Massage Matters, Summer 2010

S u m m e r 2 0 1 0

A J o u r n a l f o r R e g i s t e r e d M a s s a g e T h e r a p i s t s

Susan Chapelle: The 2010 “RMT of the Year” brings the ‘alternative’ to the mainstream

Unique RMTs: Harriet Hall, RMT and Okanagan Hobby Farmer

Mechanical Drainage of Non-Vascular Edema Affecting Nerves

Massage Matters

2 • b c m a s s a g e t h e r a p i s t s ’ j o u r n a l • S u m m e r 2 0 1 0

I n May 2010, I was in Montreal at the Canadian Life and Health Insurers Association (CLHIA) Claims Division conference. This is the second year

the MTABC has participated in this event. We joined in with the Massage Therapy Alliance of Canada (MTAC) to represent the profession in Canada.

The conference provided great opportunity to talk to the insurers and hear their concerns. Since this conference was only a week after the CBC-Ontario exposé regarding fraud and massage therapy billing, there was much to talk about.

Fraud is a serious issue across Canada, whether you are in a regulated province or not. Could British Columbia have the same problems?

Insurers want to know that they are paying for “medically necessary” treatments. Identifying “medically necessary” is challenging but it has to be done because massage therapy billing to third party insurers is amongst the highest in Canada. RMTs should be aware that we are on the insurers’ radar screen and should ensure pristine billing practices.

After surveying some of the larger employer group plans, we are finding small but significant trends to down grade employment benefit packages in terms of massage therapy availability. This trend encourages the need for continuous insurer education about the high standards of B.C. RMT’s training and advanced education. We will reinforce that research and evidence-based practices underline our commitment to safe, smart and effective health care.

Over the next year the MTAC and the MTABC, will be working with the national insurers to develop protocols to address this issue, providing comfort to the insurers that the bills RMTs are paying are bona fide.

There is no question that this challenge is serious. However, we must continue to produce evidence that Registered Massage Therapists in BC have positive affects on patient outcomes

Damon Marchand, President

President’s Message

Please direct your comments to [email protected], subject heading “Letters,” where they will be forwarded to the MTABC Board for review.

Editor in ChiefDavid DeWitt

EditorLori Henry

PublisherPaul Holden604-608-5154 [email protected]

SalesVictoria Chapman 604-741-4189 [email protected]

DesignDon Chin

Editorial BoardSandra ColdwellBodhi HaraldssonAnita WilsonBrenda LockeRachel ScottDee WillockDamon Marchand

Mission StatementThis publication is intended to provide a voice to BC’s Registered Massage Therapists, a source for the latest research and a vehicle for the general population to understand and respect the valuable work of our RMTs.

Massage Matters is published three times a year for Registered Massage Therapists. Funding is provided from the MTABC and advertising revenues.

Massage Therapists’ Association – MTABC180 - 1200 West 73rd Avenue Vancouver, British Columbia V6P 6G5Tel: 604-873-4467 Fax: 604-873-6211Toll Free: 1-888-413-4467 Email: [email protected]

www.massagetherapy.bc.ca

Massage Therapists’ Associationof British Columbia

Massage MattersA J o u r n a l f o r R e g i s t e r e d M a s s a g e T h e r a p i s t s

b c m a s s a g e t h e r a p i s t s ’ j o u r n a l • S u m m e r 2 0 1 0 • 3

contents

in this issue:People 4

Computer 13

Science 14

Classified 18

Cover photo credit: DT DeWitt

■ Note, the “Parkinson’s and Massage Therapy” article in the last issue (Winter 2010) had a typo. The phone number should have been 604-662-3240 and the email should have been [email protected].

Mechanical Drainage of Non-Vascular Edema Affecting Nervesby dr. david decamillis, 14

The 2010 “RMT of the Year” Brings the ‘Alternative’ to the Mainstream by rachel scott and dt dewitt 4

Alison Marshall-Rath: Success Over Chronic Fatigue Syndromeby kari walker 6

Unique RMTs: Harriet Hall, RMT, Okanagan Hobby Farmer and Moreby kari walker 10


by rachel scott and dt dewitt

Some have called her “a force of nature” and her credentials confirm this praise. Accordingly, it’s not surprising that Susan Chapelle received the 2010 “Registered Massage Therapist of the Year” award from the Massage Therapists’ Association of British Columbia (MTABC).

As modest as she is industrious, Susan says she “... did not expect to be considered.” Adding, “...it is an incredible honour” to be chosen for this award.

An 11-year resident of Squamish B.C. she validates the province as “one of the most amazing places to work” emphasizing “it is filled with fantastic and inspiring therapists.”

Susan’s philosophy of balance has allowed her to incorporate many passions into her practice. While her career in registered massage therapy spans over 16 years, she initially used her experience working in the entertainment industry, to assess and treat performing artists. Now her focus on patients has shifted to treating the local community, and caring for patients who have experience in the health care system.

