Back Clinic Therapeutic Massage Team. We all want to relax. In our hectic lives, it’s hard to find time for R&R. If you deal with this in your life, a massage is in order. Massage therapy is a general term that refers to various types of soft tissue manipulation for therapeutic purposes. It involves manually working on the body with gentle pressure or through the use of mechanical aids. Depending on the way the massage is applied, it can be used to provide relaxation and well-being.
Healthcare providers recognize massage therapy as a legitimate therapy for lower back pain. It utilizes manual manipulation to improve circulation, relax muscles, improve range of motion, and increase endorphin levels. This therapy usually follows some medical treatment. Types of therapy include neuromuscular, sports, and Swedish.
For example, Neuromuscular therapy, which is the most effective treatment for low back pain, consists of alternating levels of pressure applied to muscles to alleviate the muscle spasms. First of all, make sure to drink plenty of water following a massage. With massaging procedures, the tissues of your body will be stimulated, resulting in the release of toxins.
Drinking at least 10 glasses of water throughout the day will flush out the toxins. Aim to drink 2-3 glasses within the first hour or so and then at least 8 more within the next 24 hours. In the hour following the massage, drink several glasses and then continue with eight more in the next 23 hours.
For individuals dealing with headaches, can utilizing self-care techniques help ease symptoms?
Headaches Self Care
There are different self-pain-relieving approaches to ease headache-related pain that use non-medication options. While headache self-care pain-relieving techniques can help temporarily, they are recommended to help ease headache symptoms until professional treatment is available. Individuals are encouraged to try multiple strategies to find the right treatment regimen that works for them, which is usually a process of trial and error. Self-care headache relief maneuvers can include temple massages, breathing exercises, exercise, or applying a cold pack to the head.
Self-Care Relief
Commonly used for tension headaches or migraine, a few examples of self-care techniques include (Espí-López G. V. et al., 2016)
Massaging the temples, neck, or scalp with the hand, fingers, or a massage tool.
Applying a cold pack to the affected area.
Heat can be used on the affected area, like a headband or a hot shower.
Compression such as a handkerchief or belt wrapped tightly around the head or pressing firmly on the painful area.
Compression is more commonly utilized in migraineurs versus scalp massage in people with tension headaches. This is often due to the throbbing sensation caused by a migraine versus a tension headache, which feels like a tight grip or band around the head.
Individuals with cluster headaches are more likely to utilize unique approaches, such as covering one ear, rotating the head, shallow breathing, moving around, or closing the nostril on the same side as the head pain.
Various scientific studies support the potential benefit of these complementary therapies. However, individuals should talk with a healthcare provider to choose the best strategy for their headache type and their unique needs/goals. Working with a chiropractic team can help expedite healing. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment plan through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Tension Headaches and Chiropractic Care
References
Espí-López, G. V., Zurriaga-Llorens, R., Monzani, L., & Falla, D. (2016). The effect of manipulation plus massage therapy versus massage therapy alone in people with tension-type headache. A randomized controlled clinical trial. European journal of physical and rehabilitation medicine, 52(5), 606–617.
Millstine, D., Chen, C. Y., & Bauer, B. (2017). Complementary and integrative medicine in the management of headache. BMJ (Clinical research ed.), 357, j1805. doi.org/10.1136/bmj.j1805
For individuals who sit regularly for work and are slumping forward, can strengthening the rhomboid muscles help prevent posture problems and relieve pain?
Rhomboid Muscles
The rhomboids are a group of muscles in the upper back. A rhomboid major and minor muscle on each side of the upper back forms the shoulder girdle, which, along with other muscles, helps maintain the stability of the shoulder and shoulder blade. The rhomboid muscles control:
Pulling
Lifting
Rotating the shoulder blade.
These muscles also contribute to arm movement and enable lifting the arms above the head.
The rhomboid muscles support healthy posture and upper back. (Yoo W. G. 2017)
Sitting for an extended time, slumping forward, overstretching the arm above the body, sleeping on one side, repeated throwing motions, and sports like volleyball can affect the rhomboid muscles and cause pain symptoms.
