Monday, September 30, 2013


Mechanical Forces That Act on the Body
Mechanical forces occur from actions that involve pushing, pulling, friction, or sudden loading, such as a direct blow. Five different kinds of force act on the body tissues. (DESCRIBED IN A BIT SO KEEP READING) Tissue types respond differently to different forces. Bending forces seldom harm the soft tissues but will break bone. Tensile forces seldom injure bone but often damage soft tissues. Massage therapists can use these same mechanical forces therapeutically during massage application.
During massage we should be able to modify the massage application from surface to deep, fast to slow, and long to short, as appropriate, based on the client's individual needs. The intention and outcome of the massage application should appropriately influence fluid movement, nervous system function, musculoskeletal function, and connective tissue pliability in both acute and chronic conditions. Our attention to the client is based on an intent to serve our clients in a focused and compassionate manner.
Massage manipulations, which are modes of application, are used to apply mechanical force during massage in an appropriate way to achieve the determined outcome for the massage.  In the massage and bodywork community we use many different names to describe the mode of application.   We glide /effleurage/ stroke and knead/petrissage/ twist and the list goes on in a very confusing way.  Regardless of what we call what we do, the application can be effectively determined by describing what is able to be observed during the application, the modifications to the application such as how deep, speed, direction, location, duration repetitions, pull and drag on the tissue and so forth.  Then by determining the mechanical forces acting on the body tissues the likely outcome of the application can be described.   An example is provided at the end.  The following paragraphs describe the types of mechanical forces and the potential injury and therapeutic application pertinent to therapeutic massage.
Compression forces occur when two structures are pressed together . Compression is a common way that tissues become injured. Ligaments and tendons resist compressive injury. Muscle tissue, because of its extensive vascular structure, is not as resistant to compressive forces. Excessive compression force ruptures or tears the integrity of the muscle tissue, causing bruising and connective tissue damage.
Compression is a major mechanical force used in the application of massage to support circulation, stimulate nerve function, and restore connective tissue pliability. The massage therapist applies compression in such a way as to achieve benefits without damaging tissue, usually with the broad-based application of compressive force

(From Fritz S: Mosby's fundamentals of therapeutic massage, ed 5, St Louis, 2013, Mosby.)
Tension forces, also called tensile forces, occur when two ends of a structure are pulled away from each other .Bone resists tensile forces. However, tensile stress injuries are the most common way soft tissues are damaged. Examples of tensile stress injuries include avulsion (complete tearing of attachment), muscle strains, ligament sprains, tendinitis, fascial pulling or tearing, and nerve traction injuries (sudden nerve stretching such as that which occurs in stingers). Tensile stress injuries are described as first degree (mild), second degree (moderate), and third degree (severe).
Tensile force is applied during massage, particularly during gliding and traction. Therapeutically, tensile force supports proper alignment of fiber structures and can increase pliability in connective tissue.

(From Fritz S: Mosby's fundamentals of therapeutic massage, ed 5, St Louis, 2013, Mosby.)
Bending forces are a combination of compression and tension . One side of a structure is exposed to compressive forces, whereas the other side is exposed to tensile forces. Bending forces are a common cause of bone fractures and ligament injuries but seldom harm other soft tissues.
Bending is used during massage when kneading methods are applied. The proprioceptors in muscles and tendons respond to these forces. Bending forces also affect connective tissues, especially the viscosity of the ground substance.

Shear is a sliding mechanical force with friction created between structures that are sliding against each other. Excessive shearing force at a ligament or tendon creates an inflammatory irritation that leads to adhesion and fibrosis.
Shear and friction, called cross-fiber friction, is a massage method that uses specific force to create therapeutic inflammation to reverse fibrotic connective tissue changes.

Application of torsion force to a single soft tissue structure is not very common and is rarely the cause of significant tissue injury. Torsion force applied to a group of structures (e.g., a joint) is much more likely to be the cause of significant injury. For example, when the foot is on the floor and the individual turns the body, the knee as a whole is exposed to significant torsion force
Torsion forces are best understood as twisting forces. Massage methods that use kneading introduce torsion forces and target connective tissue changes and fluid movement.
 Example of combined loading: torsion loading (A) + tension loading (B) + compression loading (C).
Ease occurs when tissue is slack.  Bind occurs when tissue is taut.

