How often should you get massage?

neck massageUntil recently, your massage therapist relied upon her or his experience to give you guidance. I’ve usually been reluctant to recommend that clients with come more than once a week, no matter what their issue, partly because of the expense, yet experience has taught me that an issue like neck pain and stiffness will resolve more quickly with more frequent treatments. In fact, I have found that waiting more than a week between massages lets the tissues return to their former state and that a whole host of conditions resolve better with work done twice a week. Certainly, when I had my auto accident, it seemed like I needed massage at least twice, if not three times, a week in order to improve.

New research backs up my experience. A paper published in the most recent issue of the Annals of Family Medicine found that the effective dose for chronic neck pain is two 60 minute massages twice a week for four weeks, with three times a week proving even more effective.* Thirty minute massages at three times a week were no more effective than no massage.

The take-home message here is three-fold. First, when your massage therapist recommends more treatment you probably really need it. You have a better chance of improving if you follow her/his advice. Second, more massage is better, at least up to a point. Third, this is great information for your therapist; if you’re dealing with chronic neck pain, you might take the initiative and suggest a full hour two to three times a week. You can cite this study if you encounter resistance.

If neck pain is not your issue, guidance on how often is still fuzzy, since this is one of the first studies to look at dosing for massage (meaning how much, how often), although the authors cite a study which found osteoarthritis does better with weekly to twice weekly massage of 60 minutes duration rather than 30 minutes duration or what they call usual care. However, if this is how it works for necks, why wouldn’t more be better for low backs, hamstrings, etc?

*Five-Week Outcomes From a Dosing Trial of Therapeutic Massage for Chronic Neck Pain, Karen J. Sherman, et al., The Annals of Family Medicine, March/April 2014 vol. 12 no. 2 112-120

We are currently accepting new clients. To schedule a massage, call or text (541)350-1613 or email us at radiant@radianthealthbend.com. For acupuncture, call or text (541)420-6574.

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Massage for headaches originating in the neck

Many headaches, especially those which are one-sided, are caused by neck tension or problems with the cervical spine. The technical term for this is a cervicogenic headache. The pain is actually referred from the neck to the head. They are often accompanied by neck stiffness, and even pain in the shoulder and arm. Because trigger points, adhesions, and muscle spasms in neck muscles often cause headaches, I have had good luck using massage and craniosacral treatments. Now research is beginning to provide evidence that massage helps, but before I talk about the research I want to back up a step.neck massage

How did the neck become so bad to begin with? It might be the result of an injury, such as whiplash. There could be scar tissue, or damage to the spine itself, such as compressed disks, arthritis, deteriorated vertibrae, and spinal stenosis, which have caused the muscles to spasm and develop trigger points. Massage can’t do anything about many of these conditions. However, poor posture is a very common reason for neck problems, and that can be fixed. Sometimes it takes a great deal of time and effort to do postural retraining and core strengthening, but a determined person can change long-ingrained habits. Massage can help with that, but that’s a subject for another post.

According to a recent review paper, there is little evidence that conventional treatment for cervicogenic headache (medication,  nerve blocks, facet joint injections, surgical procedures such as fusions, etc.) works [1]It can be costly and frustrating to try a series of these treatments, without any benefit.

For centuries, if not millenia, people have used massage as a safe and effective way to relieve neck tension and pain. Now, a pilot study of eight people indicates that it really can help [2]. The authors measured neck mobility before, right after and two weeks after an eight-minute massage (only eight minutes, come on!). They found significant increase (from 27.5° to 45.9°) in rotation after three treatments, and no significant regression after two weeks.

While that study only looked at improvement in neck mobility, another study published in 2013 found that massage combined with appropriate exercise (2x/wk for 6 wks) helped relieve headaches[3]. Although those authors found that cervical manipulation combined with exercise did more than massage, many of my clients do both and have faster results with the combined therapies. Not everyone is willing to get chiropractic treatments, so massage with exercise remains a viable option.

One obvious problem with both of these studies is the lack of a control group, perhaps one which only does exercise, does acupuncture, or takes muscle relaxants. Since massage research is still in its infancy, and a pilot study only looks at feasibility, we’ll have to wait on better research to say more.

I’m currently accepting new massage clients at my clinic in Bend, Oregon. To make an appointment, or ask questions, phone me at (541)350-1613, or email at radiant@radianthealthbend.com.

