Advancing health promotion through massage therapy practice: A cross-sectional survey study.

The human resources needed to provide health promotion services to improve health behaviors in populations are currently limited. Health promotion and education is included in the definition of massage therapy, and many within the massage therapy profession understand that health promotion and education are a part of massage therapy practice. However, the amounts and types of health promotion activities in massage therapy practice have not been thoroughly explored. The objective of this study was to investigate the current attitudes, practices, and barriers toward providing health promotion in a national sample of practicing massage therapists. A descriptive cross-sectional survey disseminated May to August 2016 to practicing massage therapists in the United States. The majority (90.2%) of the 182 participants agree or strongly agree that it is important for massage therapists to provide health promotion. Therapists with less favorable attitudes about providing health promotion reported more barriers to providing the messages to their patients. Barriers to providing health promotion included a lack of guidelines, knowledge, and skills. Training and guidelines for massage therapists regarding health promotion would be a reasonable next step for future research development. Utilizing massage therapists as health promoters may provide opportunities to deliver more prevention messages to patients which may impact public health.

Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Trial.

OBJECTIVES: To investigate the efficacy of shoe orthotics with and without chiropractic treatment for chronic low back pain compared with no treatment. DESIGN: Randomized controlled trial. SETTING: Integrative medicine teaching clinic at a university. PARTICIPANTS: Adult subjects (N=225) with symptomatic low back pain of ≥3 months were recruited from a volunteer sample. INTERVENTIONS: Subjects were randomized into 1 of 3 treatment groups (shoe orthotic, plus, and waitlist groups). The shoe orthotic group received custom-made shoe orthotics. The plus group received custom-made orthotics plus chiropractic manipulation, hot or cold packs, and manual soft tissue massage. The waitlist group received no care. MAIN OUTCOME MEASURES: The primary outcome measures were change in perceived back pain (numerical pain rating scale) and functional health status (Oswestry Disability Index) after 6 weeks of study participation. Outcomes were also assessed after 12 weeks and then after an additional 3, 6, and 12 months. RESULTS: After 6 weeks, all 3 groups demonstrated significant within-group improvement in average back pain, but only the shoe orthotic and plus groups had significant within-group improvement in function. When compared with the waitlist group, the shoe orthotic group demonstrated significantly greater improvements in pain (P<.0001) and function (P=.0068). The addition of chiropractic to orthotics treatment demonstrated significantly greater improvements in function (P=.0278) when compared with orthotics alone, but no significant difference in pain (P=.3431). Group differences at 12 weeks and later were not significant. CONCLUSIONS: Six weeks of prescription shoe orthotics significantly improved back pain and dysfunction compared with no treatment. The addition of chiropractic care led to higher improvements in function.

A pilot randomized controlled trial of flexion-distraction dosage for chiropractic treatment of lumbar spinal stenosis.

OBJECTIVE: The purpose of this pilot clinical trial was to assess the feasibility of recruiting older adults with lumbar spinal stenosis (LSS) into a clinical trial that used different dosages of flexion-distraction manipulation. METHODS: This randomized controlled trial used a 4-group design. Three groups consisted of chiropractic flexion-distraction manipulation applied at different dosages (8, 12, or 18 treatments). The fourth group was given 8 treatments of placebo care. Feasibility measures included recruitment goals, adherence to various treatment schedules, credibility of the placebo treatment, and rates of adverse events. The primary outcome measure was the Swiss Spinal Stenosis Questionnaire, a validated self-report of LSS symptom severity and physical function. RESULTS: The recruitment and adherence goals of the study were met with a total of 60 subjects randomized (n = 15 per group) and most subjects attending at least 75% of their scheduled visits. No adverse events were reported by any of the subjects in the trial. Our placebo treatment did not appear to be credible; most subjects correctly guessed that they were receiving a placebo treatment. Between-group effect size estimates were small, indicating larger samples are needed for future studies. CONCLUSION: This pilot study showed that it is feasible to recruit patients with LSS and that most subjects will adhere to a 6-week treatment schedule. The information gained from this trial will be useful to inform the design of larger trials.

Magnetic resonance imaging zygapophyseal joint space changes (gapping) in low back pain patients following spinal manipulation and side-posture positioning: a randomized controlled mechanisms trial with blinding.