Anatomy
There are two rhomboid muscles. The major originates on the thoracic spine from the second through the fifth vertebrae and inserts on the side of the shoulder blade facing the spine. The minor is superior to the major and inserts on the C7 and T1 vertebrae. The muscles connect between the spine and each of the shoulder blades. When they contract, they pull the shoulder blades together. The muscle fibers run diagonally. They affix the scapula against the torso, allowing a stable base from which the arms can move.
Symptoms
When rhomboid muscles are overused or strained, symptoms can include the following:
Tenderness around the shoulder blade.
Limited range of motion in the shoulder.
Pain around the shoulder blade.
Upper back pain.
Neck pain.
Arm fatigue when performing repetitive overhead movements.
A crunching sound when moving the shoulder.
Weakness in the arm.
Chest pain.
Muscle Building
The action of the rhomboid is to bring the shoulder blades together, lift them or elevate them, as when shrugging, and rotate them so they face downward, away from the head. Bringing the shoulder blades together or scapular retraction builds the rhomboids to support the upper back.
To improve or prevent posture problems or mild, muscle-related upper-back and/or neck pain, 10 to 15 repetitions of scapular retraction performed one to three times every day are targeted exercises that could be recommended to help strengthen the muscles. However, consult a primary care provider, physical therapist, or chiropractor for serious medical conditions that affect posture to develop a personalized exercise program specific to the individual’s condition or injury. Everybody is different, and there is no one-size-fits-all when incorporating exercise to manage back pain. The physical therapy team may recommend other exercises to help manage or reverse any postural issues. (Kim, D. et al., 2015)
Overstretched Muscles
The human body has a unique and challenging relationship with gravity, which creates a downward pull on its structures, including the spine, head, and shoulders. As gravity pulls, the shoulders roll forward, and the chest can sink in. (Harvard Health, 2022). The rhomboid muscles may become overstretched, or the pectoral muscles and soft tissues in front may tighten up and constrict. Strengthening the rhomboids can help release the pectoral muscles.
Forward Head Posture
Unhealthy posture can lead to chronic pain and back problems. (Kripa, S. et al., 2021) Over time, unhealthy posture can also cause a forward head posture. (U.S. National Library of Medicine Clinical Trials, 2020) Forward head posture can lead to soft tissue strain, a kink in the neck, and fatigue in the muscles holding the head up, which can cause chronic neck pain. Maintaining strong extensor muscles in the lumbar and thoracic spine can help prevent back and neck problems as the body ages.
Injury Medical Chiropractic and Functional Medicine Clinic
We passionately focus on treating patients’ injuries and chronic pain syndromes and develop personalized care plans that improve ability through flexibility, mobility, and agility programs tailored to the individual. Using an integrated approach, our areas of chiropractic practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols to relieve pain naturally by restoring health and function to the body through Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them, as Dr. Jimenez has teamed up with the top surgeons, clinical specialists, medical researchers, and premier rehabilitation providers to provide the most effective clinical treatments. We focus on what works for you and strive to better the body through researched methods and total wellness programs.
Functional Healing
References
Yoo W. G. (2017). Effects of pulling direction on upper trapezius and rhomboid muscle activity. Journal of physical therapy science, 29(6), 1043–1044. doi.org/10.1589/jpts.29.1043
Kim, D., Cho, M., Park, Y., & Yang, Y. (2015). Effect of an exercise program for posture correction on musculoskeletal pain. Journal of physical therapy science, 27(6), 1791–1794. doi.org/10.1589/jpts.27.1791
Kripa, S., Kaur, H. (2021). Identifying relations between posture and pain in lower back pain patients: a narrative review. Bulletin of Faculty of Physical Therapy, 26. doi.org/https://doi.org/10.1186/s43161-021-00052-w
U.S. National Library of Medicine Clinical Trials. (2020). Strengthening and stretching exercise to improve forward head posture and rounded shoulders. Retrieved from clinicaltrials.gov/study/NCT04216862
Can incorporating acupressure provide effective relief and benefits for individuals looking to try natural treatments for common health ailments?
Acupressure
Acupressure is a type of complementary medicine that is rising in popularity due to its simplicity and accessibility. It can assist in treating various diseases and conditions. (Piyush Mehta et al., 2016) Anyone can learn it, and no special equipment is required. It is an effective and safe therapeutic option with no known side effects. (Youngmi Cho et al., 2021) It is a cost-effective intervention similar to acupuncture. (Lukas Israel et al., 2021)
What Is It?
