Meditation Promotes Mindfulness

The Default Mode Network (DMN) involves regions of the brain associated with mind-wandering – namely, the medial prefrontal cortex and the posterior cingulate corticies, that may cause lapses in attention and anxiety.   To assess whether mindfulness-based meditation can reduce activity along this brain axis, Judson Brewer, from Yale University School of Medicine (Connecticut, USA), and colleagues analyzed 12 experienced mindfulness meditation practitioners, and a group of 13 control subjects who never practiced the technique.

The researchers used functional MRI to assess brain activation during both a resting state and a meditation period in each subject.  Compared with novice meditators, experienced study participants had significant deactivation in parts of the brain associated with the DMN.  As well, the team found that practiced meditators reported less mind-wandering during meditation than did their less experienced counterparts.

The study authors conclude that: “Our findings demonstrate differences in the default-mode network that are consistent with decreased mind-wandering. As such, these provide a unique understanding of possible neural mechanisms of meditation.”

Aside from attention lapses and anxiety, the “default mode network,” or DMN, has also been associated with certain conditions, including ADHD and Alzheimer’s disease. Conversely, mindfulness training has been shown to benefit certain conditions, such as pain, substance use disorders, anxiety, and depression.

Action Points


  • Explain that this study found that meditation diminishes activity in areas of the brain associated with mind-wandering, the so-called default mode network in the medial prefrontal cortex and the posterior cingulate corticies.
  • Note that the study used functional MRI to assess brain activation during both a resting state and a meditation period in experienced mindfulness meditation practitioners and controls.

So to assess whether mindfulness-based meditation can reduce activity along this brain axis, the researchers analyzed both experienced meditators and controls who’d never practiced the technique. The researchers used functional MRI to assess brain activation during both a resting state and a meditation period in 12 experienced mindfulness meditation practitioners and 13 controls.

Groups attempted three different types of meditation: concentration, loving-kindness, and choiceless awareness. Concentration is intended to prevent practitioners from engaging with their preoccupations; loving-kindness focuses on fostering acceptance; and choiceless awareness allows for focusing on whatever arises in the conscious field of awareness at any moment.

Brewer and colleagues found that experienced meditators reported less mind-wandering during meditation than did controls, which was true across groups.

At the same time, they generally saw less activation in the main nodes of the DMN — the medial prefrontal cortex and the posterior cingulate corticies — in experienced meditators than in controls.

While there was significantly less activation in the posterior cingulate cortex/precuneus and in the superior, middle, and medial temporal gyri and uncus, the trend toward diminished activation in the medial prefrontal cortex was not significant, they noted.

With regard to the specific types of meditation, the researchers found less activation in experienced meditators than in controls in the following regions:

  • Concentration: posterior cingulate cortex, left angular gyrus
  • Loving-kindness: posterior cingulate cortex, inferior parietal lobule, and inferior temporal gyrus extending into hippocampal formations, amygdala, and uncus
  • Choiceless awareness: superior and medial temporal gyrus

When using the posterior cingulate cortex as a seed region, the researchers saw significant differences in connectivity patterns with several other brain regions, notably the dorsal anterior cingulate cortex, for experienced meditators compared with controls. And when using the medial prefrontal cortex as the seed region, they found increased connectivity with the fusiform gyrus, the inferior temporal and parahippocampal gyri, and the left posterior insula.

These patterns held during the resting-state baseline period as well, the researchers said, suggesting that meditation practice “may transform the resting-state experience into one that resembles a meditative state, and, as such, is a more present-centered default mode.”

The researchers concluded that the overall results “support the hypothesis that alterations in the DMN are related to reduction in mind-wandering.”

Though the study was limited by a small sample size, the researchers concluded that the findings may have a host of clinical implications, including treatment of conditions linked with dysfunction of these areas, such as ADHD or Alzheimer’s disease.

Is Soup Toxic to Your Health?

Bisphenol A (BPA) is a plasticizer that is regarded as an endocrine disruptor that may be linked to  cardiovascular disease, diabetes, and liver abnormalities.  Commonly used in food can linings, Karin B. Michels, from Harvard School of Public Health (Massachusetts, USA), and colleagues assessed the urinary bisphenol A (BPA) levels of 75 healthy men and women, ages 18 years and older, who consumed homemade soup for five consecutive days, and then ate canned soup for another five days in a row.

Urinary levels of BPA averaged 1.1 mcg/L during the homemade soup segment, but reached 20.8 mcg/L during the canned soup segment.   Observing that: “The effect of such intermittent elevations in urinary BPA concentrations is unknown,” the team urges that: “Even if not sustained, [it] may be important, especially in light of available or proposed alternatives to [BPA-containing] epoxy resin linings for most canned goods.”

