au
Feature:
BioTensegrity
ontents
BioTensegrity
2
14
Clinical Study
25
The Price of Smart Phones: Ten common dysfunctional postures and injuries caused by smart phone useJoe Muscolino
40
Perspectives
45
48
Research
56
Research Highlights
Pro iles
60
61
Figure 1 Crystals and complex biological structures. a) luorite; b,c) iron pyrite; d) spinel; e) partial spirals
of muscles and fascia in the human body. Figures b-e reproduced from Scarr 2014 Handspring.
mechanical system that integrates them into a complete functional unit. It is a conceptual
model that is causing a paradigm
shift in biomechanical thinking
and changing the way that we
think about functional anatomy.
Biotensegrity recognizes that the
forces of attraction and repulsion
at the molecular scale are comparable with those of tension and
compression at higher size scales,
and are easily modelled using
cables and struts, respectively
( igure 2). It is a simple reevaluation of anatomy as a network of structures under tension
and others that are compressed;
parts that pull things together
and others that keep them apart;
basic physics!
Biotensegrity
Introduction
Fig 1. This is the upper limb represented as a lever system where joint space (at the elbow) would require a pin for point A
(shoulder) and point B ( ist) to move towards each other. There are no pin joints, or levers, in biologic forms. They can appear to
make lever-like motions, however this is not the basis or the limit of their structure. Copyright: Joanne Avison
Fig. 2. The froth on the top of your morning coffee is an everyday example of a cellular network. (Image: Authors own)
Fig. 3. Hierarchical organisation exists at the microscopic level such as looking at the arrangement of connective tissue (With
kind permission of Dr J.C.GUIMBERTEAU and EndovivoProductions)
Fig. 4. Hierarchical organisation also exists at the macro level of skin markings on animals such as the Giraffe. Image by Shane
McDermott Photography reproduced with his kind permission (www.wildearthilluminations.com)
es, giving rise to the ability to move around as humans and animals do; the way they do.
BioTensegrity is an essential model for massage
therapists and movement practitioners of every
stripe. Understanding this model will provide you
with the vocabulary and underlying logic of body
architecture that forms the context of therapeutic
bene its. BioTensegrity will add to your con idence
and ability to achieve those therapeutic goals. A new
era is dawning in our understanding of anatomy and
living movement. That new anatomy and understanding of whole body structure is BioTensegrity.
References
1. Levin, S. M., 1982. Continuous tension, discontinuous compression, a model for biomechanical support
of the body. Bulletin of Structural Integration, Rolf
Institute, Bolder:31-33.
2. Ingber DE. 2008. Tensegrity-based mechanosensing from macro to micro. Prog Biophys Mol Biol. 97(6
-3):163-179.
3. Scarr, G. M., 2014. Biotensegrity, The Structural
Basis of Life. Handspring Publishing Ltd. ISBN:
9781909141216.
4. Sharkey, J. 2008 Concise Book of Neuromuscular
Therapy. A Trigger Point Manual. Lotus Publishing
and North Atlantic Press.
5. Avison, J. 2015. YOGA Fascia, Anatomy and Movement. Handspring Publishing Ltd.
John Sharkey, Clinical Anatomist and Founder
European Neuromuscular Therapy. MSc., Department of Clinical Sciences, University of Chester/NTC,
Dublin , Ireland. E-mail address:
john.sharkey@ntc.ie www.johnsharkeyevents.com
Joanne Avison Professional Structural Integrator
and Advanced Yoga Teacher (E-RYT500) KMI, CTK,
IASI. Kinesis Myofascial Integration. E-mail address:
jo@joanneavison.com www.joanneavison.com
Read 6 Questions to John & Jo on page 60-61.
Maximise Oxygenation
A N AT O M Y F O R T H E 2 1 S T C E N T U RY
BIOTENSEGRITY
with John Sharkey
Sydney, June 2016
Myofascial Trigger Points (MtPs) Versus
Neuropathies
A unique integrated neuromuscular approach for the
treatment of unresolved pain due to MtPs or nerve
insults.
This is that one stop workshop that covers everything
you need to know about identifying and treating Myofascial Trigger Points and nerve injury. David G Simons
(Travel and Simons), the farther of Myofascial Trigger
Points was mentor to John Sharkey and wrote the forward to Johns first book (a trigger point manual). Differentiating between neural generated pain and Myofascial
Trigger Point pain is essential in providing the correct
soft tissue interventions for successful therapeutic outcomes.
Fig. 1. Image used for the First BioTensegrity Summit in Washington DC; September 18th 2015. [biotensegritysummit.events.] and
reproduced with kind permission from capacitor.org and the photographer RJ Muna (rjmuna.com).
Fig. 2. The Elastic Body relies on different elements to ind Elastic Integrity for each individual movement signature; relating closely to
the fascial body type.
There is, however, a much more valuable and powerful distinction available, once we appreciate the
myofascial body and its structure, as a whole dynamic anatomy of continuity. This distinction lies in recognising elasticity as paramount and understanding
that for some individuals it is enhanced by stretching
and for others it is the opposite. There are those that
will increase their natural elastic integrity by stiffening the tissues. This makes sense if the foundations of
BioTensegrity and the context it provides to describe
human movement are de ined. This is as the basis of Elasticity as an Asset
the collagen network of every human form: a matrix
Identifying authentic elasticity is extremely valuable
intimate to every tiny part of us, formed under tenas a teaching tool and an important kinaesthetic dicsion since we began to self-assemble as embryos.
tionary to expand and refer to. This is partly because of its global application in reading bodies accuEnergy Storage Capacity
rately and partly because it makes sense of structurElasticity is the source (and containment and replenal integrity of the whole animated form. Elasticity
ishment) of our energy storage capacity. Once we
really means resistance to deformation and implies
understand it and there are a lot of misconceptions
ef iciency of reformation. In other words; how do we
around it we have an immeasurably valuable rechange shape, respond appropriately and then resource for vitality. Really it comes down to an approstore optimum shape after doing so? The best way of
priate balance between overall tensional stiffness
obtaining structural integrity might include stretchTerra Rosa E-mag 15
ing and strengthening but such ef iciency and resilience (see Fig .1) is by no means limited to either.
Elasticity emerges as the paramount asset to ef icient movement and poise in stillness. It refers to
moment-by-moment changes locally and globally,
while nourishing structural integrity over time.
Exploring New Terms
It has been shown that fascial stiffness and elasticity
play a signi icant role in many ballistic movements of
the human body. First discovered by studies of the
calf tissues of kangaroos, antelopes and later of horses, modern ultrasound studies have revealed that fascial recoil plays in fact a similarly impressive role in
many of our human movements. How far you can
throw a stone, how high you can jump, how long you
can run, depends not only the contraction of your
muscle ibres; it also depends to a large degree on
how well the elastic recoil properties of your fascial
network are supporting these movements. Robert
Schleip4
Robert Schleip refers in this quote to the elastic recoil properties of fascia in ballistic movements.
