Shoulder Research Article

COMPARISON OF MASSAGE BASED ON THE TENSEGRITY
PRINCIPLE AND CLASSIC MASSAGE IN TREATING CHRONIC

SHOULDER PAIN
Krzysztof Kassolik, PT, PhD, a, b Waldemar Andrzejewski, PT, PhD, a, b Marcin Brzozowski, PT, MSc, c
Iwona Wilk, PT, MSc, d Lucyna Górecka-Midura, PT, MSc, d Bożena Ostrowska, PT, PhD, a
Dominik Krzyżanowski, PT, MSc, e and Donata Kurpas, MD, PhD f
ABSTRACT
Objective: The purpose of this study was to compare the clinical outcomes of classic massage to massage based on
the tensegrity principle for patients with chronic idiopathic shoulder pain.
Methods: Thirty subjects with chronic shoulder pain symptoms were divided into 2 groups, 15 subjects received
classic (Swedish) massage to tissues surrounding the glenohumeral joint and 15 subjects received the massage using
techniques based on the tensegrity principle. The tensegrity principle is based on directing treatment to the painful area
and the tissues (muscles, fascia, and ligaments) that structurally support the painful area, thus treating tissues that have
direct and indirect influence on the motion segment. Both treatment groups received 10 sessions over 2 weeks, each
session lasted 20 minutes. The McGill Pain Questionnaire and glenohumeral ranges of motion were measured
immediately before the first massage session, on the day the therapy ended 2 weeks after therapy started, and 1 month
after the last massage.
Results: Subjects receiving massage based on the tensegrity principle demonstrated statistically significance
improvement in the passive and active ranges of flexion and abduction of the glenohumeral joint. Pain decreased in
both massage groups.
Conclusions: This study showed increases in passive and active ranges of motion for flexion and abduction in
patients who had massage based on the tensegrity principle. For pain outcomes, both classic and tensegrity massage
groups demonstrated improvement. (J Manipulative Physiol Ther 2013;36:418-427)
Key Indexing Terms: Massage; Shoulder; Pain; Range of Motion
fficient functioning of the shoulder depends on the
E
a
Assistant Professor, Physiotherapy Group, University School
of Physical Education in Wroclaw, Wrocław, Poland. proper functioning of muscles, which run above the
b
Assistant Professor, State College of Medical Education in joints and stabilize the scapular bone to the ribs and
Opole, Physiotherapy Institute, Opole, Poland. spine. The complexity of this system means that it can be
c
Assistant, Physiotherapy Group, University School of Phys- prone to dysfunction. 1 When pain appears, shoulder
ical Education in Wroclaw, Wrocław, Poland.
d
PhD Student, Physiotherapy Group, University School of mobility may be partially or totally impaired, 2 which
Physical Education in Wroclaw, Wrocław, Poland. decreases the patient's quality of life. 3
e
Assistant, State College of Medical Education in Opole, The tensegrity principle of massage is based on aiming
Physiotherapy Institute, Opole, Poland. treatment at the painful structures in addition to the tissues
f
Assistant Professor, Family Medicine Department, Wroclaw that structurally support the painful area (eg, muscles,
Medical University, Wrocław, Poland.
Submit requests for reprints to: Marcin Brzozowski, PT, MSc, fascia, and ligaments). According to the tensegrity prin-
University School of Physical Education, Faculty of Physiother- ciple, improper functioning of a single element of the
apy, 51–612 Wrocław, al. Paderewskiego 35/p-4, Poland shoulder system can cause disorders in other elements. 4-6
(e-mail: marcin.brzozowski@awf.wroc.pl). This may be explained by the structural dependency of the
Paper submitted September 22, 2010; in revised form January system's elements, which is based on attempting to balance
14, 2012; accepted January 22, 2012.
0161-4754/$36.00 pushing and pulling forces. Balance in the living organism
Copyright © 2013 by National University of Health Sciences. (ie, structures at the subcellular, cellular, tissue, organ, and
http://dx.doi.org/10.1016/j.jmpt.2013.06.004 system levels) is built of many elements and ensures
418
Downloaded for Anonymous User (n/a) at Macquarie University from ClinicalKey.com.au by Elsevier on March 04, 2018.
For personal use only. No other uses without permission. Copyright ©2018. Elsevier Inc. All rights reserved.
Journal of Manipulative and Physiological Therapeutics Kassolik et al 419
Volume 36, Number 7 Massage in Treating Painful Shoulder
