Article by Greg Morling

Polarity Therapy has been gaining in popularity since its inception by Randolph Stone nearly five decades ago. In Australia, training courses in Polarity have been very well attended and this article provides an overview of this very interesting energy – based healing practice.

The basis of Polarity Therapy is energy and the assertion that the flow and balance of this energy in the human body is the foundation of good health. If the energy flows smoothly without significant blockage of fixation then one can expect to have good health but if is unbalanced, blocked or fixed due to stress or other factors, pain and disease may arise. The UK journalist, Anne Woodham, co-author of The Encyclopaedia of Natural Healing writes;

Polarity therapy is a natural health care system based on the human energy field. The undisturbed flow and balance of the electromagnetic energy in and around the body is the basis for health and wellbeing on physical, emotional, mental, and spiritual levels. Blocked currents and disharmony in the energy field result in manifestations of tension, pain, disease, or illness. With Polarity the blockages and restrictions are cleared. The client’s energy field is restored to its natural state of balance. The result manifests as a release of holding patterns in body, mind, and soul.

Woodham goes on to explain that Polarity Therapy is not a replacement for medical care but a very useful interface to many other healing disciplines, including massage therapy.

I have written on energy work in a past Mostly Massage Magazine issue, however the interrelatedness of Polarity to other energetic vibrational dynamics sets it apart; the Chakra system of yogic beliefs is an important underpinning aspect of this balancing process. This ancient Indian Vedic philosophy called the Five Tattvas is based on the five elements; fire, ether, air, water and earth.

Each Element may find relationship to parts of our being; Two thirds of our body consists of water, another percentage is bones, organs, nails, teeth, hair and soft tissue which could be considered earth. We also breathe air and have a respiratory system. You could say that to some extent we are made of air. The warmth that our body generates is what gives us good candidacy for fire. Ether is space, the most subtle element that gives rise and integrates the other four elements. Too much ether present in a person can make them ungrounded. Many different combinations of elements and elemental imbalances are possible. When energy and by association, these Elements are unbalanced, blocked or fixed due to stress or other factors, pain and disease arise. The Elements all have certain characteristics that can be identified by a trained Polarity practitioner but are not the only factors assessed in Polarity; specific bodywork protocols, nutritional guidelines and exercise may also be part of the complete Polarity treatment.

History of Polarity Therapy

Polarity therapy is a comprehensive health system that was founded in the mid-20th century by Dr Randolph Stone, an Austrian-born naturopath, osteopath and chiropractor who practiced in the USA. Stone’s research into Eastern and Western concepts of health convinced him that the human energy field is affected by touch, nutrition, movement, sound, attitudes, relationships, life experience, trauma and environmental factors. He also pioneered many of the techniques of craniosacral therapy that were later developed by osteopathic physician and clinical researcher, John Upledger. It is interesting to also note that Randolph Stone had become increasingly disillusioned with the bodywork approaches which he felt to be rather mechanistic rather than holistic. It is possible that one of the reasons for the resurgence in the popularity of Polarity here in Australia could be due to the very same reasons.

Where it May be Useful

Polarity therapy has proven useful with conditions such as allergies, arthritis, asthma, burn out, cancer, chronic fatigue syndrome, circulatory problems, depression, digestive disorders, mental and emotional disturbances, fibromyalgia, headache, health maintenance, hormonal imbalances, infertility, inflammation, injury, insomnia, major life changes, menopausal symptoms, menstrual disorders, neuralgia, PMS, pre and post surgery, pregnancy and post partum, sciatica, skin disorders, spiritual growth, stress management, and stress related symptoms. Furthermore, with Polarity unresolved past and past life trauma can be accessed and healed.

What to Expect in a Polarity Session

A session usually lasts 60-90 minutes and begins with questions about your medical history and lifestyle. You are then asked to lie clothed on a couch for a polarity assessment.

The practitioner moves his or her hands around your head, down towards your feet, up the body over the five energy centres and finishes back at the head. Touch may be light (neutral) to restore body awareness and balance; medium (positive) to stimulate energy by stroking, moulding and rocking the body; and firm (negative), which uses deep-tissue manipulation to release ‘blocked’ energy.

The results of polarity therapy sessions can vary from profound relaxation to emotional outbursts of anger or grief as areas of stagnation are cleared.

You may be given stretching exercises to perform at home and a health-building, cleansing diet with plenty of fruit and vegetables. If the practitioner feels that negative thought patterns are a factor, counseling techniques may increase self-awareness and the emergence of your own inherent ‘knowing’ can help you realise your potential.