Nearly 10 years after founding Squamish Therapeutic Massage, Susan’s special qualities are reflected in many areas. One area is the environment. Her clinic is made entirely of local wood and recycled materials; including floors made out of recycled wine cork, making the building great for the environment and those who thrive within it. No chemicals, solvents or glues were used in its construction, meaning therapists, and their expanded practice of 1,800 patients, can breathe in peace of mind.

Another plus is Susan’s diligent maintenance of the practice’s integrity. “Squamish Therapeutic

The 2010 “RMT of the Year” brings the ‘alternative’ to the mainstream

People

Susan Chapelle, RMT in her environmentally friendly clinic.photo: DT DeWitt


Massage Therapists are hired to reflect my philosophy of treatment,” she said. “All the therapists have over five years of experience and a deep knowledge of anatomy.”

Susan is also a keen educator, teaching at colleges in Canada and internationally on massage therapy as a post-cancer and post-surgical treatment. She believes that “... all patients should have access to education and soft tissue treatment after undergoing any surgery.”

Susan completed a funded study on therapeutic massage as a soft tissue protocol for post treatment breast cancer patients. Last year she presented the protocol at the International Fascia Research Congress (FRC) in Amsterdam and was met with “incredible support from the medical establishment and her patients.”

Finally, as a volunteer for the Squamish Nation’s Women Centre, she teaches new mothers

massaging techniques for colicky babies. She also volunteers at the Squamish Hospital treating palliative care patients.

Through this work she has been invited onto the board of directors with the palliative care association. She is now the first ‘alternative’ practitioner working with the Squamish General Hospital (SGH), receiving numerous invitations to medical continuing education seminars.

Susan hopes the recognition from MTABC will create further opportunities for research grants. She plans to undertake a mastectomy study in Squamish. “I am seeing four to six patients from our cancer clinic once a week to measure the effects of massage therapy on their post-surgical symptoms,” she confirmed.

More information on Susan Chapelle and Squamish Therapeutic Massage can be found at [squamishmassage.com]. •

With national level AIS instructor Paul John Elliott

A ctive Isolated Stretching (AIS)

3-Day Seminar

A ctive Isolated Stretching (AIS): the Mattes Method is a cutting edge method of stretching used by today’s massage therapists, personal trainers, athletic therapists and fitness professionals. Working with the body’s natural

physiological makeup, this method of stretching improves circulation and increases fascial elasticity which helps eliminate physical pain and improve human performance. AIS is an outstanding modality for improving posture, eliminating abnormal curvatures such as scoliosis and kyphosis as well as restoring proper body alignment and helping eliminate physical pain. AIS plays a crucial role in the treatment of diseases or injuries such as Spinal Cord Injuries, MS, Sciatica, Carpal Tunnel Syndrome, Thoracic Outlet Syndrome, Neck and Back pain as well as Shoulder and Rotator Cuff conditions.

This 3 day course will empower you with stretching and myofascial protocols that will compliment your current techniques wand strategies.

Instructor: Paul John Elliott, LMT, Certified AIS Instructor, Advanced AIS Practitioner

■ Dates: August 27, 28, 29 (Fri, Sat, Sun), Time: 9 am–6 pm, Location: Calgary, AB (TBA )

■ Dates: October 22, 23, 24 (Fri, Sat, Sun), Time: 9 am–6 pm, Location: Victoria, BC (TBA)

■ Dates: November 12, 13, 14 (Fri, Sat, Sun), Time: 9 am–6 pm, Location: Toronto, ONT (TBA)

■ Dates: November 26, 27, 28 (Fri, Sat, Sun), Time: 9 am–6 pm, Location: Regina, SASK (TBA)

Please check www.stretchingcanada.com for further details

■ Course Cost: $650.00 ❙ NHPC – 15 Continue Competency Credits MTAA – 24 Primary Continuing Education Credits ❙ CATA – 9.0 credits for 24 hour course

For registration information contact: Denise Williams (403) 679-9221 ❙ [email protected] Visit: www.stretchingcanada.com to fill out registration form See website for details and dates and locations of other future seminars


Alison Marshall-Rath: Success Over Chronic Fatigue Syndrome

by kari walker, RMT, author

In January 1993, Alison Marshall-Rath, Ph.D. was excited about building her career as a neuropsychologist. New doors were opening for her, and the future looked good. But she was also having myalgic pain and saw RMT Don Campbell for treatment; this helped so she assumed the pain would pass in time. Then in May, she completely collapsed and was never able to return to work, even to clean out her desk.

Alison sought help from a naturopath and was quickly referred to a physician and then to a specialist in chronic pain. Dr. Cecil Hershler (M.D., Ph.D., F.R.C.P. (C)) confirmed the diagnosis of Chronic Fatigue Syndrome (also called Myalgic Encephalomyelitis). CFS/ME is a debilitating condition characterized by persistent fatigue unrelated to physical exertion that is not relieved by adequate rest. The complete list of symptoms is too long to give here, but some of the main ones include:

• sleep disorders• widespread muscle and joint pain• “foggy” brain that makes it difficult for

the patient to remember or focus• muscle weakness• hypersensitivity (to light, chemicals, etc.)• loss of balance• digestive disorders (such as IBS)

CFS/ME may even cause cardiac and respiratory problems. It is most prevalent in women between the ages of 40 and 60, and there is no known cause at this time. Most cases have a sudden onset, usually following an illness or prolonged period of significant stress. This closely mimics Fibromyalgia, except that most CFS/ME patients show evidence of increased immunological activity.

