Massage therapy is one of the oldest methods in
the gallery of health care practices. References to massage are
found in Chinese medical texts 4,000 years old. Massage has been
advocated in Western health care practices in an almost unbroken
line since the time of Hippocrates, the "father of
medicine." In the 4th century B.C., Hippocrates wrote,
"The physician must be acquainted with many things and
assuredly with rubbing" (the ancient Greek and Roman term
Some of the greatest physicians in history
advocated massage, including Celsus (25 B.C.-50 A.D.), who wrote
De Medicinia, an encyclopedia of Roman medical knowledge that
dealt extensively with prevention and therapeutics using massage;
Galen (131-200), the most influential physician in the ancient,
medieval, and Renaissance worlds, who addressed techniques and
indications for massage in his book De Sanitate Tuenda (which is
translated as The Hygiene, meaning prevention); and Avicenna
(980-1037), a Persian physician who wrote extensively about
massage in his Canon of Medicine, which was considered the
authoritative medical text in Europe for several centuries. A
sampling of other noted advocates includes Ambrose ParJ, who
wrote the first modern textbook of surgery; William Harvey, who
demonstrated the circulation of the blood; and Herman Boerhaave,
who introduced the clinical method of teaching medicine.
Modern, scientific massage therapy was
introduced in the United States in the 1850s by two New York
physicians, brothers George and Charles Taylor, who had studied
in Sweden. The first massage therapy clinics in this country were
opened by two Swedes after the Civil War: Baron Nils Posse ran
the Posse Institute in Boston, and Hartwig Nissen opened the
Swedish Health Institute near the U.S. Capitol in Washington, DC.
Several members of Congress and U.S. Presidents, including
Benjamin Harrison and Ulysses S. Grant, were among the massage
As the health care system in the United States
became more influenced by biomedicine and technology in the early
1900s, physicians began assigning massage duties (which were also
labor-intensive, requiring more time to be spent with patients)
to assistants, nurses, and physical therapists. In turn, in the
1930s and 1940s, nurses and physical therapists lost interest in
massage therapy, virtually abandoning it. However, a small number
of massage therapists carried on until the 1970s, when a new
surge of interest in massage therapy revitalized the field,
albeit in the realm of alternative health care. That interest has
continued to the present.
Massage therapy is the
scientific manipulation of the soft tissues of the body to
normalize those tissues. It consists of a group of manual
techniques that include applying fixed or movable pressure,
holding, and/or causing movement of or to the body, using
primarily the hands but sometimes other areas such as forearms,
elbows, or feet. These techniques affect the musculoskeletal,
circulatory-lymphatic, nervous, and other systems of the body.
The basic philosophy of massage therapy encompasses the concept
of vis medicatrix naturae--that is, aiding the ability of the
body to heal itself--and is aimed at achieving or increasing
health and well-being.
Touch is the fundamental medium of massage
therapy. While massage methods can be described in terms of a
series of techniques to be performed, it is important to
understand that touch is not used solely in a mechanistic way in
massage therapy; there is also an artistic component. Because
massage usually involves applying touch with some degree of
pressure, the massage therapist must use touch with sensitivity
to determine the optimal amount of pressure appropriate for each
person. Touch used with sensitivity also allows the massage
therapist to receive useful information about the body, such as
locating areas of muscle tension and other soft-tissue problems.
Because touch is also a form of communication, sensitive touch
can convey a sense of caring--which is an essential element in
the therapeutic relationship--to the person receiving massage.
Using the wrong kind of touch--sometimes thought of as
"toxic touch"--is counterproductive, tending to render
a technique ineffective and to cause the body to defend or guard
itself, which in turn introduces greater tension.
The advancement of higher
standards and the development of a system of professional
credentials have paralleled the dynamic growth of the massage
therapy profession. Massage therapists are currently licensed by
19 States and a number of localities; additional States are
expected to adopt licensing acts in the near future. Most States
require 500 or more hours of education from a recognized school
program and a licensing examination. While some States require
continuing education, most massage therapists voluntarily take
additional courses and workshops on a regular basis during their
The National Certification Exam, a professional
certification program accredited by the National Commission for
Certifying Agencies in December 1993 and currently administered
by the Psychological Corporation, was inaugurated in June 1992.
More than 9,000 people nationwide were certified as of July 1994.
Six States have already adopted the exam as their licensing exam,
and more States are expected to follow suit.
The Commission on Massage Training
Accreditation/Approval, a national accreditation agency that was
set up in accord with the guidelines of the U.S. Department of
Education, currently recognizes 60 school programs. Curriculums
must consist of 500 or more hours and include specified hours of
anatomy, physiology, massage theory and practice, and ethics.
The primary sponsor of the national
certification and accreditation programs is the American Massage
Therapy Association (AMTA), the largest and oldest national
professional membership association for massage professionals.
AMTA currently has more than 20,000 members and publishes the
Massage Therapy Journal. The association recently founded the
public, charitable AMTA Foundation to fund projects for research,
education, and outreach; the foundation awarded its first grants
in June 1993.
Each of a number of other national nonprofit
membership associations for massage professionals has between 200
and 1,500 members. These groups usually are formed for
practitioners of specific methods. To alleviate the competition
and infighting that are sometimes found among various
professional groups, an innovative coalition known as the
Federation of Therapeutic Massage and Bodywork Organizations was
formed in 1991 by the AMTA, the American Oriental Bodywork
Therapy Association, the American Polarity Therapy Association,
the Rolf Institute, and the Trager Institute. The federation
fosters greater communication and cooperation among its members.
The number of massage therapists in the United
States can only be estimated, because no formal census has been
taken. Furthermore, a census or estimate would be affected by the
criteria for inclusion, which would involve such variables as
extent of training, number of hours worked, and whether methods
used by an individual are considered forms of massage. It is
estimated that there are approximately 50,000 qualified massage
therapists in the United States, providing some 45 million 1-hour
massage sessions per year. The number of massage therapists
appears to be increasing rapidly along with a corresponding
increase in use by the American public. An estimated 20 million
Americans have received massage therapy. Indeed, in the study by
Eisenberg and colleagues (1993)--which found that 34 percent of
the American public used alternative health care--relaxation
techniques, chiropractic, and massage were the most frequently
used forms of alternative health care.
Some 80 different methods may be
classified as massage therapy, and approximately 60 of them are
less than 20 years old. There are several reasons why this is the
The period of the 1940s to the mid-1970s was
relatively dormant for the massage therapy profession. Little
standardization was established in the field. Then in the 1970s,
stimulated by changes in society such as greater interest in
fitness, healthier lifestyles, personal improvement, and
alternative methods of health care to complement conventional
medicine, interest in massage therapy increased. An influx of new
practitioners brought with them a wave of new ideas and
creativity regarding ways to use hands-on techniques. Since there
was little standardization, these techniques sometimes developed
into freestanding methods rather than being incorporated into an
existing system of classification.
