Hollistic Health Journal

CHAPTER 26 Manipulative and Body-Based Methods OBJECTIVES This chapter should enable you to • Describe the manual healing methods of chiropractic, energy medicine/healing, massage therapy, Trager approach, Feldenkrais method As the name implies, manipulative and body-based therapies focus on bodily structures, including the

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bones, joints, soft tissue, and circulatory and lymphatic systems. Although they may address similar conditions and share a holistic perspective, each of these methods has unique approaches. The effectiveness of these therapies in relieving musculoskeletal pain causes them to be popular. Chiropractic Approximately 8% of American adults have used the services of a chiropractor, usually for back pain (National Center for Complementary and Integrative Health, 2016). Chiropractors must meet specific training (typically a 4-year academic program that includes both classroom work and direct care experience) and licensing requirements. Some chiropractors also complete a 2- to 3-year residency for training in specialized fields. Many health insurance plans cover the chiropractic treatments. History tells us that manipulation as a healing technique was used as early as 2700 BC by the Chinese. The Greeks (in 1500 BC) and Hippocrates (460 BC) also used spinal manipulation to cure dysfunctions of the body. Daniel Palmer founded chiropractic in the Midwest in 1895, and it is now the fourth largest health profession in the United States. Palmer believed that all body functions were regulated by the nervous system and that because nerves originate in the spine any displacement of vertebrae could disrupt nerve transmission (which he called subluxation). He hypothesized that almost all disease is caused by vertebral misalignment; therefore, spine manipulation could treat all disease. Today the theory has changed to what is being called intervertebral motion dysfunction. The key factor in this theory involves the loss of mobility of facet joints in the spine. KEY POINT Chiropractors believe that a strong, agile, and aligned spine is the key to good health. How It Works The spine is made up of 24 bones called vertebrae with discs of cartilage cushioning between each vertebra. The spinal cord runs through the middle of the vertebrae with many nerves branching off through channels in the vertebrae. Chiropractors believe that injury or poor posture can result in pressure on the spinal cord from misaligned vertebrae, and that this can lead to illness and painful movement. The chiropractor identifies and corrects the misalignments through manipulation, which are called adjustments. Muscle work is also incorporated as muscles attach and support the spine. Manipulation and muscle work can be done by hand and/or be assisted by special treatment tables, application of heat or cold, or ultrasound. Some chiropractic physicians also advise about nutrition and exercise. The first visit includes a detailed medical history and examination of the spine. Sometimes X-rays of the spine are also obtained. The findings are reviewed by the chiropractor, and a plan is established with a suggested number of follow-up treatments. What It Helps Chiropractic is useful for lower back syndromes, muscle spasms, midback conditions, sportsrelated injuries, neck syndromes, whiplash and accident-related injuries, headaches, arthritic conditions, carpal tunnel syndrome, shoulder conditions, and sciatica. KEY POINT In the United States, chiropractic practitioners must meet the licensing and continuing education requirements of the state in wh accredited college. Words of Wisdom/Cautions With a conscientious, professionally trained chiropractor, there are few side effects; however, some soreness may be experienced for a few days after a spinal adjustment, and occasionally symptoms get worse. Manipulations are contraindicated in persons with osteoporosis and advanced degenerative joint disease as these might be worsened by spinal adjustment. Caution is needed when chiropractic is done in older adults due to risk of increased bone brittleness that can contribute to fractures. TIP FOR PRACTITIONERS Advise clients not to accept body manipulations by individuals who are not licensed chiropractors. Unqualified and inexperienc Massage Therapy Massage is among the most common forms of alternative therapies used in the United States. It consists of the therapeutic practice of kneading or manipulating soft tissue and muscles with the intent of increasing health and well-being and assisting the body in healing. There are many different types of massage, such as lymphatic massage, sports