Massage therapy complements chiropractic by helping adjustments last longer and increasing patient confidence and compliance
Massage therapy and bodywork techniques are gaining respect and popularity as legitimate forms of alternative health care. Many chiropractors find these techniques both beneficial for their patients, and complementary to chiropractic.
As a trained massage therapist, Robert Haberkorn, DC, began his chiropractic career already convinced of the value of massage. He still uses massage in conjunction with chiropractic and also employs a massage therapist in his Palm Springs, Calif, clinic. “One benefit of having massage therapist and chiropractors working together is that the massage therapists can see more surface areas,” he explains. “Often, they can point out things the doctor might not see,” he says, since they typically spend longer periods of time with patients.
Getting Touch-y Feel-y
Patients may open up more during a long, relaxing massage session. It is not uncommon for patients to disclose details about a condition they forgot to mention to the doctor. Also, when massage therapists works with unclothed patients, they may also notice signs or pathology that could otherwise go undiagnosed.
A preliminary massage can also smooth the way to an easier adjustment, notes June Wieder, DC, a former New York City chiropractor and bodywork practitioner who has moved her practice to Ridgecrest, Calif, near Death Valley.
Wieder uses a bodywork technique called Trager, which she characterizes as a gentle technique well suited for her elderly patients. She is also trained in Swedish massage, shiatsu, and other techniques. She describes her use of chiropractic, Trager, and massage as “a beautiful, effective combination.
Trager works well on joint mobility and freeing up the body,” she says. “It increases range of motion (ROM), using gentle wave-like movements through the body. It is a good way to relax those muscles before giving an adjustment.”
Otherwise, she notes, when muscles stay tense, they can pull the bones out of alignment again after the adjustment; with massage, adjustments tend to last longer.
Currently, Wieder refers patients to outside massage therapists when she is too busy to see them. However she is seeking an in-house therapist, as well as an acupuncturist. “I’d rather offer it right then and there instead of sending patients out of the office,” she says.
Haberkorn, who uses applied kinesiology as a diagnostic tool, prefers that his patients be massaged after the adjustment, rather than before. Although he agrees that preliminary massages often makes adjustments easier, he has found that massages can mask patients’ reflex points when working with applied kinesiology. “With my massage background, it is easier to find trigger points and problem areas,” he says. “So I send in the massage therapist to relax those areas after I’ve put the bones in place.”
Having both services in one place is a benefit to patients, he adds. Unfortunately, insurance companies do not always agree to pay for massage and chiropractic on the same day and in the same office—a problem for Haberkorn, who has some patients who live 1-hour away. “It’s not uncommon to have a massage and then an adjustment afterward, or the other way around,” he says.
Wieder says her massage and bodywork background makes her more attractive to patients. “It alleviates some of their fears,” she says. If a patient has had a painful adjustment in the past due to resistance caused by muscle tension, he is reassured by her ability to “soften up the muscles so the bone goes into place with just a slight pressure.”
Patients also have positive expectations that they will receive more hands-on work. And, if they have trouble choosing which health professional to visit, a two-in-one combination covers more bases. “It can be a one-stop shop,” she quips.
Wieder says her patients recover more quickly with the combination of techniques, and they have created a high referral base for her business. Haberkorn notes that having a massage therapist in the office and teaching a nutrition class at his local massage school has had a very positive impact on his own referral base.
“People will [visit] a massage therapist when they’re afraid to go to a doctor,” he explains. “They think a massage will make it feel better. I see so many people who have gone to a massage therapist and reported that ‘My leg has been numb for about 2 years, but I figured I could rub it out.’ They’re afraid to go to doctors because the doctor might find something wrong with them, [whereas] massages are not as threatening.”
The Midas Touch
Massage attracts people because they enjoy it, Haberkorn adds. “It’s something people feel good about [and] look for.” Some people who are reluctant to part with a $5 copay for chiropractic care are willing to pay cash for a massage and even leave a tip, he notes. The difference may be partly because more touch is involved, he suggests. “Human touch is a need, just like food and water. There are people who are actually touch-starved, I believe,” he says.
Research confirms the healing value of touch and massage. In one study1 involving premature infants who were massaged for 15 minutes, three times a day over a period of 10 days, the benefits included an average 47% weight gain. Researchers projected a potential $47 billion saving in hospital costs if premature infants were routinely treated with 10 days of massage.
Another study by Tiffany M. Field, PhD, director of Touch Research Institutes, University of Miami School of Medicine,2 documented increased attention following a 15-minute chair massage. Subjects were able to compute math questions more accurately in less time after the massage.
