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Location: Berkeley, CA, United States

Wednesday, August 15, 2007

People have always known massage "works". As noted in the first introduction to Massage, Manipulation and Traction by Dr. Sidney Licht, even MD's did massage in the past. Massage was put aside by the medicos in favor of pharmaceuticals.

Massage, Manipulation and Traction, edited by Sidney Licht, M.D.

Preface to 1976 Reprint

In the second half of the twentieth century most books on therapy of such age are considered obsolescent, and often, justifiably so. This book claims exception because the methods described have not changed during the life of this book, and in many cases for much longer.

During this period there has been such a renewed interest in the subject of pain, that journals and societies dedicated to the control of pain have appeared. Pain has become a specialty and although new surgical, pharmaceutical and electrical approaches have claimed success, massage, manipulation and traction still enjoy the gratitude OF those who suffer from certain musculoskeletal complaints.

Of greatest interest to readers of this book is the recent development of theories concerning the cause and relief of pain. Much of this has been summarized in a book which we recommend: Pain Relief by Dr. John G. Hannington-Kiff (William Heinemann Medical Books, Ltd., London, 1974). Most of what we discuss in this addendum is discussed and documented in the Hannington-Kiff book.

In 1959, a Dutch surgeon, W. Noordenbos, advanced a concept of pain mechanisms based on the properties of peripheral nerve sensory fibers. He suggested that there were at least two different kinds of fibers: small diameter, which conduct skin and visceral pain impulses to the spinal cord at slow conduction rates and large-diameter fibers which inhibit transmission of impulses travelling the fast route to the brain.

Six years later, Ronald Melzack, a Montreal psychologist and Patrick D. Wall, a London surgeon, proposed the Gate-Control Theory of Pain which has since been faulted by a few reviewers but which remains attractive and useful, especially to those of us who believe empirically that massage can and does offer relief to some patients for whom other approaches are less satisfying. The Melzack-Wall gate-control theory proposes that there is a "gate" or monitor in the substantia gelatinosa of the dorsal horn of the spinal cord in the form of transmission (T) cells. There are thick and thin fibers from the periphery along which impulses travel at different speeds; fast for the thick, slow for the thin. Pleasant stimulus impulses travel faster along the thick fibers than do pain stimuli along the thin. when the pleasant stimuli reach the T cells they influence them to "close the gate" against pain stimuli which may arrive later. If the pain stimuli arrive in great abundance or intensity they can "crash" the gate, and the pain impulses will continue cephalad to cerebral pain centers.

There are also, fibers from the brain which send messages to the T cells from above which may modulate the flow of impulses, inhibition or facilitation. The thin fibers (called A-delta and C) may have a strong influence on the T cells and "open the gate" to pain stimuli allowing impulses to continue upward individually or by summation, or, by permitting spread of pain impulses involving larger areas than subserved by the original site of pain. This is a simplified view of the important contribution of Melzack and Wall, first enunciated in the journal Science in 1965.

This unifying theory of pain is applicable to massage. The stroking of the skin can initiate different stimuli which run the gamut from sensual pleasure (gentle stroking) to pain (hacking, connective tissue massage). Gentle striking is so pleasant that the stimuli it sends along large-diameter fibers arrive at the T cells in the spinal cord before the painful stimuli. The T cells often respond by "closing the gate". Thus effleurage can inhibit the transmission of painful stimuli to higher centers for varying periods of time. Of course, eventually, painful stimuli by their intensity or cumulative effect may "crash the gate". This is one reason the sedating effect of massage may last only an hour or two. Even relief of short duration may break the "vicious cycle" of pain and thus offer longer relief.

What is important about the new theory is that there is now an explanation which lends respectability to the likely reasons why in so many instances massage "works". Of course, previous theories about massage are still viable, for example, improved circulation and thus evacuation of local accumulation in painful tissues of katabolites, and so on.

Sidney Licht, M.D. June, 1976

1 Comments:

Anonymous James Toon said...

The science is necessary to deliver the message that tissue manipulation is beneficial, but sometimes when research isn't plentiful or supportive, I default to the undeniable truth that body work feels good and what feels good in terms of human touch is therapeutic.

2:09 PM  

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