Canadian RMT Spring 2018 Canadian RMT Spring 2018 | Page 13

Massage as a Functional
Neuromodulation Intervention
By Alejandro Elorriaga Claraco, MD (Spain),
N
Director McMaster Contemporary Acupuncture Program
eurons are arguably the most interesting cells of
the body for Manual Medicine Practitioners. Their
remarkable properties include: 1. Neuromodulation
= the ability to modify their own activity functionally, and 2.
Neuroplasticity = the ability to change structurally in response
to repeated stimuli.
Functional neuromodulation refers to the physiology of the
multiple “built-in” neural circuits that participate in the inte-
gration and modulation of neural signals at every level of the
nervous system. These
responses involve both
“top down” and “bottom
up” circuits. Understand-
ing of these neural path-
ways and their neuro-
physiology (see drawing
on opposite page) support
the thesis that “massage
therapy interventions” are
fundamentally “functional
neuromodulation inter-
ventions”. Briefly, during
“massage therapy inter-
ventions” different recep-
tor fields in the somatic
tissues are stimulated by
mechanical and thermal
signals generated by the
hands of the therapist. As
a result, and depending
on the type of nerve fiber
stimulated, different neu-
ropeptides (such as sub-
stance P, endorphins and oxytocin) and neurotransmitters
(such as glutamate, GABA, and dopamine) are secreted along
specific neural circuits involved in the functional neuromodu-
lation of nociception in the central nervous system. The end
result: 1. a significant number of nociceptive signals are prevent-
ed from ever reaching the brain, which helps with our wellbeing
and 2. functionality of the somatic neuromotor and the sympa-
thetic vasomotor systems is preserved, by several mechanisms,
including the elimination of nociceptive interferences.
During massage therapy interventions, different neuromodu-
latory circuits are engaged depending on the innervation of
the tissues and on the quality of the inputs used. Most massage
therapy interventions have the potential to engage the whole
variety of skin, fascial, and musculoskeletal somatic sensory
fibers, carrying both exteroceptive information (pain, touch,
temperature) and proprioceptive information (position sense,
joint movement, muscle length, rate of change of muscle length,
muscle stretch, tendon tension, ligament tension). For instance,
techniques involving tissue
distraction will stimulate
sensory receptors such as
Pacinian corpuscles, Ruffini
organs, and small myelinated
free nerve endings in the fas-
cia, while gentle but more vig-
orous work around the joints
will involve the stimulation of
thick myelinated fibers (type
I and II) involved in proprio-
ception and kinesthesia.
Many practitioners still
think about massage therapy
interventions as primarily
“mechanical” in nature (and
they are right from the input
standpoint), however, as dis-
cussed, most of the benefi-
cial effects of massage can be
explained by the functional
neuromodulation model.
This model also explains the
beneficial effects observed in
response to needling techniques, electrostimulation, and even
movement!
As a summary: according to contemporary neurophysiology,
we can state that “massage is a functional neuromodulatory
intervention” because it activates functional neuromodulatory
neural circuits, promoting modulation and integration of seg-
mental, intersegmental and supraspinal sensory-motor-sympa-
thetic signals, resulting in less discomfort and better quality of
movement for the recipients of massage therapy interventions.

Spring 2018
13