SMI Newsletter — June, 2014


Greetings from SMI!

Manual therapists working in the areas of performance, prevention and rehabilitation must never stop learning. The most effective therapists are always experimenting with new techniques, trying new approaches and modifying treatments. This is exactly what we encourage and promote at SMI. Sometimes new ideas and approaches work, and other times they don’t. But over the long haul, this approach develops therapists who are more effective, more efficient and able to deal with a wider array of dysfunctions, injuries and problems.


In this newsletter we examine a couple of relatively new techniques that have influenced our work, as well as a study that confirms something we have been doing all along. Enjoy the articles, take care of yourself and feel free to contact us with any questions or concerns!

~ The SMI Team


SMI in San Francisco!

Just a reminder that SMI therapist Eva Popper is now working in San Francisco a few days a month! She is working in the Alamo Square district at 425 Divisadero St,Suite 209. You can schedule by calling the Palo Alto office at 650­-322­-2809.

Massage and Low Back Pain: There’s the rub!


Massage and Low Back Pain: There's the rub!

There hasn’t been a lot of research conducted  when it comes to testing the benefits of massage therapy.  One of the better studies was completed back in 2011.(1)  It examined the effects of two different types of massage on chronic low back pain of non-specific origin compared to “usual care.”  Usual care could include taking pain medications or muscle relaxants, performing home treatment techniques such as stretching or icing, or simply doing nothing at all.  Although the study was not perfect, it did result in some useful information and provides a stepping stone for additional research.


The participants consisted of 400 adults diagnosed with non­specific, moderate ­to ­severe low back pain lasting for at least three months.  Each participant was randomly assigned to one of three groups.  The first group received a weekly whole ­body relaxing massage for 10 weeks.  The second group received weekly massages that focused on specific muscle problems around the lower back and hips.  The control group was allowed to pursue “usual care” on their own.


What did it find? 

After 10 weeks, participants in both massage groups reported greater improvements in pain and functioning compared to those in the usual care group.  Daily function improved, on average, by 3.5 to 4 points on a 23­ point scale. Average pain improved by just over 2 points on a 10 ­point scale.  For the control group, functioning improved by about 1 point, whereas pain improved by .8 points.


Digging deeper, the study uncovered some more enlightening information.  At the conclusion of the 10 ­week intervention, approximately 65% of the participants of both massage groups experienced significant improvements in pain and function whereas as only 38% of the usual care group did.  AND, almost 4 of every 10 participants in the massage groups said their pain was nearly or completely gone, compared to only 4% in the usual care group. When the message worked, it worked extremely well.


What do we recommend? 

At SMI, we always individualize treatment plans based on the specific needs of the client. BUT in general, for chronic low back pain of non­specific origin, we recommend trying 3-­5 sessions over the course of one month and then assessing the progress.  We will also give you specific exercises to do at home to supplement the sessions in the clinic.  If you do not see improvements by that point, it is probably something that is not going to respond to our work. We will help you explore alternative approaches.


If you have any questions or concerns, please don’t hesitate to contact us!


1.  Cherkin DC, Sherman KJ, Kahn J, Wellman R, Cook AJ, Johnson E, et al. A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain: A Randomized, Controlled Trial. Ann Intern

Med. 2011;155:1­9.

Pain, Neuroplasticity, and How SMI Can Help


Clients and therapists alike have long attributed the benefits of massage to changes made within the musculoskeletal system. While this is true, recent advances in imaging technology have directed focus toward an expansive, additional area – the brain. From an unchanging, passive receiver of messages to a dynamic, evaluative, adaptive orchestrator,we are slowly discovering the brain plays a huge role, especially in how we are able to perceive and use our bodies. One of the central principles that makes this area of research exciting is the concept of neuroplasticity. 


