Alexander technique: There are currently no available published reports of serious complications as a result of Alexander technique instruction. It has been suggested that this technique may be less effective in patients with learning disabilities or mental illness. The Alexander technique has been used by pregnant women and during delivery without reports of complications although safety in these circumstances has not been established scientifically. The Alexander technique should not be used as the only treatment approach for medical or psychiatric conditions and should not delay the time it takes to consider more proven therapies.
Applied kinesiology: AK is generally believed to be free of direct adverse effects although the potential exists for it to be harmful indirectly by delaying the appropriate diagnosis of serious conditions. AK should not be relied upon as the sole diagnostic or therapeutic approach to potentially serious conditions, and it should not delay the time it takes to speak with a qualified healthcare provider about such conditions.
Asian bodywork: With proper training, self-administered acupressure and acupressure performed by an experienced therapist appear to be generally safe. Reports in the scientific literature of serious long-term complications are currently lacking. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
Chiropractic: There are many reports of serious complications during and after spinal manipulation (particularly with cervical spine/neck manipulation). However, the frequency of these events remains controversial and unclear. The most common adverse effect is believed to be local discomfort in the area of treatment although most concern centers around the less common but potentially life-threatening risks of stroke/vertebral artery dissection and spinal cord/nerve damage. Deaths have been reported. Some researchers and practitioners attribute chiropractic side effects to poor technique, and others believe that the use of high-velocity forceful rotational (twisting) motions of the head increase the risk of serious complications and suggest using lower-velocity/force non-rotational motion.
Craniosacral therapy: The safety of craniosacral therapy has not been thoroughly studied scientifically. Although the movements of this technique are usually gentle, there may be a small risk of stroke, nervous system damage, bleeding in the head, intracranial aneurysm, or increased pressure in the brain. The following people should approach craniosacral therapy with caution: those with recent head trauma or skull fracture, diseases that affect the brain or spinal cord, conditions in which a change in pressure in the brain would be dangerous, and those with disorders of blood clotting. In theory, craniosacral therapy may make some existing symptoms worse. Adverse results have been reported in patients with traumatic brain syndrome. There are anecdotal reports of diarrhea, headache, and increased anger after treatment. It has been proposed that craniosacral therapy may enhance the effects of drugs used for diabetes, epilepsy, or psychiatric disorders although this has not been tested in scientific studies. Craniosacral therapy should not be relied on as the sole treatment (instead of more proven approaches) for potentially severe conditions, and it should not delay consultation with an appropriate health care provider about a symptom or condition.
Hellerwork / Rolfing®: The safety of Hellerwork has not been thoroughly studied scientifically. In theory, Hellerwork may make some existing symptoms or conditions worse. Deep-tissue massage is not advisable in some conditions. Patients should speak with a qualified health care provider before starting treatment.
Mobilization: Patients are advised to communicate with their manual therapists if their joints begin to feel uncomfortable in the process of receiving mobilization therapy. Open honest communication with a practitioner is encouraged to receive maximum benefit from this treatment. A manual therapist does not want to bend joints in unusual positions, and every person has restrictions of what feels like a comfortable range of motion.
Reflexology: Reflexology is discouraged in patients with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Patients with osteoarthritis affecting the foot or ankle, or severe vascular disease of the legs or feet should seek a medical consultation prior to starting reflexology. In general, patients should inform their medical practitioner of any existing medical problems or medications. Some reflexology texts note specific conditions that theoretically may be negatively affected by this therapy although scientific data is lacking in these areas. These conditions include diabetes, heart disease or the presence of a pacemaker, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones, or kidney stones. Caution is advised in pregnant women, due to reports that rigorous stimulation of the feet may lead to uterine contractions. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.
Alexander technique: An assumption underlying the Alexander technique is that people can be trained to alter habitual patterns of movement, including movements that are thought to be involuntary. It has been suggested that musculoskeletal movements and relationships can have direct effects on other aspects of health or function, and that beneficial movement patterns can be reinforced through repetition. For instance, improving the position of the head and spine is thought to be important to achieving optimal health. Most Alexander technique teachers instruct students by using both verbal directions and light touch. Students are encouraged to understand and sense what they are doing and to make use in everyday life of what they have learned.