Another source of new techniques was the
various forms of massage native to most cultures around the world
but not previously described outside each culture. For example,
many of the forms of massage that come from Asia are based on
concepts of anatomy, physiology, and diagnosis that differ from
The proliferation of methods has slowed. It is
expected--as has happened in the development of other
professions--that as the development of standards and credentials
continues, there will be some consolidation and integration of
The forms of massage therapy described in this
section are either among the most widely used or representative
of a group of similar practices. Several forms that include
additional techniques besides massage are listed briefly here and
discussed in more detail in the following sections. In actual
practice, many massage therapists use more than one method in
their work and sometimes combine several.
Swedish massage uses a system of long gliding
strokes, kneading, and friction techniques on the more
superficial layers of muscles, generally in the direction of
blood flow toward the heart, sometimes combined with active and
passive movements of the joints. This system is used to promote
general relaxation, improve circulation and range of motion, and
relieve muscle tension. Swedish massage is the most common form
Deep-tissue massage is used to release chronic
patterns of muscular tension using slow strokes, direct pressure,
or friction directed across the grain of the muscles with the
fingers, thumbs, or elbows. It is applied with greater pressure
and to deeper layers of muscle than Swedish massage.
Sports massage uses techniques that are similar
to Swedish and deep-tissue massage but are specially adapted to
deal with the needs of athletes and the effects of athletic
performance on the body.
Neuromuscular massage is a form of deep massage
that is applied specifically to individual muscles. It is used to
increase blood flow, release trigger points (intense knots of
muscle tension that refer pain to other parts of the body), and
release pressure on nerves caused by soft tissues. It is often
used to reduce pain. Trigger point massage and myotherapy are
Manual lymph drainage improves the flow of
lymph by using light, rhythmic strokes. It is primarily used for
conditions related to poor lymph flow, such as edema,
inflammation, and neuropathies.
The reflexology, zone therapy, tuina,
acupressure, rolfing (structural integration), Trager,
Feldenkrais, and Alexander methods are addressed in the following
The various methods of massage therapy can be divided into two major groupings:
Traditional European methods based on
traditional Western concepts of anatomy and physiology, using
five basic categories of soft-tissue manipulation:
effleurage (gliding strokes),
tapotement (percussion), and
vibration. Swedish massage is the main example.
Contemporary Western methods based on modern
Western concepts of human functioning, using a wide variety of
manipulative techniques. These may include broad applications for
personal growth; emotional release; and balance of the mind,
body, and spirit in addition to traditional applications. These
methods go beyond the original framework of Swedish massage and
include neuromuscular, sports, and deep-tissue massage; and
myofascial release, myotherapy, Bindegewebsmassage, Esalen, and
manual Lymph Drainage.
In addition, there are structural, functional,
and movement integration methods that organize and integrate the
body in relationship to gravity through manipulating the soft
tissues or through correcting inappropriate patterns of movement;
methods that bring about a more balanced use of the nervous
system through creating new, integrated possibilities of
movement. Examples are Rolfing, Hellerwork, Aston patterning,
Trager, Feldenkrais, and Alexander.
From 1873, when the term
massage first entered the Anglo-American medical lexicon, through
1939, more than 600 journal articles appeared in mainline English
language journals of medicine, including the Journal of the
American Medical Association, Archives of Surgery, and the
British Medical Journal. During the past 50 years, reports on
nearly 100 clinical trials have been published in the medical and
allied health literature. Many well-designed studies have
documented the benefits of several methods of massage therapy for
the treatment of acute and chronic pain; acute and chronic
inflammation; chronic lymphedema; nausea; muscle spasm; various
soft-tissue dysfunctions; grand mal epileptic seizures; anxiety;
and depression, insomnia, and psychoemotional stress, which may
aggravate significant mental illness. A larger number of studies
also have been carried out in Europe, particularly in the former
Soviet Union and East Germany. Unfortunately, the published
reports on most of these have not been translated into English.
The following studies reflect
the versatility of massage therapy and its broad and diverse
range of applications.
Premature infants treated with daily massage
therapy gain more weight and have shorter hospital stays than
infants who are not massaged. A study of 40 babies with low birth
weight found that the 20 massaged babies had 47-percent greater
weight gain per day and stayed in the hospital an average of 6
fewer days than 20 similar infants who did not receive massage;
the cost saving was approximately $3,000 per infant (Field et
al., 1986). Cocaine-exposed preterm infants given massages three
times daily for a 10-day period showed significant improvement.
Results indicated that massaged infants had fewer postnatal
complications and exhibited fewer stress behaviors during the
10-day period, had 28-percent greater daily weight gain, and
demonstrated more mature motor behaviors at the end of the 10-day
course of massage therapy (Field, 1993).
A study comparing 52 hospitalized depressed and
adjustment-disorder children and adolescents with a control group
that viewed relaxation videotapes found that the massage therapy
subjects were less depressed and anxious and had lower saliva
cortisol levels (an indicator of less depression) (Field et al.,
Another study showed that massage therapy
produced relaxation in 18 elderly subjects. This study
demonstrated physiological signs of relaxation in measures such
as decreased blood pressure and heart rate and increased skin
temperature (Fakouri and Jones, 1987).
A combination of Swedish massage, shiatsu, and
trigger point suppression in 52 subjects with traumatically
induced spinal pain led to significant alleviations of acute and
chronic pain and increased muscle flexibility and tone. This
study also found massage therapy to be extremely cost-effective
in comparison with other therapies, with savings ranging from 15
percent to 50 percent (Weintraub, 1992a, 1992b). Massage has also
been shown to stimulate the body's ability to control pain
naturally; in one study, massage stimulated the brain to produce
endorphins, the neurochemicals that control pain (Kaarda and
Tosteinbo, 1989). Fibromyalgia, a painful type of inflammation,
is an example of a condition that may be favorably affected by
A pilot study of five subjects with symptoms of
tension and anxiety found a significant response to massage
therapy based on one or more psychophysiological parameters,
including heart rate, frontalis and forearm extensor
electromyograms, and skin resistance; these changes denote
relaxation of muscle tension and reduced anxiety (McKechnie et
Another study found that massage therapy can
have a powerful effect on psychoemotional distress in persons
suffering from chronic inflammatory bowel disease. Stress can
worsen the symptoms of ulcerative colitis and Crohn's disease
(ileitis), which can cause great pain and bleeding and even lead
to hospitalization or death. Massage therapy was effective in
reducing the frequency of episodes of pain and disability in
these patients (Joachim, 1983).
Lymph drainage massage has been shown to be
more effective than mechanized methods or diuretic drugs to
control lymphedema (a form of swelling) secondary to radical
mastectomy (removal of breast tissues). It is expected that using
massage to control lymphedema will significantly lower treatment
costs (Zanolla et al., 1984).
The pace of research in
the United States involving massage therapy appears to be
increasing, and the activities of OAM may play a supportive role.
