Sep
5
2023
Research confirms that some forms of massage help against low-back pain
But not all techniques live up to the promises made for them
Most people have experienced back pain – and many hope that massage will relieve it. But not all forms of massage have been scientifically proven to help against low back pain. That is what the German Institute for Quality and Efficiency in Health Care (IQWiG) pointed out in information published on informedhealthonline.org today.
Back pain often affects the lower back and can be a big physical and psychological burden. “The cause of back pain is not always immediately clear,” explains Professor Peter Sawicki, the Institute’s Director. “But low back pain usually gets better on its own within a few weeks.” Back pain is only rarely caused by a more serious health problem.
Classic massage, Thai massage and acupressure could help against low back pain
If low back pain does not get better on its own, massage therapy could be a worthwhile option. “Research suggests that classic massage, Thai massage and acupressure can relieve low back pain that has lasted longer than several weeks,” says the Institute’s Director. In classic (Swedish) massage the affected area of skin and muscles are massaged, in Thai massage the limbs are pulled and stretched, and acupressure involves applying pressure to certain points on the body. “But relying on massage alone does not appear to be the best approach when it comes to back pain”, adds Sawicki. Research indicates that people could benefit more if they combine massages with exercises and stretching. In some trials this combination of approaches led to better pain relief and mobility compared to massage alone.
Not all massages are the same
“Not all forms of massage have been scientifically proven to help against chronic back pain though,” concludes Sawicki. “So it is worth finding out about the different techniques before deciding to have a certain type of massage.” An overview of the most common forms of massage is now available on http://informedhealthonline.org/low-back-pain-can-massage-help.630.en.html
The researchers pointed out that the main goal of massage therapy can be very different. For example, some therapists are aiming to help the person (and their muscles) relax, while others are more focused on stretching or working on the body in other ways. Although the trials studied various massage techniques, there were not enough comparisons of treatments to show which forms of massage might be the most worthwhile for people with different problems.
Many of the treatments had mixtures of several elements – like massage oils, stretching, and more than one type of massage technique. The researchers concluded that acupressure (by hand or using an instrument to apply the pressure) may be particularly effective, but more research is needed to be sure. Based on the small amount of research so far, it seems that Thai massage achieves similar results to classic massage techniques. However, foot reflexology massage does not appear to relieve back pain or improve mobility. The people in the trials did not have any serious adverse effects. Some reported having pain during or shortly after treatment. And some had an allergic reaction to a massage oil and got a rash.
Sep
5
2023
Assessment Through Touch, by Leon Chaitow, Now in the 3rd edition, fully revised and published in February 2010 with CD-ROM.
This useful guide to palpation for musculoskeletal diagnosis and assessment describes and illustrates the skills needed to increase sophistication of palpatory assessment skills and practice. A companion CD-ROM supports the skills with video clips, and each technique is reinforced with practical exercises and self-assessment questions.
This book is available from: http://www.terrarosa.com.au/book/palpate.htm
By combining a workbook approach with the use of video demonstrations and audio explanations on a CD-Rom, Palpation Skills provides the student and developing practitioner with a portable workshop which they can access at any time. The book helps to extend the range of skills by bringing together suggested approaches from a variety of disciplines.
* Covers the palpation and assessment of all tissues and systems, including the skin, muscle structure, and the spine and pelvis
* Gives practical guidance and instruction on a broad variety of palpation techniques
* All the palpation techniques covered are clearly described and illustrated in the text and supported by video film on the CD-Rom
* Each technique is supported by practical exercises and self assessment questions.
* Further questions relating to the video clips are included in the CD-Rom
* Directs the beginner in the correct way to carry out the techniques and provides additional techniques for the practitioner to add to his basic library of skills
* Provides outcome expectations against which progress can be measured.
* The video support can help to identify how to improve these skills.
* Written by a highly respected practitioner and teacher – brings his workshops to the individual at home and in the clinic
* 2 colour printing throughout the text helps to clarify the structure of the content and the details of the movements being shown in the diagrams
* The CD-Rom (featuring video clips) supports and supplements the written text.
This book is available from: http://www.terrarosa.com.au/book/palpate.htm
Sep
5
2023
Short-Term Effect of Muscle Energy Technique on Pain in Individuals with Non-Specific Lumbopelvic Pain: A Pilot Study
NM. Selkow; TL. Grindstaff; KM. Cross; K Pugh; J Hertel; S Saliba
ABSTRACT: Muscle energy technique (MET) is a form of manual therapy frequently used to correct lumbopelvic pain (LPP), herein the patient voluntarily contracts specific muscles against the resistance of the clinician. Studies on MET regarding magnitude and duration of effectiveness are limited.
This study was a randomized controlled trial in which 20 subjects with self-reported LPP were randomized into two groups (MET or control) after magnitude of pain was determined. MET of the hamstrings and iliopsoas consisted of four 5-second hold/relax periods, while the control group received a sham treatment. Tests for current and worst pain, and pain with provocation were administered at baseline, immediately following intervention and 24 hours after intervention. Separate 2×3 ANOVAs were used to assess results as change scores.
Visual analog score (VAS) for worst pain reported in the past 24 hours decreased for the MET group (4.3mm±19.9, p=.03) and increased for the sham (control) group (17.1mm±21.2, p=.03). Subjects receiving MET demonstrated a decrease in VAS worst pain over the past 24 hours, thereby suggesting that MET may be useful to decrease LPP over 24 hours.