Recent data from the National Health and Nutrition Examination Survey, for example, indicated that the 95th percentile for urinary BPA was 13.0 mcg/L, Michels and colleagues noted.

BPA is used in a wide range of consumer and medical products to soften plastics. Studies have shown that BPA can mimic the action of female reproductive hormones and may be linked to cardiovascular disease, diabetes, and liver abnormalities. Infants’ exposure is a particular concern because they may be more sensitive to these effects than adults.

Last month, researchers found that children whose mothers had high urine levels of BPA during pregnancy were more prone to behavioral problems.

The U.S. government, after initially dismissing concerns about BPA in baby bottles and other consumer products, reversed course in 2010 and promised a major research effort to pin down the health risks.

Because BPA is also used in food can linings, Michels and colleagues sought to examine whether canned soups would be a vehicle to increase human intake of the chemical.

They used five varieties of vegetarian Progresso soups, including tomato and minestrone, and five similar homemade soups. Participants were randomly assigned to start with the commercial or homemade soups, eating a serving of each variety at lunchtime daily for five days. After a two-day washout period, participants who first ate the canned products then had a week of the homemade soups, and vice versa.

Participants could otherwise eat what they pleased during the study.

Urine samples were collected in the late afternoon on the fourth and fifth days of each period. To minimize intraindividual variations, each person’s samples from consecutive days were mixed prior to analysis.

BPA levels in urine were adjusted for dilution, using a formula that included the samples’ specific gravity.

All the participants had detectable BPA in their urine after eating the canned soup, whereas 23% of samples in the homemade-soup phase were BPA-free.

The mean individual difference between mean adjusted urinary BPA levels following canned versus homemade soups, 22.5 mcg/L, was highly significant, with a 95% confidence interval of 19.6 to 25.5 mcg/L, Michels and colleagues reported.

Results were nearly identical for participants who started the trial with canned soup compared with those initially assigned to the homemade soups.

The researchers did list several limitations to the analysis. The study involved one institution (all participants were students or employees of the Harvard School of Public Health) and the canned soup came from a single manufacturer.

More important, Michels and colleagues indicated that “the increase in urinary BPA concentrations following canned soup consumption is likely a transient peak of yet uncertain duration. The effect of such intermittent elevations in urinary BPA concentrations is unknown.”

But they argued that the magnitude of the peaks seen in their study is great enough to cause concern.

“Even if not sustained, [it] may be important, especially in light of available or proposed alternatives to [BPA-containing] epoxy resin linings for most canned goods.”

Good for the Heart, Guard Against Cancer

As an American Heart Association Strategic 2020 Goal, “ideal” cardiovascular health is one of elements that aim to improve Americans’ heart health by 20% and reduce deaths from heart disease and stroke by 20%.  Laura J Rasmussen-Torvik, from Northwestern University (Illinois, USA), and colleagues followed more than 13,000 healthy individuals for 13 years, measuring seven “metrics” of heart health at the start and tracking any cancer that developed.

Those seven factors are: not smoking, normal BMI (a calculation based on weight and height), physical activity, healthy diet, and safe cholesterol, blood pressure and fasting blood glucose levels.  Between 1987 and 2006, the participants developed more than 1,800 new cancers, namely prostate, breast, lung and colon. But, the more “ideal” factors people had, the less likely they were to develop cancer. Compared to people who had none of the seven factors, having just one reduced the risk of cancer by 20%. Three factors lowered the risk of cancer by 22%, and five to seven pushed the risk down 38%.

The study authors conclude that: “Ideal cardiovascular health metrics are also collectively associated with lower cancer incidence.”

Individuals who don’t smoke and who maintain a healthy body-mass index (BMI), normal blood pressure and two to four other “ideal” measures of heart health have a 38% lower risk of developing cancer, according to research scheduled for presentation Wednesday at the annual meeting of the American Heart Association in Orlando, Fla.

The study authors hope the score they’ve developed will help doctors drive home the message that prevention is key to both cancer and heart disease.

“Physicians need motivation to really push the issue of prevention with patients,” said lead author Laura J. Rasmussen-Torvik, an assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago.

Other experts agreed.

“If we give patients a double whammy [message], in the ideal world, we might be preventing two of these biggest killers. It might be a stronger message,” said Dr. Tara Narula, a cardiologist with Lenox Hill Hospital in New York City.

“People generally know that healthy behaviors prevent heart disease and cancer, but to [relate risk factors such as cholesterol] to cancer is novel,” added Dr. Harmony Reynolds, associate director of the Cardiovascular Clinical Research Center at New York University Langone Medical Center in New York City. “It’s very nice to have that crossover in practice. Sometimes I talk to patients about lowering their cholesterol and exercising, and they get very fatalistic saying that, in my family, cancer is the problem. It’s very convenient to be able to say these things.”