A list of studies (directed by Tiffany Field) under way at the
Touch Research Institute of the University of Miami Medical
School illustrates the range of possibilities for research:
Infant studies--infants exposed to human
immunodeficiency virus (HIV), depressed infants, infant colic,
sleep disorders, and pediatric oncology.
Child studies--asthma, autism, posttraumatic
stress disorder following natural disasters, neglected and abused
children in shelters, preschool behavior, pediatric skin
disorders, diabetes, and juvenile rheumatoid arthritis.
Adolescent studies--depressed adolescent
mothers, adolescent mothers after childbirth, and eating
Adult studies--job performance and stress,
eating disorders, pregnancy and neonatal outcome, hypertension,
HIV-positive adults, spinal cord injuries, fibromyalgia syndrome,
rape and spouse abuse victims, and couples therapy.
Elderly studies--volunteer foster
grandparents giving and receiving massage, and arthritis.
The preceding section
indicates the diversity and breadth of applications of massage
therapy and suggests the range of possibilities for future
General studies of the efficacy and
effectiveness of massage therapy are still needed. Outcome
studies are recommended that would allow massage therapists to
work in a manner and setting that approximate actual working
conditions as much as is possible. Cost-effectiveness studies
also are needed. Several of the studies cited in this report have
indicated that massage therapy provides substantial cost savings;
this is a critical issue related to health care reform. To verify
the savings, some of the more recent studies should be replicated
as part of this approach.
There are numerous possibilities for studying
effects of massage on many health conditions:
Since massage therapy is especially effective
with soft-tissue problems, studies involving muscle strains,
sprains, tendinitis, problems related to acute and chronic muscle
tension, and other such conditions would be useful, as would
studies of the effect of massage on the tissue healing process.
Because research offers mounting evidence
that a significant percentage of health problems can be
attributed to stress and that stress reduction can be a powerful
means of preventing or treating such problems, studies of the
stress-reduction effects of massage therapy would be valuable.
Another question that needs to be addressed
is whether massage can cause cancerous tumors to metastasize.
The various subject areas under investigation
at the Touch Research Institute are also examples of areas that
merit further study.
Barriers and key issues.
Several barriers and
key issues need to be addressed to make research on massage
therapy more productive:
Study design. A key issue related to research
is the need for researchers to collaborate with massage
therapists during the design stage of a study. Some previous
studies used massage in an inappropriate or ineffective manner.
For example, the duration of massage is an important factor; a
common error is use of massage sessions that are too brief to be
effective. Another error is the choice of techniques that are not
Appropriate use of therapists. Properly
qualified and skilled massage therapists should be used in each
study. Some studies have been carried out in which individuals
who were untrained or undertrained applied massage; it then
became impossible to discern whether any negative results meant
that massage was ineffective or that it was not applied properly.
Collaborations. Since few individuals are
both doctorate-level researchers and massage therapists, it is
recommended that NIH facilitate collaboration between researchers
and massage therapists. Researchers would benefit by knowing more
about interesting and promising possibilities for research,
resources available from the massage therapy profession, and
massage therapy itself. Massage therapists would benefit by being
able to locate researchers with whom to collaborate (1) to pursue
study ideas and (2) to have a better understanding of the needs
of researchers and the research process itself.
Translations. Because many studies are in
foreign languages, translations of such studies are needed.
Regulatory barriers. Another key issue is the
existence of barriers to practice that hinder massage therapists;
these must be removed. In some States, regulatory boards use
powers granted through licensing laws to limit the practice of
legitimate massage therapy by qualified massage therapists. These
barriers also restrict the ability to conduct research on massage
therapy in traditional settings, such as clinics and hospitals,
thereby hampering research efforts.
If regulatory, insurance payment, and research
barriers are not removed, they will inhibit progress regarding
massage therapy, along with other forms of alternative health
Pressure Point Therapies
Pressure point therapies use finger pressure on
specific points--usually related to the oriental meridian points
(see the glossary), but also other neurological release
points--to reduce pain and treat various disease states. There
are antecedents in Europe, Asia, and the United States. Adamus
and A'tatis described a pressure system in 1582, and the sculptor
Cellini (1500-71) wrote of using pressure points to relieve pain.
In 1770 the Jesuit Amiat contributed to European understanding
with an article on Chinese pressure point "massage."
This article influenced the Swedish therapeutic massage pioneer
Ling. In turn, Swedish therapeutic massage influenced traditional
Japanese folk massage in the early 20th century, and this
cross-fertilization became known as shiatsu. About 1913,
Fitzgerald, an American, developed what came to be known as zone
therapy. Fitzgerald had been influenced by Bressler in Europe.
The use of pressure points has evolved under several systems,
some of which are discussed below.
Fitzgerald's work with hand reflex
points was developed and promoted by Ingram in the United States
and Marquardt in Europe. Because in this system specific
"zones" on the feet are related to specific organs, the
system is often called zone therapy. There is a related system of
hand zone therapy as well. The results reported for the process
include relief of pain; release of kidney stones; and recovery
from the effects of stroke, sinusitis, sciatica, and menstrual
and other disorders (Marquardt, 1983).
Traditional Chinese massage.
Chinese remedial massage methods were described in the texts of
the Han period (202 B.C. to circa 220 A.D.). By the Tang Dynasty
(618-907 A.D.), these systems were taught in special institutes.
Both "tonification" (energizing) and
"sedation" techniques are used to treat and relieve
many medical conditions. Major techniques in use are
ma, rubbing with palm or finger tips;
pai, tapping with palm or finger tips;
tao, strong pinching with thumb and
an, rapid and rhythmical pressing with thumb,
palm, or back of the clenched hand;
nie, twisting, with both thumbs and tips of
the index fingers grasping and twisting the area being treated;
ning, pinching and lifting in a stationary
na, moving while performing ning; and
tui, pushing, often with slight vibratory
These techniques are usually used in
combinations. Two prominent groupings of techniques are known as
an-mo and tui-na.
Widely varying illnesses and conditions are
treated with traditional Chinese massage, including the common
cold, sleeplessness, leg cramps, painful menses, whooping cough,
diarrhea, abdominal pains, headache, asthma, rheumatic pains,
stiff neck, colic, bed-wetting, nasal bleeding, lumbago, and
Currently, four systems in
which the fingers manipulate the oriental meridian system are in
widespread use in the United States. In all these systems,
pressure is applied to meridian points (acupuncture points on the
meridians; also called acupoints) to stimulate or sedate them.
Amounts of pressure and length of application vary according to
the system, the ailment, and the intent. All of these
systems--shiatsu, tsubo, jin shin jyutsu, and jin shin do--rely
on traditional oriental medical theory (see the "Alternative
Systems of Medical Practice" chapter), although their
treatment methods vary considerably.
Shiatsu and tsubo rely largely on sequenced
applications of pressure applied from one end of each meridian to
the other. The patient reclines, usually lying on the back and
then the front for approximately equal periods as the
practitioner uses thumb pressure to stimulate the point through a
combination of direct pressure and transference of qi (see the
glossary) to the point from the practitioner's thumb.