OBJECTIVE: The purpose of this study was to quantify lumbar zygapophyseal (Z) joint space separation (gapping) in low back pain (LBP) subjects after spinal manipulative therapy (SMT) or side-posture positioning (SPP). METHODS: This was a controlled mechanisms trial with randomization and blinding. Acute LBP subjects (N = 112; four n = 28 magnetic resonance imaging [MRI] protocol groups) had 2 MRI appointments (initial enrollment and after 2 weeks of chiropractic treatment, receiving 2 MRI scans of the L4/L5 and L5/S1 Z joints at each MRI appointment. After the first MRI scan of each appointment, subjects were randomized (initial enrollment appointment) or assigned (after 2 weeks of chiropractic treatment appointment) into SPP (nonmanipulation), SMT (manipulation), or control MRI protocol groups. After SPP or SMT, a second MRI was taken. The central anterior-posterior joint space was measured. Difference between most painful side anterior-posterior measurements taken postintervention and preintervention was the Z joint "gapping difference." Gapping differences were compared (analysis of variance) among protocol groups. Secondary measures of pain (visual analog scale, verbal numeric pain rating scale) and function (Bournemouth questionnaire) were assessed. RESULTS: Gapping differences were significant at the first (adjusted, P = .009; SPP, 0.66 ± 0.48 mm; SMT, 0.23 ± 0.86; control, 0.18 ± 0.71) and second (adjusted, P = .0005; SPP, 0.65 ± 0.92 mm; SMT, 0.89 ± 0.71; control, 0.35 ± 0.32) MRI appointments. Verbal numeric pain rating scale differences were significant at first MRI appointment (P = .04) with SMT showing the greatest improvement. Visual analog scale and Bournemouth questionnaire improved after 2 weeks of care in all groups (both P < .0001). CONCLUSIONS: Side-posture positioning showed greatest gapping at baseline. After 2 weeks, SMT resulted in greatest gapping. Side-posture positioning appeared to have additive therapeutic benefit to SMT.

Quantification of cavitation and gapping of lumbar zygapophyseal joints during spinal manipulative therapy.

OBJECTIVES: The purpose of this study was to use previously validated methods to quantify and relate 2 phenomena associated with chiropractic spinal manipulative therapy (SMT): (1) cavitation and (2) the simultaneous gapping (separation) of the lumbar zygapophyseal (Z) joint spaces. METHODS: This was a randomized, controlled, mechanistic clinical trial with blinding. Forty healthy participants (18-30 years old) without a history of low-back pain participated. Seven accelerometers were affixed to the skin overlying the spinous processes of L1 to L5 and the S1 and S2 sacral tubercles. Two additional accelerometers were positioned 3 cm left and right lateral to the L4/L5 interspinous space. Participants were randomized into group 1, side-posture SMT (n = 30), or group 2, side-posture positioning (SPP, n = 10). Cavitations were determined by accelerometer recordings during SMT and SPP (left side = upside for both groups); gapping (gapping difference) was determined by the difference between pre- and postintervention magnetic resonance imaging scan joint space measurements. Results of mean gapping differences were compared. RESULTS: Upside SMT and SPP joints gapped more than downside joints (0.69 vs -0.17 mm, P < .0001). Spinal manipulative therapy upside joints gapped more than SPP upside joints (0.75 vs 0.52 mm, P = .03). Spinal manipulative therapy upside joints gapped more in men than in women (1.01 vs 0.49 mm, P < .002). Overall, joints that cavitated gapped more than those that did not (0.56 vs 0.22 mm, P = .01). No relationship was found between the occurrence of cavitation and gapping with upside joints alone (P = .43). CONCLUSIONS: Zygapophyseal joints receiving chiropractic SMT gapped more than those receiving SPP alone; Z joints of men gapped more than those of women, and cavitation indicated that a joint had gapped but not how much a joint had gapped.

Distribution of cavitations as identified with accelerometry during lumbar spinal manipulation.