Fibromyalgia patients also responded well to massage, a further study3 found. One group of patients received a 30-minute massage twice a week for 5 weeks. Compared with another group that was taught relaxation techniques, the patients reported more sleep while their physicians assigned lower pain, disease, and tender point ratings.
The effectiveness of massage increases when combined with exercise and education about proper posture. In a study of treatments for subacute low back pain, comprehensive massage therapy (including soft tissue massage, remedial exercise, and posture education) was the only method found to decrease the intensity of pain for all members of the group that received this modality.4
The same group also scored better on measures of function, as well as intensity and quality of pain than the other three groups, who received either soft tissue manipulation alone, remedial exercise alone, or a sham laser treatment.
Benefits of the Rub
Scientific evidence is mounting for the claimed benefits of massage. Massage is said to improve health by boosting body processes. Some include:
• increased ROM;
• increased blood circulation, which in turn aids the utilization of nutrients;
• improved lymph flow;
• reduced heart rate, increased oxygen capacity;
• improved posture;
• lower blood pressure;
• strengthened immune system;
• improved function of sebaceous and sweat glands;
• increased production of endorphins and serotonin, which decrease pain;
• helping tissues retain their elasticity; and
• improvement to conditions such as insomnia, allergies, digestive disorders, arthritis, asthma, sinusitis, nervousness, anxiety, and depression.
Massage also stimulates muscles and improves muscle tone. “Massage can cause up to a 40% contraction of the muscle,” Haberkorn says. “So if someone is paralyzed, you can actually slow down the muscle loss through massage.
“I worked with someone who was wheelchair-bound,” he continues, “and we were actually able to get some of his flexibility back.”
Passionate about the beneficial value of massage therapy, Haberkorn, has presented seminars at the California Chiropractic Association conventions to help massage therapists and chiropractors better understand each other. “A lot of chiropractors and doctors do not understand that you can get dramatic effects from a massage,” he says. “They think a massage just makes you feel good, it’s just rubbing muscles. But I’ve seen benefits that compare to the effects of chiropractic.”
Haberkorn suggests massage therapy can be helpful in treating conditions such as: peripheral nerve entrapments (thoracic outlet syndrome, carpal tunnel syndrome, and golf and tennis elbow); recurrent subluxations due to hypertonic muscles, circulation-related symptoms like diabetes, cold hands and feet, and swelling; short, tight muscles; and auto-accident-related trauma such as whiplash and strains.
In some countries, such as China, massage therapists are as respected as doctors, he adds. “Tui na massage is one of the four branches of Chinese medicine. It’s designed for healing.”
According to the American Massage Therapists Assocation (AMTA), in America, current numbers of massage therapists, including students, are approximately 220,000. An estimated $4 to $6 billion is spent on massage therapy annually, and the AMTA quadrupled its membership in just 10 years during the 1990s.
It’s All in the Technique |
| The Associated Bodywork and Massage Professionals Association (www.abmp.com) reports there are more than 200 massage and bodywork techniques. Some of the most popular are: • Swedish massage—the most widely used massage technique. Developed by a 19th-century Swedish athlete, Per Henrik Ling, this method uses a variety of movements: 1) long, firm strokes, are directed towards the center of the body; 2) kneading or grasping movements work deeply into the muscles; 3) percussive, rhythmic movements, such as hacking, a light, quick chopping motion with the side of the hand performed up and down the length of a muscle, are used to create a relaxing effect; 4) light vibration or friction is a cross-fiber movement that affects the underlying tissue, which is used on very sensitive areas such as the face; and 5) therapists may also actively or passively move a client’s joints. • Alexander Technique—a practice of postural re-education that works to change habits of holding tension that negatively effect posture. Many performers have used this technique to attain a relaxed upright posture. • Craniosacral or cranial sacral therapy—a very gentle touch used to locate and release areas of restriction in the craniosacral system. As discovered by William G. Sutherland, DO, the cranium is not one immovable piece, but several interlocking sections capable of very slight movement. In 1977, John E. Upledger, DO, OMM, built on the technique when he discovered membranes surrounding the brain and spinal cord. These membranes affect the movement of cerebral spinal fluid and can be manipulated by gentle palpation. This therapy can be particularly helpful for those with headaches and temporomandibular joint syndrome. • Deep tissue massage—often used on a specific area, rather than the whole body. The therapist uses slow strokes and deep finger pressure on areas of contracted soft tissue to