Applied kinesiology: AK practitioners may evaluate the health status of patients according to three health factors: chemical, mental, and structural (physical). It is proposed that ill health may result from an imbalance in these factors. The practice of AK may be followed by joint manipulation or mobilization, myofascial therapies, cranial techniques, meridian therapy, clinical nutrition, dietary management, or reflex procedures. Environmental or food sensitivities may be evaluated by muscle testing, a method that correlates muscle strength with the body's reaction to potential allergens.
Asian bodywork: Several traditional Asian medical philosophies consider health to be a state of balance in the body, which is thought to be maintained by the flow of life energy along specific meridians. A disease state is believed to occur when energy flow is blocked, deficient, or in excess. A goal of acupressure is to restore normal life energy flow using finger and palm pressure, stretching, massaging, and other bodywork techniques. It is believed that there are 12 primary channels and eight additional pathways which circulate life energy throughout the body and maintain the balance of yin and yang. It is proposed that acupressure may reduce muscle pain and tension, improve blood circulation, release endorphins, and release/eliminate toxins. The mechanism of action may be similar to other techniques such as acupuncture (stimulation of acupoints with needles), moxa (acupuncture using a burning stick of dried mugwort leaves), or other forms of manual stimulation.
Chiropractic: There are traditional and scientific-based hypotheses regarding the mechanism of action of chiropractic and spinal manipulation. There is overlap between some of these theories with research in several areas. However, the physiologic mechanism of spinal manipulation remains largely unknown. The vertebral subluxation hypothesis proposes that alterations in normal anatomical/physiologic relationships between contiguous articular structures result in disease, and that chiropractic/manipulative methods can reduce these positional abnormalities. "Vitalism" is the concept that the body has the innate ability to heal itself if relieved of spinal irritations or subluxations. Correction of subluxations has been suggested to restore the flow of life force throughout the body, which results in a brief convalescence and a return to optimum health. There is limited scientific evidence in these areas. The nerve compression hypothesis suggests that intervertebral subluxations can cause irritation or compression of spinal nerve roots and interfere with nerve transmission. The fixation hypothesis proposes that vertebral muscles become locked and lose range of motion leading to the release of neurotoxic mediators and abnormal nerve conduction. The axoplasmic aberration hypothesis asserts that compression of spinal nerves or nerve roots may hinder axoplasmic transport and damage nerves.
Craniosacral therapy: In the early 1900s, the osteopathic doctor William Sutherand developed a theory which proposed that relationships and motions of the bones of the skull (cranium), of the fluid that flows through the brain and spinal column (cerebrospinal fluid), of the membranes around the brain and spinal cord (meninges), and of the bones of the lower back (sacrum) lie at the core of the body's functioning and vital energy. A series of techniques grew out of these concepts, which were further developed in the 1970s by John Upledger, also an osteopathic doctor. Dr. Upledger coined the term craniosacral therapy, which refers to a form of therapeutic manipulation that is oriented to tissue, fluid, membranes, and energy. There are numerous anecdotes about treatment benefits although effectiveness and safety have not been thoroughly studied scientifically. Craniosacral therapy may be practiced by osteopathic doctors, chiropractors, naturopathic doctors, or massage therapists. This technique is sometimes referred to as the cranio-occipital technique or cranial osteopathy (when practiced by osteopathic doctors) although it is controversial whether there are actually subtle differences between these approaches.
Massage: Scientific research of massage is limited, and existing studies use a variety of techniques and trial designs. Firm evidence-based conclusions about the effectiveness of massage for any health condition cannot be made at this time. Numerous theories exist on how massage therapy may be beneficial although there is limited research around the mechanism of action. It has been suggested that massage may have local effects on muscles and soft tissues and may reduce inflammation, stimulate oxygenation of tissues, soften or stretch scar tissue, break up adhesions, reduce buildup of lactic acid in muscles, induce muscle fiber relaxation, and stimulate healing of connective tissues or damaged muscles. Swedish massage practitioners suggest that this approach can assist the body in delivering nutrients and removing waste products from various tissues by improving circulation. Massage therapy is said to transform nervous energy into a more steady state. Rhythm in massage is regarded as important to establishing balance, and the nervous system is thought to benefit from repetition and tempo. Rhythms are felt to have a meditative quality that is refreshing both to the therapist and client. The environment is often regarded as being integral to massage therapy as well, and it often consists of a comfortable, warm, and quiet location although sports massage may be administered in a gym or locker room setting. Most approaches involve the client lying face down on a platform or table with a sheet covering the lower body. Depending on the technique, sessions may last from 15 to 90 minutes.