Fig 1. The tensegrity principle: balancing pushing and pulling forces.
mutual stability, although it may not always be linked in a muscle in contact with plexus brachiales and arteria sub-
direct way. 5,7,8 Considering the elements of movement clavia could be an example of such a correlation. Abnormal
systems (ie, muscles, ligaments, fascia), tension is directly tension of this muscle could disturb functioning of both
dependent on each of the components. For example, nerves that originate in this plexus as well as arteries ori-
tension of levator of scapula muscle is dependent on ginating in the subclavian artery.
rhomboid, supraspinal, and serratus anterior muscles, Moreover, low effectiveness of classic massage in treat-
which all have insertion at the same part of the scapula. In ing painful shoulder could be explained by the results of
addition, the tensegrity principle suggests the possibility the experiments of Kukulka et al 22 and Sullivan et al. 23
of indirect dependency of tension in the movement They stated that, despite that classic massage treatment
system. An example may be tension of erector spinae caused restoration of the physiological rest tension of the
muscle and hamstring muscles. Although they are not massaged muscle and increased the blood circulation in its
directly connected to each other, the tension between them vicinity, the improvement was not sustained. This may be
is transferred through sacrotuberal ligament. 9 because the effect of massage performed to reduce the rest
Disorders of the shoulder include abnormalities of the tension of muscles lasted only for tenths of seconds
rotator cuff, 5,10,11 muscles, tendons (eg, the first head of the according to their studies. 22,23 The authors proposed that
biceps muscle), ligaments, and joint capsule. 4 In many cases, the unnatural tension of tissues in the area of the painful
the etiology of painful shoulder syndrome is not clear. 12 shoulder could be transmitted according to the tensegrity
Some theorize that shoulder pathology may be initiated by principle to other tissues (eg, muscles, fascia, and liga-
an inflammatory factor, 13-15 which can be the outcome of ments). Based on this hypothesis, it is proposed that the
overload and can subsequently lead to fibrosis. 13,14,16 application of massage using the tensegrity principle could
Therapies used in the treatment of painful shoulder possibly address the elements of muscle-fascia-ligament
syndrome include pharmacotherapy, 4,17,18 joint injections, system (directly or indirectly linked with the tissues) re-
exercise, ultrasound, electrotherapy, and laser. 1,4,13,17,18 sulting in restoring the proper tension of the affected tissues.
Manual therapy, chiropractic manipulation, and surgery Moreover, restored tension could be longer lasting. This
have also been used. 1,4 Classic massage (Swedish massage) principle is based on a study that demonstrated myography
has been used in treating painful shoulder; however, it has of exemplary muscles while massaging (kneading tech-
shown minimal benefit. 2,19,20 nique) other muscles linked indirectly with them. 24
The authors of this study propose that poor results of Therefore, the purpose of this study was to compare the
classic massage in treating shoulder pain may be due to clinical outcomes of level of pain and range of motion
applying it only in the nearest vicinity of the shoulder. It (ROM) using massage based on the tensegrity principle
is possible that improper tension transfer from afflicted (using typical classic massage techniques on muscles,
tissues to other tissues (linked directly or indirectly to them) fascias, ligaments that are structurally, directly or indirectly,
is not being addressed. Such groups of tissues form a linked with the painful tissues, not exclusively in the area of
muscle-fascia-ligament system, which could be correlated shoulder) and classic (Swedish) massage (using typical
with the functioning of the nerves and vessels running near classic stroking massage techniques on muscles, fascia, and
the shoulder (Fig 1). 21 Functioning of scalenus anterior ligaments only to the area of shoulder).
420 Kassolik et al Journal of Manipulative and Physiological Therapeutics
Massage in Treating Painful Shoulder September 2013
Fig 2. Inclusion and exclusion criteria.
Fig 3. The patient flow diagram.
Fig 4. Patient position during classic massage and massage based on the tensegrity principle performance.
METHODS classic massage of movement systems. She was thoroughly