In the specialist’s office that day, Alison sat in disbelief at the severity of the diagnosis. But this is going to go away, she thought.

People

Alison Marshall-Rath, Ph.Dphoto: DT DeWitt


Unfortunately it didn’t. “Within a few weeks my health had slipped down to a basic survival mode,” Alison says. “A buzzing pain over took most of my body. I couldn’t tolerate any bright light; I was foggy-headed and had blurry vision. I was entirely dependent on sleep medication to get even a few hours of rest but woke exhausted and remained feeling that I was freezing and starving. Although I didn’t know it at the time, my muscle tissue was being used up to maintain metabolism”.

Dr. Hershler, well aware of alternate treatments, prescribed massage therapy for pain relief and increased circulation. Don Campbell had already noticed that Alison’s back was as tight as a rock and that she needed dedicated treatments. As she became too weak to drive he suggested a taxi, but after her collapse, when she would have stopped coming altogether, he took it upon himself to drive her to and from the appointments.

The illness continued to run its course. After six months, “My legs had become toothpicks as my body used up fat and muscle tissue. Walking around was like moving in a sea of oil, I couldn’t breathe properly or feel my feet touch the ground clearly. Brief alterations in visual and motor functions also occurred. Twenty years

of training in brain function let me know which parts of my brain were being afflicted by the disease, but I had to calm down before I could reason it out and remember that brain tissue can and does heal after damage.”

Alison’s was a severe form of CFS/ME, with fluctuating cycles of relapses and occasional improvements. Times of wellness came for a few hours here and there, and she remained focused on them. She knew that if she was well some of the time, then her body could regain its normal homeostasis.

She believes she lived through the next few years largely because of Don Campbell’s help. He continued to pick her up for her massage therapy treatments. Besides helping with the muscular pain and tissue repair, Don’s reliability and expertise added to the success of the treatments.

The turning point began with the noticeable increase in muscle bulk in her body. One day Alison recalls Don exclaiming, “There’s meat in this hand!”

“That is when I began to have sensation of muscle below the surface of my back around my shoulders blades,” she adds. “I recall

Continued on page 8

E-mail : [email protected]


People

him saying often before this time that he was working on deeper tissue, doing cross-fiber stimulation but I could not tell. I could feel the weight of pressure only on the surface of my skin. It was a stunning relief that an RMT can so quickly locate a trigger point that I couldn’t identify.”

Eventually, Alison retrained herself to stand upright by positioning her back against a wall while looking in a full-length mirror. “When I was straight, I’d close my eyes to feel my feet on the floor. I had to relearn the sensation from heel to toe.”

By 1996 she was strong enough to drive to a clinic closer to her apartment. “Don graciously wished me well, and I knew that I was saying goodbye to a humanitarian whose help was life-sustaining.”

And so we come to the true purpose of this article. In Alison’s own words, “I always wanted to give (Don) the acknowledgement he deserves when I became well again and to do this through his professional association. Thank you Don Campbell, RMT!!! I do not think that I would have survived the early years of the disease without his diligent help. I give immense bouquets to Dr. Hershler for taking the medical lead and to my family

physician, Dr. Helene Bertrand, who continued to recommend RMT treatment. Bouquets also go to RMTs Karen Buckley, Sheryl Hamilton, and Yvonne Poulin who gave me needed treatments.”

Over the past few years Alison has made a miraculous comeback (something which only 5-10% of CFS/ME patients

achieve), and works hard to maintain it. She is able to walk

10 km or ride her bike 20 km or more. Relapses happen but they are not severe, limiting her energy and ability for a time. She feels it is critical to remain positive and “you get more of what to focus on.”

Today she feels she’s, “in a good position to encourage others who are fighting the effects of CFS/ME, and to confirm the essential service of RMTs in restoring health. In my experience

the RMT was at the ‘front line’ of defense.”Alison’s story gives hope to those suffering from CFS/ME, FM

and other related disorders. She intends to follow the progress of studies focusing on the extent of brain involvement during CFS/ME.

Thank you Don Campbell, for your outstanding efforts, and for representing your colleagues so well. •

BetsyAnn Baron has been a massage therapist since 1991. In 2001 she began studying CORE Myofascial Therapy with George Kousaleos and soon after, through advanced studies, became a therapist specializing in CORE Structural Integration. The fifteen years of experience as soloist with Les Grands Ballets Canadiens de Montreal, prior to studying massage therapy; have given her first hand experience with the body, its movements and its injuries. BetsyAnn is highly regarded and appreciated as both a therapist and a teacher.

