Abstract
Manual Therapies, East and West
Manual healing traditions exist in all nations. With the advent of scientific medicine in the West, they were viewed with disdain by the medical establishment and in many cases forced underground. But something so primordial and valuable can never be fully suppressed. Western manual healing arts—osteopathy, chiropractic, and massage therapy, along with lesser known offshoots such as naprapathy and Rolfing—emerged to fill the gap left by conventional medicine's willful turning away from these healing methods and their nonbiochemical focus. In the East, this dichotomy never took root to the same extent. In Asia and other non-Western settings, manual treatments evolved side-by-side with herbal and, later, pharmaceutical therapies.
In our era, East and West have met in an emergent global culture. As long as relations are based on mutuality rather than hegemony, both will be immeasurably enriched through the interchange. One significant aspect of this global phenomenon is the exchange of health insights on a worldwide basis. Since our founding 17 years ago, The Journal of Alternative and Complementary Medicine, based in North America and Europe, has sought out and published excellent articles from researchers and practitioners on all continents—from China, India, Korea, Japan, Iran, Israel, and nations in Latin America and Africa. We all have much to learn from each other. At the deepest level, our purpose is one and the same.
Artful Scrutiny of a New Approach
In this issue (pp. 231–237), we are pleased to publish a noteworthy article, “Primary Massage Using One-Finger Twining Manipulation for Treatment of Infantile Muscular Torticollis,” by Yixin Kang and colleagues in the Department of Rehabilitation Medicine at the Linzi District People's Hospital, in Shandong Province, People's Republic of China. Kang et al. report on a condition that, left untreated, can result in long-lasting disfigurement, with all the physical and emotional consequences that can arise in its wake. These investigators compared their alternative manual method to conventional tuina manipulation, which in China constitutes first-line usual care for this condition. They explain that twining manipulation “involves a smaller contact area, provides faster frequency and stronger penetrating force, and produces better effects in promoting blood flow, removing blood stasis, promoting tissue regeneration, subduing swelling, and alleviating pain.” The twining method, which in this hospital-based study is delivered by a medical physician working in the Department of Massage, involves a pendular movement delivered to the sternocleidomastoid muscle (SCM) at a frequency of 250–250 times per minute, for a total of 20 minutes in most cases. In addition, adjacent muscles and key acupuncture points are manually stimulated.
Because failure of manual intervention is often followed by glucocorticoid injections or surgery, both of which entail significantly heightened risks, the stakes are high. Kang's team found that one-finger twining and tuina were both helpful to a large majority of patients, with the twining approach yielding significantly superior results.
This large study, with over 200 patients in each group, was a randomized trial in which outcomes were judged not only by head–neck deflection and range of motion but also with measurements of the morphology and size of the SCM using two-dimensional ultrasonography, and measurement of blood flow in the SCM with color Doppler ultrasonography. Thus, as with other examples of the highest quality research in complementary and alternative medicine (e.g., Ornish et al's. 1 use of quantitative coronary angiography to demonstrate reversal of atherosclerosis with diet and lifestyle changes, or Streeter et al's. 2 use of magnetic resonance spectroscopy to measure changes in brain γ-aminobutyric acid levels after yoga, corresponding with improvements in mood and anxiety), Kang et al. employed high-tech methods to validate a low-tech intervention. In more ways than one, the work by Kang's team truly embodies “the best of both worlds.”
Sharing Knowledge, Finding Common Ground
Western practitioners of manual healing arts can clearly benefit from advances such as those described by Kang and colleagues, though it should also be noted that in the West, manual approaches for infantile torticollis already exist within both chiropractic and medicine. I recall being told by the late J.F. McAndrews, a chiropractor, of a conversation he had with Irving Dardik, a medical doctor, when the two served together on the group planning medical services for U.S. Olympic athletes in 1980, the first year that chiropractors treated American Olympic athletes in an official capacity.
In a wide-ranging discussion on spinal adjustment and manipulation, Dardik related that on more than one occasion in his medical practice, he had delivered a baby with severe torticollis. To remedy the condition, he would lay the newborn on its back, hold its head and neck in his two hands, and deliver an adjustive thrust, which elicited a sound “like the breaking of a dry twig” and was followed by full resolution of the torticollis. When McAndrews told me this story a few months later, he noted that he, too, had used precisely this method in some cases of pediatric torticollis.
It is worth noting that in 1980, the official position of the American medical establishment was that spinal manipulation for any purpose was useless at best and frequently harmful. It is further worth noting that even today, efforts by some medical practitioners and their allies to ban chiropractic care for persons under the age of 18 are underway in more than one nation. The struggle goes on.
Despite opposition from such retrograde forces, manual therapies continue to develop and mature worldwide. In November 2008, in Beijing, China, the World Health Organization convened its first Symposium on Manual Methods of Health Care, delegating to the World Federation of Chiropractic the responsibility for organizing this landmark event. With the expanding range of manual practice, the increasingly broad and deep research foundation that underlies it, and the continuing integration of chiropractors, massage therapists, and other manual practitioners into the mainstream of health care delivery in many nations, manual therapies are truly coming of age.