CONNECTIVE TISSUE MANIPULATION

It is very useful in situations where there is a non-mechanical ele- ment to the symptoms, where there is clear autonomic involve- ment and where there are seemingly musculoskeletal symptoms overlying apparent visceral symptoms or history. It is a very inter- esting and satisfying technique to use, but it must be used with caution due to the potential potency of adverse reactions. It is highly recommended to any experienced manual therapist chal- lenged by the more intractable conditions and a complex, fasci- nating approach to treatment. The importance of adequate train- ing cannot be over-emphasised.

THE AUTHOR Liz Holey, MCSP, is assistant dean and head of physiotherapy for the School of Health and Social Care at the University of Teeside. She is the author of several well respected books on the subject of mas- sage including Evidence Based Therapeutic Massage and the Handbook of Clinical Massage. She is widely acknowledged among her peers for her expertise in massage and specifically in connective tissue manipulation.

References 1. Dicke E, Schliack H and Wolff, A. A Manual of Reflexive Therapy of the Connective Tissue. S.S. Simon 1978. ISBN 0932652018 2. Teirich-Leube H. Grundrilß der Bindegewebsmassage. Fischer Verlag 1990. ISBN Unavailable 3. Schuh I. Bindegewebsmassage. Urban and Fischer Verlag 1992. ISBN 3437006991 4. Ebner M. Connective Tissue Manipulations. Kreiger Pub.Co. 1985. ISBN 0898747635 5. Holey LA. Connective tissue zones: an introduction. Physiotherapy 1995;81(7):366-368 6. Holey EA and Watson MJ. Inter-rater reliability of connective tissue zones recognition. Physiotherapy 1995;81(7):369-372 7. Holey LA and Lawler HL. The effects of classical massage and connec- tive tissue manipulation on bowel function. British Journal of Therapy and Rehabilitation 1995;2(11):627-631 8. Holey EA and Cook EM. Therapeutic Massage. WB Saunders 1997. ISBN 0702019232

9. Holey EA. Connective tissue massage: a bridge between complementary and orthodox approaches. Journal of Bodywork and Movement Therapies 2000;4(1):72-80 10. Holey EA. Connective Tissue Manipulation: Towards a Scientific Rationale. Physiotherapy 1995;81(12) 11. Head, H. (1898) Die Sensibilitaetsstörungen der Haut bei Viszeral Erkrankungen cited in: Bischoff, I. and Elminger, G. (1963) Connective tis- sue massage in: Licht, S. (ed) Massage Manipulation and Traction, Waverley Press 1963. ISBN unavailable 12. Korr I. The Collected Papers of Irwin M Korr, American Academy of Osteopathy 1979 13. Koizumi K and Brooks C. The integration of autonomic system reac- tions: a discussion of autonomic reflexes, their control and their associa- tion with somatic reactions. In: Adrian, R.H. et al (eds) Reviews of Physiology. Springer-Verlag 1972 14. Sato A and Schmidt R. Somato-sympathetic reflexes: afferent fibres, central pathways, discharge characteristics. Physiology Review 1971;53:916-947 15. Klein S and Hendrickx A. Neurophysiological rationale for the employ- ment of the basic build up in connective tissue massage in Dicke, E., Schliack, H. and Wolff, A. (eds) A Manual of Reflexive Therapy of the Connective Tissue, S.Scarsdale 1978 pages 34-37 16. Frazer FW. Persistent post-sympathetic pain treated by connective tis- sue massage. Physiotherapy 1978;64(7):211-212 17. Kaada B and Torsteinbo O. Vasoactive intestinal polypeptides in con- nective tissue massage. General Pharmacology 1987;18(4):379-84 18. Kaada B and Torsteinbo O. Increase of plasma beta-endorphins in con- nective tissue massage. General Pharmacology 1989;20(4):487-489 19. McKechnie AA, Wilson F, Watson N and Scott D. Anxiety States: A pre- liminary report on the value of connective tissue massage. Journal of Psychosomatic Research 1983;27(2):125-129 20. Reed BV and Held JM. Effects of sequential connective tissue massage on autonomic nervous system of middle-aged and elderly adults. Physical Therapy 1988;68(8):1231-1234 21. Turchaninov R and Prilutsky B. Massage therapy a beneficial tool in treat- ing fibromyalgia. Massage and Bodywork 2004;Feb-Mar;19(1):82-93 22. Citak I et al. Connective tissue manipulation in treatment of fibromyalgia syndrome: a pilot study.

Fizyoterapi Rehabilitasyon

2001;12(3):110-114 23. Akbayrak T, Citak I, Demirturk F and Akarcali I. Manual therapy and pain changes in patients with migraine — an open pilot study. Advances in Physiotherapy 2001;3(2):49-54

along the ilium towards the greater trochanter. Four repetitions of each stroke was applied and this was also repeated on the other side. No further treatment was given, until the effects were assessed. Laura rested supine for 15 minutes following treatment.

Treatment was given alternate days, excepting weekends. No adverse effects were reported. On treatment two, the frequency and severity of pain remained unchanged but Laura reported having felt relaxed and having slept very well since the CTM. On treatment three, Laura reported the ‘tingly’ feeling in the thigh had disap- peared and the sensation was almost normal. On treatment four, the back pain was 3/10 and Laura’s position had to remain static for 40 minutes before the onset of pain. Stretching exercises were intro- duced. Following six treatments, the pain had gone. A six week and three month review was arranged. At six weeks, it was found that some residual symptoms returned. One more session was given. There had been no recurrence at three months. The improvement in subjective symptoms were accompanied by a gradual return to nor- mal of the skin and connective tissues until the zones were no

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longer apparent. According to the theory of CTM, the zones had occurred follow- ing physiological changes in the skin and connective tissue as a result of a spinal segment becoming hyperactive. This was induced by the kidney stone. The internal problems had resolved, but the CT changes remained and eventually caused symptoms of their own, mediated through the sympathetic nervous system. The stimulus had the effect of stimulating the parasympathetic nerve endings at the apex of the sacrum and the autonomic nerve endings in the same spinal segment. This in turn ‘de-sensitised’ the sympathetics (parasympathetic stimulation was shown by improved sleep and a feeling of relaxation) and reduced the sym- pathetically-maintained pain, parasthesia and tissue changes.

Occasionally, other unexpected positive effects may occur - for example, a patient may experience improved bowel function as a result of treatment. This tends to occur as the bowel zones lie on the ‘basic section’ so are generally treated with early treatments.

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