However, if biotensegrity is the basis of the architecture of our collagen matrix, then it also has elas- Fig. 3. The Bendy Wendy body type, sketch reproduced with pertic integrity when we are still. We do not de late.
mission from the author.
The body bene its from the value of elasticity just as
much when sitting on a meditation cushion or run
ning a marathon: peak performance and peak preThe useful schematic in Fig.2 is deceptively simple.
formance are both animated by the same system.
Balance and access come from the centre: it is a
Understanding and recognising innate elasticity is
question of ensuring balance of suitable stiffness,
made more dif icult by the many different meanings which means suitable resistance to deformation and
we have for the word elasticity itself. There is a
ef icient reformation. This is unique for each indigeneral perception that it is associated with stretch- vidual. In fact, Bendy Wendy (see Fig. 3) may need
iness and lexibility (the archetypal heroes in most
more stiffness, not more stretching.
yoga-based movement classes). The enemies in that
The terminology needs some reframing and the idea
environment might be seen as tension, stiffness,
that yoga is synonymous with stretching might be a
strain or stress. In the definition of elasticity howevdisservice to the potential power of its contribution
er, it is the lack of suitable stiffness that can be a
to elastic integrity. Elastic energy is very low-cost
de icit to structural integrity. Despite the level to
metabolically: it is the essence of healthy, vital
which it is favoured in yoga teaching, stretching is
movement. On or off the mat, we seek a signature
just one aspect of a much broader picture: one that
becomes clear if BioTensegrity principles are appre- our body signs with vitality whatever movements
we are doing. Mixing modalities to bring this balciated.
ance may be the most useful way to work and foster
In order to see this as a general and global distincthis valuable asset of architectural integrity. In othtion for movement integrity and overall vitality
er words, a balance between stretching-type move(including at rest) we can include four main attribments and those based upon resistance may hold a
utes of elastic integrity (Fig. 2).
key to elastic integrity.
16 Terra Rosa E-mag
Poroelasticity is a feature of geology that is also relevant to the extracellular matrix.5 The combination
of our tissues and contained fluids includes these
characteristics as essential ingredients of our architectural form, from embryo to elder. They change
constantly and yet remain in integrity, re-arranging
as we do, movement-by-movement and moment-bymoment; inwardly and outwardly. This is what defines us as living forms and is re-defined by understanding the geometries of biologic forms, such as
the full model of BioTensegrity represents on every
scale. We are made up of various chambers in and
Viscoelasticity. In liquids, this same principle is
measured in viscosity (thickness). Honey is more
around the Extra Cellular Matrix; holding together
viscous than water because it resists deformation
a variety of colloids, foams and emulsions of our inwhen you stir it. Water has relatively lower viscosity ternal chemistries and fluids. Thus a poroelastic asand is less resistant to deformation. Viscoelasticity
pect of our internal close packing systems may be a
acts as a damper (i.e. such as would be placed on a valuable aspect of the BioTensegrity model.
stiff car spring to modify the rate of elastic return). It
While the tissue itself has recoil properties, a common misunderstanding is that the balance of elasIn these models, the soggiest one (Fig.4) is the
tin and collagen within the fascial ibres gives rise
most stretched, which in this model makes it the
to our elasticity. Elastin ibres can elongate up to
weakest of the three. Stretching is an ingredient in
150% of their length and restore or reform. It is, in
the recipe for structural integrity but only in balfact, one of the suite of tissues the body calls upon
ance with suitable stiffness and depending, to some
in wound healing.10 Suitable tensile properties in
extent, on the movement signature of the individual. our tissues and their overall elastic integrity rely
The mast, with no elasticated fabric, retains its elas- upon the stiffness of the collagen matrix, which is
ticity when it is bounced, held out or up or hung upessentially low in deformation and relatively high
side down. It is independent of gravity in that sense. in resistance to it (i.e. stiffness). (It stretches up to
about 5% only.) This, in balance with our architecIt is the most balanced and resilient of the three
models because it has the highest tensional integrity ture, creates overall energy storage capacity. If we
were too elasticated we could not function: the
and stiffness: it is by far the stiffest of the three. In
this context, it is the guardian of the highest energy energy literally leaks. It can look like a soggy structure that needs strengthening, stiffening, or makstorage capacity.
ing taut. A marquee is not a tensegrity structure as
such, because it relies on being pinned by guy
The mast in Fig 5 is made of guitar strings and hol11
low steel arrow shafts. It is exceptionally light and wires to the ground (we do not, even though we
encloses a maximum of space with the fewest mate- are bound to return to it. We can move independently of gravity). However, a tent is a tensionrials. Any force applied to it can be seen and felt to
compression model of sorts. Imagine using elastic
be transmitted to varying amplitudes throughout
guy wires and bendy tent poles. They would not
the whole structure. This is a compelling model of
tension or stiffen the fabric of the marquee sufbiological dynamic architecture, seen throughout
iciently to take appropriate care of the internal
the dynamic anatomy of living forms and their high- space or the external forces acting upon it. They
ly ef icient ability to move around.12 It is a trianguwould have low resistance to deformation. This
is the basic and simple way to begin understandlated structure (which provides some relative stability) and reveals a host of properties that we have ing our innate dependency on the logic of BioTensegrity as a powerful model of the architecture of
throughout our tissues. It stands up, in all direcour living form.
tions, by itself and, as a whole, it can bounce. It is
also a model of a closed kinematic chain with multithreat to its structural integrity. In a cartwheel or a
bar linkage and no levers.13 (See also Fig. 1 on page
yoga pose with the spine parallel to the ground, the
9).
bones would break apart if the spine followed the
Whatever direction you pull or push this model in,
rules of a stacked linear structure. It cannot be usethe structure gives, but naturally resists deforfully analysed on the basis of Newtonian physics
mation which means it has high elasticity. Whether
and laws of compression-based, hard matter organiyou pull, push, bend or twist, the architectural gesation. Human bodies do not conform to that logic.
ometries naturally counter any movement by stiffOur various soft tissues (harder bones and softer
ening the whole structure in resistance to defortissues around them of varying densities are all soft
mation. It then reforms immediately from defortissues) conform to the very different laws of soft
mation (within its resilience range) maintaining the
matter. They are non-linear biologic structures.
right internal spatial relationships. This relates to
Once we place ourselves in a handstand, or pound
our ability to perform postures or athletic feats,
around a running track, bits of us dont fall off!! As a
without toppling body parts. If the human spinal
general rule, in healthy bodies, we restore our form
column really was a stacked vertical column, then
soon after making shape changes. This makes us
even a slight tilt, would destroy our structural integliving examples of how BioTensegrity principles
rity. Columns are compression structures, like
work as dynamic whole physiologies.
stacked bricks in a house wall. They conform to the
laws of hard matter and non-biological linear orWhat this suggests is, effectively, the muscles can
ganisation. If we change the angle of the ground or
act more like brakes, while the tendinous tissues
attempt to move the structure it poses a signi icant
lengthen and shorten like springs. In terms of ap18 Terra Rosa E-mag
Fig.6 Images of research by Kawakami and colleagues (see note 13), after Schleip, showing the cooperation of muscles and fascial
tissues. A is the classical view of the muscle moving with a relatively static tendon; B is the research result, showing the muscle acting
more like a brake, while the tendon lengthens and contracts, acting more like a spring.
scale.