BetsyAnn is a Board certified Structural Integrator and member of the International Association of Structural Integrators ( IASI). She also a member of the Fédération Québecoise des Massothérapeutes (FQM).

Structural Myofascial Therapy (SMFT) With course developer BetsyAnn Baron

Coming to the following locations: (Locations and Times TBA)—Course Level 1: ■ Montreal: November 5–7, 2010 (bilingual) ■ Calgary: November 19–21, 2010; Course Level 2: ■ Montreal: March 4–6, 2011 (bilingual) ■ Calgary: April 1–3, 2011

CEUs: NHPC: 15 CMTBC: 21 MTAA: 24

SMFT is a deep, hands on therapeutic technique combined with postural awareness exercises, which treat the body’s myofascial system. With slow, deep and deliberate manoeuvres, this work accesses the myofascial structure with amazing efficiency.

In Level 1 you will learn:■ Full myofascial body treatment protocol including anatomy/physiology to support

your understanding of the work.■ Postural Somatic Awareness (PSA) a fantastic subjective evaluation and educational

tool for you the therapist as well as for your clients.■ How to work with these 3 paradigms, (treatment protocol):

❘ palliative ❘ corrective ❘ integrative ❘

Your clients will: ❘ Rejuvenate injured tissue ❘ Increase their range of motion ❘ Breathe deeper and easier ❘ Decrease chronic pain ❘

SMFT enriches the practices of massage therapists, physiotherapists, athletic therapists, osteopaths and other hands on health care professionals.

Course cost: $525.00: $500 + GST payable by cheque, money order, OR credit card

For more information on how to register please contact Denise Williams: at [email protected] or call (403) 679-9221Structural Myofascial Therapy

“In my experience

the RMT was at the

‘front line’ of defense.”

Cranial Sacral Therapy Certificate ProgramLearn how to use gentle touch to support the body’s natural capacity for self repair. This part-time program is designed to fit into your schedule and is approved for education credits by the College of Massage Therapists of BC.

Courses for Health Care ProfessionalsNew this Fall: Complete education credits to maintain your designation or upgrade your skills

Call 604.323.5971 or visit www.langara.bc.ca

Awaken your Healing Potential

Learn more.

Aromatherapy for Massage Therapists $299. Sat/Sun, Oct 16-17, 10am-6pm This is a fascinating hands-on, experiential course where you learn to incorporate essential oils to facilitate balance and wellness in the body. Cranial Sacral Therapy for Massage Therapists $299. Sat/Sun Oct 23-24, 9-5pm Build on previous massage learning, and explore the body through fascial connections and gentle manipulation. Release restrictions, improve blood flow, and optimize body function. Hot Stone Therapy for Massage Therapists $299. Sat/Sun Sept 25-26, 9:30-5:30pm Hot stone therapy goes beyond the physical experience of typical massage and enters deeper dimensions of relaxation, health and well being. Thai Reflexology for Massage Therapists $598. Sat/Sun Sept 11-12 & Oct 9-10, 9-5pm Learn and incorporate traditional Thai foot reflexology massage into your massage practice. Thai foot massage uses light finger pressure as well as using other massage tools.

1 0 • b c m a s s a g e t h e r a p i s t s ’ j o u r n a l • S u m m e r 2 0 1 0

Harriet Hall, RMT, has led a diverse professional life. Now she not only works at her clinic three to four days a week, but most of her downtime is taken up tending to her organic hobby farm in Sorrento, B.C. While they might seem worlds apart, the two jobs complement each other surprisingly well.

Harriet was always fascinated by how human life worked, and in her teens decided she wanted to be a doctor. But it was the sixties, and both her mother and guidance counsellor persuaded her to choose a different career more “appropriate for a girl”. She opted to forgo medical school but never let anyone discourage her again, and doesn’t regret her decision because other doors opened for her. In the end she returned to her interest in health care, and graduated from WCCMT in Vancouver in 1991. Now

she works in a private clinic seeing clients of all ages. She sees herself as a detective trying to figure out all the factors involved in a patient’s dysfunction, then formulates a plan to support a positive change.

Long before she became an RMT, however, Harriet was a teacher. Her lifelong passion for learning and sharing knowledge made her a natural. She started out as a swimming instructor, and later attended SFU’s Professional Development Program, where she graduated in 1978. She taught elementary school for a few years, and while she loved the actual teaching, she felt constrained by the system. Later on in her career as an RMT, she taught at OVCMT for ten years. She loved it, and feels she made a positive contribution to the growth of her students.

by kari walker, RMT, author

Continued on page 12

Unique RMTs ❘ Harriet Hall, RMT and Okanagan Hobby Farmer (and a few other things)

Harriet Hall, RMTphoto: DT DeWitt

b c m a s s a g e t h e r a p i s t s ’ j o u r n a l • S u m m e r 2 0 1 0 • 1 1

www.somaticexplorations.com • 604.519.0555

Some of the offerings in the Lab:Pro-section: The viewing and study of anatomy utilizing a pre-dissected form.