trained in both methods. Range of motion measurements of
Subjects were recruited from patients presenting to a
the glenohumeral joint by the goniometric method were
private practice clinic in the Wroclaw, Poland area. Forty-
conducted by a physiotherapist (PhD in physiotherapy, a
seven subjects were assessed for eligibility for massage
graduate from the University School of Physical Education
treatment due to chronic painful shoulder lasting for at least
in Wroclaw, Department of Physiotherapy), who had no
3 months (duration based upon patient recall). All subjects
knowledge of which group the patient was assigned. During
were evaluated (eg, medical history, orthopedic evaluation
the study, both the therapist conducting massage and the
tests, shoulder imaging) by the same physician. Inclusion
one performing measurements were not informed about the
and exclusion criteria were used (Fig 2). Twelve subjects
results. During the 2-week therapy period and the month
were excluded using the following exclusion criteria: acute
following the experiment, the patients were not provided
pain, previous bone fractures, and bone relocations in the
any other medical treatment. All subjects consented to
area of the shoulder girdle, neck spondylosis, hemiparesis,
participate in the study, and the study was approved by the
rheumatoid arthritis, or any neurologic symptoms. The
Senate Ethics Committee in University School of Physi-
physician made a list of the 35 patients, assigning each a
cal Education in Wroclaw on November 28, 2007. The
number in the order in which they agreed to participate. The
study was registered at ClinicalTrials.gov (Identifier:
physician had no knowledge of the assignment criteria into
NCT01307826). Each person was informed about the
the 2 treatment groups.
goal of the planned research, the method of conducting it,
Patients assigned with even numbers were included in
and they gave declarations of consent to participate.
the classic group and ones with odd numbers to the
tensegrity group. Patients were blinded to which group they
were in. Five patients did not complete the therapy (Fig 3);
therefore, 15 persons in each group were included in this Methodology of Classic Massage
study. The average age of the female patients was 53.9 Each classic massage session lasted 20 minutes. Classic
years (± 16.0, n = 19) and of the males 43.6 years (± 12.3, massage of the shoulder girdle and glenohumeral joint
n = 11). was performed in a side recumbent position. The head was
The first group received 10 classic massage sessions in supported by a cylindrical cushion to relax the neck
the area of the glenohumeral joint. The second group muscles. The patient's upper limb on the side on which he
received 10 massage sessions based on the tensegrity was lying was under his head. The other upper limb, which
principle. In both groups, the massage was performed 5 underwent the treatment, was placed on cushions, with
times a week for 2 weeks. To achieve consistent procedures flexion at the glenohumeral joint at a 30° angle and at the
in both groups, the massage was performed by the same elbow joint at a 90° angle to cause maximum muscle
therapist (MSc in physiotherapy, a graduate from the relaxation. In addition, the position enabled comfortable
University School of Physical Education in Wroclaw, access to the anterior, lateral, and posterior shoulder muscle
Department of Physiotherapy), who is experienced in groups. To achieve relaxation of the iliolumbar muscle, a
Fig 5. Patient's state evaluation card for the needs of massage based on the tensegrity principle.
roll was placed under the lower limb situated on top so attachment on the humeral bone. The hand stroking the
that the bend in the hip joint and knee joint was at 60°, and front part of the shoulder moved to the major pectoral
a small abduction in the hip joints was caused (Fig 4). muscle, whereas the hand stroking the back of the shoulder
During the massage, typical classic massage techniques moved to the area of the scapula. Afterward, friction by
(Swedish) were used—stroking with the palms (effleurage), means of fingers was performed in the same direction.
friction with the palms, kneading (petrissage), percussion Petrissage was done in 3 lines: anterior, lateral, and pos-