What this research all suggests is that we rely on
elasticity perhaps more than we realise. The revelations about the fascial matrix are shifting the explanations we have for biomechanical function. They
also raise many new questions and begin to make
sense of why describing the experience of animating
yoga postures in terms of levers, for example, is so
awkward. According to Dr Levin there are no levers
in biologic systems. Anywhere.17
Terra Rosa E-mag 19
Fig. 7. The so-called Super icial Back Line22 is a metaphor for continuity. It is not separate in the living body from the layer beneath
or those either side of it. In a movement class we do not have time
to assess muscle by muscle nor does the body move that way.23
Fig. 9. This puppy is using its whole body, from tail tip to nose
tip to balance the overall structure. The BioTensegrity model
explains this as a whole body architecture; expressing emergent
properties to balance from moment to moment, as distinct from
the more classical lever mechanics. (Reproduced with kind permission from Shane McDermott,
www.wildearthilluminations.com)
Endnotes:
1 Schleip R. Schleip, D.G. Mu ller, Training Principles for
Fascial Connective Tissues: Scienti ic Foundation and
Suggested Practical Applications, Journal of Bodywork
and Movement Therapies 17: 103115; 2013 and Terra
Rosa e-magazine No. 7, March 2011.
2 Joanne S Avison, YOGA Fascia, Anatomy and Movement,
ty principles for many years. His Skwish toys were licensed to a local company to manufacture in 1987. Manhattan Toys subsequently bought that company and the
licensing rights in 1995.
7Ibid. See also, for further reading: http://
www.intensiondesigns.com/bones_of_tensegrity.html
8 Note: For an example of insuf icient stiffness, this reference links to a ilm about a condition called Swimmer
puppy syndrome : see YouTube references to Swimmer
Puppy Syndrome: http://www.wimp.com/
puppytherapy/ for video
9 Bruce Hamiltons designs can be seen at
www.tensiondesigns.com.
10Adjo Zorn and Kai Hodeck; In: Erik Daltons The Dy-
ics. Journal of Australian Association of Massage Therapists.Volume 14, issue 2 Winter 2015
theme see YOGA Fascia, Anatomy and Movement, Handspring Publishing 2015, Chapter 12, Yoga and Anatomy
Trains
Way of Maintaining the Functional Integrity of the Myofascial System?, Journal of Bodywork and Movement
Therapies 15(3): 268280; 2011.
27 Doug Richards, University of Toronto, Assistant Profes-
Available at www.terrarosa.com.au
Terra Rosa E-mag 23
Methods
Institutional context: This study was conducted at the Motion
Analysis Laboratory, Spaulding Rehabilitation Hospital, Partners HealthCare, LLC, Boston, and was approved by the
Spaulding institutional review board. The study was registered with ClinicalTrials.gov (NCT01322399) prior to beginning the recruitment of participants.
Design: Following screening, enrolment, and baseline data
collection, participants were randomized in a 1:1 ratio to parallel treatment groups. Follow-up data were collected at 20
weeks after baseline.
Subjects: We included men and women aged 1865 living in
the greater Boston area, with CNSLBP of 6 months duration
which was not attributed to infection, neoplasm, severe
radiculopathy (assessed by frequent severe pain radiating
down a leg), fracture, or inflammatory rheumatic process,
with a patient rated bothersomeness of pain on average over
the preceding 6 months 3 on an 11-point ordinal verbal response scale (0=none, 10=worst imaginable), i.e. moderate to
severe range. Prior arrangement to enter or having recently
entered treatment at any Boston area outpatient rehabilitation clinic was also required.
We excluded candidates for i) impaired hearing, speech, vision, or mobility; ii) current or anticipated receipt of payments from Workers Compensation or other disability insurance; iii) prior treatment with any type of SI; iv) plans to initiate additional treatment for back pain other than outpatient
rehabilitation care during the period of the study; v) exclusions for safety; vi) exclusions for anticipated lack of therapeutic response; vii) conditions that might confound
measures of balance and movement; viii) conditions that
would confound data on inflammatory biomarkers; ix) any
other condition that would impair the patients ability to
complete the study.
Sample Size: Using data from a clinical trial of massage and a
meta-analysis of trials of balneotherapy, both for low back
pain, a sample size of 40 was estimated as adequate to detect
Minimal Clinically Important Differences (MCID) in pain and
disability.[22,23] The sample was later increased to 46 to
compensate for dropouts.
Treatment: All participants were required to attend a recently
arranged course of outpatient rehabilitation at any rehabilitation clinic in the Boston area. Typical courses of outpatient
rehabilitation (OR) for CNSLBP employ varying combinations of analgesic and anti-inflammatory medication, joint
manipulation, therapeutic exercise, cognitive behavioural
treatment, and education. Participants were allowed 20
weeks to complete their course of OR. The number and frequency of treatments were determined by each participant
and their therapist.
Ten sessions conforming to the Rolf Ten Series protocol were
provided free of charge to each participant assigned to the
SI+OR group. SI treatments were provided by five therapists
who met the criteria of graduation from the training programs of the Rolf Institute of Structural Integration,[24]
the Guild for Structural Integration,[25] or Kinesis Myofascial Integration (KMI)[26]; a minimum of 10 years clinical
practice of SI; and membership in the International Association of Structural Integrators.[27] The KMI graduates
agreed to provide the Rolf Ten Series instead of the twelve
sessions taught by KMI, which include the Ten Series.