"Barefoot shiatsu" is a form that uses foot pressure to
stimulate the meridian points. Sessions typically treat the
meridians of the entire body in an attempt to bring relaxation,
harmony, and balance to the patient. Shiatsu, which is
traditional in Japan, has been used in the United States quite
extensively for about 20 years. Therapy sessions have a strong
focus on long-term health improvement. Procedures include
specific treatments for a variety of functional disorders as well
as postural, stress-related, and emotional problems. Conditions
that have been improved include headache, asthma, bronchitis,
diarrhea, depression, and circulatory problems (Namikoshi, 1969).
Jin shin jyutsu and jin shin do have developed
sequences of meridian point pressure applications that are
specific to the ailment being addressed. These systems are used
more often than shiatsu and tsubo as alternative treatment
approaches. Jin shin jyutsu, the "art of circulation
awakening," was developed in Japan by Jiro Murai in the
early 1900s and brought to the United States in the 1960s by Mary
Iino Burmeister. It is the antecedent of jin shin do, which was
developed in the United States by Iona Teeguarden in the 1980s.
Sessions are primarily for treatment of specific problems. The
approach is similar to that of acupuncture, as the meridian
connections to the organs are understood and applied, but from
somewhat different application perspectives. Pressure is applied
to the meridian points, which are then held in specific patterns,
to tonify or detonify (energize or enervate) the meridian qi.
Conditions addressed include a wide range of organic dysfunctions
Postural Reeducation Therapies
Three prominent therapies in the United States
use as their approach the reeducation of the body through
movement and physical touch. In all three systems--Alexander,
Feldenkrais, and Trager--patients are taught how to retrain their
bodies to come into alignment to release and change postural
faults, to improve coordination and balance, and to relieve
structural and functional stress. A major principle underlying
the three methods is that awareness has to be experienced rather
than taught verbally. The awareness may then lead to more
effective use of one's whole self.
The Alexander method is a
system of body dynamics, especially in respect to the head, neck,
and shoulders. The technique was developed by the actor F.M.
Alexander, who created the method after concluding that bad
posture was responsible for his chronic periods of voice loss
(Maisel, 1989). The technique includes simple movements that
improve balance, posture, and coordination and relieve pain.
During a session the client typically goes through a series of
standing and seated exercises while the practitioner applies
light pressure to points of contraction in the body. These
pressures are intended to awaken kinesthetic response
(sensitivity to motion by the muscles) and retrain the
kinesthetic organs in the joints to their proper spatial
relationship. The process is taught in many drama schools and is
popular with performers. The techniques help clients learn how to
use their bodies with less tension and more awareness and
Alexander practitioners report success with
neck and back pain, postural disorders, whiplash injury,
breathing problems, myalgia, rheumatica, repetitive strain
injury, hypertension, anxiety, stress, and other chronic
The Feldenkrais method was
developed by Moshe Feldenkrais, a Russian-born Israeli physicist,
who turned his attention to the study of human functioning. His
work integrated an understanding of the physics of the body's
movement patterns with an awareness of the way people learn to
move, behave, and interact (Feldenkrais, 1949, 1972, 1981, 1985).
He began teaching his method in North America in the early 1970s.
The Feldenkrais method consists of two branches--"awareness
through movement" and "functional integration."
Awareness through movement. This verbally
directed form of the Feldenkrais method consists of gentle
exploratory movement sequences organized around a specific human
function (such as reaching, bending, or walking) with the
intention of increasing awareness of multiple possibilities of
action. A group of students may be standing, sitting, or lying on
the floor. Thinking, sensory perception, and imagery are also
involved in examining each function.
Functional integration. This method involves
the practitioner's use of words and gentle, noninvasive touch to
guide an individual student to an awareness of existing and
alternative movement patterns. The teacher communicates to the
student--who may be lying, sitting, standing, kneeling, or in
motion--how she or he organizes herself or himself and suggests
additional choices for functional movement patterns. The use of
touch is for communication, not correction, and there are no
special techniques of pressing or stroking. Any changes in
functioning result from the student's actions.
Practitioners report success with a variety of
postural and functional disorders in such diverse applications as
sports performance, equine training, physiotherapeutics, zoo
animal rehabilitation, the performing arts, neurological and
orthopedic physical therapy practice, pain management, and
habilitation of developmentally impaired children.
Currently, the North American Feldenkrais Guild
has approximately 1,000 members. As of January 1994, 31 training
programs lasting 3 to 4 years were available around the world for
The method is a synthesis of modern ideas and
basic research findings in perception, motor learning, neural
plasticity, and sensory integration (Edelman, 1987; Georgopolus,
1986; Jacobson, 1964; Jenkins and Merzenic, 1987; Jenkins et al.,
1990; Kaas, 1991; Kandel and Hawkins, 1992; Seitz and Wilson,
1987; and Sweigard, 1974). Only limited clinical research studies
have been conducted to document the Feldenkrais method. Clinical
successes have been cited in several review articles and clinical
guidelines for physical therapy and pain management (DeRosa and
Porterfield, 1992; Jackson, 1991; Lake, 1985; and Shenkman and
Butler, 1989) and have included reports on exercise for the
elderly and for persons recovering from spinal injury (Ginsberg,
1986; Gutman, 1977).
In one research study, Jackson-Wyatt and
colleagues (1992) used video analysis to measure the kinetics of
the change in motor ability in a vertical jump test in a subject
who completed eight 5-day weeks of 6-hour training days in a
Feldenkrais practitioner training program. Dramatic improvement
in power, velocity, and movement efficiency were demonstrated.
Narula (1993) similarly examined the
sit-to-stand movement, walking speed, and grip strength of four
subjects with class 2 rheumatoid arthritis. After attending a
twice-weekly 75-minute class for 6 weeks, all subjects showed
decreased pain, improved walking performance, and improved
kinetics of the sit-to-stand movement, but no improvement in grip
strength. The results suggest that lessons in awareness through
movement could be used by individuals to improve their functions
despite long-term disabling medical conditions.
Ruth and Kegerries (1992) used a 25-minute,
four-step process to test the flexion range of neck motion in
college students before and after half the group received a
15-minute sequence from the awareness through movement methods.
Compared with the control group, students experiencing this
sequence showed measurably improved neck flexion motion and a
decrease in the perceived effort to accomplish this motion.
Since Feldenkrais's functional integration
method involves a highly individual interaction between
practitioner and client, outcomes research should be long-term,
using both subjective and objective measures. Such studies could
establish whether various applications of the Feldenkrais method
are useful both for medical care and in educational systems.
Trager psychophysical integration. The Trager
method uses light, rhythmic rocking and shaking movements that
loosen joints, ease movement, and release chronic patterns of
tension. This method was developed by a Hawaiian physician,
Milton Trager, on the basis of his experience as a trainer for
the sport of boxing. The Trager practitioner uses his or her
hands with the aim of influencing deep-seated psychophysiological
patterns in the client's mind and interrupting the projection of
those patterns into body tissues.
