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Articles Of The Week May 9, 2021

Sometimes getting some focus is difficult, especially if you’ve been working on a project for an extended period. While these brain breaks are intended for kids, us adults could probably use one or two of them as well.

20 Energizing Brain Breaks For Kids – Lee Douglas

There are several courses out there professing how they can screen or predict injuries in athletes. So, what does the research say on predicting injuries in runners? Well, you’ll have to read this article to find out.

The Elusive Art of Predicting Running InjuriesAlex Hutchinson

Some really interesting stuff on helping people with pain. New research showing how interactions with a persons environment can influence a persons pain experience.

How Enactive Philosophy Can Transform the Treatment of Chronic Pain – Jenny Logan

We’re big fans of this podcast and big fans of Bronnie, so naturally we had to share this. They cover the clinical encounter and how it relates to a BPS framework.

The Massage Collective Podcast With – Bronnie Lennox Thompson

“As the body of knowledge to support the use of massage therapy continues to grow, understanding the basic science behind what we do and the guiding principles of adaptability enable us to apply this work to a number of pathologies.” Great to see this kind of information being developed.

Massage Therapy For The Postoperative Population; Shoulder, Hip, Knee, and Ankle – Richard Lebert

Trigger Points With Paul Ingraham


 

This week we have our second guest on the podcast the one and only Paul Ingraham.

Paul Ingraham is a Vancouver science journalist and publishing entrepreneur and a former Registered Massage Therapist.  He left that profession over concerns about pseudoscientific beliefs and practices, and went on to create PainScience.com, a website about the science of pain, injury, treatment, and rehab. He has written hundreds of articles and ten books on these themes (and about half of those are about repetitive strain injuries).  He’s also a reluctant runner and an avid ultimate player with a long list of his own sports injuries and pain problems. He is currently sheltering in place with his wife, still hiding from SARS-CoV-2, working on his next book and an endless supply of science updates to PainScience.com.

Trigger point doubts article:
https://www.painscience.com/articles/trigger-point-doubts.php

Trigger points book:
https://www.painscience.com/tutorials/trigger-points.php

General article about massage science (an excellent place for MTs to start on PainScience.com):
https://www.painscience.com/articles/does-massage-work.php

 

Paul Ingraham

How Can Massage Help Runners?

Some runners swear by it, others say it’s a waste of money. The fact that most elite runners have regular massage suggests there must be something in it, but how valuable a tool is it for recreational runners? Is there any evidence it reduces injury or increases performance? Let’s take a look…

What Does Massage Do?

The most commonly proposed benefits of massage are:

  • Massage helps flush away lactic acid
  • Massage improves circulation
  • Massage breaks down muscle/fascia adhesions.

It may therefore come as a surprise to hear that none of these are supported by research. In fact, the application of a little basic science suggests that such claims are either unlikely or simply not true.

What?” …I hear you shout. “So all that time & money I’ve invested has been for nothing?

No, hold on to your horses – I am a big fan of massage, I have after all taught it for several years. There is no doubt in my mind that it can help runners, just not in the way you think, and probably not as much as you may have been lead to believe.

Flushing Myths

Modern research has made it quite clear that muscle soreness is not caused by lactic acid build-up. Lactic acid (or more accurately ‘lactate’) actually clears from the bloodstream the moment you stop running, so the idea that massage helps ‘flush it out’ makes no sense.

How about flushing out toxins? Well, in all honesty, despite a lot of therapists using that as a reason, no one can actually say what these ‘toxins’ actually are. It’s an idea that sounds good but is certainly not scientifically based.

Linked with these flushing myths is the idea that massage ‘improves circulation’. Despite this being a very common claim, any increase in circulation would actually be minimal. Circulation increases when you raise metabolic demand; in other words, getting on and off the massage couch a few times will increase circulation far more than receiving a massage.

Breaking Down Knots


Ok, stay with me. Remember, I am a fan of massage and will get to the benefits soon. We just have to clear up the misconceptions first. Many runners put up with (and even expect) considerable discomfort during a sports massage in the belief that the therapist is applying the required force to break down ‘knots’ or ‘scar tissue’.

This idea is once again a myth; surgeons use scalpels to cut through scar tissue, so the belief that pressure from a thumb or elbow could break it down is obviously misplaced.

If your muscles feel more relaxed or lengthened after a sports massage, fantastic. But it’s not because the therapist has managed to force physical changes in your body’s tissues. It’s actually quite scary to think that a human being could do that with their bare hands.

How Does Massage Help Then?


So, what does massage do then? Studies show that massage after exercise can reduce the intensity of post-exercise soreness, so what is happening? Some of you may already be asking ‘why does it matter how it works, as long as it does?’

The answer to that question is as follows: if we know how something works, we can tweak it to make it work even better. If you (and your therapist) truly believe that the deep tissue massage is ‘breaking down scar tissue’, you will both be happy to put up with considerable pain, with shouts of “this hurts like hell but I know it’s necessary” and “no pain, no gain!”

Though there is a lot about pain that we do not yet understand, what we do know is that allowing a therapist to pummel you can actually lead to a delay in recovery. Pain is an output from a nervous system that is essentially trying to protect you from real or perceived damage. Trying to fight pain doesn’t make sense because all you’ll ultimately do is wind the nervous system up even more and cause it to output even more pain.