Outcomes: The primary outcome of the study was pre-defined
as a comparison across treatment groups of change between
baseline and 20-week follow-up on a patient-rated visual
analog scale (0100 mm) of bothersomeness of pain on average over the preceding week (VAS Pain), anchored as
0=none, 100 mm=worst imaginable.[28] The secondary outcome was a comparison of changes in the total of the RolandMorris Disability Questionnaire (RMDQ) over the same period.[29,30] Pre-defined exploratory outcomes included the
Short Form 36 Health Survey (SF36),[31] the sum of days
and half days disabled over the past week, and Global Satisfaction with Care. These questionnaires are all patientcompleted and have been recommended for use together in
low back pain trials.[32,33] All data were analysed on an intent-to-treat basis, i.e. the last available data for each dropout
was substituted for their missing 20 week data. Because of
our small sample size, the Wilcoxon rank sum test was specified to test the significance of between group differences in
change scores.
Adverse events were monitored through reports submitted by
study staff and a biweekly Patient Questionnaire. We also
recorded all elevations VAS Pain scores 30mm above baseline as adverse events. In addition we collected feasibility
data on the demographic characteristics of unenrolled compared to enrolled candidates, compliance with assigned treatment, and dropouts.
Results
Recruitment, Enrollment, Treatment Compliance, and Dropouts: The study was conducted between April, 2011 and August, 2013. Enrolled compared to unenrolled candidates were
approximately equivalent in gender, age and race. The demographic and prognostically relevant characteristics of the
treatment groups were also acceptably similar at baseline.
Attendance at OR treatments was unexpectedly low, but was
not significantly different between treatment groups. In the
SI+OR group, attendance at SI was almost perfect. The overall rate of dropout was 11%, which is within the range that has
been recommended as a standard for assessing back pain
trials, and was not significantly different between groups.
[34]
Outcomes: The median reductions in VAS Pain, the primary
outcome, of 26 mm [Interquartile range 31.5, 3.0] in
SI+OR compared to 0 mm [24.5, 6.5] in OR alone were not
significantly different (Wilcoxon rank sum 2-sided test
p=0.075#) (Figure 1). However, the median reductions in
RMDQ, the secondary outcome, of 2 points [4.5, 1] in SI
+OR compared to 0 [2, 0] in OR alone, were significantly
different (p= 0.007) (Figure 2). The between group difference
in median change of two points is the smallest suggested absolute MCID for the RMDQ [46].
Other pre-specified outcomes which were different between
treatment groups at a significance level of p<0.01 were the
SF36 subscale for Bodily Pain, and Global Satisfaction with
#p values referred to here and later quantify the probability that the between group difference detected does not reflect an actual difference
between similarly defined groups in the larger population from which the study sample was drawn. The generally observed convention is that
findings of between group difference with p<0.05 are "significant," but those was p>0.05 are non-significant. The threshold of 0.05 is arbitrary; and the validity of any particular p value depends on the assumption that the distribution of the data being tested in the larger population conforms to one of a few mathematically defined distributions, the most common of which is normal distribution.
Table 1: VAS Pain responder analysis: responder/non-responder ratios compared across treatment groups .
Pain Reduction
SI+UC (n=23)
UC alone (n=23)
RR (CI)
10-20%
17/6
9/14
1.89 (1.07-3.32)
0.036*
>30%
15/8
7/16
2.14 (1.08-4.26)
0.038*
>50%
12/11
6/17
2.00 (0.91-4.41)
0.130
>20 mm
12/11
7/16
1.71 (0.83-3.56)
0.231
>40 mm
5/18
2/21
2.50 (0.54-11.60)
0.414
n: sample size; RR: relative risk, the ratio for SI+UC divided by the ratio for UC alone; CI: 95% confidence intervals## for RR; 1. Fisher's exact 2-sided p value; * significant difference at p<0.05.
Improvements in the primary outcome, VAS Pain, were not
significantly different between treatment groups, but improvements in the secondary outcome, RMDQ, were significantly greater in SI+OR than in OR alone, with the difference
between median change scores satisfying the lowest recommended absolute MCID.[37] Among pre-defined exploratory
outcomes the SF36 subscale for Bodily Pain, and Global Satisfaction with Care both improved more in SI+OR than in OR
alone.
With respect to feasibility, we successfully recruited and enrolled a sample whose demographic characteristics did not
differ significantly from those unenrolled. Randomization
produced treatment groups that were acceptably equivalent
on prognostically significant variables. Compliance with SI
treatment was high, suggesting that any discomfort associated with it did not dissuade the majority of participants assigned to SI+OR from attending. Neither the incidence nor
the seriousness of adverse events was significantly increased
by the addition of SI to OR. Dropouts were within acceptable
limits, and we found no evidence of crossover between treatment regimes. However, the length of time to recruit the cohort was unexpectedly long, and compliance with the requirement to receive OR treatment was unexpectedly low. Both
would need to be remediated in a follow-up study.
Limitations: Because this study assessed the effect of SI as an
adjunct to OR compared to OR alone, its outcomes should not
be taken to indicate the effect that SI alone might have on
CNSLBP. The large number of exclusion criteria might have
resulted in the enrolment of a sample that was not representative of the typical clinical population, and this might
limit the generalizability of these results. It was not possible
to blind participants or therapists to treatment assignment
because of obvious differences between the experiences of SI
and OR treatment. Effective maintenance of the initial blinding of investigators proved to be impossible due to limited
administrative staffing, but the potentially biasing effect of
this was mitigated by the fact that all outcomes were patientrated. Compliance with the requirement to receive OR was
unexpectedly low and might have contributed to the median
change scores of zero for both VAS Pain and RMDQ in the OR
##95%
confidence intervals represent the range of values within which the estimated value might vary for 95% of all possible samples that
might be selected from the larger population. Like the p value, it assumes that the distribution of values in the larger population conforms to
one of a few mathematically defined models.
Acknowledgements
This study would not have been possible without the generous collaboration of Alec Meleger, Paolo Bonato, Peter
Wayne, Helene Langevin, Ted Kaptchuk, and Roger Davis.
Major study expenses and Dr. Jacobsons effort were funded
by a career development award from the National Center for
Complementary and Integrative Health, National Institutes
of Health (NCCIH/NIH, K01AT004916). Dr. Kaptchuks effort was supported by a mentorship award from NCCIH/NIH
(K24AT004095). Supplemental funding was provided by the
Ida P. Rolf Research Foundation, Harvard Medical School,
the Rolf Institute of Structural Integration, Dean Rollings,
and Hal and Sonya Milton. Administrative and technical support was generously provided by the Motion Analysis Laboratory, Spaulding Rehabilitation Hospital, Partners Healthcare,
LLC, and by Harvard Medical School. We also thank the volunteers who served as independent monitor and on the data
safety monitoring committee, and the SI practitioners: Lou
Benson, Lisa Grey, Ellen Halpern, Tim Roode, and Garret
Whitney.