This method of movement reeducation is
distinguished by compressions, elongations, and light bounces as
well as rocking motions. These actions cause patients or clients
to begin to experience freedom of movement of their body parts.
Since practitioners believe they are affecting the inhibiting
patterns at their source, it is expected that clients can
experience long-lasting gains.
The goal of Trager work is general functional
improvement, partly by creating a feeling of pleasure in being
able to move body parts more freely. The process incorporates a
meditative state called "hookup," which is intended to
enhance sensory, kinesthetic, and other pleasurable experiences
for the client.
Several case histories describe long-term
improvement in movement function for persons with multiple
sclerosis; in chest mobility with lung disease (Witt and
MacKinnon, 1986); and in trunk mobility with childhood cerebral
palsy (Witt and Parr, 1986). Other reports suggest success in
treating chronic pain of various sorts, headaches, muscular
dystrophy, muscle spasms, temporomandibular joint pain, recovery
from stroke, spinal cord injuries, and polio.
The Trager method also includes Trager
"mentastics," a system of mentally directed physical
movements developed to maintain and enhance a sense of lightness,
freedom, and flexibility. Mentastics is used by Trager
practitioners and is taught to clients to enhance results.
There are now more than 800 certified Trager
practitioners around the world. Training is available in the
United States and several other countries.
Structural Integration (Rolfing)
Unlike most systems of body manipulation, which
are concerned with the muscular system or the skeletal systems or
both, structural integration focuses on the fascias, which are
sheets of connective tissue. Ida Rolf, whose work was the
foundation of the various systems of structural integration,
noted that while bones support the body and muscles connect the
bones. It is the enwrapping fascias that support and hold the
muscle-bone combinations in place. Rolf's second precept was that
the fascias would maintain not only the normal relationship of
bone and muscle but also whatever postural misalignment the body
might adopt. This misalignment could incorporate effects of
trauma as well as poor posture.
Later theorists have used renowned architect
and designer Buckminster Fuller's "tensegrity mast" as
an explanatory model for the relationship of the bones and
fascias. In this structure, none of the solid elements are
connected directly together but are held by tensioned wires. The
structure becomes a model for the body if the solid segments are
called the bones and the flexible wires are called the fascias
When the body attempts to distribute the stress
of an injury, the result is likely to be shortened and thickened
fascias, which may in turn lead to symptoms somewhere other than
the site of the original trauma. Structural integration is a
system to "unwind" and stretch the distorted fascias
back to their normal condition, thereby allowing the bones and
muscles to come back to normal alignment and the body to return
to normal functioning. Structural integration, or
"Rolfing," involves stretching the fascia sheaths by
applying sliding pressure to the affected area with fingers,
thumbs, and occasionally elbows. In its early days, the process
was known to be quite painful, but later refinements in technique
have made Rolfing considerably more comfortable.
Rolf postulated that the plasticity of the
fascias in the body could offset the aging process (Rolf, 1973).
Research in Rolfing has suggested beneficial results with
cerebral palsy in children (Perry et al., 1981), state-trait
anxiety (i.e., a person's current anxiety state or level is
measured against his or her anxiety traits) (Weinberg and Hunt,
1979), the stress and symptoms of lower back pain and whiplash
(Rolf, 1977), and changes in parasympathetic tone (degree of
vigor and tension of muscles innervated by parasympathetic
nerves) (Cottingham et al., 1988a, 1988b). Changes in
psychological and physiological function have also been measured
(Silverman et al., 1973).
The Rolf Institute, the first school to teach
the principles of structural integration, offers a
post-bachelor's degree training program requiring 28 weeks of
classroom work. Today there are also three other schools based on
Rolf's work and 1,500 practitioners who treat an estimated
150,000 individuals per year. Licensing requirements differ in
Aston patterning, developed by Judith Aston,
and Hellerwork, developed by Joseph Heller, are major offshoots
of structural integration. Both incorporate movement reeducation
training to bring the body into fuller activity and expression.
Several therapeutic systems using manual
healing are designed to release bodily held emotions through
various combinations of activity on the part of the client and
applied pressure or holding on the part of the practitioner.
These systems derive from Wilhelm Reich's original observations
about bodily held emotions and his work with patients and clients
to release emotion (Reich, 1973). In this work, the client
assumes and holds one of several different postures, either
seated or reclining. Simultaneously, the practitioner applies
pressure to areas of abnormal stress that are revealed by the
posture. The client may then be invited to breathe deeply into
the stressed area. The combination of external, inwardly directed
pressure and outwardly directed breath exaggerates holding
patterns that have become so deeply imbedded that the client is
no longer aware of them. Release of the emotion can be quite
pronounced, resulting in spontaneously revealed insight,
increased freedom of movement, and new social postures.
Individual releases during the process may be accompanied by
pronounced but brief periods characterized by increased body
heat, tingles, and reported rushes of "energy."
Bioenergetics, core energetics, Lowenwork,
neo-Reichian therapy, radix, and some other methods derive from
Reich's basic approach.
Although some psychotherapists incorporate
various forms of this work into their practices, there are
constraints in some States because of ethical questions about
touching the client. Discussions with various psychotherapists
indicate that some would like to include these therapies but fear
to do so at this time, when the legal and ethical considerations
have not been resolved. Those who do the work operate in a dual
capacity--as psychotherapist and bioenergetic body worker.
However, they do not apply touch during straight psychotherapy
sessions, and the straightforward touch used during the body work
is clinically applied pressure and not sensually evocative.
Biofield (see the glossary) therapeutics, often
called energy healing or laying on of hands, is one of the oldest
forms of healing known to humankind. Discovery, partial
characterization, and use of the biofield have risen
independently among peoples and cultures in every sector of the
world (see table 1).
The earliest Eastern references are in the
Huang Ti Nei Ching Su WLn (The Yellow Emperor's Classic of
Internal Medicine), variously dated between 2,500 and 5,000 years
ago (Veith, 1949). The earliest Western references are in
hieroglyphics and in depictions of biofield healings dating from
Egypt's Third Dynasty._ Hippocrates, a major figure in Western
medicine, referred to the biofield as "the force which flows
from many people's hands" (Schiegl, 1983). Franz von Mesmer,
an Austrian physician who investigated and popularized this
process in the late 18th century, referred to the biofield as
"animal magnetism" to differentiate it from "metal
magnetism," which he understood to be a similar but
different medium (Mesmer, 1980). In the United States, use
increased after Mesmer's "magnetic healing" became
popular in the 1830s. (Among others, both Andrew Still (founder
of osteopathy) and Daniel Palmer (founder of chiropractic)
practiced for a time as magnetic healers (Gevitz, 1993).