“Ideal” cardiovascular health is one of the American Heart Association’s Strategic 2020 Goals, which aim to improve Americans’ heart health by 20% and reduce deaths from heart disease and stroke by 20%.

For this study, researchers followed more than 13,000 healthy individuals for 13 years, measuring seven “metrics” of heart health at the start and tracking any cancer that developed. Those seven factors are: not smoking, normal BMI (a calculation based on weight and height), physical activity, healthy diet, and safe cholesterol, blood pressure and fasting blood glucose levels.

Between 1987 and 2006, the participants developed more than 1,800 new cancers, namely prostate, breast, lung and colon. But, the more “ideal” factors people had, the less likely they were to develop cancer.

Compared to people who had none of the seven factors, having just one reduced the risk of cancer by 20%. Three factors lowered the risk of cancer by 22%, and five to seven pushed the risk down 38%.

“If you lower yourself by one point [risk factor], that’s a significant decrease in cancer risk and a lower risk of heart disease,” said Dr. Christopher Cove, assistant director of the cardiac catheterization lab at the University of Rochester Medical Center in New York. “That’s exciting.”

When the researchers looked at the same participants but removed smoking from the measure, the association was no longer significant but the trend was still in the right direction.

“This says that, yes, smoking is really important but we still see the trend when smoking is taken out, so adhering to a healthy diet and having a low BMI are still important for cancer risk,” said Rasmussen-Torvik.

The association might have been even clearer had the study had more participants and more cases of cancer, said Reynolds.

It’s not clear why these associations exist, but Narula hypothesized they could relate to overall inflammation, which drives both heart disease and cancer.

The study authors said they hope to see more collaboration between the American Heart Association and cancer advocacy groups.

“I think the American public is very confused about conflicting health messages,” said Rasmussen-Torvik. “If organizations like the American Heart Association, the American Cancer Society and the American Diabetes Association could work together to emphasize some core prevention goals, that could be beneficial to all groups.”

Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

Active Lifestyle Reduces Risk of Depression

Previous studies have reported an inverse association between physical activity and depression. Michel Lucas, from Harvard School of Public Health (Massachusetts, USA), and colleagues studied data co0llected on 49,821 US women enrolled in the Nurses’ Health Study, all of whom did not experience symptoms of depression in 1996.

Surveying for physical activity a total of five times during the study period, and following subjects for 10 years to assess for clinical depression, the team found that women who reported exercising the most in recent years were about 20% less likely to get depression, as compared to those who rarely exercised.As well, the more hours the subjects spent watching TV each week, the more their risk of depression rose.

The researchers warn that:  “Analyses simultaneously considering [physical activity] and television watching suggested that both contributed independently to depression risk.”

According to findings published in the American Journal of Epidemiology, researchers found that women who reported exercising the most in recent years were about 20 percent less likely to get depression than those who rarely exercised.

On the other hand, the more hours they spent watching TV each week, the more their risk of depression crept up.

“Higher levels of physical activity were associated with lower depression risk,” wrote study author Michel Lucas, from the Harvard School of Public Health in Boston.

More time spent being active might boost self-esteem and women’s sense of control, as well as the endorphins in their blood, although the study could not prove directly that watching too much television and avoiding exercise caused depression, she added.

The report included close to 50,000 women who filled out surveys every couple of years as part of the U.S. Nurses’ Health Study, and covered the years 1992 to 2006.

Participants recorded the amount of time they spent watching TV each week in 1992, and also answered questions about how often they walked, biked, ran and swam between 1992 and 2000.

On the same questionnaires, women reported any new diagnosis of clinical depression or medication taken to treat depression.

The analysis only included women who did not have depression in 1996. Over the next decade, there were 6,500 new cases of depression.

After the researchers accounted for aspects of health and lifestyle linked to depression, including weight, smoking and a range of diseases, exercising the most — 90 minutes or more each day — meant women were 20 percent less likely to be diagnosed with depression than those who exercised 10 minutes or less a day.

Women who watched three hours or more of television a day were 13 percent more likely to be diagnosed with depression than those who hardly ever tuned in, but Lucas said at least part of that link might be due to women replacing time they could be exercising with TV watching.

One alternative explanation the researchers brought up is that women might have been experiencing some symptoms of depression before they were diagnosed, leading them to exercise less. A formal diagnosis could have come later.

“Previous studies have suggested that physical activity is associated with a lower risk of depressive symptoms,” said Gillian Mead, who studies geriatric medicine at Edinburgh’s Royal Infirmary but was not involved in the study.

A Golfer’s Worst Nightmare Rehabilitated Through Massage

For many golfers, the only meaningful way to spend a sunny day is out on the links. With 18 holes to look forward to — the sun’s rays caressing the greens, blue skies inviting deep breathes, and the warm leather grip of a favored club in hand — nothing much can break their joy of being alive.