The concept of acupressure activates acupoints or pressure points across meridians or channels connected to various organs to balance energy and promote health. Practitioners believe that the quality or state of a person’s energy determines their health. (Piyush Mehta et al., 2016) Acupressure is the stimulation of acupoints using either the fingers or a tool. Massage techniques like Amma, Shiatsu, Tui Na, and Thai massage incorporate acupressure in their treatments and follow the same energy channels as acupuncture.
The Way It Works
Acupressure works similarly to acupuncture. The Gate Control Theory theorizes that pleasure impulses reach the brain four times faster than pain impulses. Continuous pleasurable impulses close the neural gates and block slower messages, like pain. According to this theory, acupressure improves the pain perception threshold. (Piyush Mehta et al., 2016) Stimulating acupoints activates functional responses, like releasing hormones. These hormones serve various functions, physical, like regulating organ function, and mental, like regulating emotions, and releasing them can help improve health and well-being. (Piyush Mehta et al., 2016)
Acupressure is a simple and effective intervention that can be self or professionally administered.
Acupoints are activated in the elbows, fingers, feet, knuckles, palms, or thumbs.
Though acupressure doesn’t require specialized tools, they are available for convenience.
Some practitioners used Bian stones to activate acupoints.
Acupressure is often used alongside modern medicine, as it treats common or coexisting symptoms, such as anxiety or stress. Some of the conditions for which acupressure may be effective include.
Stress and Fatigue Reduction
Stress and fatigue are common but often arise alongside other ailments or conditions if persistent or severe, anxiety and fatigue can significantly affect quality of life by reducing an individual’s ability to participate in daily activities. In a study looking at shift work nurses who experience stress and fatigue from the intensity of their work, acupressure significantly reduced their symptoms. (Youngmi Cho et al., 2021) In studies with breast cancer survivors, acupressure was also used to decrease fatigue levels and was shown to be an effective and low-cost option for managing persistent fatigue alongside standard care for breast cancer. (Suzanna Maria Zick et al., 2018) (Suzanna M Zick et al., 2016)
Can Help With Anxiety and Depression
Depression and anxiety can be part of a disorder or exist on their own. Acupressure may help alleviate some of the anxiety and depression that arise as part of a condition or ailment. In the shift work nurses study, acupressure helped decrease anxiety levels. (Youngmi Cho et al., 2021) In other studies, acupressure reduced anxiety scores and improved depressive symptoms in individuals with mild to moderate symptoms. (Elizabeth Monson et al., 2019) (Jingxia Lin et al., 2022) (Suzanna Maria Zick et al., 2018)
Pain Reduction
Individuals experience physical pain for a variety of reasons. Pain can come from temporary sports injuries, work, sudden awkward movements, and/or chronic illness. Acupressure can effectively reduce pain as a complementary therapy. (Elizabeth Monson et al., 2019) In a study, athletes who had a musculoskeletal sports injury reported decreased pain intensity after three minutes of acupressure therapy. (Aleksandra K Mącznik et al., 2017) In another study, breast cancer survivors showed significant improvements with acupressure. (Suzanna Maria Zick et al., 2018)
Nausea Relief
Nausea and vomiting are conditions that are common for those who are pregnant or undergoing chemotherapy. It also can be a medication side effect or arise with migraine or indigestion. There is evidence that acupressure may be effective in alleviating symptoms. Some researchers believe a particular type of acupressure known as auricular acupressure is the most effective for treating chemotherapy-induced nausea and vomiting alongside standard treatment. (Jing-Yu Tan et al., 2022) However, further research is needed to determine whether this is a viable, ongoing option for treating nausea and vomiting. (Heather Greenlee et al., 2017)
Sleep Better
Acupressure can be an effective and low-cost option for managing breast cancer symptoms. One study found relaxing acupressure techniques improved sleep quality and quality of life in breast cancer survivors. Additionally, researchers note that relaxing acupressure is more effective for improving sleep and quality of life than stimulating acupressure. (Suzanna M Zick et al., 2016)
Allergy Reduction
Allergic rhinitis is inflammation caused by an allergic reaction. Previous trials have found that acupressure could improve overall health by reducing seasonal allergic rhinitis symptoms and the need for allergy medication. (Lukas Israel et al., 2021) Researchers also noted that individuals are likely to adhere to self-applied acupressure therapy as a form of self-massage. (Lukas Israel et al., 2021)
Always consult a healthcare provider before starting acupressure treatments, especially if you have any pre-existing health conditions. At Injury Medical Chiropractic and Functional Medicine Clinic, we treat injuries and chronic pain syndromes by developing personalized treatment plans and specialized clinical services focused on injuries and the complete recovery process. Flexibility, mobility, and agility programs are tailored for all age groups and disabilities. If other treatment is needed, individuals will be referred to a clinic or physician best suited to their injury, condition, and/or ailment.