Historically, beliefs about causation in this
type of healing have clustered around two views that remain
active today. The first is that the "healing force"
comes from a source other than the practitioner, such as God, the
cosmos, or another supernatural entity. The second is that a
human biofield, directed, modified, or amplified in some fashion
by the practitioner, is the operative mechanism. Some of the
terms presented in table 1 are devoid of religious or spiritual
overtones, while others carry religious aspects common to the
culture in which they were or are used.
Therapeutic application of the biofield is a
process during which the practitioner places his or her hands
either directly on or very near the physical body of the person
being treated. In so doing, the practitioner engages the
perceived biofield from his or her hands with the recipient's
perceived biofield either to promote general health or to treat a
specific dysfunction. The person being treated, who is usually
clothed, reclines in some forms of the process but is seated in
The process is not instantaneous, as it is in
"faith healing." (Faith is not a factor in the biofield
process.) Treatment sessions may take from 20 minutes to an hour
or more; a series of sessions is often needed to complete
treatment of some disorders.
The ability to perform biofield healing appears
to be universal, although most people seem unaware of possessing
the talent. As with any innate talent, practice and learning
appropriate techniques improve results.
There is consensus among practitioners that the
biofield that permeates the physical body also extends outward
from the body for several inches. Therefore, no real difference
is seen between placing the hands directly on the body (either by
direct skin contact or through clothing) or in close proximity to
the body. In either case, the practitioner's biofield is
understood to come into confluence with the recipient's biofield.
There are advantages and disadvantages to each approach in
Extension of the external portion of the
biofield is considered variable and dependent on the person's
emotional state and state of health. Practitioners describe the
external portion, sometimes called the "aura," as
tactilely detectable (see the "Biofield Diagnostics"
section) and less dense than the portion permeating the physical
Biofield practitioners have a holistic focus,
for most treatment sessions produce results that encompass more
than one aspect of the person's health. Within that focus there
is, however, a range of therapeutic intents:
General (e.g., stress relief, improvement of
general health and vitality).
Biologic (e.g., reduction of inflammation,
edema, chronic and acute pain; change in hematocrit and T-cell
levels; and acceleration of wound healing and fracture repair).
Vegetative functions (e.g., improvement of
appetite, digestion, and sleep patterns).
Emotional states (e.g., changes in anxiety,
grief, depression, and feelings of self-worth).
Dysfunctions often classified psychosomatic
(e.g., treatment of eating disorders, irritable bowel syndrome,
premenstrual syndrome, and posttraumatic stress disorder).
Some practitioners incorporate mental healing,
or focused intent to heal, as part of their biofield treatments.
This is also called psychic healing, distant healing, nonlocal
healing, and absent healing. Mental healing can also be performed
by itself at a considerable distance from the recipient. It is an
active process on the practitioner's part, involving centered,
focused concentration; it may include various imagery
(visualization) techniques as well. (See the "Imagery"
section and the "Prayer and Mental Healing" section in
the "Mind-Body Interventions" chapter.)
A related mind effect sometimes used in
biofield healing is described as the practitioner, by effort of
will, extending the biofield (principally from the hands) into
the recipient's body with increased force, sometimes from a
distance of several feet. Chinese qigong masters are considered
especially adept at this. The process appears to be draining;
interviews with practitioners who do this procedure indicate they
are limited in the number of treatments they can perform in a
Some practitioners meditate before giving a
treatment in order to enter a so-called healing space; some
others maintain a meditative state during treatment.
methods have been developed to determine the condition of the
patient's general health and present disorder by sensing, with
touch, subtle perturbations in the biofield (clairsentience).
Janet Quinn, researcher of the therapeutic touch method, writes
that "assessment [of the external portion] focuses on
perceiving the way this energy is flowing and is distributed in
the patient" (Krieger, 1992). Patricia Heidt adds that areas
of "accumulated tension" or "congested
energy" are detected (Heidt, 1981b). Barbara Brennan,
developer of the healing science method, describes the use of
"high sense perception," which includes other subtle
perceptions of the external biofield (Brennan, 1987).
Biofield researcher Richard Pavek writes of
similar subtle tactile cues detected when the hands are placed
directly on the body during SHEN _therapy as "changes in
temperature . . ., tingles, prickles, `electricity' (sensation of
light static), pressure or `magnetism' . . . sensations are
usually different over an area of physical pain, inflammation,
tension and/or when release of emotion occurs" (Pavek, 1987,
Many practitioners develop their treatment
plans entirely by interpreting these various tactile sensations.
Others use biofield diagnostics to supplement conventional
methods, such as nursing diagnostic forms or chronic pain
Considerable interchange of
technique occurs between Europe and the United States and some
between the United States and Asia.
United States. The process of using biofields
has been treated with a reflexive mixture of awe and disgust,
reverence and fear, and belief and disbelief, but this situation
appears to be changing as more and more people seriously
investigate the process from a critically neutral perspective.
No formal census is available, but reasonable
estimates suggest that some 50,000 practitioners in the United
States provide about 120 million sessions annually (Pavek, 1994).
Of these, about 30,000 have trained in therapeutic touch (Benor,
1994). For some, it is a major part of their vocational activity;
others use the process occasionally to help family and friends.
Many practitioners have had no formal training in the process,
and many have independently discovered biofield effects. Others
learned rudimentary techniques from friends or trained in one of
several schools that teach various forms of the process. Reviews
of school enrollment records indicate that most practitioners are
Some practitioners, often those who have
independently discovered the process, and some teachers ascribe
to it a religious or spiritual basis. A few link the process with
specific religious activities.
No State has licensing requirements for
biofield practitioners. Because legal constraints in many States
prohibit the use of the terms patient and treatment, most
practitioners use the terms receiver and session in describing
Some, possibly because they fear being charged
with practicing medicine without a license, have cloaked
themselves by incorporating under the name of a healing church.
They often deny attempting to treat biological disorders and
describe their process as "healing the spirit," from
which "healing of the physical" will follow.
In the past 20 years or so, formal training in
the process has emerged in considerable strength in this country.
At this time several teaching establishments with standardized
training programs teach different forms of the process; most
grant certificates. Schools differ considerably in curriculum,
focus, length of training, extent of internship, and
certification requirements. Some schools are semistructured
associations of instructors trained in a particular method;
others are more centrally organized.
The major biofield therapies used in the United
States are summarized in table 2.
At least four forms of biofield
therapy--healing science, healing touch, SHEN therapy, and
therapeutic touch--have been taught in a number of medical
establishments. Currently, student nurses are trained in one or
another system in more than 90 colleges and universities around
the world. Acupuncturists, massage practitioners, and nurses who
pass these courses receive continuing education credit from
several State bureaus for training in these four forms.
Most of the practitioners of this process work
independent of conventional medical and health practitioners. The
conventional practitioner may occasionally be aware that his or
her patient-client is seeing a biofield practitioner
collaterally, but most are not.
However, while much of the current activity in
this discipline can be considered separate and alternative, the
process is beginning to seep upward into mainstream medical and
health practices. It is likely that several thousand
practitioners of conventional therapies currently combine one or
another of the biofield therapy processes with their primary
approaches. Among these are nurses, counselors, psychotherapists,
chiropractors, and massage practitioners who at least
occasionally use a form of biofield therapy as an adjunct.
