked using the Bournemouth MSK scale, PGIC, WOSI, active range of motion
measurements measured with a goniometer, and routine Posturology assessments.

Results: There was significant improvement in range of motion in the shoulder, elbow, and both
hips as well as eliminated SI joint pain and some diminished pain in the posterior gluteal area.
The patient also claimed to have experienced improved performance in BJJ training.
Discussion: The participant was training for a tournament throughout the duration of the study,
thus he was training more than normal (5-6 time weekly); this is likely why there was less
improvement in pain than there was improvement in functionality.

Keywords: Brazilian Jiu-Jitsu, range of motion, shoulder, hips, elbow.

The Use of Massage Therapy to Relieve Chronic Low Back Pain


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.

The Effect of Massage Therapy on Postural Dysfunction Exacerbated by Parkinson’s Disease


Bronze Winner
Keiko Marumo
MacEwan University
Edmonton, Alberta, Canada

Background: The causes that lead to low back pain (LBP) vary, and include poor
postural alignment, muscle fatigue, and chronic conditions. Deviations from
balanced upright posture can result, leading to hypertonicity in compensatory
muscles. With increased kyphosis and forward head posture, affected tissues
include scapular retractors and anterior cervical muscles. With decreased lumbar
lordosis, affected tissues include lumbar, trunk and hip muscles. Conditions such
as Parkinson’s disease (PD), can exacerbate LBP, since a common sign of it is
postural change.
Objective: To show that massage therapy is effective in reducing LBP by
applying relaxation, myofascial release (MFR), mobilization, and stretching
techniques, and hydrotherapy heat to postural misalignment resulting from PD.
Methods: A 55-year-old male diagnosed with PD in 2012, presented with
shooting LBP in the left lumbar region after lifting a heavy gate. Clinical analysis
suggested muscle strain exacerbated by postural changes related to PD. The
treatment aim was to decrease LBP in the affected muscles. The treatment plan
involved 50-minute sessions of massage, once a week, for five weeks. Techniques
included hydrotherapy heat application, relaxation techniques, MFR techniques,
passive stretches, and passive mobilizations. The treatment was provided by a
second year massage therapy student.
Results: The patient reported an overall decrease in pain intensity, by rating pain
descriptors. The patient also reported a general decrease in disability caused by

Massage Therapy Treatment for Diabetic Peripheral Neuropathy: Case Report


Honorable Mention
Veronika Peycheva
MacEwan University – Edmonton, Alberta, Canada

Five massage therapy sessions were provided to a patient with long-standing diabetic peripheral neuropathy (DPN). The aim of the treatment was to increase circulation in the lower limbs and through that improve tissue health. Also it was suggested that massage therapy could help with pain management and thus help the patient with everyday tasks and work. Nerves and blood vessels get compromised with DPN leading to poor healing and thus development of ulcers on the legs. Though some limitations were present, five sessions still proved to be effective in providing relief to the patient and allowing the patient to work and maintain daily activities. The major suggestion is that with chronic issues such as DPN massage can be helpful if provided on the ongoing base, and not just for five session. Also it is very important to educate the patient about feet-care and self massage in order to get the maximum benefits in terms of tissue health and circulation in the lower limbs.

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


Gold Winner
Youlanda Casciaro
MacEwan University
Edmonton, AB, Canada


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.
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.

Massage Therapy as a Treatment for Rheumatoid Arthritis Affecting the Wrist and Hand: A Case Report


Brandy Sharpe
MacEwan University – Edmonton, Alberta, Canada


Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease with a characteristic
destructive nature, and is marked with periods of exacerbations and remissions. Affecting any
joint in the body, RA presents with inflammation, pain, stiffness, edema, and a decrease in joint
function over time. The cause of RA is unknown.

Objective: To examine the effects of massage therapy on RA affecting the wrist and hand using
goniometry, grip strength measures, pinch strength measures, and subjective pain scales.
Methods: The study period included an initial and final assessment with the treatment being six
massage therapy sessions carried out by a student massage therapist over a seven-week timespan.
The subject, a 64-year-old female, presented with RA affecting the left wrist and hand. The
intent of the treatment was to increase grip strength, pinch strength, and range of motion (ROM),
and to decrease pain. In order to achieve these goals, a massage routine with specific techniques
was created. Longitudinal stroking (effleurage), petrissage, trigger point (TrP) therapy, frictions,
manual oscillations, and paraffin wax were the methods applied to the affected hand and wrist.

Results: Grip and pinch strength improved in both the affected and unaffected hands. ROM
increased in the affected hand. The unaffected hand’s ROM results varied, with a slight increase
in one motion and a decrease in another. The subject reported a decrease in pain in the affected
wrist and hand.

Conclusion: The results suggest that certain massage therapy techniques, when implemented
regularly, have a positive effect on RA in the form of increasing strength and ROM, and
decreasing pain.