Enhance Performance with Functional Foot Orthotics
References
Mehta, P., Dhapte, V., Kadam, S., & Dhapte, V. (2016). Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments. Journal of traditional and complementary medicine, 7(2), 251–263. doi.org/10.1016/j.jtcme.2016.06.004
Cho, Y., Joo, J. M., Kim, S., & Sok, S. (2021). Effects of Meridian Acupressure on Stress, Fatigue, Anxiety, and Self-Efficacy of Shiftwork Nurses in South Korea. International journal of environmental research and public health, 18(8), 4199. doi.org/10.3390/ijerph18084199
Israel, L., Rotter, G., Förster-Ruhrmann, U., Hummelsberger, J., Nögel, R., Michalsen, A., Tissen-Diabaté, T., Binting, S., Reinhold, T., Ortiz, M., & Brinkhaus, B. (2021). Acupressure in patients with seasonal allergic rhinitis: a randomized controlled exploratory trial. Chinese medicine, 16(1), 137. doi.org/10.1186/s13020-021-00536-w
Zick, S. M., Sen, A., Hassett, A. L., Schrepf, A., Wyatt, G. K., Murphy, S. L., Arnedt, J. T., & Harris, R. E. (2018). Impact of Self-Acupressure on Co-Occurring Symptoms in Cancer Survivors. JNCI cancer spectrum, 2(4), pky064. doi.org/10.1093/jncics/pky064
Zick, S. M., Sen, A., Wyatt, G. K., Murphy, S. L., Arnedt, J. T., & Harris, R. E. (2016). Investigation of 2 Types of Self-administered Acupressure for Persistent Cancer-Related Fatigue in Breast Cancer Survivors: A Randomized Clinical Trial. JAMA oncology, 2(11), 1470–1476. doi.org/10.1001/jamaoncol.2016.1867
Monson, E., Arney, D., Benham, B., Bird, R., Elias, E., Linden, K., McCord, K., Miller, C., Miller, T., Ritter, L., & Waggy, D. (2019). Beyond Pills: Acupressure Impact on Self-Rated Pain and Anxiety Scores. Journal of alternative and complementary medicine (New York, N.Y.), 25(5), 517–521. doi.org/10.1089/acm.2018.0422
Lin, J., Chen, T., He, J., Chung, R. C., Ma, H., & Tsang, H. (2022). Impacts of acupressure treatment on depression: A systematic review and meta-analysis. World journal of psychiatry, 12(1), 169–186. doi.org/10.5498/wjp.v12.i1.169
Mącznik, A. K., Schneiders, A. G., Athens, J., & Sullivan, S. J. (2017). Does Acupressure Hit the Mark? A Three-Arm Randomized Placebo-Controlled Trial of Acupressure for Pain and Anxiety Relief in Athletes With Acute Musculoskeletal Sports Injuries. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 27(4), 338–343. doi.org/10.1097/JSM.0000000000000378
Tan, J. Y., Molassiotis, A., Suen, L. K. P., Liu, J., Wang, T., & Huang, H. R. (2022). Effects of auricular acupressure on chemotherapy-induced nausea and vomiting in breast cancer patients: a preliminary randomized controlled trial. BMC complementary medicine and therapies, 22(1), 87. doi.org/10.1186/s12906-022-03543-y
Greenlee, H., DuPont-Reyes, M. J., Balneaves, L. G., Carlson, L. E., Cohen, M. R., Deng, G., Johnson, J. A., Mumber, M., Seely, D., Zick, S. M., Boyce, L. M., & Tripathy, D. (2017). Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: a cancer journal for clinicians, 67(3), 194–232. doi.org/10.3322/caac.21397
Ho, K. K., Kwok, A. W., Chau, W. W., Xia, S. M., Wang, Y. L., & Cheng, J. C. (2021). A randomized controlled trial on the effect of focal thermal therapy at acupressure points treating osteoarthritis of the knee. Journal of orthopaedic surgery and research, 16(1), 282. doi.org/10.1186/s13018-021-02398-2
For individuals suffering from neck pain and headaches, can craniosacral head massage therapy help provide relief?
