Valence Massage and Physical Therapy

07/31/2025

Biomechanical explanations for pain and dysfunction often rely on old narratives that imaging and science has shown to be wrong. Moving more, increasing load tolerance, and training can help with pain, even spinal flexion.

07/17/2025

Updating your narrative with research is absolutely necessary for a clinician. I have learned special tests for shoulder impingement in no less than 5 continuing education seminars, that's not to even mention physical therapy school. https://www.facebook.com/100063774721900/posts/1313334844135661/?mibextid=rS40aB7S9Ucbxw6v

The area between the humeral head and the acromion, coracoacromial ligament, and acromioclavicular joint is known as the subacromial (under the acromion) space. Within this space is the supraspinatus tendon, long head of the biceps brachii tendon, subacromial bursa (fluid-filled sac that reduces friction), and the capsule of the shoulder joint.

When most people discuss shoulder impingement, they are referring to these tissues being compressed in this space. 

The shoulder impingement theory was popularized by a surgeon in the 1970’s before he proposed a surgery to treat the issue. Since then, here’s what we’ve learned:

1. If symptoms were solely caused by compression of these overlying structures, we’d expect their removal to improve symptoms and function. However, research demonstrates that subacromial decompression is no better than placebo surgery.
2. Subacromial decompression also doesn’t seem to change the long-term prevalence of rotator cuff tears. Rotator cuff tears are present in asymptomatic individuals and are more common as we age, like many other imaging findings. 
3. Compression of tissues in the subacromial space is common, occurs equally in people with and without symptoms, and happens with normal, day-to-day tasks. 
4. A smaller subacromial space is not correlated with symptoms or disability. 

So shoulder impingement exists, but it’s not the bogeyman it’s been made out to be. 

To learn how to properly manage this condition, click the link in our bio or search “E3 Rehab Shoulder Impingement” on YouTube!



•YouTube: 
•Programs, Blogs & 1-on-1 Coaching: www.e3rehab.com

04/28/2025

Massage is not a "find it and fix it" approach but it can be transformative. It is a partnership between patients and providers with many well documented benefits. Often, massage gets pidgeon-holed with luxury or pampering services, or worse with magical thinking and scammers. I am so happy when I see posts from legitimate therapists, doing the work to educate the public.
https://www.facebook.com/100063614677961/posts/1250006737129804/

04/06/2025

Back pain does not have just one cause, so it doesn't have just one solution either. https://www.facebook.com/100063521441542/posts/1213990924061611/?mibextid=rS40aB7S9Ucbxw6v

A great quote.

Agree or disagree?

Let me know in the comments 😉

03/25/2025

*realistic* goals

03/20/2025

FYI: Vitamin C is very beautiful. https://www.facebook.com/100064555159421/posts/1047372384091257/

Can you guess what this picture is?

It's actually an image of Vitamin C, taken with polarised light.

Vitamin C is essential for collagen formation and wound healing and a lack of it can lead to scurvy. Its study led to the awarding of both the medicine and chemistry prizes in 1937: the first to Albert von Szent-Györgyi, who first isolated the vitamin, and the second to Norman Haworth for determining its molecular structure.

More about the 1937 medicine prize: https://bit.ly/2QcpJGC
More about the 1937 chemistry prize: https://bit.ly/2U4IxbI

02/14/2025

When you think of mental health, do you think about massage therapy?

Massage has large, well-documented benefits for mental health, stress-level, mood, and quality of sleep.

Receiving touch is of critical importance, as many studies have shown that touch promotes mental and physical well-being. We conducted a pre-registered (PROSPERO: CRD42022304281) systematic review and multilevel meta-analysis encompassing 137 studies in the meta-analysis and 75 additional studies in...

02/10/2025

Just published 🔥

Physical inactivity is the most important unhealthy lifestyle factor for pain severity in older adults with pain: A SHARE-based analysis of 27,528 cases from 28 countries.