While Polarity Therapists should be knowledgeable in the four major therapeutic strands of Polarity; touch, exercise, diet, and mental-emotional process, most practitioners tend to favor one area over others, so the work may vary considerably from one practitioner to another.

Conclusion

While there have been several well written books on the subject of Polarity by respected practitioners such as James Oschman, Frank Sills and of course, Randolph Stone himself, valid scientific research evidence on this technique does not exist. This, of course is not surprising as many very successful holistic and energy based practices are not evidence based medicines. We may need to rely a lot more on transference and counter transference or the power of the therapeutic relationship between practitioner and client/patient for an explanation as to why practices like Polarity are therapeutically successful.

There are certainly similarities between Polarity and other holistic, energy-based healing practices that would all contend that our physical, psychological and spiritual well-being depends on the free and uninterrupted flow of ‘life energy’ around the body. This is most certainly true for Acupuncture and there is no reason to think that Polarity Therapy would be any less effective in rebalancing the body’s energy. 

General References

Millenson, J. Mind Matters, Psychological Medicine in Holistic Practice, Eastland Press 1995

Oschman, J. Energy Medicine, The Scientific Basis (Churchill Livingstone, 2000).

Sills, F. The Polarity Process. North Atlantic, 2002.

Stone, R.: “Polarity Therapy Vol. I & 2 CRCS, 1986

http://www.earthlit.com/polarity-therapy.html accessed 20.7.07

Article by John Kron

This article was originally published in 2006 Sept/Oct Edition The Journal of Complementary Medicine. Our thanks to the editor for allowing us to reprint a portion of that article.

Myofascial therapy is an assessment and treatment protocol for pain caused by trigger points. These points are descrete, focal hyperirritable spots and are most commonly treated with Myofascial Release (MFR) incorporated by many massage therapists, or needling techniques used my myotherapists

Background

Myofascial therapy (MFT) is a diagnostic and treatment protocol that is mostly used for musculoskeletal pain. US physician Dr Janet travel, who found that small, tender areas in muscle called trigger points produced pain in characteristic patterns in the body^1,2 developed MFT in the early 1940’s.

1960, Dr Travell formed a medical partnership with Dr David G Simons, an aerospace physician with an interest in physiology, that lasted until her death in 1997² They published their landmark book their landmark book Myofascial Pain and Dysfunction: The Trigger Point Manual in 1983.³

MFT has been taken up by a number of professions in Australia, particularly myotherapists, as well as physiotherapists, osteopaths and doctors. Myofascial therapy performed without needling is, of course performed by massage therapists as well.

It should be noted that the approach of many practitioners towards myofascial pain is that trigger points may be the primary cause of pain or in fact secondary to any of one of numerous conditions, including mechanical stress such as postural imbalance, neurological disorders such as somatic reflex, and inflammatory diseases such as fibro-myalgia and rheumatoid arthritis. ^22,23

An example of a trigger point as a secondary cause of pain is postural imbalance that causes a trigger point to produce myofascial pain. In this case, treatment is likely to be most effective when directed at the cause, i.e. postural imbalance. However, because MFT regards trigger points as the primary cause, treatments are directed towards them. The MFT approach will be the focus of this article.

Rationale

Myofascial pain is produced by ‘discrete, focal, hyperirritable spots in a taut band of skeletal muscle’ called trigger points.⁴ Epidemiological studies have found prevalence rates of myofascial pain in 21 to 30 per cent of patients presenting to orthopaedic and general medical clinics, and in 85 to 93 per cent of patients in pain-management clinics.⁵

A trigger point develops when a group of sarcomeres, the basic contractile units of a muscle fibre⁶, are shortened, causing adjacent sarcomeres in the same fibre to lengthen in order for the whole fibre not to shorten overall.⁵

Trigger points are considered to be active or latent. Active trigger points cause pain at rest or on movement. Latent trigger points may cause some stiffness but are pain-free until pressed upon.

The current theory of the pathophysiology of myofascial pain is that acetylcholine (a neurotransmitter) leaks across the myoneural (motor end-plate) junction, causing exposed muscle fibres to shorten. This leads to the formation of a taut band of muscle.

Contracted muscle fibres of the taut band compress adjacent blood vessels. Maintaining this contracted state increases the metabolic needs of the taut band fibres and decreases the ability of the local blood vessels to support the increased muscle metabolism. The resulting tissue distress causes the fibres to release chemicals that stimulate pain nerve endings.

