Medical Massage Therapy
and Soft Tissue Injury

Medical massage therapy treats soft tissue injury and pain. Statistics show that over 80% of pain comes from soft tissue injuries and dysfunction. Current research repeatedly shows that manual therapy works for people suffering from musculoskeletal pain conditions and dysfunction.

Musculoskeletal pain and dysfunction are the leading cause of disability of people in their working years. The Institute of Medicine reports that 116 million Americans suffer from chronic pain, costing up to $635 billion in treatment and lost productivity annually.

Medical massage therapy can achieve a lot of positive results for this pain and dysfunction. In short, it can improve how you feel and, therefore, your productivity.

Brief History of Medical Massage Therapy

Medical massage has its roots in Russia. Some pioneers in the field come from the US, but their research and therapies were better known and practiced overseas. In the mid 1900’s, treatment and therapy in the United States took on progressive means of electronic stimulation, pharmaceutical and more “sophisticated” means. Russia continued in its tradition of massage as a common medical treatment.

In Russia it was taught to physicians in medical school. Massage was used as a treatment for many ailments in and out of hospital settings. In that country massage is commonly done for the people’s well being. For that reason, Russia has done in-depth research on how massage affects the body and bodily systems.

Massage in the US

In the US massage became a spa treatment or basically Swedish massage for relaxation, stress relief and preventative health care. This should be called therapeutic and relaxation massage.

Medical massage therapy in the US is now becoming more and more effective for treating specific medical conditions and pathologies. It is now being integrated into the medical community.

As massage therapy becomes more popular, it is becoming fragmented into numerous “massage modalities”. Massage therapists are starting to specialize in one technique or another.

Medical massage therapy is distinguished not as one technique, or form of massage, but by using a large variety of proven techniques with known results for a specific soft tissue injury, dysfunction or pain cycle. The practitioner uses techniques according to what has proven to work for the specific need.

Insurance for Massage Therapy:
One question often asked is, “Does insurance pay for massage”? If massage helps my health, has many benefits to my overall well-being and helps with pain and healing, why wouldn’t it?

Unfortunately, insurance companies do not pay for preventative massage for wellness. HMO’s do not pay for massage at all. However, some healthcare insurance, auto insurance injury and workman’s comp do pay for massage, if a doctor prescribes it.

Flex Spending Accounts sometimes will reimburse for massage with a doctor’s prescription, if your insurance doesn’t. If you have money in your account at the end of the year that you have to use, treat yourself to gift certificates for the next year. Inquire about your plan specifically to make sure.

Medical massage therapy is the focused use of certain massage techniques. It is outcome based and must be physician directed in order to be billed to insurance claims. Medical massage is science-based and gets results. It is massage with a specific goal in mind for a specific condition, problem or rehabilitative therapy.

Treating accidents, injuries and sicknesses with massage move the massage from a “therapeutic” session to a corrective, restorative, results-oriented treatment. If someone needing medical massage therapy doesn’t have a doctor’s prescription, the medical massage therapist can work from the patient’s complaints (self referral), medical history and by palpating muscle tissues. (Disclaimer: massage therapists do not diagnose.)

What's the Difference?

What is the difference between Swedish massage and medical massage therapy? There are several. Medical massage is not done for health maintenance purpose. Medical massage deals with soft tissue injury and dysfunction.

Here’s an analogy to help explain: We do maintenance on our cars to keep the machine in good running order. On the other hand, when something goes wrong major or minor repairs to specific parts might be needed. Medical massage therapy is the repair not the maintenance.

Medical massage deals directly with the specific locally affected tissue and is not a full body massage. It is usually done in shorter segments two to three times per week to heal the tissue. The therapist will do more assessment of your condition before hand. Then from session to session the therapist will keep thorough records of what is done and the progress that is made.

In a longer, relaxing massage the therapist might work for 25 minutes just on your back. Ahhh, feels good, right? However, if you have injured tissue that will not solve the problem.

The relaxing massage will produce endorphins at the site of the injury. Endorphins are natural pain killers. When you get off the massage table the pain might be gone for the moment. Then the endorphins wear off and the pain comes back! The relaxing massage does not repair the damaged tissue.

A long, relaxing massage and its intense nerve stimuli will inhibit cellular function. (Excess stimulation over-stresses the limbic control center of the brain, causing a negative effect.) The shorter stimulus of medical massage improves cellular function.

The goal of medical massage therapy is to bring repair and healing to tissue and injury, and to stop the pain cycle that goes with it. The medical massage therapist does a specific protocol on the soft tissue injury to get the muscle cells to heal and repair injured tissue.

Effects on the Nervous System

Another goal of medical massage therapy is to assess what caused the problem in the first place. For example, a forward head carriage with rounded shoulders might be the cause of thoracic outlet syndrome, putting pressure on the brachial plexus nerve bundle. Nervous system impairment can directly or indirectly affect all muscle and/or organ tissues in an area.

Many times a pain-spasm-pain cycle, a chronic condition lasting longer than 30 days, has a hidden, deeper cause. All pain comes from the brain. The nerve receptors pick up signals sending them to the brain to be deciphered.