• Upper Extremity (7 credits CMTBC) • Posterior Thorax (7 credits CMTBC)

• Anterior Thorax and Viscera (14 credits CMTBC) • Head, Neck & Brain (7 credits CMTBC)

Complete Dissection: Participant driven & performed dissection of a human form over six days of Lab time. (42 credits CMTBC)

SOMATIC EXPLORATIONS IS A FIRST OF ITS KIND FACILITY

IN CANADA, PROVIDING ACCESS TO THE HUMAN BODY FOR

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Despite everything else going on in her life today, she hasn’t quite been able to give up her love of sharing knowledge. This past spring she even planned and taught a course called “Growing Your Winter Vegetables” at Okanagan College. And little wonder, since she’s what you might call a vegetable growing expert.

With her Accredited Music Therapist partner of 34 years, Harriet runs what she terms, “a small mixed, low-tech (possibly medieval) biodynamic hobby farm: a profusion of fruit, vegetables/herbs/native plants, bees, sheep and chickens.” It evolved over time, starting with vegetables and bees, but they’ve had sheep for 20 years and grow about 80% of their own food. “‘Looking our meat in the eye’ is our motto and don’t forget, if you listen closely, you can hear a carrot cry when you pull it out of the ground. We are also hosts to 100s, perhaps thousands of native bees, wasps and other pollinating winged critters as well as a vast array of birds, some bats and several species of snakes. A hobby farm is just that; one works hard because it is enjoyable but no money is made. We try hard to utilize everything and generally any surplus goes sporadically to a farmers market or to those of my clients who ask.”

Perhaps the most surprising thing is that working the farm actually enhances Harriet’s role as an RMT. She says the farm grounds her, with its seasonal cycles and daily rhythm. Simple things, really. The bees teach her patience and cooperation. Planting and weeding allow her meditative time to “mellow out” and reflect. The animals demonstrate the importance of unconditional love, and emphasize the significance of routine and punctuality. “Farming encourages a respect for all life and a thankfulness to be alive,” Harriet says. “Being a therapist has given me a model to follow when trying to figure out when to intervene or call the veterinarian if there is a problem. The beauty of the setting gives my clients comfort.”

Idyllic though her lifestyle might seem to some, the catch is the long hours and amount of effort it takes to keep up a hobby farm like hers. She describes farming as working from “can’t see to can’t see.” In other words from dawn ‘til dusk. She maintains the balance with hard work and routine, and her clients are accepting if something comes up and Harriet needs to make a last minute cancellation. They don’t even mind the baby monitor projecting “barn radio” into the clinic during lambing season, so she can keep an ear on new additions to her flock. Just last week she spent one morning preparing fleeces when the sheep shearer came to the farm, then saw clients in the afternoon. And as a bonus, the lanolin in the wool is great for her hands.

Juggling the demanding schedule of her farm and clinic amounts to a whole lot more than the average forty-hour work week, the pay isn’t much, and there is always something that needs to be done. But you won’t hear her complaining. Harriet loves what she does. “I am truly blessed,” she says. •

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Harriet says the farm grounds her, with its seasonal cycles and

daily rhythm.photo: Harriet Hall

Harriet and her Beesphoto: David Hockin


Part 1 – OverviewIn the digital era computers are a great tool, including in

the health care field. As a RMT, you are in a position to provide your clients

with health resources that would improve their well-being. If you were connected to the internet, you would find additional resources to help meet your clients’ diverse

heath needs, enhancing your practice exponentially. You would also be able to access online billing, and create a website for your clinic. In the next Massage Matters, we will list more benefits for using a computer. Highlights include information on online billing services such as Green Shield, Office Management and Exercise Software, and what your practice can gain from access to the MTABC website and other online resources. •

Modernize your practice: What a computer can do for an RMT clinic

ReseaRch Updatea. Jon stoessl, cM, Md, FRcpc, FaaN Director, Pacific Parkinson’s Research Centre University of British Columbia, Vancouver, BC

caRe iN Late-stage paRkiNsoN’ssusan calne, cM Retired RNFormer National Parkinson Foundation Outreach Coordinator Pacific Parkinson’s Research Centre University of British Columbia, Vancouver, BC

MedicatioN MaNageMeNtMonique giroux, Md

Medical DirectorBooth Gardner Parkinson’s Care Center, Kirkland, WA

speech aNd physicaL theRapiesBecky Farley, phd, Ms, pt Assistant ProfessorDepartment of Physiology, College of MedicineUniversity of Arizona, Tucson, AZ

cogNitive chaNges aNd paRkiNsoN’sFrank Loomer, Md

Medical Program Director Seniors Mental Health Royal Jubilee Hospital, Victoria, BC

paiN aNd paRkiNsoN’sLisette Bunting-perry, MscN, RN

Assistant Clinical Director Parkinson’s Disease Research, Education and Clinical CenterVeterans Affairs Medical Center, Philadelphia, PA

Parkinson Society British Columbia presents

A SPECIAL Seminar for Healthcare Professionals

Friday, october 29, 2010 I 9:00am – 4:30pmdelta vancouver airport hotel I Richmond, British columbia

Parkinson’s is a complex, chronic, neurological disorder that affects 11,000 individuals in British Columbia. This seminar

is a unique opportunity for healthcare professionals to learn about the latest in Parkinson’s research, medication and treatment

from renowned experts in the field.