massage, Swedish massage, shiatsu massage, myofascial release, trigger point massage, Thai massage, and infant massage. A form of deep tissue massage that is known as structural integration is called Rolfing. This system works deeply into muscle tissue and fascia to stretch and release patterns of tension and rigidity and to return the body to a state of correct alignment. How It Works There have been few scientific studies that explain the mechanisms by which massage works, although it is known to bring relief and relaxation to recipients. It is understood that besides stretching and loosening muscle and connective tissue, the action of massage also • Improves blood flow and the flow of lymph throughout the body. • Speeds the metabolism of waste products. • Promotes the circulation of oxygen and nutrients to cells and tissues. • Stimulates the release of endorphins and serotonin in the brain and nervous system. KEY POINT Massage can be seen as a form of communication from the therapist that brings comfort, gentleness, connection, trust, and peac What It Helps Massage is good for health maintenance as well as an adjunct to healing. Research supports the benefits of massage for low back pain (Furlan, Imamura, Dryden, & Irvin, 2008; Trampas, Mpeneka, Malliou, Godolias, & Vlachakis, 2015), cancer pain (Kutner et al., 2008; Lee et al., 2015), caregiver stress (Pinar & Afsar, 2015), arthritic pain (Field, Diego, Gonzalez, & Funk, 2015; Juberg et al., 2015), chronic neck pain (Sherman, Cherkin, Hawkes, Miglioretti, & Deyo, 2009), and hypertension control (Nelson, 2015; Walaszek, 2015). Massage also can be useful for conditions that can benefit from relaxation. REFLECTION What would it take for you to build regular massages into your life? Words of Wisdom/Cautions There are a few contraindications that will be screened by the massage therapist when taking a medical history at the first visit. This is a reason for choosing a well-trained and qualified massage therapist. Ask for credentials and assure the therapist meets the licensing requirements for massage therapists. The Trager Approach In the 1920s, a physician, Milton Trager, developed a method which he called Psychophysical Integration, a method of passive, gentle movements with traction and rotation of extremities to help reeducate muscles and joints. Through this method, muscle tightness is relieved without pain, and the end result is a sense of freedom, flexibility, and lightness. How It Works In the Trager approach, the practitioner begins by entering a state of meditation and using gentle touch to gently move the joints and body parts. This is done to establish communication with the nerves that control muscle movement to release and reorganize old patterns of tension, pain, and muscle restriction. A session lasts 60–90 minutes, and after a session, instructions are given for a series of simple movements (called Mentastics) to help maintain the results of the treatment. Deep relaxation of mind and body is also promoted during these movements. What It Helps The Trager approach is promoted as a means to help chronic pain, muscle spasms, fibromyalgia, temporomandibular pain, headaches, plus many other neuromuscular disorders. Words of Wisdom/Cautions Scientific evidence supporting the benefit of the Trager approach to therapy is lacking, although with a trained practitioner, harmful side effects should not exist. KEY POINT Although scientific evidence supporting the effects and benefits of a therapy may be lacking, if it brings relaxation and comfort its use. Feldenkrais Method Feldenkrais teaches a person how to alter the way the body is held and moved. It is a gentle method of bodywork that involves movement. Moshe Feldenkrais developed this method after suffering a knee injury. He studied and combined principles of anatomy, physiology, biomechanics, and psychology and integrated this knowledge with his own awareness of proper movement. How It Works In Feldenkrais, by developing awareness of body movement patterns and changing them through specific exercises, flexibility, coordination, and range of motion improve. Through instruction, a teacher guides a person through a series of movements, such as bending, walking, and reaching. These movements can help reduce stress and pain and improve self-image. It is believed these movements access the central nervous system. There are two types of sessions: (1) a set of movement lessons called awareness through movement learned with a group and (2) individual hands-on sessions called functional integration. The results benefit mind and emotion, as well as the physical body. KEY POINT Feldenkrais teaches a person to be