At least three forms are currently in use in
hospitals: healing touch and therapeutic touch are used for a
variety of reasons in several hospitals (Quinn, 1981, 1993), and
SHEN therapy is used in alcohol abuse, drug abuse, and
codependent recovery programs in a few hospitals (Sunshine and
Europe. The United States falls far behind
other countries in legal recognition of biofield therapy.
Currently, more than 8,500 registered healers in the United
Kingdom (British Medical Association, 1993) "are permitted
to `give healing' (a term for the process in common usage in the
United Kingdom) at the request of patients" (p. 92).
Approval has been obtained to use the process at the 1,500
government hospitals. In some situations, biofield healers are
paid under the U.K. National Health Service (Benor, 1993).
Physicians receive postgraduate education credits for attending
courses in the biofield process, and healers are able to purchase
liability insurance policies similar to those covering physicians
In Poland and Russia, biofield healing is being
incorporated into conventional medical practice; some medical
schools include instruction in the process in the curriculum. In
Russia, the process is under investigation by the Academy of
Science. In Bulgaria, a government-appointed scientific body
assesses abilities and recommends licensing for those who pass
rigorous examinations (Benor, 1992).
Asia. China leads the rest of the world in
research on therapeutic application and methods of increasing
biofield effects. Biofield healing is called wei qi liao fa, or
"medical qigong" (chi kung), in China, where proficient
practitioners are called "qigong masters." Qigong
masters are described as having developed their qi (biofield) to
a high degree through qigong exercises._ (A few qigong masters
are reported to be able to anesthetize patients for surgery
solely with this method [Houshen, 1988]). Reduction of secondary
cancers by medical qigong masters is commonly reported; there are
clinics for that purpose alone.
Departments of medical qigong research exist in
every college of traditional Chinese medicine in China. Both
national and regional governments sponsor periodic international
conferences on medical qigong. American researchers are
frequently invited to present papers at these conferences.
No generally accepted
theory accounts for the phenomena of biofields. As one might
expect of a discipline often perceived as bordering between
superstition and random process on the one hand and science and
technique on the other, there are profound differences--both
inside the discipline among practitioners and researchers, and
outside among theoreticians--as to the exact nature of the
phenomena. In many cases, the view of the biofield is not a
clearly defined one; it often mixes concepts of physics and
metaphysics, or ancient and modern wisdoms (see the glossary).
The current major hypotheses are that the
metaphysical (outside the four dimensions of
space and time and untestable),
an electromagnetic field effect, and
a presently undefined but potentially
quantifiable field effect in physics.
There are three metaphysical approaches:
Spiritual energy. Practitioners of some
methods believe that they are channeling a spiritual energy that
has innate intelligence or logic and knows where and to what
extent it is required (Baginski and Sharamon, 1988). Reiki and
also "radiance," a form of reiki, are examples of this
view (Ray, 1987). Reiki teaches that the practitioner is merely a
conduit for spiritual energy. After training, the practitioner is
initiated and given the power to heal; sacred symbols are often
used to give added power to the process (Jarrell, 1992). Another
system with a similar approach, mari-el, incorporates the use of
angels or spiritual guides in the healing practice.
Interacting human and universal energy
fields. Heidt and others have postulated that both the healer and
the healed are vibrating fields of energy (Heidt, 1981b) that
interact with the environmental energy field around them for
healing purposes. Brennan describes a similar process as one of
"harmonic induction" (Brennan, 1987).
Repatterning of resonant vibratory fields.
Going further, Quinn and nurse-theorist Rogers state that current assumptions (about Therapeutic Touch),
which remain "untested" and "untestable,"
[are that] people are energy fields. We are not saying that
people have energy fields in addition to what they are. . . .
[Instead they are] open systems engaged in continuous interaction
with the environmental energy field. [Therefore] when a person is
"sick" there is an imbalance in the person's energy
field, [and] when a person uses his or her intent to help or heal
a person, the energy field of the person may repattern towards
greater wellness. . . . The Therapeutic Touch practitioner
knowingly participates in . . . "a healing meditation,"
facilitates repatterning of the recipient's energy field through
a process of resonance, rather than "energy exchange or
transfer" (Quinn, 1993).
The healing intervention is seen as a
"purposive patterning of energy fields, a mutual process in
which the nurse uses his or her hands as a mediating focus in the
continuing patterning of the mutual patient-environment energy
field process" (Rogers, 1990).
In addition, certain models in physics may
offer some explanation of biofield phenomena. Although quantum
physics, the branch of physics that treats atomic and subatomic
particles, has been proposed to explain the effects of a related
phenomenon, mental healing at a distance (see the "Mind-Body
Interventions" chapter), it has not proved to be a useful
model to explain biofield healing. For example, Brennan states,
"I am quite unable to explain these experiences without
using the old [classical physics] frameworks" (Brennan,
1987, p. 26).
Classical physics is a model that is applied
with high precision to large-scale phenomena involving relatively
slow motion, such as the flow of fluids, electromagnetic currents
and waves, hydraulics, aerodynamics, and atmospheric physics. It
appears to be a reasonable model to apply in studying biofield
Indeed, much of the terminology used by
biofield practitioners to describe their work--while somewhat
imprecise and variable--clearly describes quantitative and
qualitative factors similar to those in fields of classical
physics. For example, qi appears to be equivalent to flux in
electromagnetic fields, for it describes direction and quantity
of field. Polarity between the hands and between different bodily
regions appears to be equivalent to polar difference in
electromagnetic fields and to pressure differential in
hydrodynamics. Pavek describes the biofield as having
"circulating [flux] patterns . . . similar in formation and
function to magnetic fields or electrostatic fields" (Pavek,
1987, p. 61). (See table 3 for other analogies.)
Around 1850, Karl von Reichenbach (discoverer
of kerosene and paraffin) demonstrated apparent biofield
polarities and determined apparent velocity through a copper rod
to be about 4 meters per second (von Reichenbach, 1851)._ In
1947, L.E. Eeman demonstrated a polarity through the arms and
hands and another through the spine with his device known as an
Eeman screen (Eeman, 1947). (See fig. 2.)
In about 1950 Randolph Stone, developer of
polarity therapy, determined that flux density showed polarities
within the physical body (Stone, 1986).
In 1978, Pavek compared paired-hand placements
and reversed paired-hand placements on patients by hundreds of
trained and untrained practitioners; he noted that one
arrangement consistently resulted in relaxation and feelings of
well-being but that the other set consistently produced agitation
and anxiety. From this he deduced normal (healthy) qi polarities
and movement patterns in the body (Pavek, 1987). (See fig. 3.)
In 1985 Pavek expanded on these findings by
demonstrating coherent linkages between qi patterns, emotional
holding patterns, and autocontractile pain response while
developing biofield treatments for disorders often classified as
psychosomatic (Pavek, 1988b; Pavek and Daily, 1990) and
correlating emotional holding patterns with Chinese five-phase
theory (Pavek, 1988a).