Keywords: Rheumatoid arthritis, massage, manual oscillations


Massage Therapy as a Treatment for Medial Epicondylitis in a Guitarist: A Case Report


Honorable Mention
Sadie Friesen
MacEwan University – Edmonton, Alberta, Canada


Background: Medial epicondylitis is an overuse injury characterized by micro-tears in the
musculotendinous unit of the flexor-pronator musculature. Medial epicondylitis presents with
pain, tenderness, stiffness, limited range of motion, loss of strength and reduced function. Pain
syndromes of the musculotendinous unit are noted to be the most common of all upper extremity
disorders in instrumentalists. Massage therapy can be of benefit to these presentations.

Objective: To examine the effects of massage therapy on pain, adhesions and scar tissue,
hypertonicity, pinch and grip strength and performance in a guitarist with medial epicondylitis.

Methods: The study period included an initial and final assessment with treatment scheduled for
five massage therapy sessions carried out by a second-year massage therapy student over a sixweek
period. The subject, a 54-year-old male guitarist, presented with medial epicondylitis on
the left side. Assessment measures included pain scales, pinch and grip strength measures, and
the Disabilities Arm, Shoulder and Hand (DASH) Questionnaire. The treatment plan was
prepared with the intention of decreasing pain, reducing adhesions and scar tissue, reducing
hypertonicity, increasing pinch and grip strength and increasing performance. This would be
achieved through the application of moist heat, skin rolling, myofascial release, direct fascial
techniques, wringing, muscle stripping, trigger point therapy, and frictions completed with ice.

Results: The subject reported a decrease in pain affecting the arm, wrist and hand. Pinch and grip
strength improved in the left hand. DASH scores decreased.

Conclusion: The results suggest that a variety of therapeutic massage techniques have a positive
effect on medial epicondylitis when received regularly. Massage therapy increased strength and
decreased pain in subject, along with other symptoms commonly seen in medial epicondylitis.

Massage and Atlanto-Occipital Mobilization to Improve Symptoms in a Boy with Autism


Honorable Mention
Dan Vidal
Center for Neurosomatic Studies – Clearwater, Florida

This project was a 5 week-long case study examining the potential therapeutic effects of massage and atlanto-occipital mobilization on a 3 year old boy with autism.

The hypothesis was that alleviation of distortions in the atlanto-occipital joint would improve circulation to and from the brain which might in turn help improve the client’s language and communication skills.

While the effects of general massage techniques were negligible, the effects of atlanto-occipital mobilization in particular were significant. After just one treatment involving atlanto-occipital mobilization the client’s ATEC scores improved by 20%. The client’s mother also noticed remarkable improvements in his behavior in the days and weeks following the treatment. This has profound implications for the potential benefit of targeted manual therapy for children with autism spectrum disorder.

Effects of Massage Therapy on Pain, Sleep Quality, and Breathing Function in a Sciatica Patient


Bronze Winner
Melinda Lugo
Center for Neurosomatic Studies – Clearwater, Florida


The purpose of my case study was to determine if massage, combined with inner unit stabilization exercises, could decrease pain, improve sleep quality, and increase breathing pattern functionality in a patient with sciatica. My research participant presented with low back pain classified as sciatica. She reported having issues with poor sleep quality, and had a history of recurrent pneumonia and chronic bronchitis. The patient’s goals were to have more energy, be free of pain, and get better sleep. Current research show a growing interest in the role breathing pattern disorders play in trunk stability, functional movement, and pain pathologies. I focused on treating muscle groups that would affect the patient’s back pain and breathing issues and worked with the patient to develop a home care plan that aimed to target trunk stability. The patient and I were very pleased with the results: her back pain was resolved, her sleep improved, and she was breathing better. I’m happy to report that she is still doing well.

Effects of Massage Therapy on Pain Associated with Partial Lumbarization of S1


Honorable Mention
Briana Covey
Canadian College of Massage and Hydrotherapy
Halifax, Nova Scotia, Canada

Introduction: Lumbarization, known as a transitional vertebra or lumbrosacral transitional
vertebra, is a congenital abnormality where the first segment of sacrum is not fused. The purpose
of this study is to explore the effects of massage therapy on the management of chronic low back
pain associated with right sided partial lumbarization of S1, by using General Swedish and non-
Swedish massage techniques.
Methods: The patient was chosen based on her chronic back pain due to her right sided partial
lumbarization of S1. A treatment plan was designed using General Swedish and non-Swedish
technique and performed for ten, one hour treatments. The patient’s progress was monitored
using a visual analogue scale for pain, energy, and quality of sleep, as well as assessment of
range of motion.
Results: Results showed a three point decrease in day-to-day pain of the patient. Improved
quality of sleep by two points and increased energy levels by three points in the morning and one
point in the evening were reported as well.
Conclusion: The outcomes of this study therefore suggests that massage therapy is an effective
treatment for managing chronic low back pain due to right sided partial lumbarization of S1.