This is why stress, poor nutrition, lack of food, etc. can all increase pain. They all cause the nervous system to feel more vulnerable. And this is where we now reveal the most likely mechanism behind massage… it relaxes the nervous system

Relaxing The Nervous System


Studies show that massage can reduce both depression & anxiety. It relaxes the nervous system, removing threat and giving it less reason to output pain or restrict movement. This is why after a suitably deep massage we often feel less pain and can move more freely. The effect will not necessarily last forever (we have all seen how the initial pain often returns after a few days) but it can be a way to speed up recovery, allowing us to train more intensely without increasing the risk of overload and injury. We all enjoy a firm massage but putting up with too high a pressure runs the risk of doing the opposite.

Conclusion

Massage can help runners, just probably not for the reasons traditionally given. By relaxing the nervous system (as opposed to winding it up), massage can aid recovery, allowing you to train vigorously without increasing the risk of injury. The skill of the massage therapist, therefore, lies in applying a suitable amount of pressure at the right time. Talk of ‘breaking down scar tissue’ or ‘realigning tissues’ is outdated and can lead to runners putting up with unnecessary pain that can actually delay recovery.

 

Also, if you missed it, we had Matt on the podcast last week, give it a listen here: “Helping Runners With Matt Phillips” 

Articles Of The Week April 25, 2021

Admitted from the authors, more research has to be done on this, but this is important. Many in our profession use essential oils, however, after this study, you may want to re-think this in your practice if you are using them.

Scientists find new evidence linking essential oils to seizures – Beth Newhart

There have been studies to show how blue light therapy can help with sleep and Seasonal Affective Disorder (SAD), but could it help with concussions? Well, we know massage is effective with helping sleep, so maybe both could be good?

Can Blue Light Therapy Help Concussion Symptoms? – Ashley Brzezicki

“There is no shortage of press about the positive effects of meditation on people, and there are plenty of studies to back them up. But there is also evidence—evidence that’s been growing for decades—that prolonged meditation can have a drastic negative impact on some people. This doesn’t make the practice bad, or invalidate the help it has given to many … but ask yourself if you’ve ever heard anything about the possible dangers of meditation. Why is that?”

Why Does Nobody Talk About The Dangers Of Meditation? – Jordan Heath-Rawlings

Could these COVID lockdowns be affecting our mental health? For sure! But there’s good reason why and it’s affecting how we focus along with other cognitive functions.

Brain fog: how trauma, uncertainty and isolation have affected our minds and memory – The Guardian

A number of years ago I took an IASTM course so I could save my hands. There were some pretty bold claims in the course and honestly I never really questioned it till years later. However, here’s the good and the bad of this technique.

IASTM Whatever Butters Your Bread – Taylor Laviolette

Downplaying Pathology

One of my favorite podcasts is Dr. Oliver Thomson’s Words Matter. Through his podcast, Dr. Thomson addresses a wide range of topics relevant to my practice, both as a physical therapist as well as an educator. While an entire hour spent unpacking concepts surrounding the way a clinician approaches a patient presenting with back pain may sound rather niche-y and not of particular interest to an SLP, voice professional, or other professionals, but the episode that I just finished listening to is completely relevant for all of us. If you can broaden the context to include all aspects of diagnoses and envision how our patients enter our clinic, you’ll see the immediate relevance of the information covered in this episode.

One of the takeaways is revealed in the portion of the talk that looks at patient expectations in how we assess, and the expectation of all of the things that we will find wrong with the patient.

Much of this feeds into the traditional medical model that is ramped up in manual therapy evaluations. Our patients pay us to find out what is wrong with them and then do things to make them less wrong. In past articles I’ve covered my views on concepts of causation and pathology and how, when presented in the silo-based format of a specific manual therapy mindset, makes us seem the expert on finding problems with their fascia (or joint, or muscle, or trigger points).

They expect this from us, but by telling them what is wrong, we may be doing a disservice at many levels.

First off, our silo-based training makes every problem look like a problem based on our training. In my post life as an MFR therapist, every problem was explained in fascial-based language. But that language, and the concepts that underpinned it, are not ones accepted by the outside medical community.

So by telling my patient what was wrong with their fascia, I may have been telling mistrusts.

Second, by telling what is wrong with them I am reinforcing how broken they are. Sure, I am offering solutions (my services), but layering on pathological perceptions builds strongly on nocebic concepts (not a good thing).

In the podcast episode, Dr. Thomson and his guest, Dr. Ben Darlow, speak about how reinforcing the positive during an evaluation can step our patients back from the edge of feeling broken. While most want a diagnosis, what most really want is reassurance that they are NOT broken.

Most patients come to us having seen a few other professionals and, most likely, have been told some rather sorry explanations for why they are having problems. 

If the poor input came from someone at the top of the food chain, such as the ortho surgeon, or similar, those explanations are hard to undo. One cannot forget what they’ve already heard. But many of the bad explanations for problems come from those on a equivalent level, professional-wise. It’s not easy to undo the crappy thoughts injected into our patient’s brains by others, but we can start by telling our patients what is NOT wrong as we assess. The podcast explains this much better than I can, and there are a whole lot more gems that I believe all will benefit from.

You can listen to the entire podcast from the links at this page.