👉 Recognised as a complex biopsychosocial condition, chronic pain is strongly influenced by the social and economic environment in which individuals work and live, making it a major global public health problem (https://pubmed.ncbi.nlm.nih.gov/34062143/). It is responsible for significant healthcare utilisation, lost productivity and reduced quality of life for patients (https://pubmed.ncbi.nlm.nih.gov/31079836/). Overall, pain is more prevalent in women and generally increases with age (https://pubmed.ncbi.nlm.nih.gov/32583713/). Specifically, among people over 50 years of age, the prevalence of episodes of musculoskeletal pain ranges from 20%-50% (https://pubmed.ncbi.nlm.nih.gov/37720912/).

👉 A brand-new cross-sectional study by Núñez-Cortés and colleagues used data from the SHARE Wave 9 survey (27,528 cases from 28 countries) to investigate associations between lifestyle factors – physical inactivity, sleep problems, smoking and inadequate diet and pain severity ((mild, moderate, severe) in adults aged over 50 years. Statistical models adjusted for demographic and health-related covariates were applied to quantify associations. (https://www.mskscienceandpractice.com/article/S2468-7812(25)00018-9/fulltext)

🔑 Key Findings

🏃‍♀️ Physical Inactivity:

Participants who hardly ever or never engaged in moderate physical activities were significantly more likely to report severe pain (Odds Ratio [OR]: 4.35; 95% Confidence Interval [CI]: 3.85–4.92). This association was the strongest among all variables studied.

Regular physical activity had a dose-response relationship with pain severity, reinforcing its importance in pain prevention and management.

👉 Other Lifestyle Factors:

😴 Sleep problems:
Associated with severe pain (OR: 1.83; 95% CI: 1.69–1.99), reflecting the bidirectional relationship between pain and sleep disturbances.

🚬 Smoking:
Weakly associated with severe pain (OR: 1.21; 95% CI: 1.13–1.34), with challenges in quitting smoking among those in pain

🥗 Diet:
Infrequent consumption of fruits and vegetables was linked to severe pain (OR: 1.78; 95% CI: 1.22–2.61). Healthy dietary habits may reduce pain through anti-inflammatory mechanisms

🤕 Pain Regions:
The associations were more pronounced in participants with pain in multiple body regions than those with pain in a single region

🔁 Bidirectionality:
The study notes potential bidirectional relationships, where pain may hinder physical activity and sleep, while inactivity and poor sleep exacerbate pain

⭕ Limitations

The study’s cross-sectional design prevents causal inference.

Self-reported data may be prone to recall bias.

Certain variables, such as obesity and psychological factors, were not included

💡 Clinical Implications:

✅ The results highlight the critical role of physical inactivity in pain severity, supported by findings from other studies. Sedentary behavior may exacerbate pain through mechanisms like systemic inflammation, reduced functionality, and fear-avoidance behaviors.

✅ Healthcare professionals should prioritize not only identifying key lifestyle factors but also addressing the barriers that hinder behavioral changes necessary for adopting a healthy lifestyle. Common barriers include biomedical beliefs, kinesiophobia, catastrophizing, perceived unfairness, and low levels of acceptance (https://pubmed.ncbi.nlm.nih.gov/37952339/). To overcome these challenges, interventions designed to reconceptualize pain and promote behavioral change are essential. Pain science education has demonstrated effectiveness in reducing catastrophic thinking and kinesiophobia (https://pubmed.ncbi.nlm.nih.gov/37516218/), thereby enhancing confidence in physical activity and adherence to exercise programs (https://pubmed.ncbi.nlm.nih.gov/33076759/).

✅Cognitive behavioral therapy for sleep issues and dietary interventions promoting anti-inflammatory foods were also recommended based on these results.

02/02/2025

https://www.facebook.com/100059715961024/posts/1020884006578789/?mibextid=rS40aB7S9Ucbxw6v

Today’s Daily Cartoon, by Suerynn Lee. https://newyorkermag.visitlink.me/bAT2gI

01/07/2025

You would expect, even insist, that before getting your back popped by a Chiro, they should examine you and have a specific target in mind to "adjust" Right?