The Author
Eric Jacobson, PhD, MPH, investigates alternative medicine at Harvard Medical School. He was trained by Ida Rolf in
1974, completed advanced training with the Rolf Institute in
2005, and has a private practice of Structural Integration in
Boston.
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By Joe Muscolino
The introduction of any new technology often comes with unexpected consequences. This is certainly true with widespread use
of the smart phone. Although it is
a wonderful marvel of communication that allows us to be connected with our loved ones,
friends, and business colleagues,
as well as connect us to the internet and therefore the world
around us, unfortunately it comes
at a price. That price is the physical stress that it can place on our
body. One only needs to go to a
public place and observe others
while using their smart phones.
The odds are that we will see
many dysfunctional postural patterns and future injuries in the
making. However, most of these
conditions can be avoided if we
pay attention to our biomechanics as we hold and use the smart
phone.
As therapists, it is important to be
aware of these common conditions so that we can be prepared
to assess for them, and if found,
provide the appropriate clinical
orthopedic work to ameliorate
the condition. Being aware of
these potential problems also
arms us with the knowledge
needed to be able to offer the client valuable postural advice
about how to properly hold and
use the smart phone so that the
development of these problems
can be avoided.
1. Golfers Elbow
2. Tennis Elbow
Tennis elbow, also known as lateral epicondylitis or lateral epicondylosis, is a condition in
which in lammation and/or degeneration of the common extensor tendon occurs, usually accompanied by hypertonicity of the
bellies of the associated muscles.
This condition is caused by overuse of the muscles of the common
extensor tendon that attaches to
the lateral epicondyle of the humerus. These muscles are the extensor carpi radialis brevis, extensor digitorum, extensor digiti
minimi, and the extensor carpi
ulnaris. As a group, these muscles
do extension of the wrist joint
and the ingers. It would seem
that these muscles do not need to
contract when gripping and holding a smart phone because this
32 Terra Rosa E-mag
Figure 2. Prolonged holding of a smart phone (or shown here as pen) can
lead to overuse, fatigue, and dysfunction of the common extensor tendon.
This condition is known as tennis elbow.
Figure 3. Crimping a smart phone between the shoulder and ear physically
stresses muscles of scapular elevation.
3. Uptight Shoulders
Developing uptight elevated shoulders with a
smart phone occurs when the phone is crimped
(compressed) between the ear and shoulder, because this posture requires contraction of scapular
elevation musculature to bring the shoulder up to
hold the phone against the ear (Figure 3). Muscles
of scapular elevation that are used/overused and
likely to become fatigued, tight, and injured are the
upper trapezius and levator scapulae. Crimping a
phone also requires contraction of same-side lateral Figure 4. Holding the phone out in front of the body
lexion musculature of the neck to help press the ear can overly stress, fatigue, and injure musculature of the
anterior shoulder.
downward against the phone and shoulder. This
further requires contraction of, and therefore physically stresses, the upper trapezius and levator scapulae, as well as other muscles of lateral lexion. This
anterior deltoid strain as well as strain of the upper
problem is not new with smart phones. It was and
trapezius and levator scapulae.
still is common for people to crimp landline phones
too. However, because smart phones are much
smaller, the amount of muscular effort necessary to
crimp a smart phone is greater than to crimp a land- 5. Rotator Cuff Strain/Tendinitis
line phone.
Holding a phone out in front of the body with humeral lexion can also stress and injure the rotator
4. Anterior Shoulder Strain
cuff musculature. Whenever the arm is lifted upIt is common for people using a smart phone to hold ward in the air, whether it is up into lexion, extenthe phone in the air out in front of their body. The
sion, abduction, or adduction, it is necessary for the
dif iculty with this posture is that it requires isomet- rotator cuff musculature to contract to stabilize and
ric contraction of the musculature of humeral lexhold the (proximal) head of the humerus down into
ion at the glenohumeral joint to hold the arm out in the glenoid fossa as the distal end of the humerus
the air. Foremost among these muscles is the anteri- raises (Figure 5). Overuse of this posture can, over
or deltoid (Figure 4). Holding the arm out in lexion time, contribute to fatigue, tightening, and strain of
also requires stabilization of the scapula, which rethe rotator cuff musculature, as well as tendinitis of
quires contraction of and therefore stress to the up- the rotator cuff muscles.
per trapezius. And if the person also adds in eleva
tion of the shoulder girdle to hold the phone up
higher, it places even greater stress on the upper
trapezius, as well as the levator scapulae. Therefore,
excessive engagement of this posture can lead to
Terra Rosa E-mag 33
6. Rounded Shoulders
Rounded shoulders is a postural distortion pattern in which the scapulae are protracted and the humeri
are medially rotated. Therefore the
shoulder girdles and arms are
rounded in, hence the name. The
client with rounded shoulders has
scapular protractors (pectoralis minor and major) and humeral medial
rotators (subscapularis, pectoralis
major and teres major) that are
locked short and tight, accompanied
by scapular retractors (middle and
lower trapezius and rhomboids) and
humeral lateral rotators (teres minor and infraspinatus) that are weak
and also likely locked long and tight.
Using a smart phone often predisposes the client to this condition
because so many people hold the
Figure 5. Holding the arm out in front of the body can also physically
smart phone down low in front of
them (Figure 6). As with other over- stress, fatigue, and injure musculature of the rotator cuff group.
use conditions, occasional rounded
posture with a smart phone is not
detrimental, but when this posture is
assumed for long periods of time, the
effects can become very chronic and
severe.
8. Forward Neck
Also accompanying rounded shoulder girdles and rounded upper back
is forward head. When the thoracic
spine is hyperkyphotic, the neck naturally projects forward with a hypolordotic lower cervical spine. The
upper cervical spine then becomes
hyperlordotic as a compensation to
34 Terra Rosa E-mag
Figure 6. Holding the smart phone down low in front predisposes the
client to rounded shoulders characterized by protracted scapulae and medially rotated humeri, as well as rounded upper back, forward head, and
rounded lower back.
The 27 kg head
Having the center of weight of the head forward of the trunk requires constant isometric contraction of
the posterior cervical extensor musculature. How forceful the posterior cervical musculature must work
is dependent upon the leverage force of the weight of the head.
The average head weighs approximately 4-5 kg (10-12 pounds). However, as the head and neck are further lexed, the center of weight of the head moves increasingly anterior, increasing the leverage force of
the weight of the head against which the cervical extensor musculature must work. It has been estimated
that when the neck is lexed to 45 degrees, the head weighs the equivalent of 20 kg (45 pounds). And if
the neck is lexed 60 degrees, the head weighs the equivalent of 27 kg (60 pounds)!