Craniosacral Therapy
Craniosacral therapy is a gentle massage to release fascia or connective tissue network tension. The therapy is not new but has gained new attention because of the public interest in natural pain treatments and therapies. Studies are limited, but clinical research is ongoing to see if the therapy can become a mainstream treatment option. The therapy aims to alleviate the symptoms of various health ailments and conditions, including:
By relieving compression in the lower back, head, and spinal column, cerebrospinal fluid circulation is restored, and the body rhythms within the nervous system are reset. This provides pain relief, lowers stress, and improves overall well-being.
The focus areas are those along the fascia, the connective tissue that holds organs, blood vessels, bones, nerve fibers, and muscles in place. By working this tissue through gentle-pressure massage, practitioners help to calm the fight-or-flight response by relaxing the sympathetic nervous system. The symptoms will determine what areas of the body necessitate craniosacral therapy. Individuals with headaches will be given a head or neck massage. Other areas involved in craniosacral therapy include: (Heidemarie Haller, Gustav Dobos, and Holger Cramer, 2021)
Back
Around the spinal column.
Other areas like the joints or muscles.
The pressure applied during craniosacral therapy is light and not the same as a deep tissue massage.
The parasympathetic and sympathetic nervous systems control various body responses.
The parasympathetic nervous system supports proper rest and digestive functions, and the sympathetic nervous system regulates the body’s fight-or-flight response. (Cleveland Clinic. 2022)
Therapy Techniques
The massage techniques used in craniosacral therapy rely on low pressure intended to be as gentle as possible. The fingertips are often used to avoid applying too much pressure. Healthcare providers work the areas between the skull and the bottom of the spine to identify and reset imbalances within the body and the cerebrospinal fluid. If there is an imbalance in cerebrospinal fluid, the massage therapist will reposition the individual or press on the area to release and/or increase circulation. The techniques work to improve the body’s ability to regulate physiological responses. (Heidemarie Haller et al., 2019) During and after the session, individuals may experience different sensations, including: (Biodynamic Craniosacral Therapy Association of North America, 2024)
Relaxation.
Feeling like being in a meditative state.
Sleepiness.
Energized.
Feeling a sense of warmth.
Deeper breathing.
Feeling the body is straighter and taller.
Individuals Who Should Not Receive Craniosacral Therapy
Craniosacral therapy is considered safe; however, some individuals should avoid it or consult a healthcare provider before trying it. Those recommended not to receive the treatment include individuals with the following ailments or disorders:
Concussion or other traumatic brain injuries.
Blood clots.
Brain swelling.
Brain aneurysm – a blood-filled bulge in a blood vessel in or around the brain.
Conditions that cause cerebrospinal fluid buildup.
Treatment
Craniosacral therapy is offered by several healthcare providers, including:
Craniosacral therapy licensed massage therapists
Physical therapists
Occupational therapists
Osteopaths
Chiropractors
These professionals know how to perform the massage technique correctly.
Tension Headaches
References
Haller, H., Lauche, R., Sundberg, T., Dobos, G., & Cramer, H. (2019). Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials. BMC musculoskeletal disorders, 21(1), 1. doi.org/10.1186/s12891-019-3017-y
Haller, H., Dobos, G., & Cramer, H. (2021). The use and benefits of Craniosacral Therapy in primary health care: A prospective cohort study. Complementary therapies in medicine, 58, 102702. doi.org/10.1016/j.ctim.2021.102702
Can physical therapy with instrument-assisted soft tissue mobilization or IASTM improve mobility, flexibility, and health for individuals with musculoskeletal injuries or illnesses?