OBJECTIVE: This project determined the location and distribution of cavitations (producing vibrations and audible sounds) in the lumbar zygapophyseal (Z) joints that were targeted by spinal manipulative therapy (SMT). METHODS: This randomized, controlled, clinical study assessed 40 healthy subjects (20 men, 20 women) 18 to 30 years of age who were block randomized into SMT (group 1, n = 30) or side-posture positioning only (group 2; control, n = 10) groups. Nine accelerometers were placed on each patient (7 on spinous processes/sacral tubercles of L1-S2 and 2 placed 3 cm left and right lateral to the L4/L5 interspinous space). Accelerometer recordings were made during side-posture positioning (groups 1 and 2) and SMT (group 1 only). The SMT was delivered by a chiropractic physician with 19 years of practice experience and included 2 high-velocity, low-amplitude thrusts delivered in rapid succession. Comparisons using χ(2) or McNemar test were made between number of joints cavitating from group 1 vs group 2, upside (contact side for SMT) vs downside, and Z joints within the target area (L3/L4, L4L5, L5/S1) vs outside the target area (L1/L2, L2/L3, sacroiliac). RESULTS: Fifty-six cavitations were recorded from 46 joints of 40 subjects. Eight joints cavitated more than once. Group 1 joints cavitated more than group 2 joints (P < .0001), upside joints cavitated more than downside joints (P < .0001), and joints inside the target area cavitated more than those outside the target area (P < .01). CONCLUSIONS: Most cavitations (93.5%) occurred on the upside of SMT subjects in segments within the target area (71.7%). As expected, SMT subjects cavitated more frequently than did subjects with side-posture positioning only (96.7% vs 30%). Multiple cavitations from the same Z joints had not been previously reported.

Shoe orthotics for the treatment of chronic low back pain: a randomized controlled pilot study.

OBJECTIVES: The purpose of this pilot study was to investigate the feasibility of a randomized clinical trial of shoe orthotics for chronic low back pain. METHODS: The study recruited 50 patients with chronic low back pain through media advertising in a midwestern suburban area. Medical history and a low back examination were completed at a chiropractic clinic. Subjects were randomized to either a treatment group receiving custom-made shoe orthotics or a wait-list control group. After 6 weeks, the wait-list control group also received custom-made orthotics. This study measured change in perceived pain levels (Visual Analog Scale) and functional health status (Oswestry Disability Index) in patients with chronic low back pain at the end of 6 weeks of orthotic treatment compared with no treatment and at the end of 12 weeks of orthotic treatment. RESULTS: This study showed changes in back pain and disability with the use of shoe orthotics for 6 weeks compared with a wait-list control group. It appears that improvement was maintained through the 12-week visit, but the subjects did not continue to improve during this time. CONCLUSIONS: This pilot study showed that the measurement of shoe orthotics to reduce low back pain and discomfort after 6 weeks of use is feasible. A larger clinical trial is needed to verify these results.

Recruitment methods and costs for a randomized, placebo-controlled trial of chiropractic care for lumbar spinal stenosis: a single-site pilot study.

OBJECTIVE: The purpose of this article is to describe the methods for recruitment in a clinical trial on chiropractic care for lumbar spinal stenosis. METHODS: This randomized, placebo-controlled pilot study investigated the efficacy of different amounts of total treatment dosage over 6 weeks in 60 volunteer subjects with lumbar spinal stenosis. Subjects were recruited for this study through several media venues, focusing on successful and cost-effective strategies. Included in our efforts were radio advertising, newspaper advertising, direct mail, and various other low-cost initiatives. RESULTS: Of the 1211 telephone screens, 60 responders (5.0%) were randomized into the study. The most successful recruitment method was radio advertising, generating more than 64% of the calls (776 subjects). Newspaper and magazine advertising generated approximately 9% of all calls (108 subjects), and direct mail generated less than 7% (79 subjects). The total direct cost for recruitment was $40 740 or $679 per randomized patient. The costs per randomization were highest for direct mail ($995 per randomization) and lowest for newspaper/magazine advertising ($558 per randomization). CONCLUSIONS: Success of recruitment methods may vary based on target population and location. Planning of recruitment efforts is essential to the success of any clinical trial.

Side-effects of massage therapy: a cross-sectional study of 100 clients.