(tapottement), and vibration. Each technique was performed terior. Percussion by means of relaxed fingers was per-
7 to 8 times in particular body parts (frequency—60 to formed (ulnar side of the little finger was stroking), treating
70 moves per minute—as in normal pulse rate); percussion the deltoid muscle as a whole. Vibration was also done in
and vibration were performed for 1 minute on average. the anterior, lateral, and posterior lanes. The massage ended
The classic massage was started by stroking the shoulder by stroking the glenohumeral joint area. 25
area from the medial edge of the scapula in the direction
of the shoulder joint. Next, in the same area, friction,
petrissage, percussion, and gentle vibration (by one hand) Methodology of Massage Based on the Tensegrity Principle
were performed in the same direction. In the last part of the Each tensegrity massage session lasted 20 minutes. Each
massage, the shoulder area was stroked. Next, the deltoid patient's state was evaluated before every treatment
muscle and glenohumeral joint were massaged. The according to an evaluation for the needs of massage based
massage began with stroking the deltoid muscle from its on the tensegrity method (Fig 5). 26 Evaluations were based
on palpation of origins and insertions of tissues mentioned Table 1. Mean values and SD of passive ROMs of the
in Fig 5. This determined which elements of the muscle- glenohumeral joint in both groups (values are given in angular
degrees) and comparison of particular values between groups
fascia-ligament system showed increased tension. The
patient was placed in the same position as the patients Classic Tensegrity
treated by the classic massage (Fig 4). The techniques used Mean SD Mean SD P
for this method were the same as in the methodology of Flexion, test 1 165.5 22.1 138.5 23.0 P b .005
classic massage but were aimed at additional areas. Flexion, test 2 169.0 14.7 158.1 14.6 NS
Before the massage, palpation of the selected anatomical Flexion, test 3 166.6 18.9 159.3 13.3 NS
structures was carried out (Fig 5). The purpose of the Extension, test 1 41.8 6.1 30.5 8.7 P b .005
Extension, test 2 45.1 6.5 33.0 8.2 P b .005
assessment was to determine which tissues have the greatest Extension, test 3 43.9 6.5 33.0 8.2 P b .005
sensitivity and which showed increased tension. The thera- Abduction, test 1 151.6 23.0 123.3 17.3 P b .005
pist used light pressure by means of 2 fingertips to feel bone Abduction, test 2 158.0 17.2 145.9 12.6 P b .05
parts in area of insertion. By pressing the attachment of Abduction - Test 3 156.8 16.5 147.0 11.6 NS
a given muscle, pain was identified, which may indicate External rotation, test 1 19.0 6.9 13.1 5.2 P b .05
External rotation, test 2 19.3 6.0 15.6 5.5 NS
increased normal tone of the muscle. The result was written External rotation, test 3 17.7 6.5 15.6 6.5 NS
on the patient's state evaluation card (Fig 5). Internal rotation, test 1 28.4 5.7 24.0 8.1 NS
Based on palpation results, the massage of painful tis- Internal rotation, test 2 31.4 5.5 27.7 5.7 NS
sues was performed. Before this, the tissues with both direct Internal rotation, test 3 29.2 7.2 28.2 7.0 NS
and indirect influence on painful elements of movement Test 1, immediately before therapy; test 2, on the day the therapy ended;
system as mentioned in Fig 5 had been massaged. The test 3, 1 month after the last treatment; NS, no statistical significance.
massage was performed on the following tissues:
Table 2. Mean values and SD of active ROMs of the
glenohumeral joint in both groups (values are given in angular
1. the latissimus muscle of the back together with the degrees) and comparison of particular values between groups
superior peroneal retinaculum link with the posterior
Classic Tensegrity
intermuscular septum of the shin, the posterior part of
the iliotibial tract together with the superficial layer of Mean SD Mean SD P
the maximum gluteus muscle (tensing the posterior part Flexion, test 1 150.6 21.7 117.3 22.3 P b .005
of the iliotibial tract), and the muscles attached to the Flexion, test 2 156.2 20.9 143.3 13.9 NS
Flexion, test 3 154.4 20.4 144.6 15.0 NS
medial condyle of the arm connect with the medial
Extension, test 1 33.6 5.2 24.7 8.1 P b .005
intermuscular septum of the arm; Extension, test 2 36.1 5.4 29.6 8.3 P b .05