Hellerwork / Rolfing®: In general, Hellerwork practitioners believe that memory is held in the muscles and tissues of the body, as well as in the brain. Treating a patient at the structural level is thought to alter the psychological or neurological state. However, the primary focus of Hellerwork is structural. Hellerwork is aimed at improving or restoring the body's natural balance and posture. There are numerous anecdotes about successful treatment with Hellerwork although effectiveness and safety have not been thoroughly studied scientifically.
Jones counterstrain: Strain-counterstrain is used for a number of medical conditions with muscle involvement including bursitis (inflammation of the bursa, which is a small sac that cushions the joints), tendonitis (inflammation of a tendon), tension headaches, sciatic nerve irritation, as well as loss of joint mobility. "Tender points" is a term that identifies common points of muscle tightness. There is very little available research to determine the effectiveness of Jones counterstrain for any indication. However, the American Osteopathic Association and Jones Institute are actively involved in funding research that may elucidate the efficacy of these treatments.
Mobilization: The term "mobilization" deals with the manipulation of soft tissue encapsulating a joint (called fascia) and muscles over joints that have restricted range of motion. Fascia, muscles, and ligaments may tighten after an injury. Advocates, such as the Somatics System Institute, claim that these soft tissues around the bone need to be stretched in order to improve or restore range of motion. Tightness in joints, advocates claim, may also restrict the flow of blood, lymph, and nerve signals in the area. Manual therapy may also promote proper restoration of joint function after an injury. Although available research indicating the usefulness of mobilization is sparse, this therapy has been integrated into most physical therapy textbooks.
Myofascial release: Myofascial release involves a gentle form of stretching and compression. This therapy, also known as soft tissue mobilization or MFR, releases the uneven tightness in injured fascia. Fascia is the dense tough tissue that surrounds and covers the body's organs, muscles, and bones. There is little scientific evidence to support MFR for any medical condition. However, one study found that myofascial release combined with an electrical current improved pain and neck flexibility in individuals with neck and shoulder pain.
Reflexology: Reflexology involves the application of manual pressure to specific points or areas of the feet that are believed to correspond to other parts of the body. Reflexology is often used with the intention to relieve stress or prevent/treat physical disorders. Pressure may also be applied to the hands or ears. Reflexology charts consist of pictures of the soles of the feet on which diagrams of corresponding internal organs or parts of the body are drawn. For example, charts may display that the toes correspond to the head and neck, the ball of the foot to the chest and lungs, the arch of the foot to the internal organs, the heel to the sciatic nerve and pelvic area, and the bone along the arch of the foot to the spine. The right side of the body is believed to be reflected in the right foot and the left side in the left foot. Although most reflexologists formally claim that these relationships are not used to diagnose disease, practicing reflexologists sometimes assert that tenderness or a gritty feeling of the feet represents current or past disease in the corresponding area of the body. Reflexology is sometimes combined with other techniques and may be used by healthcare practitioners of various disciplines (such as massage therapists, chiropractors, podiatrists, physical therapists, or nurses).
Exactly how reflexology might work remains unclear. Several possible explanations have been proposed; however, none has been scientifically proven. One theory is that the body contains an invisible life force or energy field that when blocked can result in illness. It is proposed that stimulating nerve endings in the foot may unblock and increase the flow of vital energy to various parts of the body and promote healing. This is similar to techniques for other therapies, such as acupuncture or acupressure, in which mapped points on the body are treated to affect corresponding remote body parts or conditions. A different theory is that pressure exerted by reflexologists may release endorphins (compounds that alter pain sensations). Yet another explanation of how reflexology may work is that compression of specific points ("cutaneo-organ reflex points") stimulates nerves that form connections with other parts of the body and may have distant effects as part of a reflex arc. Other explanations include promotion of lymphatic flow or dissolving of accumulated uric acid crystals via direct stimulation of the feet. Reliable scientific research in these areas is limited.