Connective Tissue Protocol
1              Place crossed hands over tissue and meld hands to the skin.
2              Separate hands moving tissue to and just into bind/taut.. Do not slip.
3              Forearms can be used. Place on the tissue and meld to it.
4              Separate arms moving tissue to and just into bind/taut.
5              Small areas of tissue can be stretched by placing the short tissue between the fingers of both hands, and then without slipping separate tissues into the bind/taut and just into the tautness to stretch. .
6              Stabilize tissue at one end of the target area and hold fast. Then slowly glide, with drag maintaining tension on the tissues at all times.
7              Use shear forces to move tissue in and out of bind.(slack/taut)
8              Use bending force to move tissue into bind (skin rolling).
9              Grasp, lift, and pull to create combined loading to move tissue into and out of bind.
10           Use torsion force to twist tissue into and out of bind.
11           Stretching methods take tissue into bind. Hold at the ends of the area to be stretched and move away to create tension force.
12           Traction applies tension force to the tissues surrounding a joint. Grasp firmly above and below the joint and move hands apart to create tension force into bind.
13           Pin and stretch variation. Move target tissue from ease position toward bind and hold in place.
14           As the target tissue is held fixed, move the joint area to create the tension force into the bind.
15           Active release variation. Compress target tissue while in ease and then move from ease to bind position.
16           Client moves the jointed area away while the tissue is fixed to create the tension force to move tissues into bind.
Fritz. Mosby's Fundamentals of Therapeutic Massage, 5th Edition. Mosby, 2013. <vbk:978-0-323-07740-8#outline(>.
Describing what we do in this way provides the beginnings of a common language that we so desperately need to move forward in our professional development.  Explaining massage and other forms of bodywork in this manner preserves the integrity of the individual forms and style while identifying the commonalities.   Swedish massage as a style can still use the classical terms of effleurage and petrissage and neuromuscular methods can still use terms such as friction, trigger point release and myofascial manipulation .  Regardless of the method ,when describe by observation of what is done, the mechanical force created that acts on the tissue and the modulators of the application such as pounds of compressive force and degree of pull (tension force ) on the tissue, also location, duration and so forth  as well as intended outcome or what happened to the tissue, a common understanding  can be achieved.
I want to applaud the ELAP work group for advancing the profession by using this method to describe massage and bodywork.
The following links provide interesting information about how important mechanical forces are to the human body.
Mechanical Forces Play Major Role in Regulating Cells
Small Mechanical Forces Have Big Impact On Embryonic Stem Cells

Friday, September 20, 2013


It is frustrating for me and many others I suspect when I just have to wait on results.  That is what I am doing now-waiting.  I keep thinking that there is something I should be doing but there is no value right now for me to do anything but what to see what others end up doing.  I will be at the  AMTA convention next week in Texas.  Ed Mohr, one of the graduates from my school will be presenting at the convention and I am excited about that.

Reducing Injury and Increasing Output With Proper Body Mechanics (Hands-on)

Instructor: Edward G. Mohr
Edward Mohr developed and managed the ergonomics program at General Motors, dealing with the elimination of work related stressors. Upon retirement, he became a massage therapist and utilized his prior knowledge of the capabilities and limitations of the body to analyze the work related stressors of massage therapists.

I am waiting for my fall entry level massage training program to begin first of October.  It really surprises me how sometimes you can do everything right and it still does not always work out the way you want.  I believe that I have developed an excellent curriculum for massage education.  I have written the major textbooks for crying out loud.  My school - Health Enrichment Center - has been in business for since 1984.  The graduates typically have jobs before they graduate. The school reputation is excellent and yet I continue to struggle to get a sustainable  enrollment.  Class size is limited to 12 and I teach a large portion of the program.  Tuition is reasonable-$7000 including books for a 600 hour program.  Scheduling is flexible and program is completed in 12 months part time.  I do not participate in financial aid but offer in house reasonable payment plans.  The downside.  I live in Michigan a state that is still reeling from the economic down turn. This seems to be the major issue and there is little I can do about that but wait it out.

I am waiting to find out what revisions have been made to the  ELAP  Entry Level Analysis Project.  I have been as influential as I know how to be.  My intentions are based on the best future for the massage profession and all I can do is hope that enough people commented on the surveys and that the committee pays attention.  I want to see all the raw data which is expected for a valid research project and I am waiting to find out how I will have to adapt based on the results.

Right now I am waiting on a client. I work with professional football players primarily and provide 10 -12 sessions per week. (sometimes more).  Not bad for being in practice for 34 years and 60 years old.

I am waiting to find out what the AMTA is going to actively do about supporting massage inclusion in the Affordable Care Act. AMTA is the "for real" professional association representing Massage Therapy.  The ABMP is a private business entity and while Les Sweeney and his staff provide excellent services  to the massage community it is not their responsibility to take an active role.  I would be nice if they contributed money and other resources  but not their job.

So it is a waiting time. Waiting patiently and attentively is an important contribution .  I am paying attention and being productive.  I have really enjoyed taking Coursera college courses during this waiting time.Instructional Methods in Health Professions Education is the one I am finishing soon and will start  Going Out on a Limb: The Anatomy of the Upper Limb next week.  Woot Woot. they are FREE!

So I no longer need to wait on my client.  He is here.