Until, that is, pain strikes. Pain in the physical sense such as a muscle tear or unstable joint, or the pain they feel from a continually declining game performance. For a die-hard golfer, the two pains are equally worrisome. And, left unresolved, grow to become their worst nightmare: the end of their golfing and no more need for sunny days.

Massage therapists are all well aware that, as the human body ages: muscles atrophy, tissues lose elasticity and overall flexibility declines. What many therapists have yet to fully understand, however, is that static stretching of muscles is rarely enough to correct these affects (Siff and Verkhosansky 1993, Siff 1994, and 1998). And even dynamic stretching is an incomplete course of treatment for many of our clients — especially those who golf.

Kinematic Sequencing and Therapeutic Improvements

To effectively assess and treat the unique needs of a golf client requires that the therapist first acquire an advanced knowledge of body dynamics, namely, the kinematic sequencing of the golfer’s body.

Kinematic sequencing refers to the specific order that the body engages its muscles, bones, joints and balance to perform a movement. In our golfing clients, the movement is striking the ball.

For an efficient golf swing to take place, the process of kinematic sequencing looks like this:

  • First, the pelvis is engaged and rotates towards the ball.
  • Second, the trunk engages and follows the pelvis.
  • Third, the arms engage and follow the trunk.
  • Fourth, the hands and club follow the arms until the ball is struck.

Once the ball is struck, the body again engages in a kinematic sequence, this time of deceleration, with the pelvis engaging first, followed by the trunk, followed by the arms, followed by the hands and club. That is good sequencing.

As massage therapists, the better we understand kinematic sequencing — especially in our rotational athletes who play golf, tennis, baseball, bowling and soccer — the the better we become at assessing our clients’ pains, restrictions, limitations and frustrations.

And the first step to better assessing our clients is to perform better evaluations. Specifically, how they present when they take a static posture and when they take a dynamic posture as they describe their pains, restrictions and issues.

Static posture is, of course, the position of the body at rest, sitting, standing or lying down. This is typically what we see most often as massage therapists. Our clients sitting or standing before us or perhaps already laying on the table as they describe their pains and wait for us to treat them.

Dynamic posture, on the other hand, has the patient: move, twist, lift, pull, push and balance in order to reveal the likely causes of the client’s pain or imbalance. The difference in evaluating your client’s condition using dynamic posture as well as a static posture is often the critical and missing step in properly assessing and treating our patients (Doctor Vladimir Janda “Upper and Lower Cross Syndrome” 1979, cited in Lewitt 1999).

To only evaluate your client in a static posture would be missing the holistic nature of human dynamic motion and posture. Sure, you can look at a left hip internal rotation when your client is on the table and find a deficiency of say 15-20 degrees, but that won’t give you an accurate picture of what’s really affecting the golf swing until you ask your client to stand up and perform the very movement that causes the trouble. So to replicate the golf swing, you must ask your client to do an internal rotation so as to move the trunk over the hip.

Frankenstein on the Golf Course

Here’s an example from my own clinic. I recently had the opportunity to work with a golfer who had bilateral hip replacements, a right knee replacement, and a left shoulder injury that was never repaired. I hate to say it, but he walked like Frankenstein and, as you can predict, his traumas lead to a continuing decline in his game performance.

When golfers ready themselves to strike the ball they bend their knees into a semi-squat formation. So to properly assess my client’s condition, I asked him to squat, slowly, all the way into a chair. And as he did so, I observed his ankles, knees, hips, trunk and motor control. I then asked him to stand on one leg. His ability to maintain a one-legged posture lasted less than three seconds. I also noted that he could not even begin to touch his toes; and he had limited trunk control, pelvic and spinal rotation. He had a forward head posture, kyphosis, and evaluation of his left shoulder joint presented the arm well in front of his ear instead of the proper placement which is beside or behind the ear. As you might infer, he clearly needed better flexibility. But, because of his hip prosthetics, it would be inadvisable to stretch his hips into internal rotation.

For this client, I began by making a basic golf movement better. Namely, the squat. Simply by teaching him to use his hips better, it allowed him to stay in a golf posture longer which helped with his swing path, tempo and striking distance — and his enjoyment of the game. We always combined our sessions with manual therapy, focusing around the hip rotators, to help him improve his hip hinge.

If you are ever presented with a client suffering with similar impairments, begin by writing down your assessment of how each muscle is affecting the joints in the lower extremities. Look at the flexibility of the feet as they relate to overall stability during weight shifts. Create more ankle mobility by addressing the dorsiflexors and removing myofascial restrictions. Check the client for the ability to do inversion and eversion of the ankles. Attempt to lengthen the quads, hamstrings, adductors, IT band, gluteals and psoas. Your goal is to increase the length of the flexor chain and increase strength to the extensor chain.