Alexander technique: The Alexander technique is an educational program that teaches movement patterns and postures with an aim to improve coordination and balance, reduce tension, relieve pain, alleviate fatigue, improve various medical conditions, and promote well-being. Actors, dancers, and athletes use the Alexander technique with the goal to improve performance. This technique is available through wellness centers, health education programs, and from individual practitioners. The Alexander technique can be traced back to F.M. Alexander, an Australian-English actor, who attributed his own intermittent voice loss to poor head and neck posture. Alexander believed that people could be trained to detect and eliminate harmful movement patterns and positions. Musculoskeletal approaches, such as the Alexander technique, are advocated by many behavioral scientists and physiologists although there are few scientific studies of this technique specifically. Sessions last up to an hour and usually make use of a mirror for instruction. Lessons are usually private although group instruction is also available. A gentle hands-on approach is used to teach movements with the head leading and the spine following, for example with stand-to-sit movements, walking, turning, breathing, or speaking. It may require 10 to 30 lessons before students become proficient, and some individuals continue lessons over extended periods of time.
Applied kinesiology: Applied kinesiology (AK) is a technique that uses muscle testing with the aim to diagnose nutritional deficiencies and health problems. It is based on the concept that weakness in certain muscles corresponds to specific disease states or body imbalances. AK practitioners may diagnose organ dysfunction, energy blockage, or allergies (including allergies to foods and drugs). Edukinesthesia is a type of AK that is used to detect the cause of learning difficulties and poor concentration. Some AK practitioners assert that this technique can be used to treat conditions by rectifying energetic and musculoskeletal imbalances in the body. AK was developed in the 1960s by George Goodheart Jr., a chiropractor who asserted that postural distortions can be associated with weak muscles. He suggested that with his assessment technique interventions could be identified and tested based on their ability to make muscles stronger and change postural distortions. In current times, AK may be practiced by chiropractors, naturopaths, medical doctors, dentists, nutritionists, physical therapists, massage therapists, nurse practitioners, or other healthcare providers. The International College of Applied Kinesiology (ICAK), founded in the 1970s, has established standards of practice for this form of assessment.
Asian bodywork (Tuina and Shiatsu): The practice of applying finger pressure to specific acupoints throughout the body has been used in China since 2000 BC, prior to the use of acupuncture. Acupressure techniques are widely practiced internationally for relaxation, wellness promotion, and the treatment of various health conditions. Multiple human studies suggest effectiveness of wrist-point (P6) acupressure for treating nausea. Shiatsu means finger (Shi) pressure (Atsu) in Japanese. Shiatsu technique involves finger pressure at acupoints and along body meridians. It can incorporate palm pressure, stretching, massaging, and other manual techniques. Shiatsu practitioners commonly treat musculoskeletal and psychological conditions, including neck/shoulder and lower back problems, arthritis, depression, and anxiety. Tuina (Chinese for "pushing and pulling") is similar to shiatsu but with more soft tissue manipulation and structural realignment. Tuina is a common form of Asian bodywork used in Chinese-American communities.
Chiropractic: Chiropractic is a health care discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system), and how this relationship affects the preservation and restoration of health. The broad term "spinal manipulative therapy" incorporates all types of manual techniques, including chiropractic. For instance, the practitioner may massage along a patient's spine in a pumping motion to relax muscular tension that may interfere with the nerves between these muscles.
Craniosacral therapy: Craniosacral therapy practitioners touch areas of the patient lightly to sense the cranial rhythm impulse of the cerebrospinal fluid (CSF), which is said to be similar to feeling the pulse of blood vessels. Practitioners then use subtle manipulations over the skull and other areas with the aim of restoring balance by removing restrictions to CSF movement. It is a process that is purported to help the body heal itself and improve a wide range of conditions. Treatment sessions usually last between 30 and 60 minutes.