Effectiveness of Massage Therapy in Improving Range of Motion and Posture of Shoulder and Cervical Region in a Morbidly Obese Patient: A Case Report


Kianoosh Esraghian
Grant MacEwan University – Edmonton, Alberta, Canada


Background: Range of motion (ROM) is defined as the extent of movement of a joint for a
certain inter-segmental rotational movement. Range of motion is primarily restricted by
musculature and skeletal structures. It may also be affected by other factors such as age, gender,
and obesity, which can have debilitating effects. Lack of physical activity, reduction in function,
and fatty tissue surrounding the joints or adjacent structures may contribute to restrictions in
range of motion in obese individuals. Lack of suitable equipment and protocols for treating
morbidly obese individuals limits the effectiveness of the therapist and the desire of the patient to
consider massage therapy as a viable treatment option.

Objective: To demonstrate the effectiveness of massage therapy on reduction of symptoms in a
morbidly obese patient experiencing pain in the shoulder, restrictions in ROM during specific
movements, and acquired postural alterations.

Methods: A 58-year-old disabled, morbidly obese male presented with pain and stiffness in his
right shoulder. A student massage therapist conducted initial and final assessments and treated
the patient over a six-week period. Techniques were chosen to help the patient reach his goals of
reducing pain, and improving range of motion and posture. Techniques utilized were trigger
point therapy (TrP), soft tissue frictions (STF) and direct fascial (DF) techniques. Stretches were
chosen to help maintain results and promote active recovery.
Results: After five treatments, shoulder and cervical ROM increased and shoulder pain
diminished. The patient was able to move through the entirety of range with minimal discomfort.

Conclusion: Results suggest that with modified positioning and techniques, massage therapy
combined with therapeutic exercises can help reduce non-specific shoulder pain, increase range
of motion, and improve posture in morbidly obese patients.

Keywords: range of motion, obesity, homecare, shoulder, cervical

Effect of Massage Therapy on the Proprioceptive System of an Autistic Child – A Case Study


Gold Winner
Rachel Benbow
HACC, Central Pennsylvania Community College
Harrisburg, PA

Background: 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
prove the efficacy of massage therapy on proprioceptive dysfunction in children
with ASD, but if proven effective massage therapy could offer a new intervention
for this issue.
Purpose: 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.
Participant: 5 year old female 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.
Improvements in proprioceptive abilities were monitored through pre and postmassage
testing activities that included single foot balancing, jumping rope, backand-
forth ball bouncing, and independent ball dribbling.
Results: 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.
Conclusion: Although positive results were achieved within this case study, more
extensive studies are needed to verify the efficacy of massage therapy on
proprioceptive dysfunction in children with ASD.

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


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.

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


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.

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


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.

Case Report on Exploration of Massage, Bodywork and Mind-Body Interventions for Parkinson’s Disease


Honorable Mention
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.

Bowenwork for Migraine – Is it all in the Head?


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.

A Specific MFR Technique for Treatment of Non-Specific Upper Quadrant Mylagia and Paraesthesia – A Case Study


Honorable Mention
Sebastien Vachon-Gravel
Atlantic College of Therapeutic Massage
Fredericton, New Brunswick, Canada

Objective: Investigate whether a case presenting with non-specific upper quadrant
muscle pain and neurological dysfunction would benefit from an isolated myofascial
release (MFR) technique, entitled herein as direct fascial glide with static unwinding (DFG-
SU), in a multitude of related variables: degree of disability and pain, shoulder girdle
kinematics and pectoralis minor length, unilateral upper-extremity strength, and
neurological functioning.
Methods: The intervention consisted of six treatments over a period of five weeks
with pre- and post-intervention examinations. Pain characteristics and degree of disability
was monitored with the Revised Short-Form McGill Pain Questionnaire (SF-MPQ-2) as
well as the Shoulder Pain and Disability Index (SPADI) and performance of Apley’s
scratch test, respectively. Shoulder girdle kinematics was examined via the combination
of an inclinometer and goniometer. Pectoralis minor length was assessed using a tape
measure against a table and a wall in supine and standing positions, respectively. A handheld
dynamometer allowed for the quantification of grip strength on the affected side.
Finally, tactile sensation and Tinel’s sign was compared using a three-point ranking
system from normal sensation to anaesthesia.
Results: Overall degree of pain, disability, and neurological pain ameliorated after
the intervention, yet no notable change in pectoralis minor length or shoulder girdle
kinematics was noted. Nonetheless, the restricted aspect of Apley’s scratch test and
unilateral grip strength improved by 3.5cm and 2kg, respectively. Finally, tactile
sensation and Tinel’s sign improved from presence of paraesthesia to normal sensation.
Conclusions: The results suggest that the MFR technique described herein
improved overall wellbeing and competence in daily tasks without significantly altering