Figure 7. Forward head posture results in the centre of weight of the head
being anterior to the trunk. This imbalance is compensated for by constant
contraction of the posterior cervical extensor musculature.
This article was originally published in Massage Therapy Journal, Spring 2015 issue, reprinted with permission from American Massage Therapy Association.
Clinical Orthopedic
Manual Therapy
with Dr. Joe Muscolino
Sydney, November 2015
This workshop covers the major clinical orthopedic assessment and treatment techniques for
the thoracic spine and ribcage.
31 Oct, 1 Nov 2015, Sydney
Case Study
The patient in question was a woman of 34 and a
physical trainer for the Royal Air Force. She presented to the clinic with pain near the superior aspect of her left scapula ( igure 1.1). The pain would
come on four miles into a run, forcing her to stop
because it was so intense. The discomfort would
then subside, but quickly return if she attempted to
start running again. Running was the only activity
that caused the pain. Her complaint had been ongoing for eight months, had worsened over the past
three, and was starting to affect her work. There
was no previous history or related trauma to trigger
the complaint.
After seeing different practitioners, who all focused
their treatment on the upper trapezius, she visited
an osteopath who treated her cervical spine and rib
area. The treatments she had received were biased
toward the application of soft tissue techniques to
the affected area, namely the trapezius, levator
scapulae, sternocleidomastoid (SCM), scalenes, and
so on. The osteopath had also used manipulative
techniques on the facet joints of her cervical spine
C4/5 and C5/6. Muscle energy techniques and trigger point releases were used in a localized area,
which offered relief at the time but made no difference when she attempted to run more than four
miles. She had not undergone any scans (e.g. MRI or
x-ray).
levator scapulae.
Dysfunction of the glenohumeral joint or even
Assessment
During a consultation (subjective history) the physical therapist will ask speci ic questions relating to
the patients presenting pain so that a picture can be
formed in their mind. This is a normal process in order for the physical therapist to come up with a hypothesis; this type of initial diagnosis will then help
the therapist decide on what tissue(s) might be responsible for causing the clients presenting pain/
symptoms. For the patient in question, the potential
tissues responsible for the pain to her superior scapula are:
Upper trapezius
Levator scapulae
Scalenes
Thoracic rib
Cervical rib (extra rib forming from the transverse process of C7)
cess of C7).
Relative shortness/tightness of the scalenes.
Positionaldue to upper crossed syndrome re-
Lets now assess the case study patient globally rather than locally, remembering that the pain only
comes on after running four miles.
Is there a link between the Gmax and the trapezius, and if so, how is this possible?
44 Terra Rosa E-mag
Last Fall I was honoured to travel to Sydney, Australia and teach leading sports therapists from all across
Australia and New Zealand. Many of these therapists
work in allied medical ields, including physiotherapy, podiatry and acupuncture. On the ninth and inal
day of the intensive seminar we invited current and
former professional and Olympic athletes to a special
clinic. Each athlete responded favorably to their
Later that decade I began teaching in England, Scot- sense of improvement from a 90-minute full body
land and the Republic of Ireland from 2009 to 2011. session, with several emailing us later in the week
with amazing stories of how their training had imMany of those students from London, Manchester,
proved. The common theme we heard was I feel
Chelsea, Bath, York, Edinburgh, Aberdeen, Galway
and Dublin assisted their Olympic teams at the 2012 more awareness of my body and how integrated my
movements have become.
London Games. Each of them took their place with
those who preceded them in offering a sports and
I am more than satis ied that during the past four
performance therapy that increased balance, respondecades I have represented one of the inest apsiveness, ease of movement, and kinaesthetic agility.
proaches to structural and functional improvement
At the same time I was engaged in creating Myofas- from the disciplines I studied 37 years ago. Each year
cial Therapy protocols for the leading athletes of the I look forward to introducing this work to curious
Florida State University Football Team. From 2011 and dedicated therapists who are searching for the
to this day these athletes receive twice a week treat- keys to providing long-lasting health and wellness to
those they serve each day. Each day I enjoy my cliniment from 10 CORE Institute graduates during the
regular season as well as during all spring and sum- cal sessions with professional and amateur athletes
mer training camps. During this time, soft-tissue in- who want to maintain elite athletic levels, with clients rehabbing from serious injuries and disease,
juries decreased by 75% and FSU won three ACC
and with those who simply yearn for a deeper sense
Championships and the 2013 National Championship. Over 30 of these athletes are now playing in the of self. Each day I ind happiness.
NFL, with many of them continuing their commitment to regular myofascial therapy.
Maximise Oxygenation
George Kousaleos, LMT is the founder and director of the Core Institute, a school of massage therapy and structural bodywork in Tallahassee, FL. He is a graduate of Harvard University, and has
practiced and taught Structural Integration, Myofascial Therapy and Sports Bodywork for the past
30 years. George has served as a member of the Florida Board of Massage Therapy and was CoDirector of the International Sports Massage Team for the 2004 Athens Olympics.
Terra Rosa
Your Source for Massage Information
AMT , ATMS, IRMA, MAA Approved CEs.
Visit www.terrarosa.com.au
Bringing Up Baby.
Bodywork Grows-up from
Infancy to Adolescent
By Art Riggs
A few months ago, some of us old-timers were reminiscing about the good, and not-quite-so-good, old
days of massage and bodywork, and how the profession has evolved. I decided to contact three longtime bodywork luminaries to get a broad picture of
how things were, where we are now, and where
they think we are heading.
Rick Garbowski is the co-owner of Georgia Massage School. He has trained more than 150 massage
instructors, has been closely involved in the education of many thousands of students, and was a
member of the Entry Level Analysis Project (ELAP)
to provide a blueprint for consistent standards of
training excellence.
Tracy Walton is one of the foremost teachers of
oncology massage and, among other contributions,
author of Medical Conditions and Massage Therapy.
I love that her background in the trenches of massage in both private practice and a spa setting bridges the sometimes-divisive dichotomy between
therapeutic and relaxation massage.
Thomas Myers is a world-renowned anatomist,
writer, educator, and philosopher who describes
himself as an expert in spatial medicine, as seen in
his theories of organizing and integrating the body
along fascial meridians in his modality Anatomy
Trains and subsequent books and videos.
48 Terra Rosa E-mag
Probably the biggest change in massage is the respect bodywork now has as an extremely worthwhile part of a healthy life for our clients, and as a
full- ledged profession rather than a fun hobby.
When Myers changed his career path to massage,
his family was disappointed and bemoaned all that
education wasted. He feels the general perception
was that massage was something old ladies did, or
was for entertainment, titillation, or an expression
of the alternative scene.