OBJECTIVE: The purpose of this study was to determine the amount and type of negative side-effects and positive (unexpected) effects experienced after a massage session. STUDY DESIGN: Cross-sectional. SETTING: Massage clinic at a health sciences university. SUBJECTS: Of the 100 new and returning massage therapy clients who agreed to participate, 91 completed all survey questions. OUTCOME MEASURES: Telephone survey and medical chart review 2-7 days postmassage. RESULTS: Overall, 10% of the massage clients experienced some minor discomfort after the massage session; however, 23% experienced unexpected, nonmusculoskeletal positive side-effects. The majority of negative symptoms started less than 12 hours after the massage and lasted for 36 hours or less. The majority of positive benefits began immediately after massage and lasted more than 48 hours. No major side-effects occurred during this study. CONCLUSIONS: This the first known study to define the rate of side-effects after massage therapy treatment. These data are important for risk-benefit analyses of massage care. Larger studies are needed to verify these data and to assess effects of different massage types and durations.

Hydrogen atom transfer reactions of imido manganese(V) corrole: one reaction with two mechanistic pathways.

Hydrogen atom transfer (HAT) reactions of (tpfc)MnNTs have been investigated (tpfc = 5,10,15-tris(pentafluorophenyl)corrole and Ts = p-toluenesulfonate). 9,10-Dihydroanthracene and 1,4-dihydrobenzene reduce (tpfc)MnNTs via HAT with second-order rate constants 0.16 +/- 0.03 and 0.17 +/- 0.01 M(-1) s(-1), respectively, at 22 degrees C. The products are the respective arenes, TsNH(2) and (tpfc)Mn(III). Conversion of (tpfc)MnNTs to (tpfc)Mn by reaction with dihydroanthracene exhibits isosbestic behavior, and formation of 9,9',10,10'-tetrahydrobianthracene is not observed, suggesting that the intermediate anthracene radical rebounds in a second fast step without accumulation of a Mn(IV) intermediate. The imido complex (tpfc)Mn(V)NTs abstracts a hydrogen atom from phenols as well. For example, 2,6-di-tert-butyl phenol is oxidized to the corresponding phenoxyl radical with a second-order rate constant of 0.32 +/- 0.02 M(-1) s(-1) at 22 degrees C. The other products from imido manganese(V) are TsNH(2) and the trivalent manganese corrole. Unlike reaction with dihydroarenes, when phenols are used isosbestic behavior is not observed, and formation of (tpfc)Mn(IV)(NHTs) is confirmed by EPR spectroscopy. A Hammett plot for various p-substituted 2,6-di-tert-butyl phenols yields a V-shaped dependence on sigma, with electron-donating substituents exhibiting the expected negative rho while electron-withdrawing substituents fall above the linear fit (i.e., positive rho). Similarly, a bond dissociation enthalpy (BDE) correlation places electron-withdrawing substituents above the well-defined negative slope found for the electron-donating substituents. Thus two mechanisms are established for HAT reactions in this system, namely, concerted proton-electron transfer and proton-gated electron transfer in which proton transfer is followed by electron transfer.

Changes in blood pressure after various forms of therapeutic massage: a preliminary study.

OBJECTIVES: The objective of this study was to determine the change in blood pressure (BP) in normotensive and prehypertensive adults resulting from a therapeutic massage, and the factors associated with such changes, including demographic and massage characteristics. SETTINGS/LOCATION: National University of Health Sciences Massage Therapy Clinic, Lombard, IL. SUBJECTS: The subjects were 150 current adult massage therapy clients with BP lower than 150/95. INTERVENTIONS: BP was measured before and after a therapeutic massage. OUTCOME MEASURES: Change in BP and potential associated factors such as type of massage, duration of massage, specific body area massaged, amount of massage pressure, and demographic characteristics were studied. RESULTS: Overall, systolic BP decreased by 1.8 mm Hg and diastolic BP increased by 0.1 mm Hg. Demographic factors associated with BP decrease included younger age (p = 0.01) and taller stature (p = 0.09). Type of massage was associated with change in BP: Swedish massage had the greatest effect at BP reduction. Trigger point therapy and sports massage both increased the systolic BP, and if both forms of massage were included in a session, both the systolic and diastolic BP readings significantly increased. No other massage factors were associated with a significant change in BP. CONCLUSIONS: Type of massage was the main factor affecting change in BP. Increases in BP were noted for potentially painful massage techniques, including trigger point therapy.