[1] Therapeutic options for cervicogenic headache, César Fernández-de-las-Peñas  and María L Cuadrado, Expert Review of Neurotherapeutics, January 2014, Vol. 14, No. 1 , Pages 39-49
[2]A pilot study to investigate the short-term effects of specific soft tissue massage on upper cervical movement impairment in patients with cervicogenic headache, Dianna Hopper, et. al, Journal of Manual and Manipulative Therapy, Volume 21 Issue 1 (February 2013), pp. 18-23
[3]Mobilization versus massage therapy in the treatment of cervicogenic headache: A clinical study, Enas F. Youssef and Al-Sayed A. Shanb, Journal of Back and Musculoskeletal Rehabilitation, Volume 26, Number 1 (January 2013), pp. 17-24

 

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The joy of an open access article

Most of you are probably not science nerds like me, but I was searching on google scholar for research articles on acupuncture published in 2013 or later and found one immediately on  PLOS| One, which is an open access journal. I am in love. Open access! That means I can read the full article for free, instead of having to pay for somewhere around $40 or $50. Being in Bend, Oregon, without a medical library nearby, can sometimes be so frustrating!

open_access

In any case, the authors [Read the original article by MacPherson, et al.] looked at 31 studies of acupuncture for “non-specific back or neck pain, shoulder pain, chronic headache or osteoarthritis” “of at least four weeks duration,” and were able to obtain individual patient data from all but two studies. They found a dosing effect, meaning that the more sessions and the more needles used per session the more pain relief patients experienced. They don’t seem to have looked at the type of pain, but they did find that real acupuncture did better than sham acupuncture.

What I love best about this is not even so much their conclusions, but the fact that I can read the entire article, and it’s well-referenced, with hyperlinks to other articles. The devil, as the saying goes, is in the details. When I can’t read those details, because I can only read the abstract, I’m never quite sure if I believe the author’s conclusions.

In this case, I’m not sure yet. Meta analysis takes results from different studies, often small and inconclusive on their own, and attempts to combine them in order to conclude something strong. Since each study has a different protocol, and a different population, and its authors have their own particular biases, meta analysis can be tricky, but, in the world of human health, it can also be the only way to figure something out, for a lot of reasons. I’m going to have to read through this paper very carefully, and look at some of their references, before I understand what they’ve done.

I applaud these authors for publishing in an open access journal. At least I have the opportunity to read their paper, unlike so many others.

If you’re interested in acupuncture for relief of chronic pain, and you would like to schedule a session, give us a call at (541)420-1613. We’re located in Bend, OR

Related articles:

Wikipedia on open access – http://en.wikipedia.org/wiki/Open_access

PLOS on open access – http://www.plos.org/open-access/

Open Access week – http://www.openaccessweek.org/

Open Science – it’s more than just journal articles, it’s about data – http://openscience.com/

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The Adverse Childhood Experiences Study

This is an informative article about some amazing research which shows the connection between bad childhood experiences and health and other problems in adults, including obesity, COPD, alcoholism, and chronic depression. It’s well written, and I think everyone should read it. I’d never heard of this longitudinal study of more than 17,000 people until I saw this post today. Since there are some real nuggets of information about the impact of abuse on brain health towards the end of this long article, read the whole thing. You’ll be doing yourself and everyone else a favor. If we as a society take these results seriously, we can reduce childhood trauma and prevent these effects from happening.

The Adverse Childhood Experiences Study.

I’m really curious now if Acupuncture and Massage, by reducing stress levels and putting people more in touch with their bodies and improving energy flows, help undo some of these deleterious effects. I speculate that they can and do. I’d love to hear what others think. This article doesn’t really talk about how to heal from these traumas, which will be another whole research study or several studies, I’m sure.

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Try Acupuncture for Low Back Pain

low back clothed

Image Courtesy of ABMP

A recent meta analysis of research studies on acupuncture published in the journal Spine found that acupuncture may help with nonspecific chronic low back pain [2013, 38(24):2124-2138] (here’s the abstract). Although the wording in the conclusion sounds skeptical, in fact, by combining 25 research studies, they found a reduction in pain and increase in function compared with no treatment or usual care (even adding in medications).  This is great news for the millions who suffer from this common problem. Instead of constantly chugging pain killers and muscle relaxants, with their potential side effects,  they may find relief with this ancient, noninvasive, relatively inexpensive, therapy.