Instrument Assisted Soft Tissue Mobilization
Instrument-assisted soft tissue mobilization or IASTM is also known as the Graston technique. It is a myofascial release and massage technique used in physical therapy where the therapist uses metal or plastic tools to improve soft tissue mobility in the body. The ergonomically shaped tool is gently or vigorously scraped and rubbed across the injured or painful area. The rubbing is used to locate and release tightness in the fascia/collagen covering the muscles and the tendons. This helps reduce pain and improve movement.
Individuals often develop tissue tightness or restrictions in the muscles and fascia after an injury. These soft tissue restrictions can limit the range of motion – ROM and can trigger pain symptoms. (Kim J, Sung DJ, Lee J. 2017)
History
The Graston technique of instrument-assisted soft tissue mobilization was developed by an athlete who created their instruments to treat soft tissue injuries. The practice has grown with input from medical experts, trainers, researchers, and clinicians.
Physical therapists use different types of tools to perform IASTM.
These massage instruments comprise various types for specific massage and release.
The Graston company designs some of the tools.
Other companies have their version of metal or plastic scraping and rubbing tools.
The objective is to help release soft tissue and myofascial restrictions to improve body movement. (Kim J, Sung DJ, Lee J. 2017)
How It Works
The theory is that scraping the tissues causes microtrauma to the affected area, activating the body’s natural inflammatory response. (Kim J, Sung DJ, Lee J. 2017)
The body activates to reabsorb the tightened or scar tissue, causing the restriction.
The therapist can then stretch the adhesions to alleviate pain and improve mobility.
Treatment
Certain conditions respond well to instrument-assisted soft tissue mobilization, including (Kim J, Sung DJ, Lee J. 2017)
Limited mobility
Decreased muscle recruitment
Loss of range of motion – ROM
Pain with movement
Excessive scar tissue formation
Augmented soft tissue mobilization or ASTM techniques can treat certain injuries and medical conditions that include:
A review compared hands-on myofascial release to instrument myofascial release for chronic low back pain. (Williams M. 2017)
Little difference was found between the two techniques for pain relief.
Another review compared IASTM to other methods for treating pain and function loss. (Matthew Lambert et al., 2017)
The researchers concluded that IASTM could positively affect blood circulation and tissue flexibility and reduce pain.
Another study examined the use of IASTM, pseudo-fake ultrasound therapy, and spinal manipulation for patients with thoracic/upper back pain. (Amy L. Crothers et al., 2016)
All groups improved over time with no significant negative events.
The researchers concluded that instrument-assisted soft tissue mobilization is no more or less effective than spinal manipulation or pseudo-ultrasound therapy for thoracic back pain.
Every case is different, and musculoskeletal conditions respond differently to various treatments. For any questions or concerns, contact your primary healthcare provider to determine if IASTM is an appropriate treatment that can help.
From Injury To Recovery
References
Kamali, F., Panahi, F., Ebrahimi, S., & Abbasi, L. (2014). Comparison between massage and routine physical therapy in women with sub acute and chronic nonspecific low back pain. Journal of back and musculoskeletal rehabilitation, 27(4), 475–480. doi.org/10.3233/BMR-140468
Kim, J., Sung, D. J., & Lee, J. (2017). Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. Journal of exercise rehabilitation, 13(1), 12–22. doi.org/10.12965/jer.1732824.412
Chughtai, M., Newman, J. M., Sultan, A. A., Samuel, L. T., Rabin, J., Khlopas, A., Bhave, A., & Mont, M. A. (2019). Astym® therapy: a systematic review. Annals of translational medicine, 7(4), 70. doi.org/10.21037/atm.2018.11.49
Matthew Lambert, Rebecca Hitchcock, Kelly Lavallee, Eric Hayford, Russ Morazzini, Amber Wallace, Dakota Conroy & Josh Cleland (2017) The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review, Physical Therapy Reviews, 22:1-2, 76-85, DOI: 10.1080/10833196.2017.1304184
Crothers, A. L., French, S. D., Hebert, J. J., & Walker, B. F. (2016). Spinal manipulative therapy, Graston technique® and placebo for non-specific thoracic spine pain: a randomised controlled trial. Chiropractic & manual therapies, 24, 16. doi.org/10.1186/s12998-016-0096-9
For individuals having difficulty moving or functioning normally due to injury, surgery, or illness, can a chiropractic and physical therapy team help expedite recovery?