Once you’ve completed all of the above, recheck the client’s movement by asking your client to perform another squat or the movement pattern that is causing the concern. If your client has yet to improve, it may indicate that just stretching the lower extremity is not enough. Adding mobility without adding stability may not change the movement pattern. You may need to become a teacher of the squat. Put a chair behind the client, have them do an isometric press into their hands to activate the core, and teach them to hip-hinge back into the chair. Then repeat your manual therapy and re-check your client’s range-of-motion. Continue to do this as many times as necessary throughout the session to reveal how much your client’s motor control is improving. You will often see minor improvements during the first session and noticeably bigger improvements during subsequent appointments.

This is the protocol I implemented with my own client and he improved dramatically. In just three months, I had him transform his gate from that of a B-movie monster to that of a young man walking with a kick in his step. He also lowered his golf handicap, feels younger, stands taller and more importantly . . . he is now free of his worst fear — that of believing that he’d never again enjoy playing 18 rounds of the great game of golf.

References

  1. Supertraining: Yuri Verkhoshansky and Mel Siff.
  2. Manipulative Therapy in the Rehabilitation of the Locomotor System: Karel Lewit, Third Edition 1999.
  3. Superstretch : Mel Siff 1994.
  4. Facts and Fallacies of Fitness : Mel Siff 1998.

Massage Education’s Future

Education is a sensitive and divisive topic within the massage therapy profession.

On one side of the argument are those who believe that today’s non-degree vocational school system is both egalitarian and in line with traditional massage therapy practices.

On the other are those who believe the current system penalizes those who want to become full participants in the health care industry. They advocate for an educational spectrum that also includes bachelors and advanced degrees. But while some form of tiered credentialing seems to be the preferred solution on both sides of this argument, it seems there are many directions for that path to take.

“I know there’s a segment of the massage population that wants to increase the hours and scope of practice for massage therapists. They want to see more evidence-based massage research and more acceptance by the allopathic medical field,” said Cherie Sohnen-Moe, WIBB blogger, author and business coach. “While I would like to see this as an option, I don’t want to see it as the main path for massage. If we do this, we will be pricing massage out of the range of the average person. As it is, most people claim they can’t afford a massage on a regular basis, if at all.”

massage education Monetary arguments can be powerfully persuasive in a profession where the average salary can hover around $30,000 per year for experienced therapists and around $10,000 per year for a first-year therapist.

“The more training you require for entry, the higher the cost of the training, the more evidenced-based you need to be to justify it, the more people you eliminate from practice and the higher the cost to the consumer,” said Keith Eric Grant, senior instructor of sports and deep tissue massage at the McKinnon Institute in Oakland, Calif., and a board member of the California Massage Therapy Council.

However, others suggest that advanced degrees can present new and important opportunities for therapists and consumers.

“Having advanced degrees available in massage therapy will open many doors for us in the research world and in the public health policy world,” said Ruth Werner, President of the Massage Therapy Foundation. “It is so frustrating to realize that right now we are missing out on a once in a lifetime opportunity to be in on the beginning of a new health care paradigm that encompasses preventive care and wellness. We’re doing our best, but it is an uphill battle largely because of this educational disparity.”

Portrait of the Profession

Most therapists today are female, in their early 40s and enter the profession as a second career, according to recent studies by the American Massage Therapy Association (AMTA) and market research done by Massage Today. The industry itself was estimated to be $12 to $17 billion in 2010. According to a 2010 U.S. Department of Labor estimate, employment for massage therapists is expected to increase 19 percent from 2008-2018, faster than average for all occupations. According to the AMTA study, between July 2009 and July 2010, approximately 48 million adults received a massage at least once.

Most therapists work an average of 15 hours a week providing massage (this includes time spent on other business related tasks). Therapists charge an average of $60 for a one-hour massage and earn an average wage of $41 an hour (including tips) for all massage-related work. The AMTA study also found that today’s therapists are heavily reliant on repeat business. The average annual income for a massage therapist in 2010 (including tips and working approximately 15 hours per week) was estimated to be $31,980.

Current Education and State Regulation

According to the AMTA survey, there are more than 300 accredited massage therapy schools nationwide and nearly 90,000 nationally certified therapists. What does it mean to be nationally certified? According to the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB), to meet this standard, a therapist must demonstrate a mastery of core skills and knowledge, pass an exam, adhere to a code of ethics and established standards of practice and take part in established continuing education standards.

Massage therapists have an average of 660 hours of initial training and take an average of 22 hours of continuing education per year. Perhaps the most interesting piece of information from the AMTA study was that 92 percent of massage therapists strongly or somewhat agree there should be minimum education standards for massage therapists.

