This paper is the basis of a presentation given to Glens Falls Hospital (New York) staff as part of a symposium on Complementary and Alternative Medicine on June 19, 2003.
Nearly all promotional literature on massage features the soothing, nurturing sensations of calming music, pleasant aromas and slow methodical massage strokes. This approach is only of limited success in relaxing muscles, and then when the cause of the muscle tension is emotional stress.
Only some muscle tension is due to emotional
stress. When spasms are due to overwork and lactic acid buildup
(Griner, p.55), or to injury, the tensed muscles will not respond
using gentle long strokes. Stronger, deeper stroking will be good,
but will not by themselves release spasms. Heat, I like to use
hot stones, will loosen spasms in muscles, but it too, is of limited
When this is the case, the muscle tension is due to neurological processes possibly within the muscle itself, and beyond the control of the brain. These tight muscles may be causing chronic pain, aching muscles and prolong injury recovery time; reduced circulation and edema and swelling, fatigue after exercise; cramps and muscle spasms; reduced movement and limited flexibility; tension headaches and many other specific problems. (Griner, P58-60)
The muscles are in spasm because the nerve reflexes are maintaining the spasm. (Griner, p.55; Cash, p.199) (See also Cailliet Ch.3).
Numerous specific massage techniques categorized as neuromuscular therapy, i.e., the Trigger Point Method, can be employed to release these tight muscles. This therapy can be painful and may not achieve the desired results. Muscle energy techniques, either post isometric relaxation, or reciprocal inhibition can also be used. (Cash, p. 206) The strain-counter strain technique may also be effective (Cash, p. 220; Chaitow). Vibration is an often-overlooked modality that can be effective (Travell, Vol I , p. 27).
Vibration is one of the five classical massage strokes. Manual vibration techniques are present in Tui Na, a Chinese Massage technique that dates back 3000 years. Here vibration is a quick shaking motion done to raise the Chi level at a acupressure cavity, or to stimulate a muscle, or to loosen a muscle, or to increase Chi and Blood circulation.(Pritchard, p. 8, 84; Jwing Ming, p. 118.)
Many other civilizations also used manual vibration for a variety of purposes. The Japanese used vibration to loosen rigid muscles and to reduce rheumatic pain in the l6th century. (Snow, p. 5) In Europe throughout the 1800s, therapists used percussive strokes, a form of vibration, for many of the same reasons.(Snow, p. 7-9)
By 1904 machines of every description were duplicating manual vibration and percussive massage techniques, and the leaders in this field were the doctors of that time. (Snow, p. 16-73)
Therapeutic vibration needs to be distinguished from harmful industrial vibration. During the operation of vibrating power tools, as for example, vibrating hammers, pneumatic drills, grinders or chain saws, workers are exposed to segmented hand arm vibration. This exposure can result in a reflex contraction of the muscle called tonic vibration reflex, which can amplify the load by 200%. (Sanders, p.143-6) This effect is, I believe, associated with the reaction to an already strained muscle. Under conditions of non-load, I have seen that the judicious use of vibration integrated into the massage regime has the exact opposite effect of relaxing the muscle further.
The basis of vibration, from a Newtonian physics perspective, is that a small rhythmical force exerted on the bodys surface will travel deeply within, exerting small pressure waves on resistant tight muscles. Gradually, these gentle forces stretch the muscle in small increments until the entire muscle is relaxed. As a result, stress on vertebral disks is lessened, subluxations of joints may come to realignment, nerve entrapments are reduced and the vibrations can directly promote enhanced circulation. (Griner, p. 11)
The hands can very effectively produce vibration and percussion manually. The technique that I favor is a brisk cross-fiber stroke that follows the contour of the spastic muscle without attempting to grind the muscle into submission. I would then follow this technique with a rhythmical pushing on the muscle while not loosing contact with the muscles. This technique is done with a straight hand and wrist, using the fingertips.
Another devise that can produce percussive vibration manually, and is quite ancient in origin, is a set of bongers, or muscle beaters. (Snow, p16) They come as a pair of 2 medium firm rubber balls on the end of a flat steel spring about 8 long with a handle at the free end. They naturally oscillate when struck against the body. Clutching down on the spring can modify the frequency. While I have not incorporated bongers into my massage, I have included them in this paper for their historical interest. They are described in Snows 1904 text and are yet currently available.
One popular machine that I have used is the Thumper. The Thumper produces a pulse at a frequency of 20 to 35 cycles per second and an amplitude of ¼ inch; my older model is fixed at 27 cycles per second, and the Mini Pro has 20, 30 and 40 cycles per second. The full size Thumper is a large machine that is excellent for the lower back. I have personally used the Thumper on my back when I strained it. Five minutes gave relief for eight hours of massage work. I get excellent results, also, using it on the bottom of the feet. One client thought that five minutes with the Thumper was equal to her usual weekly hour of Reflexology.