With my own background in graduate study in both
literature and exercise physiology, my abrupt march
to the beat of a different drummer in my career path
caused similar well-meaning concern for my wellbeing, if not my sanity, and reactions in the form of
what Walton describes as raised eyebrows. Like Myers, however, when friends and family saw the happiness and ful ilmentas well as the inancial rewardsI got from my work, and the bene its to my
clients, they quickly changed their views.
Thirty- ive years ago, not only was the public unaware of the therapeutic and medicinal bene its of
massage (partly because of the misperceptions that
Myers mentions), but bodywork also faced downright hostility from ill-informed local governments
and other therapeutic modalities who either feared
competition or possibly felt it their duty to protect
massage to mainstream acceptance for both relaxation and therapeutic bene its. Now, of course, spas
abound, massage is increasingly seen in hospital settings, and chiropractors regularly employ massage
therapists in their of ices. Even physical therapists
are now having massage therapists perform manual
therapy on their patients.
Massage is now considered a legitimate career. Just
look at the name of an association in the USA:
Associated Bodywork & Massage Professionals.
Interestingly, as bodywork becomes mainstream,
Myers notices a difference in the nature of todays
therapists. When he began, someone pursuing a career in massage had to be a bit of a rebel making an
actual cultural choice. He feels most therapists had
to be very strong in their commitment and willing to
confront a somewhat condescending or adverse public opinion, but that many therapists today dont
have the same verve and drive to excel. Looking at
massage as more of a trade rather than a craft or art,
some are content to work for the security of meagre
wages and poor working conditions that may cause
injury and burnout. Rather than expressing their excellence, some therapists are hampered by assembly
-line routines or rigid, unimaginative protocols of
generic massage that shackle creativity and feelings
of ful ilment. Many new therapists I speak with are
unaware of their potential for inancial and emotional ful ilment if they challenge themselves and learn
more sophisticated techniques.
The success of our profession is much more than a
word-of-mouth grass roots movement. Unlike in its
infancy, massage now has an abundance of welldocumented studies demonstrating its therapeutic
value. All of our experts agree this is good, but that
many more studies need to be conducted. Myers especially mentions the increasing connection between
physical therapy and bodywork and that as the two
ields grow closer together, we will need more studies and veri ication.
to specialize in.
Great progress has been made since the accreditation chaos of 30 years ago, and it is hoped that Garbowski's and others work with ELAP will solve
many of these issues and make life easier for both
therapists and clients. The great news is that massage and bodywork has had phenomenal success in
the last few decades and will continue to grow. As
some problems are solved, new ones will undoubtedly spring up. For instance, will massage begin to
be covered by health insurance? Myers feels this
would expand the availability to a wide range of clientele. This plan works well in Canada, where all
citizens are granted a certain number of massages
per year with a minimum of red tape, simply having
to submit a receipt from the sessions.
With his interest in evolution, Myers has noticed
changes in the structure of clients over the years
just from the environmental changes in posture as
we spend more time hunched over computers and
commuting. I ind an increasing need for bodywork
for the it generation who spend large amounts of
time exercising in many forms, sometimes causing
injuries from over-exerciseespecially in the burgeoning market of extreme exercise classes with
minimal supervision. For success in whatever venue
we work, in the future, we need to adapt to the
changing environment of new technology, business
models, and evolving needs of our clientele, including an aging population.
The Tangibles
Having the bene it of our longtime experts advice, I
asked them what suggestions they would have for
therapists.
For his suggestions, I see a connection in Myerss
comments about the early confusion de ining massage and his desire for clarity in present-day therapists self-perception and self-de inition. One needs
to decide just where ones niche lies in the continuum of an art, a craft, a science, or a skill. Myers feels
the divisiveness between different modalities is
counterproductive. As a profession with so many
different approaches, we need to make allies, not
Terra Rosa E-mag 53
competitive separations.
Walton emphasizes good body mechanics and to
keep moving, relaxed, and breathing, and to explore
different forms of movement training including
dance and sports to shake things up and keep the
body from resting on habit.
Garbowski is in agreement, suggesting getting into
the habit of stretching, strengthening, and continually perfecting your mechanics: I have yet to meet a
healthy massage therapist who does not enjoy what
they do for a living. Most importantly, he says,
Listen intently to your clients. Massage therapy is a
customer service industry driven by repeat business and referrals from existing clients.
I would agree with all of our experts, particularly
the suggestions to stay healthy in our physically demanding work with lexibility, strength, and using
gravity and core energy rather than muscling. However, I would emphasize the mental and emotional
aspects of our work to stay focused, interested, and
passionate. Rather than resting on my laurels, I ind
Presenter:
Ron Alexander
STT [Musculoskeletal],
FFT Founder and Teacher
Research Highlights
Compiled By Jeff Tan
Isometric contraction reduce tendon pain
Researchers from Adelaide investigated heavy isometric quadriceps muscle contractions for their ability to
induce immediate analgesia in 6 athletes with patellar
tendon pain and used transcranial magnetic stimulation to look at the possible motor activation changes.
First of all, they found that people with patellar tendon
pain had HUGE amounts of cortical inhibition (as if
their motor cortex was trying to limit the use of the
quads). However, a single bout of heavy (70% MVC)
isometrics reduced tendon pain pretty much instantly
(and lasted at least 45 minutes), it also reduced the associated muscle inhibition, resulting in an increase in
muscle strength. It wasnt just about heavy load though
as this cross over study also examined isotonic
(concentric / eccentric) contractions and found no effect on inhibition, and that isometrics were superior for
pain relief.
Some key points: Tendons dislike compression so any
isometric load should avoid compression, e.g. avoid
compression of the Achilles insertion at the calcaneus
in ankle dorsiflexion. Time under tension and load (i.e.
weight) both seem to be important (based on pre-study
pilot testing). Some people may need to start with below body weight loads (e.g. seated calf raise machine
for an unloaded Achilles tendon) but the elite football
player with Achilles pain will tolerate much greater
load and will need greater than body weight. Time for
the holds in the study was 45 seconds (five times) but
may need some clinical tweaking if the muscle is shaking too much. Make sure the muscle is given complete
recovery between holds when using isometrics for tendon analgesia we used two minutes.
This is an extract from an article by Ebonie Rio published in BodyinMind
Practice and research in Australian massage
therapy
Massage is the largest complementary medicine profession in Australia, in terms of public utilisation, practitioner distribution, and number of practitioners, and is
being increasingly integrated into the Australian health
care system. A research was taken to identify practice,
research, and education characteristics among the Australian massage therapist workforce.
301 randomly selected members of the Association of
Massage Therapists (Australia) completed a 15-item,
cross-sectional telephone survey.
The results showed that most respondents (73.8%)
worked 20 hours per week or less practising massage,
Research Highlights
pain compared to controls.