An argument can be made that you really can’t look at massage education without looking at the regulation of the industry, as the regulation generally set the educational criteria that must be met. Currently, 43 states and the District of Columbia regulate massage therapists or provide voluntary state certification. And with that certification, a specific educational requirement must be met. However, each state is different in what they require to be considered certified or licensed. For example, the state of Texas requires 500 hours of board-approved education, while Alabama requires 650 hours, Arizona requires 700 hours and the state of New York requires 1000 hours.

Not only are the number of hours different, so too is the mix of classes the various states require. For example, according to the Texas Department of State Health Services, its 500 hours of massage therapy course work must be “directly related to the theory or clinical application of theory pertaining to the practice of massage therapy and the manipulation of soft tissue, massage therapy laws and rules, business practices, professional ethics, anatomy, physiology, hydrotherapy, kinesiology, pathology or health and hygiene.” While the New York State Education Department requires its 1000 hours to be “complete coursework in anatomy, physiology, neurology, myology or kinesiology, pathology, hygiene, first aid, CPR, infection control procedures, the chemical ingredients of products that are used and their effects, as well as the theory, technique and practice of both oriental and Western massage/bodywork therapy. Within the 1000 hours of education, you will have to complete a minimum of 150 hours of practice on a person.”

“I think massage therapy education the way it is today is a natural outgrowth of many factors,” said Werner. “The advent of Title IV funding was, predictably, a blessing and a curse. It actually made massage school more expensive, but also made it more accessible to a wider market. You can also argue that it raised the bar for minimum expectations above what people in my generation of students got from one teacher teaching every aspect of a course.”

It can be argued that with so many accredited schools nationwide and requirements varying from state to state, that this educational environment only seems to perpetuate the problems involved in portability and the perception among other health care professionals that massage therapists might not be qualified to be a contributor on the health care team.

Grant believes more needs to be done in the current system before degree programs should be considered. “Current 500-hour requirements are very vaguely defined in terms of evidence-based outcomes. If we are truly interested in credibility, then we have a lot more that can be done in terms of validity and reliability (consistency) within the hours we already are requiring,” Grant said.

Werner agrees that standardization is important. “One major factor is that each accrediting agency has different standards and schools often choose whichever is the least expensive to work with, or the least expensive to comply with. I don’t know much about the accrediting process, but I know that some accredited secondary or vocational school systems don’t have requirements about the order in which people take classes — they just put people in the stream and hope for the best — then you get students who are learning deep tissue massage before they learn anatomy. Who thinks that’s a good idea? But the institution is accredited and it’s the cheapest way to put people through the system, and who gets short-changed? The student.”

Ralph Stephens, a nationally recognized massage therapist, author, and continuing education provider believes that, “until we have standards for massage therapy instructors, degrees will not in and of themselves accomplish much of anything.” Stephens thinks any changes made in education must be done with one question in mind, “what will provide the public with a better massage?”

The Debate

The issue of portability has been a longstanding thorn in the profession’s side for many years now. One possible solution being considered is tiered credentialing, that is, a system that includes college baccalaureate degrees and beyond.

“Their was a time when I felt like our profession could not handle tiered credentialing because it is just so hard to organize massage therapists,” Werner said. “But as I have seen more [through my work with the Massage Therapy Foundation] about what the potential for our profession is if we make the opportunity for people who want to pursue advanced education — but we should not require it.

“I’m determined that however our profession moves forward when we think about the evolution of our education, there needs to be space for people who are not bookish, but do their work and they do it brilliantly, as long as they do it safely. But what we’re missing now is space for people who are bookish.

“Right now, if you want to get an advanced degree in massage, what we’re talking about is a master’s or PhD in public health, nursing, psychiatry or gerontology. Those are the only advanced degrees I know of. It’s time for us to have bachelors, masters and doctoral degrees in massage therapy — and not for everybody — but for the people who want to do it,” Werner said.

However, not everyone feels this is the best move forward for the profession.

“Our traditional medical system is a failure, why jump on that boat when it’s sinking?” asks Sohen-Moe. “In terms of baseline requirements, it does not take a rocket scientist to perform a safe, effective massage. While I am personally an advocate of lifelong learning and would hope that practitioners would choose programs that offer some depth as well as breadth, basic programs need to be offered.”

Stephens wholeheartedly agrees. “We need to reach the public with a better product as an alternative to the allopaths, working with other alternative providers to challenge the monopoly of the pharmaceutical-allopathic cartel.”

However, this leads to the question, if an expanded scope of practice were offered with degree-level training, which theoretically leads to more acceptance by the allopathic medical field, would more patients seek out massage as an option for care of pain management or musculoskeletal issues as opposed to seeking out a prescription for drugs? Ultimately, would this type of program lead to more acceptance in the mainstream health care community and are massage therapists ready to play in that field?

