Sunday, July 26, 2009

Taxonomy to describe treatments for musculoskeletal pain

According to Rubik & colleagues (1994) massage therapy, the manual manipulation of soft body tissues to enhance health and well-being, is one of the oldest forms of medicine known to mankind and has been practiced worldwide since ancient times. Today, more than 80 different forms of massage have been identified, many developed in the last 30 years.

Lack of consistent terminology for describing the treatments given by therapists are felt world wide. Sherman & colleagues developed taxonomy to describe therapist guided module delivery for patients with musculoskeletal pain. Due to this work a new classification system evolved. Using this, practitioners using different styles of extramural medicine (manual medicine technique) can describe the techniques they employ using consistent terminology.

About the study:

A review of the literature for treatment musculoskeletal pain was done for creating the taxonomy & neck pain was the matter subjected to further studies. The results ware as follows:

1. The taxonomy was conceptualized as a 3 classification system

a. principal goals of treatment
b. styles
c. techniques

2. 4 described the principal goal of treatment

a. relaxation massage
b. clinical massage
c. movement re-education
d. energy work

3. Each principal goal of treatment could be met using a number of different styles, with each style consisting of a number of specific techniques.

A total of 36 distinct techniques were identified. Still many of these techniques could be included in multiple styles.

Following is a description principal goal directed treatments:

1. Relaxation massage is massage that is specifically given to relax the body and promote wellness. Relaxation massage has the intention of moving body fluids (such as lymph and blood), nourishing cells, removing wastes from cells, relaxing muscles and diminishing any pain. In the US, the most widely taught and practiced style of relaxation massage is Swedish massage, which employs five basic strokes: effleurage (gliding), petrissage (kneading and lifting), friction (moving the tissue layers underneath the skin), vibration, and percussion. Other common styles include spa massage and sports massage. Relaxation massage may include styles of massage that are more commonly used to address non-relaxation goals if such styles are applied with the intent to relax the body. For example, lymphatic drainage, commonly used as part of clinical massage (e.g., to reduce inflammation), is believed to be effective in stimulating the parasympathetic nervous system to promote relaxation.

2. Clinical massage involves more focused manipulation of the muscle and/or surrounding fascia and may address other systems in the body such as lymphatic, circulatory and nervous systems. Its intent is to relieve pain and restricted movement. Popular styles of clinical massage are myofascial trigger point therapy, myofascial release, neuromuscular therapy and Structural Integration or Rolfing®. They differ from relaxation massage because they include focused therapeutic goals (e.g., releasing muscle spasms, strengthening or stretching specific muscles and remodeling fascia). Clinical massage may include styles of massage often used for other principal goals. For example, Muscle Energy Technique, often used for enhancing ease of movement (movement re-education), can also be used as a clinical technique, for example, to reduce muscle spasms in a patient with whiplash.

3. Movement re-education emphasizes using movement to enhance posture, body awareness and movement. Movement re-education is generally intended to induce a sense of freedom, ease and lightness in the body. Some styles of movement re-education focus on active exercises to teach healthier ways of moving (e.g, Alexander technique, Trager®, Feldenkrais®). These styles may be used by non – massage therapists. Other styles focus on tablework in which the practitioner induces, assists or resists movement for a patient (e.g., Proprioceptive Neuromuscular Facilitation, Muscle Energy Technique, strain counterstrain). Some styles of massage commonly used for a different treatment goal, can be used to increase function and movement (e.g., sports massage).

4. Energy work (also called subtle energy techniques or body-mind therapies) are believed to "assist the flow of energy in the body" by employing very light touch or by holding the hands just above the skin. These include Reiki, Polarity and Therapeutic Touch as well as massage traditions deriving from Eastern cultures, such as acupressure, Amma, Shiatsu and Tuina. The intention of energy work is to move stagnant or blocked "energy" so it can circulate freely throughout the body.

Our questions:

1. What is the definition of massage?
2. What is Classification of massage?
3. How movement reeducation is a massage?
4. Many authorities do not even consider myofascial release as a massage (Dr. AGK Sinha: Author: therapeutic massage).

Our Comment:

Bottom line: The taxonomic classification must be included in syllabus text of concerned courses. It goads the students, teachers & professionals have protocols to follow which further brings clarity in module delivery & determining success of a treatment plan.


Sherman KJ et al; BMC Complement Altern Med. 2006 Jun 23;6:24.

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