2. the major pectoral muscle together with other motor Extension, test 3 33.6 5.6 29.6 7.9 NS
system organs, which are structurally linked; peroneal Abduction, test 1 136.0 22.0 116.0 17.1 P b .05
muscles with the anterior intermuscular septum of the Abduction, test 2 145.8 18.6 136.2 11.9 NS
Abduction, test 3 144.4 17.6 136.6 10.6 NS
shin, the tensor fasciae latae muscle of the thigh, the External rotation, test 1 14.5 5.7 11.3 4.1 NS
sartorius muscle, the inguinal ligament, and the super- External rotation, test 2 14.9 5.4 13.8 5.2 NS
ficial abdominal fascia; External rotation, test 3 13.8 5.4 13.6 5.5 NS
3. the muscles attached to the greater tubercle of the Internal rotation, test 1 22.3 5.3 20.0 6.5 NS
humeral bone (the supraspinous muscle and the infra- Internal rotation, test 2 25.2 5.9 24.4 5.9 NS
Internal rotation, test 3 23.2 6.4 24.4 6.1 NS
spinous muscle) and other muscles: the gluteus medius
muscle with the quadratus lumborum muscle structurally Test 1, immediately before therapy; test 2, on the day the therapy ended;
affects the serratus anterior muscle through tension of test 3, 1 month after the last treatment; NS, no statistical significance.
the thoracolumbar fascia, the minor pectoral muscle, and
the coracobrachialis muscle affected by the common under this muscle (aimed to restore proper blood circu-
coracoclavicular fascia, the rhomboideus minor and lation within the shoulder girdle).
major muscles, and the elevator muscle of the scapula;
4. the supraspinous muscle together with the muscles af- Palpation evaluation of the previously examined points
fected by it that are attached to the lateral epicondyle of was performed afterwards, with particular attention paid to
the humerus as well as the lateral intermuscular septum painful muscles, to analyze the effectiveness of the per-
of the arm with the deltoid muscle; formed relaxation.
5. the teres minor and teres major muscles to address blood To assess outcomes, ROMs and the Short Form McGill
circulation in the posterior circumflex humeral artery Pain Questionnaire (SF-MPQ) were used. These measures
running between these 2 muscles and relaxation of the were taken 3 times (immediately before the first massage
coracobrachialis muscle to restore proper blood circula- session, test 1; on the day the last therapy ended, test 2; and
tion in the anterior circumflex humeral artery running 1 month after the last treatment, test 3).
Table 3. Statistical significance of differences in mean values of passive ROMs of the glenohumeral joint
Classic Tensegrity
F P 1-2 1-3 2-3 F P 1-2 1-3 2-3
Flexion 0.13 .876 NS NS NS 6.66 .003 0.004 0.002 NS
Extension 1.00 .376 NS NS NS 0.43 .650 NS NS NS
Abduction 0.48 .619 NS NS NS 13.56 .0001 0.0001 0.0001 NS
External rotation 0.25 .777 NS NS NS 0.86 .431 NS NS NS
Internal rotation 0.98 .384 NS NS NS 1.64 .207 NS NS NS
NS, no statistical significance.
Table 4. Statistical significance of differences in mean values of active ROMs of the glenohumeral joint
Classic Tensegrity
F P 1-2 1-3 2-3 F P 1-2 1-3 2-3
Flexion 0.27 .764 NS NS NS 11.60 .0001 0.000 0.000 NS
Extension 1.04 .361 NS NS NS 1.89 .170 NS NS NS
Abduction 1.12 .335 NS NS NS 11.40 .0001 0.0001 0.0001 NS
External rotation 0.16 .850 NS NS NS 1.18 .318 NS NS NS
Internal rotation 0.96 .391 NS NS NS 2.49 .095 NS NS NS
NS, no statistical significance.
Table 5. Mean values and SD of values from McGill Pain Questionnaire in both groups
Classic Tensegrity
McGill Pain
Questionnaire Test 1 Test 2 Test 3 Test 1 Test 2 Test 3
15.66 ± 9.22 7.66 ± 5.32 4.66 ± 3.24
MPQ 18.66 ± 8.34 10.2 ± 5.85 8.26 ± 5.66 5.46 ± 1.41 3.8 ± 1.22 2.5 ± 1.1
NPS 6.28 ± 2.10 3.16 ± 1.77 3.7 ± 1.88 2.53 ± .64 1.66 ± .48 1.06 ± .45
PPI 2.66 ± .62 1.46 ± .51 1.2 ± .056 18.2 ± 9.49 9.53 ± 5.54 5.86 ± 3.39
Total 21.3 ± 8.7 11.66 ± 6.02 9.53 ± 5.99
Total is the total score from the McGill Pain Questionnaire. MPQ, from part A of the McGill Pain Questionnaire, sensual pain intensity and emotional pain
impression; NPS, from part B of the McGill Pain Questionnaire, visual analog scale for pain; PPI, from part C of the McGill Pain Questionnaire,
escalation of currently experienced pain; Total = total score from the McGill Pain Questionnaire; Test 1 = immediately before therapy; Test 2 = on the day