Friction Massage
Individuals may develop scar tissue or tissue adhesions that limit normal motion after injury or surgery. A pain management team may use various treatments and modalities and may incorporate friction massage as part of a rehabilitation treatment plan. Friction massage, also known as transverse friction or cross friction massage, is a technique used to help improve scar tissue and adhesion mobility to move better and decrease the negative effects. The therapist uses their fingers to massage the scar in a direction that is at right angles to the scar line. It is a specialized technique that breaks up tissue adhesions that are limiting normal movement in the skin and underlying tissues. (Haris Begovic, et al., 2016)
Scar Tissue and Adhesions
For individuals who require surgery due to an injury or an orthopedic condition, their doctor will cut into the skin, tendons, and muscle tissue during the operation. Once sutured and healing has begun, scar tissue forms. Healthy tissue is made up of collagen that is comprised of cells that are arranged in a regular pattern. Healthy collagen is strong and can resist forces when tissues are pulled and stretched. (Paula Chaves, et al., 2017)
During the healing process after an injury, the collagen cells are laid down in a haphazard pattern and form scar tissue. The random accumulation of cells becomes tight and does not react well to tension and stretching forces. (Qing Chun, et al., 2016) The body can form scar tissue after a soft tissue injury, like a muscle or tendon strain. (Qing Chun, et al., 2016)
If a muscle or tendon gets strained the body will generate new collagen during the healing. The new collagen is laid down in a random fashion, and scar tissue or tissue adhesions can form that can limit the normal range of motion. Healthy tissue stretches and glides as the body moves. Scar tissue is rigid. At the site of the scar tissue, there can be some movement, but it is tight, less pliable, and can be painful. If scar tissue or adhesions are limiting motion, cross-friction massage can improve tissue gliding and sliding. This process is referred to as remodeling.
Massage Objectives
The objectives and goals of friction massage to adhesions or scar tissue may include:
Stimulation of nerve fibers to decrease and relieve pain.
The entire area of scar tissue or adhesion should be treated.
If the scar tissue is in a muscle, it should be relaxed.
If the scar tissue is in a tendon sheath, that tendon should be slightly stretched during the procedure.
The therapist places two or three fingers over the scar or adhesion and moves their fingers perpendicular to the scar to smooth the collagen fibers down.
The fingers and underlying tissues move together.
The massage should feel deep and uncomfortable but not painful.
There may be some pain, but should remain within the individual’s tolerance.
If the massage is too painful, less pressure may be used.
After several minutes the therapist will assess the tissue mobility.
Specific stretches may be done to elongate the scar tissue or adhesions.
At-home exercises and stretches may be prescribed to maintain flexibility.
Contraindications
There are situations where friction massage should not be used and can include: (Paula Chaves, et al., 2017)
Around an active open wound.
If there is a bacterial infection.
Areas with decreased sensation.
If calcification is present in the muscle or tendon tissue.
The therapist will explain the procedure and inform of the goals and risks associated with it.
Adhesive capsulitis in the shoulder/frozen shoulder.
Joint contracture.
Ligament tears.
Scar tissue buildup after surgery or trauma.
Friction massage is a popular technique used in physical therapy, but some research suggests it is not any more effective than other rehabilitation techniques. One study found that static stretches and exercises were more effective than massage in improving tissue length and strength in uninjured soccer players. Other studies have supported this, but individuals may find that the massage helps improve injured tissues’ movement as well. (Mohammed Ali Fakhro, et al. 2020)
The main goal of any treatment in physical therapy is to help the individual regain movement and flexibility. Friction massage, combined with targeted stretches and exercises, can help individuals expedite recovery and get back to normal.