Sarcomere ‘Shortening is supported by histological studies of trigger points in canine models.^7,8 Electrodiagnostic studies have also found increased acetylcholine release.^9,5 However, studies have not found evidence of a reliable clinical test that identifies trigger points.⁴

Studies of practitioner inter-reliability, using palpation to identify trigger points, have found mixed results.^10,11 A 1999 study using diagnostic ultrasound found no difference when comparing active trigger points on one side of the body to the asymptomatic, contralateral side.¹²

Assessment and treatment

Assessment aims to identify the trigger points causing the client’s presenting pain through muscle palpation performed by the practitioner. The aim of treatment is to reverse the muscle-fibre shortening of the taut band and to achieve a normal length. This is achieved most commonly by using one of two techniques: Myofascial Release (MFR) or needling to treat active trigger points. MFR is indicated when pain is less than severe and active trigger points are difficult to identify. Needling is indicated when pain is severe and active trigger points are deep and hard to reach with MFR.

MFR involves direct moderate-pressure using the digits or elbow, with the aim of eliciting a local twitch response (LTR) – considered the most effective initial sign of contracted muscle fibre lengthening – or relieving the pain. It may take from 10 seconds up to a few minutes, depending on the irritability of the trigger point.

Needling may be performed with or without the administration of drugs or other substances. If without, it is called dry needling and involves two methods: superficial and deep (or direct). The superficial method involves inserting the needle to just above the trigger point for about 20 minutes to stimulate endorphin release and neuromuscular changes. The deep method involves inserting the needle into the trigger point to elicit an LTR. If this does not occur quickly the needle is re-inserted at a different angle until it occurs.

Drugs and substances that are injected into trigger points include anaesthetic agents (lidocaine or procaine), diclofenac, corticosteroids, saline and botulinum toxin. Less commonly practiced techniques applied to trigger points include ‘spray and stretch’, which uses a cooling agent⁴, and electrotherapy including ultrasound therapy and TENS.s

Whichever technique is used, stretching and movement exercises should be performed afterwards as a means of ‘re-educating’ the muscle to a new length. A self-management program, including stretching and movement exercises and postural advice, is also recommended. Treatment sessions for a client presenting for the first time last from 30 to 60 minutes. Acute and severe cases require a maximum of two sessions a week and many cases only one session per week. The total number of sessions required by patients is two to four until sufficient pain relief is achieved. Chronic cases may require more treatments.

Randomised control trials of myofascial therapy

Research evidence

While there is a paucity of clinical studies of MFT, some have found evidence of efficacy. Most studies have been on needling. A 2001 systematic review of 23 studies of needling concluded none were of sufficient quality or design to test the efficacy of needling technique beyond placebo. However, seven higherquality trials of injected substances found that the effect was independent of the injected substance, and three trials comparing dry needling with injection found no difference in effect. ¹³

A 2005 Cochrane review of acupuncture and dry needling for low-back pain concluded dry needling ‘appears to be a useful adjunct to other therapies for chronic low-back pain [although] no clear recommendations can be made because of small sample sizes and low methodological quality of the studies’. ¹⁴ There have also been a number of individual RCTs that have made positive findings (See above table, ‘Randomised Controlled Trials of Myofascial Therapy).

Studies have also found some evidence of efficacy and safety for oral drug therapies (including NSAlDs, tramadol, antidepressants, alpha² adrenergic agonists and anticonvulsants) for myofascial pain and/or fibromyalgia.⁵ Despite these positive results, evidence is lacking that MFT is superior to other commonly provided therapies for musculoskeletal pain.

A 2002 trial of 200 patients with subacute low-back pain found no differences between those receiving four different treatments for three weeks: back school, joint manipulation, MFT, and joint manipulation combined with MFT.¹⁵

Dr Jeremy Lewis, Research Lead at Chelsea and Westminster Hospital in London, says a possible explanation is that the clinical paradigm of a practitioner pushing on or inserting a needle into a tender spot of the body is common to numerous other therapies, such as manipulative therapy and acupressure. ‘It may be that all these therapies, each with unique underlying theories but without good evidence supporting their existence and efficacy, are in fact doing the same thing,’ says Dr Lewis, who is also a consultant shoulder physiotherapist and Visiting Reader at London’s St George University.

Use by professions

MFT can be provided as the sole therapy and it is most likely to be used in this way by myotherapists. Other professions, such as physiotherapists, osteopaths and doctors, tend to use it as one of a number of therapies or techniques.