the therapy ended; Test 3 = 1 month after the last treatment.
The mobility measurements of the glenohumeral joint by means of single-factor analysis of variance. To compare
were conducted by the goniometric method. The range of the data of ROM of glenohumeral joint between both groups,
active and passive flexion and extension and the ranges of the Student t test was used. The data from the SF-MPQ
abduction and external and internal rotation of glenohum- were analyzed by Friedman analysis of variance test.
eral joint were measured. The Wilcoxon test was conducted to check statistical
Outcomes included the SF-MPQ designed by Ronald significance between test 1 and test 2, test 2 and test 3, and
Melzack (1987). 27 The SF-MPQ is composed of 3 parts: A, test 1 and test 3. The average value and SD were calculated
B, and C. Part A (MPQ) is devoted to the kind of pain and from the results of both groups for active and passive
is composed of 15 questions. Each question can be marked movements of the joint. The significance of differences
from 0 to 3 points, where 0 means no pain; 1, mild pain; 2, between average values of passive and active movement
moderate pain; and 3, strong pain. Questions 1 to 11 describe scopes in a glenohumeral joint for both groups was compared.
pain sensation intensity (S, sensual), and questions 12 to 15
described the intensity of emotional pain impression (A,
affect). Part B of the SF-MPQ defines pain intensity RESULTS
(numeric pain scale [NPS]) and part C pain escalation Ranges of Glenohumeral Joint Mobility
(PPI) (1 question: 0, no pain; 1, mild pain; 2, moderate pain; The results of active and passive movements of the joint
3, strong pain; 4, very strong pain; 5, intolerable pain). are shown in Tables 1 and 2. The significance of differences
between passive and active movement is shown in Tables 3
Analysis and 4.
The data for the ROM of the shoulder joint before therapy, Comparing particular values of the ranges of passive and
on the day the therapy ended, and 1 month later were analyzed active flexion and abduction of the glenohumeral joint before
Table 6. Statistical significance of differences between pairs of Table 7. Comparison of particular values of McGill Pain
values from McGill Pain Questionnaire in both groups Questionnaire between groups
Classic Tensegrity Classic Tensegrity
Comparison Me Min Max Me Min Max Z P
MPQ
MPQTest1 18 8 37 16 2 35 − 0.871 .3837
MPQTest1 MPQTest2 P b .005 P b .005
MPQTest2 9 3 26 6 0 16 − 1.307 .1914
MPQTest1 MPQTest3 P b .005 P b .005
MPQTest3 8 0 23 5 0 10 − 1.97 .0488
MPQTest2 MPQTest3 NS P b .005
NPSTest1 6 2.8 9.3 5.5 2.6 7.4 − 1.182 .2372
NPSTest1 NPSTest2 P b .005 P b .005
NPSTest2 3 1.4 7.2 4.2 1.8 5.4 − 1.431 .1524
NPSTest1 NPSTest3 P b .005 P b .005
NPSTest3 4 0.7 7.2 2.3 0.3 4.3 − 1.618 .1057
NPSTest2 NPSTest3 NS P b .005
PPITest1 3 2 4 3 1 3 − 0.311 .7557
PPITest1 PPITest2 P b .005 P b .005
PPITest2 1 1 2 2 1 2 − 0.933 .3507
PPITest1 PPITest3 P b .005 P b .005
PPITest3 1 0 2 1 0 2 − 0.581 .5614
PPITest2 PPITest3 NS P b .05
TotalTest1 21 10 41 19 4 38 − 0.892 .3725
TotalTest1 TotalTest2 P b .005 P b .005
TotalTest2 10 5 28 8 3 18 − 1.141 .254
TotalTest1 TotalTest3 P b .005 P b .005
TotalTest3 10 1 25 6 2 12 − 1.887 .0591
TotalTest2 TotalTest3 NS P b .005
MPQ, from part A of the McGill Pain Questionnaire, sensual pain intensity
MPQ, from part A of the McGill Pain Questionnaire, sensual pain intensity
and emotional pain impression; ME, mean; NPS, from part B of the McGill
and emotional pain impression; NPS, from part B of the McGill Pain
Pain Questionnaire, visual analog scale for pain; PPI, from part C of the
Questionnaire, visual analog scale for pain; NS, no statistical significance;
McGill Pain Questionnaire, escalation of currently experienced pain;
PPI, from part C of the McGill Pain Questionnaire, escalation of currently
Total, total score from the McGill Pain Questionnaire; Test 1, immediately
experienced pain; Total, total score from the McGill Pain Questionnaire;
before therapy; Test 2, on the day the therapy ended; Test 3, 1 month after
Test 1, immediately before therapy; Test 2, on the day the therapy
the last treatment; Z, z-test.
ended; Test 3, 1 month after the last treatment.
the McGill Questionnaire in both groups. In the classic