Register now - Space is limited!RegistRatioN $150 (Includes lunch and parking)

For information and registration www.parkinson.bc.ca

Supported in part by

by rachel scott


by david decamillis, DC, FCCRS

End range loading is used to increase blood supply to affected nerves (vasa nervorum). 1,16 These include the peripheral nerves, nerve roots, and the cauda equina. A lack of oxygen to these areas leads to many conditions seen in the therapist’s office.

One example of lack of blood supply to the peripheral nerves would be a resulting tendinopathy. 2,3,5,7 The tendon at the site of injury undergoes neurogenesis and angiogenesis. 8,10,20 If the local proteoglycan concentration becomes too high, the hydrostatic pressure increases to the point that blood can no longer perfuse into the area and a chronic pathology develops. This low-grade pseudo inflammation can last for years. In these cases tendon degeneration often progresses as the fibrocytes die. The following is a case report.

A thirty-five year old legal secretary, previously a Highland dancer, presented with a chief complaint of bilateral Achilles’ pain in April 20054,5. The problem started in 1987 and has been constant since that time. My tentative diagnosis was bilateral Achilles’ tendinopathy due to non-vascular edema in the area. The trial of therapy consisted of stretching the nerves innervating the affected part of the tendons. I repeated this procedure three times over a period of ten days. Her symptoms were much improved after the first treatment and after one week she was asymptomatic. I last saw this patient in October, 2009. She was thirty-nine years old at that time and she reported a total abatement of the Achilles’ tendon pains. Since the first week of treatment in 2005, her Achilles’ problems had disappeared.

The patient felt a warm and tingling sensation into her Achilles’ area immediately after the treatment. I believe this sensation was due to the blood flowing into the affected nerves.

Continued on page 16

Science

David DeCamillis demonstrates End

Range Loading.photo: David DeCamillis

Mechanical Drainage of Non-Vascular Edema Affecting Nerves

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A possible explanation for this scenario of chronic low-grade inflammation is as follows. Healthy connective tissue, which in some cases is relatively avascular and aneural, undergoes injury. 11,15 The healing response results in both angiogenesis and neurogenesis at the site. 8,10,12,20 The injured area now has both a nerve and a blood supply. Here’s the problem: far too much proteoglycan is produced by the fibroblasts. 2,3,4,5,7,14,18 The hydrophilic proteoglycan now absorbs water. This increase in fluid raises the hydrostatic pressure and a pseudo inflammation results. If the hydrostatic pressure in the local tissue exceeds the capillary blood pressure at systole then no blood perfusion takes place at the local interstitial nerves. Nerves have a vasomotor effect and if these nerves don’t get oxygen then they can’t function properly.

Here are a few examples of other peripheral nerve sites, ligaments, muscles, fascia, joint capsules, articular surfaces, periostia, organs, internal structures, and skin. I also include the cranial nerves here.

The normally avascular disc15 also innervates and vascularizes after injury. 6,9,17 These new discal interstitial nerves need oxygen to function effectively as well. In discs too much proteoglycan may only be part of the problem. A misshaped disc will add to the disability.

Nerve root11 involvement may result in lumbar and lumbosacral plexus symptoms, and or unilateral back pain. Of course the symptoms will be different for thoracic or cervical nerve root involvement. After injury both neurogenesis and angiogenesis21 occur within the intervertebral foramen and again a pseudo inflammation sets up in the area. Surprisingly, healthy nerve roots are insensitive to mechanical stimulus.

Lack of oxygen to the cauda equina may result in neurogenic claudication. Other nerves in the cauda can be affected here as well. The primary dorsal branches will affect the muscles, skin and zygapophyseal joints of the lumbar spine. The coccygeal and pudendal plexuses may be involved affecting the genitals, pelvic floor, etc. The posterior branches of the lumbosacral plexus will involve the lateral rotators of the hip. Obviously, central stenosis can therefore affect more than just the legs. Lateral stenosis may lead to symptoms similar to other types of nerve root involvement and again getting the blood to the area is a vital key to healing.

Central stenosis of the cervical spine is occasionally seen in the therapist’s office as a mild form of cervical spondylotic myelopathy and lateral stenosis is seen as foraminal encroachment. Increasing the volume in both the central and lateral canal will cause a pressure drop and therefore blood can flow into the target tissues.

End range loading decreases the hydrostatic pressure around affected nerves. It changes the hydraulics of affected discs. It increases the size of the neural canal in cases of stenosis. These changes will increase blood supply

to the affected nerves to more normal levels.End range loading can be described as that mechanical

pressure applied to the target tissue after all the slack has been taken up.