Ruth Werner absolutely thinks so. “There is a new emphasis on wellness and prevention and massage deserves a seat at that table and can absolutely play in that playing field, but if we scream and kick and pound our fists and demand a seat at that table, people with doctorates will look at us and say, ’500 hours? Really?’

“The amount of money spent on massage therapy research is not commensurate with the amount of money the public spends on it and the reason for that is that there are not enough people who know how to write a good grant proposal,” Werner said. She continues, “the reason there aren’t enough people who know how to write a good grant proposal is because there is not a good degree program for massage therapists.”

Those that feel massage therapy is generally less scientific and more about the art of touch, say that something important will be lost if the profession pushes ahead with an advanced degree program.

“I fear the loss of the art of massage as we swing the pendulum to the scientific aspect of massage,” said Sohnen-Moe. “I’ve already witnessed a lot of that change in the past 15 years. Less and less people get into this field as a calling. I’ve had many technically accurate massages, but the newer practitioners seem to have something missing in their work.

“I think the way to go about addressing the education issue is to have specialty national certifications rather than advanced degrees. While I know this is a difficult and expensive process, I really think it’s the way to go,” said Sohnen-Moe. “We need to make sure our core competencies are there. Board certification is more valuable and gives us much more credibility. Doesn’t it sound better to say, ‘I am a massage therapist board certified in…whatever your specialty is.’”

And yet there are still others who feel the time for action in this area is now.

“There are enough of us who are standing up and saying there is a segment of our profession that needs to step it up and accept those higher standards and stop trying to get everyone to agree because we’re not going to agree,” said Lisa Curran-Parenteau, WIBB blogger and marketing and practice development specialist. “Let that natural separation happen. I love the nursing model. You’ve got nurse practitioners, registered nurses and licensed nurse practitioners and they all have a great vocational opportunity for themselves and they all spent different amounts of money for their education. They have a structure and everybody knows that it is and it’s portable.”

Is it now time for the profession to take responsibility for itself and the direction it wants to go? Is it time for therapists to “step it up” to market themselves and effectively communicate their experience and education? With licensure not required in all states, no portability, no defined education standards or consistent school requirements, does moving to a degree program make the most sense in providing a legitimate platform for qualified and motivated therapists to compete in this evolving health care landscape?

Where do you stand in this debate? Do you think that more people will be dissuaded from entering the profession because of the increase in educational costs if the profession required a degree? Do you think there should be a tier system with a college-level degree as an option? If there was a degree option, do you think more people would choose massage therapy as a first career rather than a second? Do you think a degree would provide more legitimacy in the mainstream health care system?

Neural-Muscle Connection Discovery Could Help People with Muscle Fatigue

Motivation. Strength. Will power. Physical condition. Stamina. All of these have long been known to contribute the extent to which humans are able to voluntarily activate muscles. But for the first time, investigators have discovered neuronal processes that are responsible for reducing muscle activity during muscle-fatiguing exercise.

The investigators say their discovery opens up new areas of research to help people who experience muscle fatigue related to illness.

“The findings are an important step in discovering the role the brain plays in muscle fatigue,” said investigator and neuropsychologist Kai Lutz. “Based on these studies, it won’t just be possible to develop strategies to optimize muscular performance, but also specifically investigate reasons for reduced muscular performance in various diseases.”

In an earlier study, the researchers showed that nerve impulses from a muscle, much like pain information, inhibit the primary motoric area during a tiring, energy-demanding exercise.

In a second study, using functional magnetic resonance imaging, the researchers were able to localize the brain regions

that exhibit an increase in activity shortly before the interruption of a tiring, energy-demanding activity—the thalamus and the insular cortex—and are thus involved in signalizing the interruption. Both of these areas analyze information that indicates a threat to an organism, such as pain or hunger.

The latest study indicates the inhibitory influences on motoric activity are mediated via the insular cortex. In tests using a bicycle ergometer, the researchers determined that the communication between the insular cortex and the primary motoric area became more intensive as fatigue progressed.

“This can be regarded as evidence that the neuronal system … not only informs the brain, but also actually has a regulating effect on motoric activity,” said investigator Lea Hilty.

Prolonged reduced physical performance is a symptom that is frequently observed in daily clinical practice, a press release noted. “It can also appear as a side effect of certain medication [and] … chronic fatigue syndrome is often diagnosed without any apparent cause.”

Masasge and How You Feel

Therapeutic Massage has been around for over 3000 years, but there has never been a more important time for massage than now, with people sitting at their desks for long hours working at their computers, the poor economy causing additional stress and people taking jobs that their bodies are not used to, to name a few.