Another machine that I currently use nearly exclusively is General Physiologys G5. The G5 has a frequency of 20 to 50 cycles per second but has amplitude of about 1/16 inch. It moves in a combined vertical and horizontal motion, which encourages circulation and muscle stretching directionally. It is the only machine that I have that has a variety of applicators; each designed to treat a different condition. I particularly like the hot water bottle/ice bag for painful joints and swelling. I use the ½ round applicator to work on trigger points and individual small muscles in the neck that are in spasm.
At the other extreme, the Nostrafon is a small but very effective vibrator that operates at very high frequency in the range of audible sound, 20 to 20,000 hertz. It has helped my clients with arthritic joint pain.
The challenge of vibration, machines or manual vibration, is to blend the vibration into a serene, pampering massage. For some clients, massage is an opportunity to zone out. These clients desire a light Swedish massage, and vibration techniques are unacceptable.
The majority of massage clients consider massage to be a therapy to address muscle-skeletal dysfunction. This group is very open to vibration techniques. I have found that vibration and percussion are extremely effective in releasing spasms, eliminating pain and restoring normal function. I use a combination of hot stones and moderately heavy stroking to initially soften tight muscles and to palpate the musculature for knots and spasms, then manual percussion techniques to stretch the muscles just short of the stretch-spasm reflex point, and then my high frequency vibrator to more completely release the knot and to enhance the circulation to insure that the knot does not return. These knots, nodules of tight spasms, are areas of longstanding tension and diminished circulation. These areas are dehydrated and the muscle cells are distressed. Whatever enhanced circulation is achieved during the short time of a massage is an effort in reversing a chronic condition. In this regard, the G-5 is extremely effective. As a conclusion to the treatment, I recommend stretching frequently and low load range of motion exercises.
Bohm, Max, MD Massage, Its Principles
and Technic (Philadelphia, WB Sanders Co 1920)
Cailliet, Rene, MD Soft Tissue Pain and Disability, 3 ed. (Philadelphia, P.A. Davis Co, 1996
Chaitow, Leon, N.D., D.O. Soft Tissue Manipulation, A practioners guide to the diagnosis and treatment of soft tissue dysfunction and reflex activity (Rochester, Vt. Healing Arts Press, 1980, 1988)
Eberhart, Noble M., MD, PhD A Brief Guide to Vibratory Technique (Chicago, New Medicine Pub. Co. 1908)
Griner, Thomas Whats Really Wrong With You? A Revolutionary Look at How Muscles Affect Your Health, (Avery, 1996)
Jwing-Ming, Yang, PhD Chinese Qigong Massage, General Massage (YMAA Pub. 1992)
Mitchell, John K. MD & Gulick, Luther Halsey, MD Mecanotherapy and Physical Education (Philadelphia, P. Blakistons Son & Co. 1907)
Mulliner, Mary Rees, MD Mechano-Therapy (Philaddelphia, Lea & Febigeo, 1929)
Pritchard, Sarah, Chinese Massage Manual, The Healing Art of Tui Na (New York, Sterling Pub Co Inc. 1999)
Prudden, Bonnie Pain Erasure the Bonnie Prudden Way, Discover the wonders of Trigger Point therapy, (N.Y. Ballantine Books, 1980)
Rusk, Howard A, MD Rehabilitation Medicine (St. Louis, CV Mosby Co, 1964)
Sanders, Martha J. MA, OTR/L Management of Cumulative Trauma Disorders (Boston, Butterworth-Heinemann, l997)
Snow, M.L.H.Arnold, MD Mechanical Vibration and its Therapeutic Application (New York, The Scientific Authors Pub Co, 1904)
Travell, Janet G. MD & Simkons, David G. MD Myofascial; Pain and Dysfunction the Trigger Point Manual (Baltimore, Williams & Wilkins, 1983)
Thumper: Wellness America, 1010 Niagara St. Buffalo, N.Y. 14213 Variable speed 20-35 pulses per second, ¼ inch stroke. Thumpers percussive energy penetrates through all muscle layers and reaches down to untie the knots. From catalog.
G5: General Physiotherapy Inc. 1-800-237 1832 While other products provide vibration therapy alone, or simply up-and-down percussion alone, G5 massage/percussors provide two force components: one perpendicular to the bodys surface, to help loosen and liquefy fluids, and the other force parallel with the bodys surface, to help mobilize fluids in a selected direction. From catalog.
Nostrafon: Nostrafon produces mixed frequencies in the 100-7500 cycle range, which can move up to 2 ½ inches inside the body. The waves emanating from Nostrafon create high speed vibrations deep down in the cells and tissues of the body resulting in alternating compression and rare functions of the zones. During the compression phase the cells are pressed together and some of the tissue fluid is squeezed out carrying with it waste material and toxins. When the pressure diminishes, a vacuum is created and fresh nutrients are drawn into the cells to fill the empty volume. These fresh nutrients form the basis of the positive therapeutic process and the therapeutic success. From catalog. Similar devise now available: Novasonic from Edcat Enterprises, 1-800-274 3566.