End range loading is effective if the following four criteria exist. The patient has to communicate with the therapist, i.e. they have to tell the therapist where the problem is and also, how the therapist is progressing during the treatment. The target area must have flexible walls at the point of end range. 13,19 The loading has to be slow in order to give the fluid enough time to move. Finally, portals of exit and entry must exist through which this fluid can move. 13,19

End range loading is not only used for shifting fluid. It is also effective treatment for collagen remodeling and intra discal nuclear migration. Remodeling of scar tissue takes six weeks of treatment. Reversing a migrated nucleus pulposis may only take one treatment.

The good news is that this form of therapy fits comfortably within the massage therapy scope of practice.

Outcomes and patient satisfaction will improve. •Dr. David DeCamillis website is www.drdavedecamillis.com.

References:1) Abele H., Pieper K.S., Herrmann M. Morphological

investigations of connective tissue structures in the region of the nervus occipitalis major, Funct Neurol. 1999 Jul-Sept;14(3): 167-170.

2) Blunden A., Dyson S., Murray R., Schramme M. Histopathology in horses with chronic palmar foot pain and age-matched controls. Part 2: The deep digital flexor tendon, Equine Vet J. 2006 Jan;38(1): 23-7.

3) Bowker R.M., Atkinson P.J., Atkinson T.S., Haut R.C. Effect of contact stress in bones of the distal interphalangeal joint on microscopic changes in articular cartilage and ligaments, Am J Vet Res. 2001 Jun; 62(6): 827.

4) Corps A.N., Jones G.C., et. al. The regulation of aggrecanase ADAMTS-4 expression in human Achilles tendon and tendon-derived cells, Matrix Biol. 2008 June; 27(5):393-401. Epub 2008 Apr 2.

5) Corps A.N., Robinson A.H., Movin T., Costa M.L., Hazleman B.L., Riley G.P. Increased expression of aggrecan and biglycan mRNA in Achilles tendinopathy, Rheumatology (Oxford). 2006 Mar; 45(3): 291-4. Epub 2005 Oct 11.

6) Freemont A.J., Jeziorska M., Hoyland J.A., Rooney P., Kumar S. Mast cells in the pathogenesis of chronic back pain: a hypothesis, The Journal of Pathology, July 2002; Vol 197(3):281-285(5).

7) Fu S.C., Chan K.M., Rolf C.G. Increased deposition of sulfated glycosaminoglycans in human patellar tendinopathy. Clin J Sport Med. 2007 Mar;17(2):129-34.

8) Kirpatrick N.D., Andreou S., Hoying J.B., Utzinger U. Live imaging of collagen remodeling during angiogenesis, Am J Physiol Heart Circ Physiol. 2007 Jun; 292(6): H3198-206. Epub 2007 Feb 16.

Science


9) Koike Y., Uzuki M., Kokubun S., Sawai T. Angiogenesis and inflammatory cell infiltration in lumbar disc herniation, Spine, 2003 Sep 1; 28(17):1928-33.

10) Krishnan L., Underwood C.J., Maas S., Ellis B.J., Kode T.C., Hoying J.B., Weiss J.A. Effect of mechanical boundary conditions on orientation of angiogenic microvessels, Cardiovasc Res. 2008 May 1; 78(2):324-32. Epub 2008 Feb 28.

11) Kuslich S., Ulstrom C., Michael C. The tissue origin of low back pain and sciatica: Orthopedic clinics of North America 1991 Apr. Vol. 22, No. 2:181-187.

12) Mammoto T., Seerattan R.A., Paulson K.D., Leonard C.A., Bray R.C., Salo P.T. Nerve growth factor improves ligament healing, J Orthop Res. 2008 Jul; 26(7): 957-64.

13) Millesi H., Zoch G., Reihsner R. Mechanical properties of peripheral nerves, Clin Orthop.1995 May;(314):76-83.

14) Mooney V. Overuse syndromes of the upper extremity: Rational and effective treatment, The Journal of Musculoskeletal Medicine, August1998; 11-15.

15) Palmgren T., Gronblad M., et. al. An immunohistochemical study of nerve structures in the annulus fibrosis of human normal lumbar intervertebral discs, Spine 1999: Vol.24, No. 20. 2075-2079.

16) Reina M.A., Lopez A., Villanueva M.C., de Andres J.A., Leon G.I. Morphology of peripheral nerves, their sheaths, and their vascularization, Rev Esp Anestesiol Reanim. 2000 Dec;47(10): 464-75.

17) Roberts S., Evans H., Trivedi J., Menage J. Histology and pathology of the human intervertebral disc, Bone Joint Surg Am. 2006 Apr; 88 Suppl 2:10-4.

18) Scott A., Lian O., Roberts C.R., Cook J.L., Handley C.J., Bahr R., Samiric T., Ilic M.Z., Parkinson J., Hart D.A., Duronio V., Khan K.M. Increased versican content is associated with tendinosis pathology in the patellar tendon of athletes with jumper’s knee, Scand J Med Sci Sports. 2007 Dec 7.