therapy and 2 weeks after therapy started (comparison, test 1 massage group, it was noted that the differences between
with test 2), significant increases were found in the patients values of each part (total values as well) of the questionnaire
treated by massage based on tensegrity principle. In this were significant except for the values between test 2 and test
group, significant increases of the above ranges were also 3. In the group of massage based on the tensegrity rule,
found during the data collation of values from test 1 (before the differences were statistically significant in all cases.
therapy) and test 3 (1 month after the last massage). Comparing particular values from McGill Questionnaire
Comparing particular values of passive ROM between between groups, values of part A of the questionnaire
groups, the results showed that mean values of flexion and differed significantly in test 3. No difference was found in
external rotation differed significantly between groups only the case of other comparisons (Table 7).
before therapy (in test 1). Mean values of extension differed
significantly between groups in all 3 measurements (in test
1, test 2, test 3). Mean values of abduction differed
significantly between groups in 2 measurements (in test 1, DISCUSSION
test 2). No difference was found in the case of other com- Although the literature on painful shoulder includes
parisons (Table 1). conservative treatments, we feel that massage as a
Comparing particular values of active ROM between physiotherapeutic method is neglected. Up to this point,
groups, it was found that mean values of flexion and studies on classic massage do not appear to show evidence to
abduction differed significantly between groups only before be included in the treatment program for these ailments. 28
therapy (in test 1). Mean values of extension differed One study analyzed the effectiveness of physical treatments
significantly between groups in 2 measurements (in test 1, applied to painful shoulder including massage; however, the
test 2). No difference was found in the case of other effect was small. Often massage studies lack detail,
comparisons (Table 2). including defined treatment methodology (ie, massage
techniques, duration of treatment, duration of a given
session, and the order and number of massaged muscles). A
Results of the SF-MPQ precisely defined massage methodology applied in painful
The values from the answers given by the patients in the shoulder syndrome taking into account all information
SF-MPQ referring to sensual pain intensity and emotional necessary for treatment performance can be a key in
pain impression (part A of the questionnaire), the pain in- showing appropriateness and effectiveness of this form
tensity (NPS), and values describing pain escalation (PPI— of therapy. 29
part C of the questionnaire) are demonstrated in Table 5. In In this study, the increased passive and active ROM in
Table 6, there are results of statistical significance of flexion and abduction for those who had massage based on
differences between values of each part and total values of tensegrity principles suggests that the effects of this type of
massage may be able to assist beyond classic massage to REFERENCES