Turns out, it probably doesn't matter at all. General, random adjustments work better, or at least just as much.

Be careful out there: https://www.facebook.com/100038893911991/posts/1373103147329469/

Just published in JOSPT 🔥

The Effectiveness of Spinal Manipulative Therapy in Treating Spinal Pain Does Not Depend on the Application Procedures: A Systematic Review and Network Meta-Analysis 💡

👉 A brand-new systematically reviewed by Nim and colleagues analyzed the effectiveness of various spinal manipulative therapy (SMT) procedures for reducing spinal pain and disability in adults. (https://www.jospt.org/doi/10.2519/jospt.2025.12707)

👉 Objectives

The study aimed to determine whether specific SMT application procedures—such as

▶︎ target selection (clinician-selected or generic approach and the rationale for the selection approach),

▶︎thrust technique (thrust procedure according to vertebral level specificity (i.e., single-level vs. multi-level thrust, thrust delivered by hand vs thrust delivered via an instrument such as Activator, or

▶︎ regional application (such as patients with low back pain receiving SMT in the lower back; a region without pain, such as patients with neck pain receiving thoracic SMT; or multiple regions, such as patients with neck pain receiving cervical and thoracic SMT

— impact the outcomes of pain relief and disability reduction.

👉 Methods

✅ Study Design: Systematic review and network meta-analysis of randomized clinical trials (RCTs).

✅ Literature Search: Sourced data from five major databases and recent systematic reviews up to September 2023. Artificial intelligence tools were employed to identify additional relevant studies.

✅ Inclusion Criteria: Focused on adults with spinal pain (cervical, thoracic, or lumbar) comparing SMT to other SMT procedures, non-recommended treatments, sham, or no-treatment controls.

✅ Outcomes Measured: Pain intensity and disability at short-term (end of treatment) and long-term (up to 12 months).

✅ Data Synthesis: Utilized network plots and evidence rankings, with heterogeneity and bias assessments.

📊 Results

👉 Studies analyzed: Included 161 RCTs with 11,849 participants. SMT procedures were primarily delivered by physiotherapists and chiropractors.

👉 Efficacy of SMT: SMT was more effective than sham or no treatment, achieving comparable results to guideline-recommended interventions (e.g., exercise, education).
👉 Comparisons Among SMT Approaches:

✅ Differences between targeted, generalized, and region-specific SMT were small and not clinically significant.

✅ Non-specific SMT applications (e.g., generalized thrusts or targeting non-symptomatic regions) had the highest probability of achieving the greatest effects on pain and disability.

✅ These findings were based on low-certainty evidence due to high within-study variability, risk of bias, and limited direct comparisons.

Clinical Importance

📌 Paradigm Shift in SMT Application: The findings challenge the long-held belief that specific SMT targeting is superior. Instead, a generalized approach appears equally effective.

📌 Focus on Patient Preferences: Clinicians are encouraged to prioritize patient comfort, preferences, and safety over adherence to specific SMT procedures.

📌 Contextual Factors: The hands-on, clinician-driven nature of SMT and associated contextual effects may significantly contribute to its therapeutic outcomes.

📌Educational Implications: Training programs should de-emphasize the importance of targeting specific spinal regions and specific biomechanical reasoning models during SMT and instead teach a more patient-centered approach.

⭕ Limitations

The evidence was rated as low or very low confidence due to methodological heterogeneity and high risk of bias in included studies.

🔑 Conclusion

This study underscores that the clinical effects of SMT on spinal pain and disability are largely independent of application procedures. These results advocate for a simplified, patient-centric approach to SMT, aligning it with modern evidence-based clinical guidelines.

12/10/2024

Get a massage before, and after having a baby. Massage provided a few hours before breast feeding can improve the growth factor concentration of breastmilk!

https://www.facebook.com/1138394159/posts/10235864260323766/

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