The Value of a Massage

Eases low-back pain, neck pain and shoulder pain
Increases range of motion
Stimulates lymph flow—the body’s natural defense system.
Stretches weak and tight muscles
Prepares the athlete and helps recover him or her from vigorous exercise
Improves joint flexibility
Lessens depression and anxiety
Reduces spasms and cramping
Relaxes and softens injured, tired, and overused muscles
Relieves migraine pain
Relaxed muscles improve posture
Provides relaxation and stress relief producing a sense of well-being

Acupuncture, Qi and the Body, Mind and Spirit

The practice of acupuncture and moxibustion is based on the theory of meridians. According to this theory, qi (vital energy) and blood circulate in the body through a system of channels called meridians, connecting internal organs with external organs or tissues. By stimulating certain points of the body surface reached by meridians through needling or moxibustion, the flow of qi and blood can be regulated and diseases are thus treated. These stimulation points are called acupuncture points, or acupoints.

Acupoints reside along more than a dozen of major meridians. There are 12 pairs of regular meridians that are systematically distributed over both sides of the body, and two major extra meridians running along the midlines of the abdomen and back. Along these meridians more than three hundred acupoints are identified, each having its own therapeutic action. For example, the point Hegu (LI 4), located between the first and second metacarpal bones, can reduce pain in the head and mouth. The point Shenmen (HT 7), located on the medial end of the transverse crease of the wrist, can induce tranquilization.

In acupuncture clinics, the practitioner first selects appropriate acupoints along different meridians based on identified health problems. Then very fine and thin needles are inserted into these acupoints. The needles are made of stainless steel and vary in length from half an inch to 3 inches. The choice of needle is usually determined by the location of the acupoint and the effects being sought. If the point is correctly located and the required depth reached, the patient will usually experience a feeling of soreness, heaviness, numbness and distention. The manipulator will simultaneously feel that the needle is tightened.

The needles are usually left in situ for 15-30 minutes. During this time the needles may be manipulated to achieve the effect of tonifying the qi. Needle manipulations are generally involved with lifting, thrusting, twisting and rotating, according to treatment specifications for the health problem. Needling may also be activated by electrical stimulation, a procedure usually called electro-acupuncture, in which manipulations are attained through varying frequencies and voltages.

Treatment protocols, frequency and duration are a matter of professional judgment of the practitioner, in consultation with the patient. A common course of treatment may initially involve between ten and fifteen treatments spaced at approximately weekly intervals, and spread out to monthly later in a program.

A professional practitioner will always warn the patient of the possibility of exacerbation at the start of a course of treatment. The patients may find that in the short term after treatment, the symptoms may in fact get worse before an improvement sets in. This is a quite common feature of acupuncture treatment.

Patients should inquire about types of needles used prior to treatment. Most practitioners now use pre-packed and sterilized disposable needles that are used  only once. If re-useable needles are being used patients should ask to see the sterilization procedures that the practitioner adopts.

The effectiveness of an acupuncture treatment is strongly dependent upon an accurate Chinese medical diagnosis. The needling skills and techniques of the practitioner will also influence greatly the effectiveness of the outcome. Acupuncture can be remarkably effective in many conditions, but in the West, patients often use acupuncture as the last option for their long-term chronic problems. Therefore we sometimes see the treatment as slow and in some cases of marginal benefit. With the gradual establishment of acupuncture as the treatment of choice for many people, the effectiveness of the approach with acute as well as with more chronic conditions is being recognized.

Acupuncture is often conducted in combination with Moxibustion. Moxibustion is the process where moxa sticks, made of dry moxa leaves (Artemisia vulgaris) is ignited and held about an inch above the patient’s skin over specific acupuncture points. Moxa is available in a loose form that can be used for making moxa cones. Alternatively, moxa is packed and rolled in a long stick like a large cigar, about 15-20 cm long and about 1-2 cm in diameter. The purpose of this process is to warm the qi and blood in the channels. Moxibustion is most commonly used when there is the requirement to expel cold and damp or to tonify the qi and blood. A single treatment of moxibustion usually lasts 10-15 minutes. Needle-warming moxibustion combines needling and moxibustion by attaching a moxa stub (about 2 cm long) to an inserted needle. This method enhances the effects of needling and is often used to treat chronic rheumatism and rheumatoid arthritis.

Chiropractic Care in 100 Words

Aches and pains are signs that your body isn’t working right.

Your brain, spinal cord and all your nerves control how your body works.

Physical, chemical or emotional stresses produce a defensive posture.

Muscles contract, locking spinal joints that pinch or irritate nearby nerves.

Lack of nervous system integrity sets the stage for disease and ill health.

A thorough examination helps chiropractors find these subluxations.

Applying a precise force to stuck spinal joints helps the body right itself.

Health usually returns as repeated visits restore nervous system integrity.

That’s why chiropractic care has helped millions get well and stay well.