increase function of the shoulder complex. However, if we
only focus on pain as a symptom and not function, both 1. Brox JI. Shoulder pain. Best Pract Res Clin Rheumatol 2003;
types of massage were shown to be equally effective for this 17:33-56.
group of patients. 2. Lesiak A. Zespół bolesnego barku - patogeneza, obraz
kliniczny i leczenie (Painful shoulder—pathogenesis, clinical
manifestation, and treatment). Rehabilitacja Medyczna 2002;
6:26-43.
Limitations 3. Rogers SN, Scott B, Lowe D. An evaluation of the shoulder
Several limitations of this study must be considered. domain of The University of Washington quality of life scale.
First, there were a small number of participants; thus, no Br J Oral Maxillofac Surg 2007;45:5-10.
4. Andrews JR. Diagnosis and treatment of chronic painful
definite conclusions can be drawn on the effectiveness of shoulder: review of nonsurgical interventions. Current
the use of massage for shoulder pain. Heterogeneity of both concepts. Arthroscopy 2005;21:333-47.
groups including diagnosis, severity, and ROMs are other 5. Ingber DE. Tensegrity and mechanotransduction. J Bodyw
important limitations. It is unknown what diagnosis each Mov Ther 2008;12:198-200.
patient had; thus, the severity of conditions may have varied 6. Yamada T, Richiert D, Tumminia SJ, Russell P. The tensegrity
model applied to the lens: a hypothesis for the presence of the
greatly between groups. Before the therapy, the groups fiber cell ball and sockets. Med Hypotheses 2000;55:36-9.
differed in 7 of 10 measured motions (lower range in the 7. Chen CS, Ingber DE. Tensegrity and mechanoregulation: from
group with massage based on the tensegrity rule) while after skeleton to cytoskeleton. Osteoarthritis Cartilage 1999;7:81-94.
the therapy, the difference appeared in only 1 case. Statis- 8. Ingber DE. Opposing view on tensegrity as a structural
tically significant changes in the group with massage based framework for understanding cell mechanics. J Appl Physiol
2000;89:1663-78.
on the tensegrity rule in some of the motions may prove to 9. Kassolik K, Andrzejewski W, Trzęsicka E, Charlton G.
be the result of worse ROM at the very beginning of the Anatomical grounds for the use of the tensegrity principle in
study in this group. Perhaps, in the opinion of the authors, massage. Polish J Physiother 2007;7:332-43.
in such a condition of glenohumeral joint, it is easier to 10. Farrell CM, Sperling JW, Cofield RH. Manipulation for frozen
achieve such results. Moreover, it is uncertain whether other shoulder: long-term results. J Shoulder Elbow Surg 2005;14:
480-4.
factors (ie, age, sex, weight, lifestyle, character of work, or 11. Tauro JC, Paulson M. Shoulder stiffness. Concise review.
sports practiced) would have significantly altered the find- Arthroscopy 2008;24:949-55.
ings. As well, only 1 therapist was used in this study; thus, 12. May S, Greasley A, Reeve S, Withers S. Expert therapists use
findings may not necessarily be transferable to other specific clinical reasoning processes in the assessment and
practitioners. Other types of therapeutic massage were management of patients with shoulder pain: a qualitative
study. Aust J Physiother 2008;54:261-6.
not included in this study; therefore, it is unknown if other 13. Bunker TD. Frozen shoulder. Curr Orthopaedics 1998;12:193-201.
types of massage would fare better or worse. As well, this 14. Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome
study only measured short-term findings; therefore, long- of frozen shoulder. J Shoulder Elbow Surg 2008;17:231-6.
term results were not measured. Finally, not taking into 15. Utivlugt G, Detrisac DA, Johnson LL, Austin MD, Johnson C.
account any comorbidities in the patients also limits the Arthroscopic observations before and after manipulation of
frozen shoulder. Arthroscopy 1993;9:181-5.
generalizability of the study results. The authors recom- 16. Bunker T, Anthony P. The pathology of frozen shoulder.
mend that larger trials be completed to further investigate J Bone Joint Surg Br 1995;77-B:677-83.
the effects of massage based on the tensegrity principle. 17. Stevenson K. Evidence-based review of shoulder pain.
Musculoskeletal Care 2006;4:233-9.
18. Wies J. Treatment of eight patients with frozen shoulder: a
case study series. J Bodyw Mov Ther 2004;9:58-64.
CONCLUSIONS 19. McMahon PJ, Sallis RE. The painful shoulder. Zeroing in on
the most common causes. Postgrad Med 1999;106:36-49.
This study showed statistically significance increases in 20. Mróz J, Kuliński W, Misztela A, Rybak T. Postępowanie
passive and active ROMs for flexion and abduction in fizykalno-usprawniające w zespole bolesnego barku (Physi-
patients who had massage based on the tensegrity principle cal-improvement treatment of painful shoulder). Balneologia
compared with those who received classic massage. For Polska 1999;41:79-83.
21. Kassolik K, Andrzejewski W, Trzęsicka E. Role of the
pain outcomes, both classic and tensegrity massage groups tensegrity rule in theoretical basis of massage therapy. J Back
demonstrated improvement for shoulder pain. Musculoskelet Rehabil 2007;20:15-20.
22. Kukulka CG, Beckman SM, Holte JB, Hoppenworth PK.
Effects of intermittent tendon pressure on alpha motoneuron
excitability. Phys Ther 1986;66:1091-4.
FUNDING SOURCES AND POTENTIAL CONFLICTS OF INTEREST 23. Sullivan SJ, Williams LRT, Seaborne DE, Morelli M. Effects
of massage on alpha motoneuron excitability. Phys Ther 1991;
University School of Physical Education in Wroclaw 7:555-60.
funded this study. No conflicts of interest were reported for 24. Kassolik K, Jaskólska A, Kisiel-Sajewicz K, Marusiak J,
this study. Kawczyński A, Jaskólski A. Tensegrity principle in massage
demonstrated by electro- and mechanomyography. J Bodyw symptoms and function of the shoulder. J Bone Joint Surg Br
Mov Ther 2009;13:164-70. 1997;79-a:738-48.
25. Beard G, Wood EC. Massage principles and techniques. 28. Ojr Vesseljen, Johansen BM, Westgaard RH. The effect of
Philadelphia and London: W.B. Saunders Company; 1964. pain reduction on perceived tension and EMG recorded
26. Kassolik K, Andrzejewski W, Sawicki Z. Kompleksowa trapezius muscle in workers with shoulder and neck pain.
ocena pacjenta w masażu medycznym (Integrated patient Scand J Rehabil Med 1995;27:243-52.
assessment in medical massage). Fizjoterapia Polska 2003;3: 29. Albright J, Allman R, Bonfiglio RP, et al. Philadelphia panel
281-6. evidence-based clinical practice guidelines on selected
27. L'Insalata JC, Warren RF, Cohen SB, Altchek DW, Peterson rehabilitation interventions for shoulder pain. Phys Ther
MGE. A self-administered questionnaire for assessment of 2001;81:1719-29.

Shoulder Research Article

Diunggah oleh

Informasi Dokumen

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Shoulder Research Article

Diunggah oleh

Hak Cipta:

Format Tersedia

COMPARISON OF MASSAGE BASED ON THE TENSEGRITY

PRINCIPLE AND CLASSIC MASSAGE IN TREATING CHRONIC

fficient functioning of the shoulder depends on the

Fig 1. The tensegrity principle: balancing pushing and pulling forces.

Fig 2. Inclusion and exclusion criteria.

Fig 3. The patient flow diagram.

METHODS classic massage of movement systems. She was thoroughly

the McGill Questionnaire in both groups. In the classic

massage may be able to assist beyond classic massage to REFERENCES

Anda mungkin juga menyukai