All muscle and connective tissue is filled with nerves. Many times the therapist must affect the nervous system to stop the pain cycle. A common cause of a pain cycle is the 24 moving bones that make up the spine. Any loss of functional movement and alignment or position of these bones will bombard the spinal cord with irritating or painful “afferent” (nerve signals that go to the brain) stimuli causing an increase in the nervous system activity.

The nerve roots as they go into the spinal cord are greatly affected by the 24 joints of the spine, and their muscles, fascia, ligaments and joint capsules that hold them together. Medical massage therapy seeks to normalize spinal motion and function. This results in alignment to all these parts to normalize the central nervous system and lessen pain.

Intervention in the fascia’s sensory receptor system helps to lengthen and strengthen the joint capsules, muscles, ligaments, and fascia. These control, support and provide normal, pain-free movement of the spine and other joints of the body. It frees the body to move without pain.

Medical Massage Therapy 
Treats a Specific Problem

“Medical massage” certification identifies that the therapist has a more in-depth education of anatomy and physiology, medical conditions, their pathology and how best to treat them. Most massage schools do not provide medical massage training. Medical massage certification is done by Continuing education providers that have pioneered the practice of medical massage.

While it is beneficial to work with the whole person, not just the problem or injury, sometimes the injury needs direct attention before the whole person can feel better. Treating the localized injury is necessary to be freed from pain and dysfunction.

Medical massage practitioners seek to find and treat the cause of the pain or injury first, not just treat the symptoms. Then the body can return to normal, pain-free functional movement. A temporary relief of symptoms is not the goal. Healing the causes is the goal of medical massage therapy.

Active Participation

During a medical massage you will be more of a participant. You will be asked many questions as the massage proceeds. Muscle testing will be done to find the exact location of your pain.

The practitioner will incorporate movement into the medical massage. During a relaxing “therapeutic massage” you are receiving a passive massage. During medical massage therapy you will still receive, but you will be asked to participate with some movement, depending on the extent of your problem.

Movement with the massage strokes activates the “proprioceptor neurons” (which mediate joints and muscles in postural locomotion and control). This will lesson pain and help with range of joint motion.

The Science: Mechanical Effects

Normal tissue does not hurt when you touch it. Muscle “guarding” is the body protecting the injury or damaged tissue by tightening up. Your body will always try to protect itself. The brain sends a nerve signal to the muscle to constrict (tighten up) in order to guard and protect the injury.

It takes energy for your body to constrict the muscle and when it is constantly constricted it takes a lot of energy. When energy is burned you have a by-product, waste. Metabolic waste at the cellular level is normal. But when you have an excessive amount of this waste by-product, it becomes a problem. The tissue cannot get rid of the excessive waste.

The soft tissue is not able to keep up with the excess waste that the cells are giving off. This waste is acidic and has a positive charge. Blood also has a positive charge. Two positives repel each other.

When this waste accumulates in soft tissue it repels the blood from the area. The soft tissue then becomes ischemic (blood starved) and metabolic waste stays in the tissue. Without good blood circulation to the injured area, nutrients are not sufficiently provided for tissue repair.

That is not the only problem. The constricted muscle will put pressure on the blood vessels and nerves in the area. At this point, the tissue slips into a pain-spasm-pain cycle.

The Science: Systemic Effects

Fatigue will commonly set in to the injured muscle and the overall body because of the injured muscle burning so much energy. When fatigue affects the body it will then start to affect the immune system. The body will become excessively stressed.

The body does not know good stress from bad stress. It just knows stress. Too much stress sends the adrenal glands into hyperactivity. Producing too much hormone, such as cortical, weakens the immune system.

What Does Massage Do?

The protocol of medical massage therapy is simple: Un-constrict the muscle and soft tissue, then bring about diffusion (movement from an area of high concentration to lower concentration). This brings about the break up and release of waste by-products from the affected area.

Then the body will naturally send a histamine response to take away the metabolic waste, as it does normally. When this happens, proper blood flow will again come back to the blood starved tissues, bringing nutrients for repair and healing. It will also help bring better lymph circulation, pain relief and muscle relaxation.

Further, medical massage therapy will help postural dysfunction. It will help loosen permanently tight muscles and strengthen lax muscles. This helps to create a balanced body that is not fighting against the force of gravity.

After Massage

In the process of a medical massage the release of metabolic byproducts will be accelerated into the system to be carried away by the venous blood flow, kidney, liver and lymph system. This is a positive, normal reaction and shows the effectiveness of treatment. However, it will cause muscle soreness in the short term. After a medical massage session always ice the affected area before going to bed that night to decrease muscle soreness.

Specific Conditions Treated
with Medical Massage

In conclusion, here are some examples of specific conditions that can be helped with medical massage therapy:

  • Whiplash
  • Nerve compressions and syndromes such as thoracic outlet, carpel tunnel and piriformis syndromes
  • Chronic back pain, strain and injury
  • Sports injuries
  • Many repetitive motion and work related injuries
  • Automobile accident injuries
  • Tendonitis
  • Arthritis
  • Fibromyalgia
  • Lymphedema
  • Headaches
  • TMJ dysfunction
  • Postural alignment problems such as tilted pelvis forward head carriage, kyphosis, lordosis and scoliosis can be helped with medical massage, easing pain in affected areas.Even problems dealing with the side effects of cancer treatment can benefit from medical massage therapy. If you have any questions about how massage might help you with your pain or injury please feel free to call me: 406-438-2695.

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