release chronic patterns of tension. • Hydrotherapy—can include the use of hot and cold compresses, steambaths, soaking in pools or tubs, as well as jets of water with which the patient is massaged. • Manual lymph drainage—originated in Europe during the 1930s to aid the flow of the estimated nearly nine gallons of lymphatic fluids through the body’s system of ducts and channels. Aids elimination of toxins, dead cells, and extraneous protein. Lymphatic drainage is particularly helpful for those who are inactive. Gentle, circular movements encourage the lymphatic fluids out of congested areas towards the lymph nodes. This technique can also be used to ease discomfort and reduce swelling associated with carpal tunnel syndrome. • Myofascial release—used since the 1950s, this softening and stretching technique developed by osteopaths is used to remove fascial adhesions and to soften and stretch scar tissue. The client is required to draw on the muscle while the practitioner maintains pressure on the restricted area, alert to feedback from the muscle in order to avoid reflexive tightening. | • Neuromuscular therapy—this deep tissue pressure technique is generally used to reduce and eliminate chronic myofascial pain. Through postural analysis, the practitioner determines where the patient’s chronic patterns of connective tissue holding may require stretching and release. • Reflexology—specific points on the feet, hands, and sometimes the ears are believed to correspond to the organs and other parts of the body. By massaging and applying pressure to these points, the organs are stimulated to greater health. • Rolfing (called Structural Integration by its originator, Ida Rolf, PhD (biochemistry))—manipulates the body’s myofascial structure to affect dramatic changes in posture. The practice was originally quite deep and painful, but current practitioners often find less pressure is equally effective. • Shiatsu massage—related to the Chinese medical practices of acupressure and acupuncture, shiatsu originated in Japan. Therapists apply pressure to key points along energy channels called meridians, to correct and balance the client’s lifeforce energy, known as chi or qi. Disease is thought to be caused by blocked or unbalanced chi. Shiatsu means “finger pressure,” but the technique can actually use many types of movement, including lifting, rolling, pinching and shaking. • Sports massage—several massage techniques can be used, including Swedish massage, rhythmic compression to soften and warm up muscles for deeper massage techniques, trigger point massage, lymphatic massage to reduce edema and effusion, and cross-fiber massage, which employs general friction to stretch fibers of large muscle groups, or transverse friction to reduce adhesions and encourage healthy, flexible healing of torn or damaged muscles. Sports massage helps the athlete maintain optimal muscle health, while event massage is an adjunct to the warm-up and can take place before, during, or after competition. Finally, rehabilitative massage can improve and enhance recovery from injury. • Trager Approach—a gentle method first developed by Milton Trager, MD, to treat patients affected by polio and other neuromuscular disorders, this technique now enjoys more general use. The client’s body or limbs are gently rocked to encourage a painless release of long-term patterns of tension, and to support more fluid movement. • Transfriction therapy or deep transverse friction—the therapist massages across muscle fibers with deep, sweeping friction. Considered particularly useful for tendon and ligament lesions and to prevent intermolecular adhesive cross links. • Trigger point massage—finger or thumb pressure is performed to release nodules in muscles and connective tissue, thereby breaking patterns of chronic tension or spasm, reduce pain and hypersensitivity, and increasing range of motion. • Tui na—developed more than 2,000 years ago in China, Tui na is related to acupuncture, but uses hand or finger pressure instead of needles. Diagnosis is made by feeling the pulses. The practitioner works to aid the healthy flow of chi along energy meridians. CP |
For more information on massage therapy, visit the following websites: AMTA: www.amtamassage.org and Associated Bodywork and Massage Professionals: www.abmp.com. CP
Grace Golightly is a contributing writer for Chiropractic Products.
References
1. Field TM. Research on massage therapy, preterm growth and development. Touchpoints. 2001;8(3):1–2. Available at: www.miami.edu/touch-research/touchpt.html . Accessed June 30, 2002.
2. Field TM. Research on massage therapy, attention and attention disorders. Touchpoints. 2001;8(3):2–3. Available at: www.miami.edu/touch-research/touchpt.html. Accessed June 30, 2002.
3. Field TM, Diego M, Cullen C, Hernandez-Reif M, Sunshine W. Research on massage therapy, fibromyalgia pain and substance P decreases and sleep improves following massage therapy. Touchpoints. 2001;8(3):3. Available at: www.miami.edu/touch-research/touchpt.html. Accessed June 30, 2002.
4. Preyde M. Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial. Can Med Assn J. 2000;162(13):1815–1820. Available at: www.amtamassage.org/foundation/article8.htm. Accessed June 30, 2002.
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