Chronic low back pain can be a very frustrating condition, especially for people who have seen doctors and never received a clear diagnosis. According to the National Institutes of Health:

Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work. Back pain is the second most common neurological ailment in the United States — only headache is more common.{ref}

The same site also mentions that most low back pain goes away quickly. When it doesn’t, it can turn into a chronic condition. WEBmd gives a list of reasons for low back pain, including overuse, injury, herniated disks and aging, but the unfortunate truth is that

Often doctors don’t really know what causes low back pain. But it is more likely to become long-lasting (chronic) if you are under stress or depressed.{ref}

There are serious reasons for low back pain, especially when it is accompanied by tingling, pain, weakness, or numbness down the legs, or problems with bladder or bowel control. Some of these could be a narrowing of the spine (stenosis), a tumor, a fracture, or inflammation of the little joints, so it’s a good idea to see a doctor if rest and walking don’t relieve your symptoms, or if symptoms don’t go away within a few weeks.

It’s when doctors don’t know why someone has pain that they fall into the category of nonspecific. The doctor may want to try injections, which can help, but which are expensive and usually need to be repeated every few months. Our acupuncturist has extensive experience treating low back pain. He’s often had patients who lived with low back pain for years experience relief after a few treatments. Like with medications, some people need maintenance, meaning they come in once a month, or during occasional flare-ups, and we always recommend an exercise regime to improve strength and flexibility. I recommend reading the entire WebMD page on the issue. Page 2 here has some great ideas for helping with chronic low back back pain, things like wearing low heels and taking frequent breaks from sitting.

Did you notice the little blurb about stress causing low back pain to become chronic? Both acupuncture and massage can help you manage your stress and that alone could make a difference.

We’re always accepting new patients, and we take insurance. Give us a call at (541)420-6574 to get acupuncture for your aching back. Albert will be happy to answer any questions. Or email us at radiant@radianthealthbend.com.

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Stress

We have all heard that stress is a killer, but you may not know some of the ramifications of living with constant stress. Because your body doesn’t function properly when you’re tense for hours and days on end, you can develop all kinds of symptoms that might not seem easily attributable to stress. Maybe you just get headaches, or it seems to take forever to heal after an injury. Maybe your digestions doesn’t work quite right, or your skin seems drier than usual. Certainly, your muscles have become rigid and good posture has gone out the window as your chest contracted and your shoulders rose around your ears.

Massage and acupuncture can help you relax and get your health back on track. My clients are often embarrassed that their stomachs start rumbling partway through their treatment, but I am pleased to hear the noise. It means that their nervous system has calmed down. But relaxing shouldn’t be something you can only do during a treatment. It should be something you practice and do on your own. I’m really grateful to Michelle Doetsch at Healing Yew for this wonderful blog on stress management:

The 5 Best Stress Management Tips

I hope you find it helpful. I did! I especially love tip #1. I practice Byron Katie‘s steps from her wonderful book Loving What Is (when I remember to do them – hey, nobody’s perfect!) and they work.

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Is Fructose Safe?

The bottom line, according to a an article in the December 2011 issue of Acupuncture Today, is no, especially not in the quantities that the average person eats these day (an average of 28 teaspoons (over a half a cup) a day in added sugars). Fructose, the sugar found in fruit, and also in table sugar, agave nectar, and, of course, high fructose corn syrup, is sweeter than glucose. It is sometimes touted as safer than glucose, because it is low-glycemic, but research has been finding that it is actually worse (see, for example hunger or this article in Time Magazine).

Coconut sugar, on the left, which looks and tastes like brown sugar, is preferabe to white table sugar, on the right, which is about half fructose.

A new health craze, coconut sugar, on the left, which looks and tastes like brown sugar, primarily contains sucrose, just like white table sugar, though it is only about 18% sugar (the best analysis I’ve seen is at Nature’s Blessing). Sucrose is half fructose and half glucose.