Chiropractic Care After Accidents and Injuries
References
Begovic, H., Zhou, G. Q., Schuster, S., & Zheng, Y. P. (2016). The neuromotor effects of transverse friction massage. Manual therapy, 26, 70–76. doi.org/10.1016/j.math.2016.07.007
Chaves, P., Simões, D., Paço, M., Pinho, F., Duarte, J. A., & Ribeiro, F. (2017). Cyriax’s deep friction massage application parameters: Evidence from a cross-sectional study with physiotherapists. Musculoskeletal science & practice, 32, 92–97. doi.org/10.1016/j.msksp.2017.09.005
Chun, Q., ZhiYong, W., Fei, S., & XiQiao, W. (2016). Dynamic biological changes in fibroblasts during hypertrophic scar formation and regression. International wound journal, 13(2), 257–262. doi.org/10.1111/iwj.12283
Fakhro, M. A., Chahine, H., Srour, H., & Hijazi, K. (2020). Effect of deep transverse friction massage vs stretching on football players’ performance. World journal of orthopedics, 11(1), 47–56. doi.org/10.5312/wjo.v11.i1.47
For individuals managing osteoarthritis, could massage therapy provide added treatment benefits?
Osteoarthritis Massage Therapy
Osteoarthritis happens when the cartilage between the joints wears away, causing stiffness and pain. Massage therapy is a treatment used to relieve various types of pain symptoms.
There are many types of massage therapy, that healthcare providers utilize to manipulate the muscles and other soft tissues to relieve symptoms, relax muscles, increase circulation, reduce inflammation, release trigger points, and restore mobility, flexibility, and function. (Ergonomic Trends. 2023)
Professional therapists can help relieve osteoarthritis joint pain by relaxing the surrounding muscles and other soft tissues to release stiffness. (Adam Perlman, et al., 2019)
Massage Objectives and Types
Massage therapists use their hands and fingers, forearms, elbows, and/or instruments to manipulate the body’s soft tissues. Soft tissues support and surround body structures and include muscle, fat, tendons, and ligaments.
The goal of osteoarthritis massage therapy is to relax muscles and soft tissues, increase blood and oxygen circulation, warm the affected area/s, relieve pain, and restore mobility and function.
Depending on the location of the muscles being massaged, individuals may be seated or lie down on a specialized table.
The amount of pressure and direction of movement depend on the body area.
Therapeutic oils and/or massage creams may be used to increase the therapy.
Types include:
Swedish
The therapist uses long strokes, kneading, and friction on the muscles.
Joints are moved to increase flexibility.
Deep Tissue
The therapist uses deep finger or instrument pressure, focusing on muscles that are tight or knotted.
Trigger Point
Trigger points represent a source of radiating pain symptoms.
The therapist focuses pressure on these myofascial tissue points using various strokes to release them.
Shiatsu
The therapist applies rhythmic pressure with their thumbs, fingers, and palms to redirect and increase energy or chi/qi.
A massage session lasts around 30–60 minutes depending on the severity of the condition and the number of sessions the patient has undergone. Chronic pain patients usually go through a series of specialized sessions that focus on specific areas and gradually build.
Risk Factors
Certain precautions must be taken before getting osteoarthritis massage therapy. Although there are a few serious risks, certain individuals are not suitable candidates and should not receive massage therapy. The conditions include: (Medical Massage Therapy Resource & Reference. 2023)
Damaged nerves.
Damaged blood vessels.
Infection and inflammation in the area to be massaged.
Open wounds.
Fever.
Taking a blood thinner.
Deep vein thrombosis – blood clots.
Bleeding disorders.
Osteoporosis – weak and brittle bones.
Recent fractures – broken bones.
Tumors.
Cancer.
Individuals who have recently undergone surgery.
Individuals with a skin condition that is contagious, like warts or herpes, or noncontagious, like psoriasis, could be aggravated by touch or pressure.
Individuals who have cancer, fragile skin, heart problems, or dermatomyositis are recommended to discuss osteoarthritis massage therapy with their healthcare provider.
Research on the effects of massage therapy on various health conditions is ongoing. Massage therapy promotes relaxation while reducing stress, which can help with chronic joint issues like osteoarthritis.
Perlman, A., Fogerite, S. G., Glass, O., Bechard, E., Ali, A., Njike, V. Y., Pieper, C., Dmitrieva, N. O., Luciano, A., Rosenberger, L., Keever, T., Milak, C., Finkelstein, E. A., Mahon, G., Campanile, G., Cotter, A., & Katz, D. L. (2019). Efficacy and Safety of Massage for Osteoarthritis of the Knee: a Randomized Clinical Trial. Journal of general internal medicine, 34(3), 379–386. doi.org/10.1007/s11606-018-4763-5
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