The Journal of Manual & Manipulative Therapy,2009, volume 17, full text PDF
Sep
5
2023
It can happen for no reason, it seems, taking you completely by surprise. And it can be excruciating. Suddenly, a muscle contracts violently, as if it had been prodded with a jolt of electricity. And it remains balled in a tight knot as painful second after painful second drags on. Cramps afflict 39 percent of marathon runners, 79 percent of triathletes, and 60 percent of cyclists at one time or another, said Dr. Martin P. Schwellnus, a professor of sports medicine at the University of Cape Town.
Cramps can occur during exercise, immediately after, or he said, as long as six hours later. Yet common as they are and terrible as they can be, no one really understands cramps. They are a medical mystery. “I would say, bottom line, there is no really convincing biological explanation for muscle cramps,” said Dr. Andrew Marks, a muscle researcher and chairman of the department of physiology and cellular biophysics at Columbia University College of Physicians and Surgeons. Medical textbooks skirt the topic, he added, often avoiding any explanation. And few scientists have studied cramps. But as anyone who has ever complained of cramps will attest, lots of advice is circulating on how to avoid them and lots of people — friends, coaches, doctors — think they have a solution.
Take a multivitamin pill to get zinc and magnesium. Massage the muscles. Drink plenty of water. Be sure to get enough electrolytes like sodium and potassium. Stretch before you start to exercise. No, stretch as soon as you finish. See a nutritionist to correct imbalances in your diet. See a trainer to be sure you are moving correctly.
Of course, Dr. Marks said, medical conditions can lead to cramps, including narrowed blood vessels, usually from atherosclerosis, or compression of a nerve, as happens in spinal stenosis. Cramps also can arise from hypothyroidism. And they can be a side effect of medications like diuretics, used to lower blood pressure, which can lead to a potassium deficiency that can cause cramps.
But, he and others said, those conditions do not explain the vast majority of cramps. “You are left with the fact that cramping usually occurs in healthy people without any underlying disease,” Dr. Marks said. There are three leading hypotheses about how to treat cramps and how to prevent them.
There’s the dehydration proposal: you just need more fluid. But, Dr. Schwellnus said, he studied athletes who cramped and found that they were no more dehydrated before or after a race than those who did not have cramps.
Then there’s the electrolyte hypothesis: what you really need is sodium and potassium. Michael F. Bergeron, who directs the environmental physiology laboratory at the Medical College of Georgia, said the electrolyte hypothesis applies to a specific type of cramp that is related to excessive sweating. It occurs, he said, when the fluid that bathes the connection between muscle and nerve is depleted of sodium and potassium, which was lost through sweat. The nerve then becomes hypersensitive, Dr. Bergeron said. “Usually you feel little twitches first,” he explained. “They last for 20 to 30 minutes and if you don’t do anything you can be in full-blown cramps.” Those cramps, he continued can move from place to place on your body, from one leg to the next, to your arms, stomach, even your fingers or your face. The solution, Dr. Bergeron said, is to drink salty fluids like Gatorade (the company sponsors his research). He said he had prevented cramps in tennis players this way. But asked whether there are any rigorous studies to confirm this hypothesis, he said no. “We haven’t done the study yet,” he said. “We’re at the point of kind of connecting the dots.”
The third hypothesis is advanced by Dr. Schwellnus. He questions the electrolyte hypothesis because his studies of Ironman-distance triathletes as well as other studies of endurance athletes found no difference in electrolyte levels between those who suffered cramps and those who did not. DR. SCHWELLNUS proposes that the real cause of cramping is an imbalance between nerve signals that excite a muscle and those that inhibit its contractions. And that imbalance, he said, occurs when a muscle is growing fatigued. His solutions for cramps are to exercise less intensely and for shorter times, to be sure you had enough carbohydrates to fuel your muscles, to train sufficiently and to regularly stretch the muscles that give you problems. These recommendations are based on his recent study of Ironman triathletes, Dr. Schwellnus said. But while he advocates those practices, he said, they have not been proved in a rigorous study. In the meantime, some doctors have resorted to experimenting on themselves, devising their own explanations and cures.
Dr. Charles van der Horst, an AIDS researcher at the University of North Carolina, said he was stunned when his calf started to cramp without warning when he was running. The pain was almost unbearable, he said, and even when the muscle finally relaxed, it cramped again when he resumed running. “I started carrying a cellphone with me on long runs,” Dr. van der Horst said. When a cramp struck, he called his wife to ask her to drive out and get him. “I think I was getting calcium deposits or something,” Dr. van der Horst said. His solution was to massage his calves at all hours, pushing deep into the muscle. This seems to work, he said, explaining that it’s been a year now since he had a cramp.
Dr. Stephen Liggett, a professor of medicine and physiology at the University of Maryland, has a different solution. He got terrible cramps in his calf during yoga. The culprit, he decided, was the drugs he takes for asthma, which can diminish the body’s supply of potassium. He knew that potassium is sold over the counter. But because high levels of potassium can be dangerous, store-bought potassium supplements are not very strong.
Dr. Liggett’s solution is not one anyone who is not a doctor should try at home. Before he does yoga, he measures the potassium levels in his blood before and after taking what he describes as a hefty dose of over-the-counter supplement. Then he calculates how much additional potassium he thinks he needs, securing it from concentrated potassium tablets from his research lab — how much he declined to say. “I didn’t want to drink two gallons of Gatorade,” Dr. Liggett explained. He hasn’t had cramps since he began “preloading,” as he calls it, with potassium. But, he said, “I haven’t done a controlled trial.” Dr. Marks, for one, is not convinced by the evidence for any of the hypotheses, nor by any of the proposed remedies. What causes cramps? “I would say the answer to that question is still open to investigation,” he said. And, he added, he hopes someone takes it up.
http://www.gainesvillesun.com/article/20080214/ZNYT04/802140319