The authors concluded that Gluteus medius weakness
and gluteal muscle tenderness are common symptoms
in people with chronic non-specific LBP. The research
is published in European Journal of Spine
Massage May Initiate Tendon Structural Changes
Physical exercise is now a widely known and studied
factor of the proper functioning of living organisms.
Many questions remain unanswered concerning various aspects of the changes in the morphology of structures subjected to chronic physical exercise.
To study the effect of massage on collagen fibres in tendon, scientists from Poland conduced an experiment on
rats.
This study was conducted on fifty Buffalo strain rats,
randomly divided into two equal (experimental and
control) groups. All animals were subjected to physical
training on a running track for 10 weeks, whereas only
in the experimental group, massage was additionally
applied five-times per week.
CONCLUSIONS:
The results of this preliminary study showed that longterm massage performed during running training may
initiate for small structural changes in the rat tendon.
The study was published in the journal in Vivo.
The addition of soft tissue massage to an exercise program for the shoulder confers no additional benefit in
pain, disability or range of motion or disability in patients with non-specific shoulder pain.
Reference
INTERVENTIONS:
The investigators also found that just one of the 14 patients with no pain, but leg weakness and parasthesias,
had a positive GTrP, versus 82.5% of patients with right
Research Highlights
-sided pain and 79.5% of those with left-sided pain.
"Taken together, these findings support the clinical observation of the authors of this study that GTrPs are
common among patients with radicular pain and that
they are directly associated with this pain condition,"
Dr. Adelmanesh and his colleagues write.
Research Highlights
Arizona College of Medicine in Phoenix led by Paul
Standley evaluated effects of duration and magnitude of The rats were divided into the following three groups;
MFR strain on wound healing in bioengineered tendons (1) normal controls, (2) rats with LC application (LC
(BETs) in laboratory.
group), and (3) rats undergoing MT after LC (LC + MT
group).
The bioengineered tendons (BETs) were cultured on a
deformable matrix and then wounded with a steel cutAccording to the CE-TOFMS analysis, a total of 171 meting tip. Using vacuum pressure, they were then
strained with a modelled MFR paradigm. The duration tabolites were detected among the three groups, and 19
of these metabolites were significant among the groups.
of MFR dose consisted of a slow-loading strain that
stretched the BETs 6% beyond their resting length, held Furthermore, the concentrations of eight metabolites,
including branched-chain amino acids, carnitine, and
them for 0, 1, 2, 3, 4, or 5 minutes, and then slowly remalic acid, were significantly different between the LC +
leased them back to baseline. To assess the effects of
MT and LC groups.
MFR magnitude, the BETs were stretched to 0%, 3%,
6%, 9%, or 12% beyond resting length, held for 90 secThe results suggest that manual therapy (MT) signifionds, and then released back to baseline. Repeated
cantly altered metabolite profiles in DOMS. According
measures of BET width and the wound's area, shape,
to the findings and previous data regarding metabolites
and major and minor axes were quantified using miin mitochondrial metabolism, the ameliorative effects of
croscopy over a 48-hour period.
MT might be mediated partly through alterations in meThe results showed that an 11% and 12% reduction in
tabolites associated with mitochondrial respiration.
BET width were observed in groups with a 9% and
Full article is available here
12% strain, respectively. In the 3% strain group, a statistically significant decrease in wound size was observed at 24 hours compared with 48 hours in the non- Role of psychosocial factors in the development
strain, 6% strain, and 9% strain groups. Longer duration of multisite pain
of MFR resulted in rapid decreases in wound size, which The November 2014 issue of Journal of Pain published
were observed as early as 3 hours after strain.
a research study on the role of psychosocial factors in
the development of multisite pain. The researchers used
The authors concluded that Wound healing is highly
experimentally induced Delayed Onset Muscle Soreness
dependent on the duration and magnitude of MFR
(DOMS) to investigate the possibility that pre-existing
strain, with a lower magnitude and longer duration
psychosocial status could predict the likelihood that
leading to the most improvement. The rapid change in
wound area observed 3 hours after strain suggests that someone would develop multisite pain.
this phenomenon is likely a result of the modification of
119 healthy university students completed questionthe existing matrix protein architecture. These data sug- naires to assess depression, fear of pain and catagest that MFR's effect on the extracellular matrix can
strophic thinking, and then reported on their experience
potentially promote wound healing. The implication of
of pain on lifting a heavy canister. They reported pain
this research suggest that 3 hours after a wound ocintensity on a numerical rating scale, and pain sites by
curred, application of 6% stretch on the area for 90 sec- shading a body chart. They then performed a set of exeronds could enhance healing.
cises designed to induce DOMS, and went home. The
The study was published in The Journal of the American next day, they came back and repeated the lifting test
Osteopathic Association
and pain reports.
The researchers investigated possible influences of genManual therapy ameliorates delayed-onset mus- der, depression, fear of pain and catastrophising on (a)
cle soreness and alters muscle metabolites (in
pain intensity and (b) number of pain sites. They found
rats).
that depression influenced neither pain outcome. Pain
Delayed-onset muscle soreness (DOMS) can be induced intensity was affected by gender: women reported more
pain sites than men (both before and after DOMS inducby lengthening contraction (LC); it can be characterized
tion), and women had a greater increase in pain after
by tenderness and movement-related pain in the exercised muscle. Manual therapy (MT), including compres- DOMS induction than men had. Pain intensity after
DOMS induction was correlated with catastrophising
sion of exercised muscles, is widely used as physical rescore. Fear of pain did not appear to modulate pain inhabilitation to reduce pain and promote functional recovery. Although MT is beneficial for reducing musculo- tensity.
skeletal pain (i.e. DOMS), the physiological mechanisms The number of painful sites was greater after DOMS
of MT remain unclear. There is still a debate whether
induction in both men and women, and both fear of
manual therapy can help with DOMS.
pain and catastrophising appeared to separately influence the number of painful sites after DOMS induction.
To study the physiological mechanism, researches from This study makes a notable contribution to what we
Japan studied the effect of manual therapy in DOMS on know about psychosocial influences on multisite pain: it
rats.
tells us that fear of pain and catastrophic thinking patLC was applied to the rat gastrocnemius muscle under
terns that exist before pain begins may predict how far
anesthesia, which induced mechanical hyperalgesia 2-4 that pain will spread, but that depression may not play
days after LC. MT (manual compression) ameliorated
the same role.
mechanical hyperalgesia. Then, they used capillary electrophoresis time-of-flight mass spectroscopy (CEFrom Body in Mind
TOFMS) to investigate early effects of MT on the metabolite profiles of the muscle experiencing DOMS.