This domain of CAM houses two original U.S. health care therapies, which are now fully licensed and almost fully accepted forms of care: osteopathy and chiropractic. It is also the home for the traditionally accepted therapeutic technique of massage. Despite some specific practices within each of these modalities, this domain
is the least disputed and most used complementary domain. Even reflexology (massage of the hands or feet based on the belief that pressure applied to specific points on these extremities benefits other parts of the body as a reflexive response through the nervous system), which lacks significant study, is sometimes recommended as a com-plementary method due to its low risk and ability to cause deep relax-ation. Each of these modalities deserves a closer look, even those with a less stringent review of scientific evidence.
Bodywork/Massage
Massage has a long history in virtually all cultures of the world. Its application is rich and varied, and encompasses a vast array of tech-niques that are only briefly summarized here. The encompassing term “bodywork” involves therapeutic touch or manipulation of the body by various specialized techniques, including those used in chiropractic and osteopathy. Its application is accepted now by both CAM and conventional medicine as being effective for relieving ten-sion, anxiety, and pain. A 1995 medical journal reported also that pa-tients receiving pediatric massage “got well sooner” (Cassileth, 1998).
However, not all types of massage and bodywork listed in Table 1.2 are considered research validated.
As evidenced in Table 1.2, not all CAM modalities are classified clearly and easily within the five domains. Some bodywork incorpo-rates mind/body techniques to achieve results and therefore resists classification.
A search of Medline produced eight studies for foot reflexology.
An Austrian study looked at mechanisms of action for foot reflex-ology (Sudmeier et al., 1999). The study reviewed changes of renal blood flow during organ-associated foot reflexology as measured by color Doppler sonography. Peak velocity of the blood flow to the right and left kidneys was studied when kidney reflex points were stimulated. This placebo-controlled study revealed a marked im-provement in the vascular resistance index, decreasing significantly in real versus sham reflexology.
Of the other seven reflexology studies, six found positive statisti-cal change for problems concerning pain, tension, bowel movement, and PMS. Some of this change was statistically significant. The one dissenting study showed an effect for foot reflexology as compared to
TABLE 1.2. Types of Bodywork and Massage
Type of
Bodywork Description Traditional
Massage
Research-validated traditional massage is taught by schools accepted by organizations such as the American Massage Therapy Association.
Chinese/
Ayurvedic
Asian cultures incorporate massage as an important part of their treatment regimens. Both Ayurvedic and Chinese massage rely on application of pressure to various acupres-sure or “marma” points. Meditation and patient participation via breath work is an important part of these applications.
Reflexology CAM purists will dispute classifying reflexology as massage.
However, it is based on the application of pressure to various reflex points. Although developed separately from Chinese medicine, modern reflexology utilizes the Chinese system of meridians and can therefore be classified as massage. As a diagnostic technique it cannot be classified this way, but most reflexologists no longer attempt to practice diagnosis.
Craniosacral Therapy
This therapy is credited to both chiropractors and osteopaths, and is aimed at the base of the skull and the lower back and buttocks area. The theory is that when spinal fluids surrounding these areas are manipulated, pain and tension are released.
Deep-Tissue Massage
Works to restore deep connective tissue and circulatory function. Also used in multiple sclerosis. Often attributed to the Swedish massage tradition.
Rolfing Based on yoga, the Alexander technique, and osteopathy.
Rolfing was developed by Ida P. Rolf and uses exercise, hand manipulation, and equipment to affect deep changes to the fascia.
Hellerwork Combines Rolfing-like techniques with emotional counseling, which may underlay physical problems.
Myofascial Release
Similar to Rolfing and Hellerwork, but not set up in multiple sessions. Uses single techniques, which may or may not be repeated.
Movement Several of these and other therapies incorporate the idea of reeducation in movement to improve pain and flexibility as well as to prevent future problems.