Jones counterstrain: Jones counterstrain, also known as strain-counterstrain, is used to treat abnormal nerve and muscle reflexes that may cause painful postural and structural problems. The technique involves finding tender points, often on or over joints, along the body. Strain-counterstrain is a gentle technique that works by placing muscles in positions for 90 seconds in order to purportedly "reset" muscles. Training manuals instruct the practitioner to ask the patient about areas of pain, injury, and restricted motion. The practitioner also feels tender points on the body and asks the patient if they are experiencing any pain. The specialist then applies gentle pressure on the painful area towards an area of less or no pain. This positional release is believed to painlessly release tender trigger points. After this release of tension, the patient should feel a decrease in or alleviation of localized pain and an increased range of motion. This release may also aid in the healing necessary to correct painful all-over postural and structural problems.
Hellerwork / Rolfing®: Joseph Heller, a practitioner of Rolfing® (manipulation of the muscles), developed Hellerwork in 1979. Hellerwork is a form of bodywork that uses multiple techniques, including deep-tissue bodywork, movement education, and verbal interaction to help improve a person's overall posture. Each session may last from 30 to 90 minutes, and a patient usually attends multiple sessions. Hellerwork professional certification involves a 1,250-hour program. There are more than 100 distinct chiropractic and spinal manipulative adjusting techniques, and there is variability between practitioners. Hellerwork is a form of Rolfing®. Some approaches use highly specialized tables or hand-held equipment. Techniques that are widely taught in chiropractic schools include: Diversified, Extremity Adjusting, Activator, Gonstead, Cox Flexion-Distraction, and Thompson. Other techniques outside of the established curriculum are taught in some chiropractic schools and in seminars. Long-lever manipulation uses the femur, shoulder, head, or pelvis to affect larger sections of the spine in a non-specific manner. Specific short lever dynamic thrusts utilize a specific traction on a transverse spinous process of vertebra, muscle, or ligament. Point pressure manipulation includes manual stimulation of specific points without attempting to actually massage a muscle or move a joint. Manual traction is a technique that incorporates the use of an external system of applied resistance to facilitate joint decompression of the spine or an extremity. Manual traction is often performed on a segment of the spine without attempting to mobilize the joint through a specific passive movement. Soft tissue therapeutic techniques are used to reduce muscle spasm, soreness, or tightness. These procedures are directed at the subcutaneous, muscular, or tendinous tissues and do not result in significant joint movement. Example techniques include myofascial trigger point therapy, cross friction massage, active release therapy, muscle stripping, and rolfing. Mobilization or articulation techniques use slow rhythmic movements rather than quick sharp thrusts and may be performed within the passive range of motion of the spine.
Massage: Touch is fundamental to massage therapy and is used by therapists to locate painful or tense areas to determine how much pressure to apply to the body and to establish a therapeutic relationship with clients. Many different therapeutic techniques can be classified as massage therapy. Most involve the application of fixed or moving pressure or manipulation of the muscles or connective tissue. Practitioners may use their hands or forearms, elbows, or feet to perform massage. Lubricants may be added to aid the smoothness of massage strokes. Techniques used in Swedish massage include (1) superficial stroking in a direction away from the heart or deep stroking towards the heart; (2) kneading in a circular pattern using fingers and thumbs; (3) deep muscle stimulation; (4) rhythmic movements such as slapping or tapping; and (5) vibration. Sports massage is similar to Swedish massage but is adapted specifically for athletes and is designed to help treat and relax muscles that are crucial to peak athletic performance. Deep tissue massage uses slow strokes, friction, and direct pressure across muscles with fingers, thumbs, or elbows, often with the goal to improve chronic muscular tension. Esalen massage focuses on generating a deep state of relaxation and is often combined with other forms of massage. Neuromuscular massage, triggerpoint massage, and myotherapy are forms of deep massage administered to specific muscles or nerve points and are used to release trigger points or entrapped nerves and to relieve pain. Classical massage aims to provide calmness and relaxation and to encourage self-healing and revitalization. St. John's neuromuscular technique may be used for chronic pain conditions that involve the musculoskeletal system. Polarity treatment is based on the concept that rebalancing the body's energy fields with gentle massage may improve health and well-being. Rolfing® involves deep tissue massage aimed at relieving stress as well as improving mobility, posture, balance, muscle function/efficiency, energy, and overall well-being. Jin Shin Do involves applying finger pressure to acupoints of the body with the goal of releasing muscular tension or stress. Bindege Webs massage focuses on treating connective tissue between the skin and muscles and is based on the theory that some ailments are caused by imbalances in these tissues. The Trager massage approach involves relearning patterns of movement in order to purportedly improve efficiency and well-being. Many other variations and styles of massage or touch exist and are often developed in specific geographic regions.
