NAMING CONVENTIONS

either because they are similar in how they are performed (eg. rocking, jostling, shaking, vibration) or because they are components of a single style of massage (eg. circular compression and rebound are techniques used in lymph drainage). In those situations, the related techniques are listed together (and designated by one or more capitalised letters before the name of the technique). Three of these techniques involve application of a for- eign substance on or near the body (eg. heat or cold). One “technique”, directed breathing, could be performed by the patient as part of many other techniques.

Techniques may be used with different intentions that depend on the circum- stances in which they are performed.

For example, direct pressure may be used in trigger point therapy to release trigger points, in sports massage to decrease pain and muscle spasms and in neuromuscular therapy to soften adhesions and make them more pliable. Also, holding is an example of another technique that could be applying with multiple intentions: it could be used to relax the tissues in Swedish massage, to warm tissues before stretching them in myofascial release, and to “balance energy” in polarity therapy. Finally, the technique of positional release is used in sports massage to restore normal muscle length and in Aston

patterning to convey a sense of ease and comfort and body awareness.

APPLYING THE TAXONOMY TO THE NECK PAIN STUDY In order to stay within the realm of com- mon practice for massaging patients with neck pain, the researchers decided against a rigid protocol that would order the flow of the session(s) or require any one tech- nique or style. We wanted to allow suffi- cient flexibility for massage therapists to adjust their massage to provide appropri- ate care for each patient’s presenting con- dition. Massage therapists were permitted to use up to ten 60-minute treatments for each patient over a 10-week period. Even though the study goal was to evaluate massage as a treatment for neck pain,

which clearly falls within the principal goal of

clinical massage, our protocol

(Table 2) was quite broad. However, we excluded styles of massage originating in Asia because most are not commonly taught to massage therapists and because shiatsu has been associated with serious adverse events in patients with neck pain (21). Consistent with our focus on clinical massage, we also limited the use of ener- gy work (eg. Reiki) to less than 20% of each treatment session. Finally, we restricted the use of some movement re- education techniques (ie. those that use active movement) and excluded a subset of clinical massage that involved formula- ic styles such as Rolfing or Hellerwork, although we permitted use of individual techniques that are used in these styles.

BOX 2: COMPONENTS OF TREATMENT PROTOCOL IN STUDY OF MASSAGE FOR NECK PAIN

1. Styles or techniques allowed with no restrictions ■ Application of cold ■ Application of heat ■ Compression – pumping or static ■ Craniosacral ■ Friction or direct pressure ■ Cross-fibre friction ■ Gliding (effluerage) – Swedish ■ Gliding – deep (effluerage,stripping) – clinical ■ Holding ■ Kneading (petrissage) ■ Lymphatic drainage ■ Percussion (tapotement) ■ Rocking, jostling, shaking, vibration ■ ROM – active or resistive (also active assisted and/or resisted stretching, MET, PNF – consisting of three types of resistive stretching: lengthening, contracting the agonist; lengthening the agonist, contracting the antagonist; and lengthen- ing the agonist, contracting agonist and antagonist)

■ ROM – passive (passive stretching, positional release) ■ Skin rolling ■ Stretching (manual) ■ Traction ■ Trigger point therapy

2. Principal treatment goals LIMITED by protocol (ie. allowed only if represent less than 20% of an individual session ) ■ Energy work (eg. Reiki, polarity, therapeutic touch, zero balancing) ■ Movement education (active exercise styles) (eg. Alexander technique, Feldenkrais method, Aston patterning)

3. Treatments DISALLOWED by protocol ■ Aromatherapy ■ Asian bodywork (shiatsu or other meridian based massage) ■ Dietary supplements ■ Recipe techniques - although components may be acceptable.

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