19) Simon B.R., Wu J.S., Carlton M.W., Evans J.H., Kazarian L.E. Structural models for human spinal motion segments based on a poroelastic view of the intervertebral disc, J Biomech Eng 1985 Nov; 107(4): 327-35.

20) Tonnesen M.G., Feng X., Clark R.A. Angiogenesis in wound healing, J Investig Dermatol Symp Proc. 2000 Dec;5(1): 40-6.

21) Yeung A.T., Yeung C.A. In-vivo endoscopic visualization of patho-anatomy in painful degenerative conditions of the lumbar spine, Surg Technol Int. 2006; 15:243-56.

Science

Massage Matters

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MTABC CEC Courses 2010 /11Registration at MTABC 604.873.4467 or [email protected]. Or mail to MTABC, 180-1200, West 73rd Ave, Vancouver, BC, V6P 6G5. Provide name, phone and email. Cancellation within 3 weeks of a course results in 20% penalty; within 2 weeks, 40%; and within 5 days or “no shows”, no refund.

Anatomy Trains Manual Therapy with Mark Finch 14 PE/A2 CreditsHoliday Inn, 711 West Broadway VancouverSeptember 11-12, FULL wait list availableOctober 16-17, FULL wait list availableFebruary 12-13, 2011MTA One Month Early $285, Regular $300 Non-MTA One Month Early $380, Regular $420

Fascia: Its Structure and Function– The Pelvic Girdle with Mark Finch, 14 PE/A2 Credits Holiday Inn 711 West Broadway VancouverVancouver–October 23-24, 2010, FULL –wait list availableMarch 5-6, 2011 MTA One Month Early $285, Regular $310Non-MTA One Month Early $380, Regular $420

Fascia: Its Structure and Function– The Shoulder with Mark Finch **NEWCredits TBA Vancouver–April 30-May 1, 2011

End-Range Loading–A New Evidence Based Idea in Manual TherapyDr. David DeCamillis, D.C., F.C.C.R.S.(c) 12 PE / A2 CreditsNew Westminster–September 25-26, 2010;Sat., 10:00-4:30 and Sunday, 9:00-3:30 Victoria–October 16-17, 2010;Sat., 10:00-4:30 and Sunday, 9:00-3:30 MTA One Month Early $275, Regular $300Non-MTA One Month Early $370, Regular $410

Ann Sleeper’s Courses: 20% repeater discount for Ann’s courses.See Ann’s web page, www.annsleeper.com

Introduction to Osteopathic Techniques, Part One. 12 PE / A2 Credits Vancouver–Holiday Inn, Sat and Sun, Sept 18-19, 2010; 10am-5pm Vancouver–Holiday Inn, Sat and Sun, Oct 2-3, 2010; 10 am-5pmVictoria–TBA, Sat and Sun, Oct 23-24, 2010; 10 am-5 pmVancouver–Holiday Inn, Sat and Sun, Nov 13-14, 2010; 10am-5pmVancouver Prices:MTA One Month Early $245, Regular $270Non-MTA One Month Early $330, Regular $365Victoria Prices:MTA One Month Early $280, Regular $310Non-MTA One Month Early $375, Regular $415

Muscle Energy Technique for the Low Back, Part 1–Lumbar & Ilia. 14 PE/A2 CreditsVancouver–Holiday Inn, Sat and Sun, October 30-31, 2010 MTA One Month Early $285, Regular $315Non-MTA One Month Early $385, Regular $425

For more course details, see MTABC web site www.massagetherapy.bc.ca and the MTABC newsletter “Massage is the Message”


SHIATSU TRAINING24 CEC credits

Zen Shiatsu School • Harrison Hot SpringsSeptember 13–16, October 4–7

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Ann Sleeper is offering private courses for 2-5 people in her home in central Vancouver. Review sessions are also available to improve your techniques. In these small groups, you can take any of the muscle energy or osteopathic technique courses listed in this journal or at www.annsleeper.comE-mail Ann at [email protected] or leave message at 604-872-1818

Systemic Deep Tissue Therapy® Workshops(also known as SDTT)

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Originated and developed by Armand Ayaltin DNM, RHT, RMT, and taught by him since the late 1980’s.It consists of its own scientifically-based philosophy, therapist-friendly

assessment and treatment. To reduce burn-out, body and hand postures are ergonomically designed. Therapy takes its cue directly from the assessment. This innovative procedure is designed to minimize the mental and physical stress of the Tx room.

In these Workshops we will teach:• Philosophy and background• How to treat the underlying cause of pain, often realizing quick and

lasting results• How to Structurally Realign the body by collapsing the compensatory-matrix,

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Courses for 2010Introductory: September 18-19. Intermediate: October 23-24.(CEC 28 for both courses combined), Cost: $399 each. For more info and to register, phone: 604.984.2611systemicdeeptissuetherapycenter.com

Massage Matters

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Massage Matters, Summer 2010