Neuroplasticity is the capacity of the brain to change it’s structure and function.(1) The brain changes with experiences and continues to do so throughout life, both positively as well as negatively. When pain persists over periods of time, the brain begins to function differently, which may actually contribute to the pain experience.(2)Neural networks responsible for providing the experience of pain become dysfunctional. Some areas become sensitized, meaning they require less stimuli to initiate a response.(3) The nervous system’s ability to suppress incoming ‘danger signals’, called descending inhibition, become inefficient and instead the same incoming ‘danger signals’ may be amplified, called descending facilitation. G.L. Moseley and H. Flor observed that “the combination of sensitization and disinhibition drive systematic change in the response profile of neurons that represent the body.”(4) Regions your brain start to reorganize. Areas of the brain which normally respond to input from parts of the body appear in adjacent areas.(5)


Changes in the physical make up of the brain due to pain are now able to be measured as well. Key areas in the brain have shown significant decrease in grey matter density. The amount of change in the brain is strongly related to the duration of and type of pain.(2)


Fortunately, the discovery of neuroplasticity can be used to help prevent pain and dysfunction. Areas that have been affected have been shown to re-reorganize as well.(5,6)  Much of the research in this area is still in its infancy but there is data indicating that when targeting the brain, not all input is equally effective.(7) For example, G.L. Moseley et al., demonstrated that tactile (touch) stimulation alone of a painful area with associated brain changes was not sufficient to decrease pain, increase accurancy in perceiving touch, or facilitate changes in the brain. They found that when recipients paid attention and differentiated between different types and locations of stimuli, changes in all three of those categories occured.(8)


How does the bodywork received at SMI fit into all of this information?


Bodywork received at SMI is accompanied by a constant, expert, and clear communication between therapist and client. In every session, our clients have an opportunity to explore more specifically and more accurately, details about what they are experiencing. The therapist asks clarifying questions, i.e. “Is there a time of day your pain appears to be better or worse?” or “Is there any position or range of motion that seems to make your pain better or worse?”. This engages the client and enables them to differentiate and understand their condition. During this process, the clients’ understanding may evolve from a vague explanation such as “my shoulder hurts” to a more specific and beneficial explanation, like “the back part of my shoulder hurts at the end of the day, especially when I try to lift it over my head.” This gives important information to the therapists’ in terms of how we work. Also, it gives the client an opportunity to better understand their experience and engage the higher centers of the brain.(4,7)


Bodywork from SMI operates on this level in the ‘hands-on’ work. One of the most important aspects of the work we do is the communication between therapist and client. Therapists often work within very specific locations,  the amount of pressure and the type of technique used is based on client feedback. Clients are asked to compare

between different areas of contact and give feedback on the qualities of sensations experienced. For example: dull, achey, burning, warm, cold, shooting pain,etc…

Can we recreate the pain you experience ? Is the quality and quantity different than what you normally feel? Again, this is important for the therapist and also provides you an opportunity to better understand and define your experience.


To sum up this information we can say: 


Neuroplasticity is an important new discovery which means that the brain changes structurally and functionally. In cases such as persistent pain, some of these changes include decreased grey matter, increased sensitization, reorganization of the brain’s ‘map of the body’, and an inability to suppress incoming ‘danger signals’. The same ‘plasticity’ that caused the brain to undergo these changes enables them to be reversed as well. 


Therapists at SMI use these principles to aid our clients in this process.


For more information regarding neuroplasticity, please refer to The Brain that Changes Itself by Norman Doidge.(9)



1.Siddall PJ. Neuroplasticity and pain: what does it all mean? Med J Aust 2013 Mar 4;198(4);177-8.

2.Apkarian AV, Baliki MN,Geha PY. Towards a Theory of Chronic Pain. Progress in Neurobiology2009;87(2):81-97.

3.Woolf CJ. Central sensitization: Implications for the diagnosis and treatment of pain. Pain. 2011 March:152(3Suppl):S2-15.

4.Moseley GL, Flor H. Targeting cortical representations in chronic pain: a review. NeurorehabilNeural Repair. 2012 Jul-Aug;26(6):646-5

5.Flor H, Braun C, Elbert T, Birbaumer N. Extensive reorganization of primary somatosensory cortext in chronic back pain patients. Neurosci Lett 1997;224(1):5-8.