Suggestion and
Visualization
Techniques such as Rubenfeld Synergy and some of these techniques use forms of hypnosis, visualization, and psycho-therapy to further extend therapeutic intent.
the relaxing effect of simple foot massage, but said that it was detri-mental in abdominal postsurgical situations in gynecology. Perhaps this was due to an overstimulation of the bowels from reflexology.
All the studies were completed from 1993 to 2000. No study replica-tions were listed.
Massage and bodywork techniques are rich and varied. There ap-pears to be little disagreement that they are ultimately effective for re-laxation and pain relief.
Chiropractic
This modality has the least illustrious history because it was founded in the late nineteenth century by D. D. Palmer, an unedu-cated laborer, and made into a mail-order financial empire by his dis-reputable son. The founder’s grandson began reversing its bad name, established schools, and began the political process for licensing.
Chiropractic practitioners in the United States understood early on the need to engage in the politics of health care, and in a mere 100 years, established the practice with licensing in all fifty states. Al-though osteopathy accomplished this, it did so by basing itself on conventional medical care. Chiropractic did so while being staunchly opposed by the AMA. In 1972, the Medicare Act was amended to in-clude chiropractic (Keegan, 2001). In 1992, a study by the Rand Cor-poration examined twenty-two clinical trials and concluded that chiro-practic is effective for various types of lower back pain (Cassileth, 1998). Finally, in 1994, an independent panel from the Agency for Health Care Policy and Research concluded that “chiropractic is the most effective treatment for acute lower back pain” (Keegan, 2001, p. 242). Although chiropractics’ claims are for a much broader range of benefit than lower back pain, this particular study ends the pur-ported idea that chiropractic is not beneficial for any reason.
Thousands of persons have gone to chiropractors, have claimed benefit, and have recommended the procedure to friends and fami-lies, making chiropractic the most sought-after alternative in medi-cine in the United States. Despite the lack of randomized clinical trial, it is unlikely that this exhaustive clinical application over the past 100 years would prove inconclusive in regard to its efficacy.
Chiropractic has now moved into directions in medicine that incor-porate post-Newtonian laws of physics (which is good, since these
discoveries have been around since 1900). These ideas include the theory that entropy, or deterioration in systems, is caused not only by gravity and the wear of friction over time, but also by the “memory”
that the body’s systems hold within themselves, of thoughts and emo-tional impact borne by the larger organism. Memory is given a spe-cific quantum role in health. Chiropractic’s founder may have been naive in some respects, but his idea that the spine is the central loca-tion of life, both physical and metaphysical, is a belief also found in Ayurveda. The practice of yoga is centered on the spine, and medita-tions involving the chakras (located where nadis or energy meridians intersect) are considered essential in drawing together mind, body, and spirit. Standard chiropractic does not embrace this particular view, but it is noteworthy that a separate culture arrived at similar conclusions to the spine’s role in health thousands of years before.
Recent developments in chiropractic practice combine these ideas in physics with beliefs about the spine to create a theory called “net-work chiropractic.” It contends that trapped negativity (physical inju-ries, emotions) becomes ensconced in the human nervous system and can be released through manipulation of the spine. Network chiropractic is a term coined by Dr. Donald Epstein, a New York City chiropractor, and is not a new theory but rather the coming together of holistic ideas that many chiropractors have used for years. These ideas incorporate lifestyle and spiritual ideas with an emphasis on emotional healing.
Osteopathy
Osteopathy is considered complementary or alternative today only in its manipulation of the soft tissue and bones. Most osteopaths do not practice this manipulation; they instead practice medicine in a way that is identical to medical doctors.
Osteopathy was also discovered or created by a single physician in 1874, Andrew Taylor Still. Osteopathy does differ slightly from Western medicine in philosophy and approach, as it considers the body a collection of systems that work together. Osteopaths must re-ceive additional training beyond the standard and required MD in or-der to become licensed in osteopathy in all fifty states. Osteopaths are the only other type of medical practitioners in the United States, be-sides medical doctors, who may prescribe controlled medications.
Osteopathic manipulation hovers in the same range as chiropractic and massage for effectiveness in pain relief.