Letters to the Editor |
COMPARISON OF MASSAGE BASED ON THE TENSEGRITY PRINCIPLE AND CLASSIC MASSAGE IN TREATING CHRONIC SHOULDER PAIN To the Editor: With reference to the recent article by Kassolik et al, 1 it would appear that there is some confusion between the treatment approach that considers shoulder mechanics from the perspective of the body as a functionally integrated unit and tensegrity; although these 2 concepts are related, they are not necessarily interchangeable. Traditionally, orthodox medicine has considered joint function and treatment in an isolated, piecemeal-like way, using a system of levers and free-body analysis based on the workings of man-made machines described by Borelli in the 16th century and that has not changed appreciably since, 2 and it is refreshing to see shoulder biomechanics being applied from an “integrated function” perspective in this article. The authors rightly point out that “according to the tensegrity principle, improper functioning of a single element of the shoulder system can cause disorders in other elements,” 1 and their consideration of structures that are anatomically distant but mechanically linked to the shoulder is a reasonable approach to their formulation of a massage therapy. However, tensegrity is only part of the integrated function perspective and is actually a “structural design principle” that recognizes tension and compression as being inextricably linked within the system and that should always be considered together. 3-6 The title phrase “massage based on the tensegrity principle” is thus misleading because tension pathways 1 do not in themselves imply a tensegrity connection, compression elements have not been detailed (they are also more than just “bones”), 6 and there is no evidence to suggest that the results had anything to do with tensegrity, as such; it is also unclear how the drawing in Figure 1 relates to tensegrity. Although the authors clearly consider the shoulder to be part of a whole-body tensegrity configuration, it is suggested that this particular approach to treatment is primarily based on a view of the body as an “integrated mechanical unit” and that the term tensegrity is superfluous to this study. The sentence “The tensegrity principle is based on directing treatment to the painful area and the tissues… that structurally support the painful area.” 1 is incorrect because tensegrity is based only on the fundamental rules of physics, 3-6 and there is also no such thing as a “tensegrity principle of massage” 1 or “tensegrity massage,” 1 which do not mean the same as “massage based on the tensegrity principle” in any case. Although all these might be considered as just splitting hairs and it is
recognized that these uses of the term tensegrity may have been intended differently, they are frequently promulgated among clinicians and lead to a misunderstanding of what the (bio)tensegrity concept is really about. Tensegrity is part of the structural architecture of biology, from molecules to the entire organisms, 3-6 and is not a particular type of treatment but part of the basic science that should underpin what all clinicians do. To conclude, the overall premise and methods that underlie this particular research do make a valuable contribution to our understanding and treatment of the painful shoulder, because it is considered in a wider anatomical and functional context than has often been the case in the past, but although a tensegrity-inspired approach to shoulder treatment is part of an integrated function perspective, by definition, it is important that the distinction between these 2 concepts is maintained. Graham Scarr, DO Private Practice, Nottingham, UK E-mail address: [email protected] 0161-4754/$36.00
Copyright © 2014 by National University of Health Sciences. http://dx.doi.org/10.1016/j.jmpt.2013.12.002
REFERENCES 1. Kassolik K, Andrzejewski W, Brzozowski M, et al. Comparison of massage based on the tensegrity principle and classic massage in treating chronic shoulder pain. J Manipulative Physiol Ther 2013;36:418-27. 2. Ethier CR, Simmons CA. Introductory biomechanics: from cells to organisms. New York: Cambridge University Press; 2007. 3. Levin SM. Putting the shoulder to the wheel: a new biomechanical model for the shoulder girdle. J Biomed Sci Instr 1997;33:412-7. 4. Levin SM. Tensegrity: the new biomechanics. In: Hutson M, Ellis R, editors. Textbook of musculoskeletal medicine. Oxford: Oxford University Press; 2006. 5. Ingber DE. The architecture of life. Sci Am 1998;278:30–39. 6. Scarr G. A consideration of the elbow as a tensegrity structure. Int J Osteopath Med 2012;15:53-65.