aware of the way the body moves and to use proper movement. What It Helps Research is limited regarding the effects of the Feldenkrais method, although people have found it helpful in improving balance and in the treatment of musculoskeletal conditions and anxiety. Words of Wisdom/Cautions There are no known side effects or unsafe conditions when Feldenkrais is provided by a trained practitioner. Alexander Therapy Alexander therapy is an educational process that identifies poor posture habits and teaches conscious control of movements that underlie better body mechanics. Frederick Mathias Alexander, an Australian actor who lost his voice while performing, developed this therapy. Discouraged by only temporary relief from medical treatments, he began studying how posture affected his voice. After 9 years of study and perfecting his technique, he began to train others. How It Works Alexander therapy teaches simple exercises to improve balance, posture, and coordination. It is done with gentle hands-on guidance and verbal instruction. It results in release of excess tension in the body, lengthens the spine, and creates greater flexibility in movement. A session can last from 30 to 60 minutes; multiple sessions usually are necessary. What It Helps Many conditions that result from poor posture can be greatly helped with Alexander therapy. This technique is taught in many drama and music universities throughout the world. There is evidence that Alexander therapy can help with low back pain and chronic pain (Smith & Torrance, 2011). Words of Wisdom/Cautions Alexander therapy is safe therapy when taught and performed by a credentialed therapist. Craniosacral Therapy Craniosacral therapy was developed in the early 1900s and is an offshoot of osteopathy and chiropractic. At that time, it was called cranial osteopathy. The basic theory behind craniosacral therapy is that an unimpeded cerebrospinal fluid flow is the key to optimum health. William Sutherland, an osteopathic physician, developed craniosacral therapy. He believed that the bones of the skull were movable and that they move rhythmically in response to production of cerebrospinal fluid in the ventricles of the brain. This belief contradicts the teachings of anatomy in Western medicine, which holds the bones of the skull fuse together at 2 years of age and are no longer movable after this point in the physical development of the body. Craniosacral therapists also believe that by realigning the bones of the skull, free circulation of the cerebrospinal fluid is restored, and strains and stresses of the meninges (that surround the brain and spinal cord) are removed, which allows the entire body to return to good health. Sutherland researched his theory over 20 years and documented physical and emotional reactions to compression on the cranial bones. Craniosacral therapy was further advanced by John Upledger, who performed scientific studies at Michigan State University from 1975 to 1983. His findings validated craniosacral therapy’s capability to help evaluate and treat dysfunction and pain. The Upledger Institute in Palm Beach Gardens, Florida, trains practitioners in this discipline. How It Works Trained practitioners palpate the craniosacral rhythm by placing their hands on the cranium (skull) and sensing imbalances. This approach is painless as the practitioner uses gentle touch (less than the weight of a nickel) to sense the imbalances in the rhythm and stabilize it. Recipients report a release of tension and a state of deep relaxation and peace. Practitioners work in a quiet setting and use no needles, oils, or mechanical devices. They take a medical history, observe, and question about any symptoms. What It Helps Currently, evidence does not support that craniosacral therapists can manipulate the bones of the skull sufficiently to affect pressure or circulation of the fluid surrounding the brain and spinal column, nor is there scientific proof of any benefit from craniosacral therapy other than relaxation (Ingraham, 2016). Words of Wisdom/Cautions As with any integrative therapy, use of craniosacral therapy with the exclusion of Western medical advice is not recommended. It is important to be discerning of claims of the benefit of this therapy for various health conditions due to the lack of scientific evidence supporting its effectiveness. Summary With pain being a highly prevalent problem, therapies that can reduce this symptom without the use of medications have an important role. Although most of these therapies carry no serious risk of causing harm, those that manipulate body parts should be done only by trained and credentialed professionals. References 1. Field, T., Diego, M., Gonzalez, G., & Funk, C. G. (2015). Knee arthritis pain and range of motion is increased following moderate pressure massage therapy. Complementary Therapies in Clinical Practice, 21(4):233–237. 