Mobilization: Mobilization is a type of manual therapy or hands-on physical therapy usually practiced by chiropractors and physical therapists. Range of motion is the ability to move a joint, such as the elbow, at the normal extent without pain. So, in the case of the elbow, an individual should be able to totally extend the forearm and then bend the elbow all the way. If this is not performed easily and without pain, then the range of motion is restricted. Range of motion problems typically develop after injury. Ligaments may be torn, bursa may move out of place, or a bone may be broken or displaced. Range of motion is considered closely related to the quality of life. If an elbow does not bend properly, then it would be difficult to perform daily tasks, such as cleaning, cooking, and opening doors. Patients seek soft tissue mobilization therapy for any number of joint complications, including those in the hands, feet, elbows, hips, neck, and spine. Typically, the therapist has the patient lie on a massage table or has the patient sit in a chair. The therapist will check most of the patient's joints for restricted range of motion. The therapist moves the joint at an angle or in a way that is difficult and/or painful for the patient to move on their own. The therapist then relaxes the joint before applying more pressure. The intended goal is to increase range of motion without further stressing joints.
Myofascial release (MFR): Each myofascial release (MFR) technique consists of the same components. The physical therapist finds the area of the skin and/or muscle tightness, and then a light, gentle stretch is applied to the tight area. The physical therapist waits for the tissue to relax and then increases the stretch. The process is repeated until the area is fully relaxed. Then, the next area is stretched. The therapist is guided by feedback felt from the patient's body, such as loosening muscles in the legs or the patient's facial expression. This feedback tells the therapist how much force to use, the direction of the stretch, and how long to stretch. Small areas of muscle are stretched at a time. Sometimes the therapist uses only two fingers to stretch a small part of a muscle. The therapist should also be able to find sore spots just by the sensation of touch. Often, patients are unable to locate sore spots or have become accustomed to them until the physical therapist finds them. The size and sensitivity of these sore spots, called myofascial trigger points, may decrease with MFR treatment.
Reflexology: Reflexologists often take a full client history before examining the bare feet systematically with the patient lying on a treatment table, couch, or reclining in a chair. During treatment, clients typically remain fully clothed, sitting with legs raised or lying on a treatment table. Reflexology is a modality that is thought to connect points on the patient's feet with the patient's wellbeing. Unlike massage, which involves a generalized rubbing motion, reflexologists use their hands to apply pressure to specific points of the foot. Practitioners start by gently massaging the feet and then begin to apply pressure to selected reflex points on the feet. The strength of pressure used often varies between practitioners and from patient to patient. This therapy should never be painful. For lubrication, therapists may use lotion or oils (some which may contain aromatherapy products). The reflexologist and client may converse throughout treatment or may remain silent, depending on client preference. Occasionally, practitioners will use instruments on the feet during therapy (for example, sticks of wood, clothespins, combs, rubber balls, rubber bands, tongue depressors, wire brushes, special massagers, hand probes, or clamps). Some reflexology instruction books state that clients may feel a tingling sensation in the part of the body corresponding to the reflex point being stimulated although this has not been documented scientifically. Individual reflexology sessions often last from 30 to 60 minutes and may be part of a 4 to 8 week course of therapy. Practitioners range from those who are self-taught to individuals who have attended training courses and belong to professional associations. Techniques can be learned and self-administered. No widely accepted regulatory systems exist for reflexology, and there is currently no state licensure or training requirement in the United States.