LETTER REPLY To the Editor: Thank you for sharing your interesting comments about our article. 1 We would like to emphasize that 141
COMPARISON OF MASSAGE BASED ON THE TENSEGRITY PRINCIPLE AND CLASSIC MASSAGE IN TREATING CHRONIC SHOULDER PAIN To the Editor: With reference to the recent article by Kassolik et al, 1 it would appear that there is some confusion between the treatment approach that considers shoulder mechanics from the perspective of the body as a functionally integrated unit and tensegrity; although these 2 concepts are related, they are not necessarily interchangeable. Traditionally, orthodox medicine has considered joint function and treatment in an isolated, piecemeal-like way, using a system of levers and free-body analysis based on the workings of man-made machines described by Borelli in the 16th century and that has not changed appreciably since, 2 and it is refreshing to see shoulder biomechanics being applied from an “integrated function” perspective in this article. The authors rightly point out that “according to the tensegrity principle, improper functioning of a single element of the shoulder system can cause disorders in other elements,” 1 and their consideration of structures that are anatomically distant but mechanically linked to the shoulder is a reasonable approach to their formulation of a massage therapy. However, tensegrity is only part of the integrated function perspective and is actually a “structural design principle” that recognizes tension and compression as being inextricably linked within the system and that should always be considered together. 3-6 The title phrase “massage based on the tensegrity principle” is thus misleading because tension pathways 1 do not in themselves imply a tensegrity connection, compression elements have not been detailed (they are also more than just “bones”), 6 and there is no evidence to suggest that the results had anything to do with tensegrity, as such; it is also unclear how the drawing in Figure 1 relates to tensegrity. Although the authors clearly consider the shoulder to be part of a whole-body tensegrity configuration, it is suggested that this particular approach to treatment is primarily based on a view of the body as an “integrated mechanical unit” and that the term tensegrity is superfluous to this study. The sentence “The tensegrity principle is based on directing treatment to the painful area and the tissues… that structurally support the painful area.” 1 is incorrect because tensegrity is based only on the fundamental rules of physics, 3-6 and there is also no such thing as a “tensegrity principle of massage” 1 or “tensegrity massage,” 1 which do not mean the same as “massage based on the tensegrity principle” in any case. Although all these might be considered as just splitting hairs and it is
recognized that these uses of the term tensegrity may have been intended differently, they are frequently promulgated among clinicians and lead to a misunderstanding of what the (bio)tensegrity concept is really about. Tensegrity is part of the structural architecture of biology, from molecules to the entire organisms, 3-6 and is not a particular type of treatment but part of the basic science that should underpin what all clinicians do. To conclude, the overall premise and methods that underlie this particular research do make a valuable contribution to our understanding and treatment of the painful shoulder, because it is considered in a wider anatomical and functional context than has often been the case in the past, but although a tensegrity-inspired approach to shoulder treatment is part of an integrated function perspective, by definition, it is important that the distinction between these 2 concepts is maintained. Graham Scarr, DO Private Practice, Nottingham, UK E-mail address: [email protected] 0161-4754/$36.00
Copyright © 2014 by National University of Health Sciences. http://dx.doi.org/10.1016/j.jmpt.2013.12.002
REFERENCES 1. Kassolik K, Andrzejewski W, Brzozowski M, et al. Comparison of massage based on the tensegrity principle and classic massage in treating chronic shoulder pain. J Manipulative Physiol Ther 2013;36:418-27. 2. Ethier CR, Simmons CA. Introductory biomechanics: from cells to organisms. New York: Cambridge University Press; 2007. 3. Levin SM. Putting the shoulder to the wheel: a new biomechanical model for the shoulder girdle. J Biomed Sci Instr 1997;33:412-7. 4. Levin SM. Tensegrity: the new biomechanics. In: Hutson M, Ellis R, editors. Textbook of musculoskeletal medicine. Oxford: Oxford University Press; 2006. 5. Ingber DE. The architecture of life. Sci Am 1998;278:30–39. 6. Scarr G. A consideration of the elbow as a tensegrity structure. Int J Osteopath Med 2012;15:53-65.
LETTER REPLY To the Editor: Thank you for sharing your interesting comments about our article. 1 We would like to emphasize that 141