2. Furlan, A. D., Imamura, M., Dryden, T., & Irvin, E. (2008). Massage for low-back pain. Cochrane Database of Systematic Reviews, (4), CD001929. 3. Ingraham, P. (2016). Does craniosacral therapy work? PainScience.com. Retrieved from https://www.painscience.com/articles/craniosacral-therapy.php. 4. Kutner, J. S., Smith, M. C., Corbin, L., Hemphill, L., Benton, K., Mellis, B. K., . . . Fairclough, D. L. (2008). Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: A randomized trial. Annals of Internal Medicine, 149(6), 369–379. 5. National Center for Complementary and Integrative Health. (2016). Chiropractic: In depth. Retrieved from http://nccam.nih.gov/health/chiropractic/introduction.htm 6. Pinar, R., & Afsar, F. (2015). Back massage to decrease state anxiety, cortisol level, blood pressure, heart rate and increase sleep quality in family caregivers of patients with cancer: A randomized controlled trial. Asian Pacific Journal of Cancer Prevention, 16(18):8127–8133. 7. Sherman, K. J., Cherkin, D. C., Hawkes, R. J., Miglioretti, D. L., & Deyo, R. A. (2009). Randomized trial of therapeutic massage for chronic neck pain. Clinical Journal of Pain, 25(3), 233–238. 8. Smith, B. H., & Torrance, N. (2011). Management of chronic pain in primary care. Current Opinions Support Palliative Care, 5(2):137–142. 9. Trampas, A., Mpeneka, A., Malliou, V., Godolias, G., & Vlachakis, P. (2015). Immediate effects of core-stability exercises and clinical massage on dynamic balance performance of patients with chronic specific low back pain. Journal of Sports Rehabilitation, 24(4):373–383. 10. Walaszek, R. (2015). Impact of classic massage on blood pressure in patients with clinically diagnosed hypertension. Journal of Traditional Chinese Medicine, 35(4):396–401. Suggested Readings 1. Bergman, T. F. (2010). Chiropractic technique: Principles and procedures (3rd ed.). St. Louis, MO: Mosby. 2. Contrada, E. (2016). Many benefits, little risk: The use of massage in nursing practice. American Journal of Nursing, 116(1):40–41. 3. DeLany, J. (2015). Massage, bodywork, and touch therapies. In M. Micozzi (Ed.), Fundamentals of complementary and alternative medicine (5th ed., pp. 247– 274). St. Louis, MO: Saunders. 4. Gouveia, L. O., Castanho, P., & Ferreira, J. J. (2009). Safety of chiropractic interventions: A systematic review. Spine, 34(11):E405–E413. 5. Juberg, M., Jerger, K. K., Allen, K. D., Dmitrieva, N. O., Keever, T., & Perlman, A. I. (2015). Pilot study of massage in veterans with knee osteoarthritis. Journal of Alternative and Complementary Medicine, 21(6):333–338. 6. Kanodia, A. K., Legedza, A. T., Davis, R. B., Eisenberg, D. M., & Phillips, R. S. (2010). Perceived benefit of complementary and alternative medicine (CAM) for back pain: A national survey. Journal of the American Board of Family Medicine, 23(3):354–362. 7. Lee, S. H., Kim, J. Y., Yeo, S., Kim, S. H., & Lim, S. (2015). Meta-analysis of massage therapy on cancer pain. Integrative Cancer Therapies, 14(4):297–304. 8. Nathenson, P., & Nathenson, S. L. (2015). Complementary and alternative health practices in rehabilitation nursing. Rehabilitation Nursing. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/rnj.227/abstract 9. Nelson, N. L. (2015). Massage therapy: Understanding the mechanisms of action on blood pressure: A scoping review. Journal of the American Society for Hypertension, 9(10):785–793. 10. Salvo, S. G. (2016). Massage therapy: Principles and practice (5th ed.). St. Louis, MO: Elsevier. 11. Stone, V. J. (2010). The world’s best massage techniques: The complete illustrated guide; innovative bodywork practices from around the globe for pleasure, relaxation, and pain relief. Beverly, MA: Fair Winds Press. Resources • Alexander Therapy • American Society for the Alexander Technique • • www.alexandertech.com Chiropractic • American Chiropractic Association • • www.acatoday.org Federation of Chiropractic Licensing Boards • • www.fclb.org World Chiropractic Alliance • • www.worldchiropracticalliance.org Craniosacral Therapy • Upledger Institute • • www.upledger.com The Feldenkrais Method • Feldenkrais Guild of North America • • www.feldenkrais.com Massage Therapy • American Massage Therapy Association • • www.amtamassage.org Associated Bodywork and Massage Professionals • • www.abmp.com Massage Bodywork Resource Center • • www.massageresource.com The Trager Approach • Trager International • www.trager.com
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