For example, a 2004 survey²⁴ of osteopathic practices carried out by the Australian Osteopathic Association Research Council found that 49.9 per cent of respondents used fascial and/or myofascial techniques on less than 40 per cent of patients, while 17 per cent of respondents used it on 80 per cent or more, says Dr Ray Myers, Head of the Division of Osteopathy at RMIT.

It should be noted that the above fascial and/or myofascial techniques is a broader range of techniques than just MFT. In fact, osteopaths have used the term fascial and/or myofascial techniques for many years prior to their adoption by Travell and Simons.

Integration

MFT has as much merit for patients or clients who present to general practice with musculoskeletal pain as any other therapy. However, there is no particular presentation of symptoms that makes one patient stand out from another to indicate it is the therapy of choice, says Dr Steve Jensen, musculoskeletal physician in Footscray, Victoria.

MFT may warrant a trial of three-to-four treatment sessions, but if no improvement is achieved, another therapy should be trialed, he says.

‘In my clinical experience, trigger points are often secondary to a primary problem located somewhere else, such as in a joint or tendon, or a biomechanical problem or disc or facet joint for spinal pain. There are occasions, however, where I will treat a trigger point and find the pain has been relieved, indicating that it was the primary problem,’ he says.

‘In addition, needling appears to more successful compared to MFR in stubborn cases.’ 

References

1. Wikipedia. Myofascial Release, URL: http:// en. wikipedia.org/wiki/Myofascial_Release, accessed 9 June 2006.
2. Wilson VP, et al. A Daughter’s Recollection.Tex Heart Inst J 2003;30(1):8-12.
3. Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol 1. Baltimore: Williams & Wilkins, 1983.
4. Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Phys 2002;65(4):653-60.
5. Borg-Stein J, Simons DG. Focused review: myofascial pain. Arch Phys Med Rehabil 2002;83(3 Suppl1):S40-7, S48-9.
6. Brukner P, Khan K, Kron J. The Encyclopedia of Exercise, Sport and Health. Sydney:Allen & Unwin, 2004.
7. Simons DG, Hong CZ, Simons LS. Endplate potentials are common to midfiber myofacial trigger points. Am J Phys Med Rehabil 2002;81(3):212-22.
8. Couppe C, et al. Spontaneous needle electromyographic activity in myofascial trigger points in the infraspinatus muscle. J Musculo Pain 2001;9:7-17
9. Simons DG, Stolov We. Microscopic features and transient contraction of palpable bands in canine muscle. Am J Phys Med 1976;55(2):65-88.
10. Lewis J, Tehan P. A blinded pilot study investigating the use of diagnostic ultrasound for detecting active myofascial trigger points. Pain 1999;79(1):39-44
11. Sciotti VM, et al. Clinical precision of myofascial trigger point location in the trapezius muscle. Pain 2001;93(3):259-66.
12. Hsieh CY, et al. Interexaminer reliability of the palpation of trigger points in the trunk and lower limb muscles. Arch Phys Med RehabiI2000;81(3):258-64.
13. Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil2001;82(7):986-92.
14. urlan AD, et al. Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev 2005;(1):CD00I351.
15. Hsieh CY, et al. Effectiveness of four conservative treatments for subacute low back pain. Spine 2002;27(11): 1142-8.
16. Itoh K, et al. Trigget point acupuncture treatment of chronic low back pain in elderly patients. Acupunct Med 2004;22(4): 170-7.
17. Iguchi M, et al. Randomized trial of trigger point injection for renal colic. Int J Urol 2002;9(9):475-9
18. Hou CR, et al. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger point sensitivity. I Arch Phys Med Rehabil 2002;83(10): 1406-1
19. Esenyel M, Caglat N, AldemirT. Treatment of myofascial pain. Am J Phys Med Rehabil  2000;79(1):48-52.
20. GarveyTA, et al. A prospective, randomized, double-blind evaluation of trigger-point injection therapy fot low-back pain. Spine 1989; 14(9):962-4.
21. MacDonald A], et al. Superficial acupuncture in the relief of chronic low back pain. Ann Royal Coli SUtg EnglI983;65:44-46.
22. Mannheim CJ. Myofascial Release Manual. New Jersey: Slack Inc, 2001.
23. Ward Re. Foundations for Osteopathic Medicine. Baltimore: Williams and Wilkins, 1997.
24. Orrock PJ. Osteopathic Census 2004. Australian Osteopathic Association Research Council.