But why is that the case? It’s natural, found in fruit, and doesn’t trigger the insulin release that is a problem for diabetics. In fact, for a while, fructose was recommended for diabetics, but it isn’t any longer. The problem lies in the way it’s metabolized in the body. If you’re eating fruit, it gets digested slowly, but, if you’re drinking a liquid, or eating a candy bar (crackers, bread, etc.), it goes into your system quickly and lands in your liver, where it turns into fat, and causes increased production of uric acid. Fructose also doesn’t appear to trigger feelings of fullness, so that people tend to consume too much at a time. This is one reason why soda and fruit juice are blamed for the increase in obesity, diabetes, and health problems in the world.

This doesn’t mean that you should switch to artificial sweeteners, which are toxic. Instead, do your best to reduce your sugar loads. Since sugar is added to many packaged foods, making your food from scratch using healthy ingredients will allow you to control how much goes into your system. Eat whole fruits, instead of drinking juice. And remember: in Traditional Chinese Medicine it’s all about balance. A little sugar won’t kill you, but 48 teaspoons a day is way, way too much. If you don’t want to cook all the time, get in the habit of reading labels, and choosing foods that are lower in added sugars.

If you want some help with healthy eating habits and weight loss, consider seeing an acupuncturist. Traditional Chinese Medicine is a powerful tool for improving your well-being. If you want coaching about a sugar addiction, or for more information about the problems with sugar consumption, go to Debbie St. Clair.

We are presently accepting new patients in Bend, Oregon. Call (541)420-6574 to schedule an acupuncture appointment.

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It isn’t the lactic acid

I am often asked by my massage clients what massage is doing to their muscles. One of their common misconceptions, especially when they have recently over-exercised and their muscles are sore, is that it is removing lactic acid from their muscles. However, it has been known for a few years that lactic acid, a by product of anaerobic exertion, actually is converted back to pyruvate pretty quickly once exercise ends and oxygen again becomes available to the cells. In fact, massage right after exercise actually decreases blood flow and lactic acid removal (see this summary in the New York Times wellness blog, and if you are really curious, follow the link in the article to the one about boxing).

So what is actually causing post-exercise muscle pain and how might massage help? A 2006 Scientific American review here explains delayed-onset-muscle soreness (or DOMS) succinctly, and this Wikipedia article brings the information bit more up-to-date. Both articles say that DOMS is not completely understood, but that it’s clear that lactic acid does not play much, if any, role. Instead, micro-tears within the muscle fibers and connective tissue, followed by inflammation (which takes a while, explaining the delay), are the current explanation for what causes the pain. And a new study, published in February, 2012, and summarized here, indicates that massage shortly after the event helps minimize this inflammation, while also promoting the production of new mitochondria (the energy machines of cells).

On the other hand, it isn’t even known if inflammation is what causes post-exercise soreness. A recent article by Radak et al. suggests that nitric oxide may be the culprit.  So, until we have a more definitive answer about what causes the soreness, the real question may be: does massage after exercise help with DOMS? Many sports enthusiasts argue that it does. I remember working a long-distance relay a couple of years back, and a physical therapist told me that she recovered much faster after such running events if she got  massage within the hour.

And there is research to back her claim (although results are not clear-cut) primarily by decreasing pain levels and swelling about 30% (see Zainuddin et al and this review by Torres et al.). This and other studies say it does not help with another post-exercise problem – decreased muscle function, although the Torres review concludes that massage helps with pain and also helps with loss of function more than ice, stretching or low-intensity exercise. Torres et al. conclude that this massage effect is not enough to be clinically significant, but 30% less pain sounds a lot better than nothing to me, especially since new research says we shouldn’t just pop painkillers after exercise, because they have a deleterious effect on our recovery.

Beyond this, some of the most interesting research from my perspective has been published on rabbits (this study, for example, show a dose-dependent effect because more compressions a la sports massage meant faster recovery for the rabbits, while this one showed increased muscle elasticity with a machine massage meant to emulate deep effluerrage (those long smooth strokes we all love)). And massage is also used after exercise on horses, something I doubt equine owners would pay for unless it really did help the horse perform better.

Of course, there are other reasons than ameliorating DOMS for having a massage. But please don’t think that it is removing lactic acid. It isn’t there in the first place to be removed.

Disclaimer: As always, research on massage is still in its infancy. Most studies of its effects are too small to have confidence in their results, until they are duplicated. That includes everything cited here.