6.Gauthier LV, Taub E, Perkins C, Ortmann M, Mark VW, Uswatte G. Remodeling the brain plastic structural brain changes produced by different motor therapies after stroke. Stroke. 2008 May;39(5):1520-1525.

7.Wand BM, et al., Cortical changes in chronic low back pain: Current state of the art and implications for clinical practice, Manual Therapy 2011 Feb;16(1):15-20.

8.Moseley GL, Zalucki NM Wiech K. Tactile discrimination, but not tactile stimulation alone reduces chronic limb pain. Pain. 2008 Jul 31;137(3):600-8.

9.Doidge N. The brain that changes itself: stories of personal triumph from the frontiers of brainscience. London: Penguin Books, 2007.

Kinesio Tape: Will it stick?


In the area of injury prevention and injury rehabilitation, new approaches, techniques and theories pop up all the time. Some end up withstanding the test of time and more importantly, withstanding the scrutiny of critical research, whereas others disappear after practitioners and recipients figure out they just don’t work.

 A fad that has been around for a few decades but skyrocketed in popularity over the last few years due to a clever marketing campaign is the use of the elastic tape known as Kinesio Taping ®. Kinesio Taping was developed in Japan by Dr Kenso Kase in the 1970’s but didn’t become popular around the rest of the world until the 2008 Summer Olympics when Kinesio Tape was donated to the Olympic athletes of 58 various countries. Other types of elastic tape such as RockTape and KT Tape sprouted up overnight. You have probably seen it on professional athletes on TV, runners darting through your neighborhood or perhaps around the office on one of your co-workers. As with any new fad, the key question is does it actually work? Let’s look at what the manufacturers’ say and compare that to what the research has discovered so far.

 The following paragraph was taken directly from the KinesioTaping website:


“The Kinesio Taping Method is designed to facilitate the body’s natural healing process while allowing support and stability to muscles and joints without restricting the body’s range of motion. It is used to successfully treat a variety of orthopedic, neuromuscular, neurological and medical conditions. Both Kinesio® Tex Tape and the training protocol have shown results that would have been unheard of using older methods and materials.”


Those are pretty strong words! Unfortunately, the good, peer-reviewed research that has been performed so far does not support those claims quite so strongly. That is not to say it does not have a positive impact. It can and does work for certain things and in certain circumstances.


In 2012, a review was published in the November issue of  Physician and Sports Medicine.(1) In 2013, a review was published in the October issue of European Journal of Physical Rehabilitation Medicine.(2) Both reviews ultimately concluded that most of the reserch done so far has flaws and that more high quality studies are needed. Even though more work needs o be done, there have been some positive findings, particularly with regard to short term pain relief.


There is conflicting evidence with other outcomes such as strength and proprioception, but there may be some benefit for certain conditions and dysfunctions in certain areas.


The bottom line is that we at SMI do use both RockTape and Kinesio ® Tex Tape. It is not going to cure, treat or prevent conditions, dysfunctions or maladies by itself, but it is another tool that helps us provide a more comprehensive and complete approach to treating and preventing pain and dysfunction. Furthermore, even a slight benefit in performance or decrease in pain is useful and desired if it is simply derived from applying a few strips of elastic tape! The more we use it, the more evidence we gather, and we can continue to streamline our approach to provide more useful techniques. It is not “the”answer and clearly not even close to what the manufacturers’ claim, but it is still worth incorporating as part of a comprehensive treatment plan.


If you have any questions or concerns, please don’t hesitate to contact us! In the meantime, check out the videos below.



 1. Mostafavifar M, Wertz J, Borchers J. Phys Sportsmed. 2012 Nov;40(4):33-40.

 2. Kalron A, Bar-Sela S. Eur J Phys Rehabil Med. 2013 Oct;49(5):699-709.


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