 

 

 

 

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Why sitting is so bad for your back and what to do about it

In today’s world, many people sit all day, often at a computer. This can be awful for your back. I just found this fabulous blog at Healing Yew about why, with tips for preventing back pain when you have to sit all day. I added a few comments at the bottom of her page on things I have also found to help.

And then there is Coach Jenny’s marvelous idea about walking instead of sitting still here. I personally want to find myself a treadmill and revamp my workspace so I don’t sit at all! I love this.

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Hard work and miracles

This past week, I did a one hour private session with Dr. Vance Bonner, and I have to tell you that it was amazing. I’ve had the great good fortune of studying with Dr. Bonner, the inventor of Structural Reprogramming, for about nine years, and it has helped me tremendously, but last week it was as if the sun finally came out and my body did this incredible shift. I could stand straight for the first time since I can remember.

This is a major miracle. When I started with her, my back looked like the Hunchback of Notre Dame. I kid you not. I really have to go through my old photos and see if I can find one that shows how bad I was. I had a fair amount of constant pain, mainly in my mid-back and neck. There was this one spot, right along my spine, maybe two or three inches below my scapulae, that always hurt. Even though I was fit in the sense that I rode my bicycle a lot and hiked and skied, I was headed for an even more stooped old age, with all of the problems that can cause (more neck pain, pinched disks and nerves, ugh!).

Vance is truly an amazing being, and I am so lucky to have worked with her all of these years, but I don’t think we would have gotten there if it hadn’t been for all of the other things I’ve done. Each added one more piece to an ever growing pile that allowed my back to take that final step. Perhaps Cranio Sacral Therapy has been the most potent of those, but years of modern dance, yoga and tai chi, acupuncture, massage therapy, energy work, Rolfing  (although not a full series) and Myofascial Release added up.

I believe that all of this, plus some inner compass which just knew that I could do it, that it could happen, that one day I would look in the mirror and see a straight back, was necessary before I could straighten. Sessions with Dr. Vance Bonner, combined with therapy from one Lillie Goldstein, massage therapist and energy worker extraordinaire, provided the final tools to create a miracle breakthrough.

One thing I noticed about Vance, is that she gives her work every ounce of her attention. When I worked with her she would stare at me, then she’d pick an exercise and push as hard on me as I needed, which was sometimes an enormous amount. She’d help hold me in positions I could not yet do by myself. She cheerleaded, cajolled, explained, demonstrated, and so on, getting me to work harder than I ever thought possible. Sometimes I would break down in tears, get angry, or feel nauseous, but I always knew we were moving forward and engaging my body, mind, and emotions.

Let me explain that last little bit. A person doesn’t become hunched like I used to be without some kind of emotional trauma. It could happen as early as the womb or during birth, or it could have come from events in our lives. It might be some decision about not being good enough, or an accident, such as a car wreck. In any case, when the body changes those emotions come to the surface. The body resists the change and will do anything it can to stop you from shifting into a new strange place, such as becoming lightheaded or wanting to throw up. I had plenty of these sorts of experiences during and after classes and private sessions.

For the most part, I have taken classes with Vance. She teaches here in Bend, OR, for six months out of the year. I thought her work was so fabulous that I studied to become a teacher and I take over her classes when she is gone. But about two years ago I screwed up my courage (like many geniuses, she’s a little fierce – it reminds me of things said about Ida Rolf) and tried a private session with her and I started making faster progress.

Vance will be heading to the Washington, DC, area soon for the next five months. If you live around there and would like some help with pain, bunions, scoliosis, poor posture, knock-knees, and other musculo-skeletal conditions, I urge you to look at her WEB site, get her fabulous book, and give her a call. Don’t let the chance pass you by.

I’m not done straightening, and I have a new goal: a flexible back. (We might even work on backbends this summer, depending upon what the class is ready for – they are one way to loosen things up, but don’t worry, we take baby-steps and help spot each other.)

Come stretch with me here in Bend, Oregon. Classes start April 23rd, 2012, on Mondays at noon and Wednesdays at six PM, and they are two hours for the dirt-cheap price of $80 for an eight week session, or a $12 drop-in fee (you can’t do yoga for that price!). The only catch is that you either have to make the first class or do a private one-hour session with me ($50). Oh, and I have some vacations scheduled in the middle of the first session. To register you need to call me. My phone? (541)350-1613

Related articles:

http://www.goodreads.com/book/show/158727.The_Vance_Stance

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