In 1992, Isaacs conducted a double-blind study
using Eeman screens, which confirmed polarity at the spine and
arms (Isaacs, 1991).
It is unclear at this time whether the biofield
is electromagnetic or some other presently unmeasured but
potentially quantifiable medium. It is popularly hypothesized
that the biofield is a form of bioelectricity, biomagnetism, or
bioelectromagnetism._ This may well be the case but has yet to be
established. Some researchers discount the possibility._
Some Chinese researchers have conducted
experiments indicating that when wei qi (the external biofield)
is used in fa qi (healing), electro-magnetic radiation in the
infrared range is produced; others found indications of
infrasonic waves. However, both phenomena appear to be minor
secondary effects (Shen, 1988; Xin et al., 1988).
Rigorous research on biofield
healing has been hindered by the belief, held by many, that
nothing more than a placebo effect is the operative factor. This
belief has affected funding, publishing, and status of
researchers. Because funding organizations and scientific
communities believed that any effects obtained were largely
placebo effects, not real effects of biofields, research has been
considered pointless. Moreover, many researchers have been
unwilling to study biofield effects that they would otherwise be
interested in, because they fear being ostracized by other
researchers. Publication of research by the journals has been
limited for similar reasons.
Notwithstanding these limitations, a number of
studies have been implemented. In the United States, there are
more than 17 published studies on biofield therapeutics.
Published U.S. studies. Because no
comprehensive database of studies on biofield therapeutics
exists, the following are considered to be only a sampling.
In two controlled studies on therapeutic touch,
Krieger found significant change in hemoglobin levels in
hospitalized patients (Krieger, 1975, 1973). In a similar study,
Wetzel found significant change in hematocrit and hemoglobin
levels of 48 subjects receiving reiki, and no significant change
with 10 controls (Wetzel, 1989).
Wirth found significant change in the healing
rate of full-thickness skin wounds in a carefully controlled,
double-blind study of therapeutic touch (Wirth, 1990), while
Keller and Bzdek found highly significant decreases in pain
scores recorded on the McGill-Melzak Pain Questionnaire by
patients with tension headache in a controlled study of
therapeutic touch (Keller, 1993; Keller and Bzdek, 1986).
Although Meehan found no significant difference
on the Visual Analog Scale and Pain Intensity Descriptor Form
between postoperative patients receiving therapeutic touch and
controls, secondary analysis showed patients receiving
therapeutic touch waited longer before requesting analgesia
(Meehan, 1985, 1988). Similarly, Heidt found significant changes
in anxiety levels of hospitalized cardiovascular patients
receiving therapeutic touch versus controls as measured on the
A-State Self-evaluation Questionnaire (Heidt, 1979, 1981a;
Spielberger et al., 1983). Quinn (1983) found similar results in
a study of therapeutic touch versus mimic therapeutic touch
without centering and intention to assist.
In a replication study on patients before and
after open heart surgery, using therapeutic touch versus mimic
therapeutic touch and no-treatment groups, Quinn found no
significant differences between the groups. Yet changes occurred
in the expected direction, and there was a significant reduction
in diastolic blood pressure among the therapeutic touch group
that was not seen in the no-treatment group (Quinn, 1989). In
another study of therapeutic touch versus mimic therapeutic
touch, Parkes showed no significant differences among elderly
hospitalized patients (Parkes, 1985).
Collins (1983), Fedoruk (1984), and Ferguson
(1986) found significant relaxation effects of therapeutic touch
with various subjects in different studies, and Quinn (1992), in
a pilot study of four bereaved people, found significant
reduction of suppressor T cells in all four after therapeutic
touch. Moreover, Kramer found significant differences in stress
reduction between treatment and control groups in a study of
therapeutic touch with hospitalized children (Kramer, 1990).
Other U.S. studies. A number of pilot and case
studies in fruitful areas have shown interesting results that are
worthy of further investigation. These studies were conducted
without controls, usually because of the severe limitations on
In four uncontrolled cases, Pavek found that
white cell decrease during chemotherapy reversed and rose
significantly after single SHEN therapy treatments at the thymus
gland (Pavek, unpublished, 1984-85). In a pilot study on SHEN
therapy and premenstrual syndrome, Pavek noted significant
long-term symptom relief and behavioral change with 11 of 13
subjects (Pavek, unpublished, 1986).
Beal, in an unpublished study of 12
hospitalized major depressives, found no statistical difference
in time of release from the hospital between 6 subjects
randomized to receive SHEN therapy and 6 controls receiving sham
SHEN therapy. However, in analyzing both subject and counselor
reports, Pavek found significant change in dreaming, emotional
expressiveness, and interpersonal contact with subjects receiving
SHEN therapy and much less change among controls (Beal and Pavek,
Other therapeutic touch research with promising
indications includes research on rehabilitation (Payne, 1989),
helping patients to rest (Heidt, 1991), mental patients (Hill and
Oliver, 1993), symptom control in acquired immunodeficiency
syndrome (AIDS) (Newshan, 1989), and severe burn patients (Pavek,
Promising research with SHEN therapy includes
research with occupational therapy clients, third-trimester
abdominal pain, reduction of pain during birthing without pain
medication, irritable bowel syndrome, posttraumatic stress
disorder, anorexia, bulimia, phobias, and chronic migraine.
There has been
considerable research on biofield therapeutics in other
countries. In China, more than 30 controlled studies on effects
of fa qi on both humans and animals were reported in the
proceedings of just one meeting, the First World Conference for
the Academic Exchange of Medical Qigong. At the same meeting, 32
studies were presented on effects on health of qigong exercises
that raise qi (Proceedings, 1988).
In an overview report, Daniel Benor has
compiled data on 151 healing studies from around the world
(Benor, 1992). In many of these studies, mental healing efforts
were combined with the biofield processes. However, 61 were
controlled, published studies of biofield healing effects without
the confounding factors of mental intent. These studies are shown
in tables 4 and 5.
Promising clinical results. While technique,
focus, and range of treatments attempted vary considerably, a
number of results are common to all forms of the biofield
Acceleration of wound healing.
Reduction of the pain of thermal burns and
acceleration of healing time.
Reduction of sunburn pain and coloration.
Reduction of acute and chronic pain.
Reduction of anxiety.
Release of pent-up grief.
In addition, practitioners of some forms of the
process report consistently good results with
recurrent panic attacks;
posttraumatic stress disorder;
irritable bowel syndrome;
nonbiological sexual dysfunction;
drug, alcohol, and codependence recovery;
anorexia and bulimia; and
third-trimester pregnancy and birthing.
Characterization of the biofield. That the
biofield has definable form, flux pattern, and polarities seems
clear to practitioners from the wealth of empirical evidence
available. However, characterization of the biofield is far from
complete, and determining its nature is paramount to its further
development among the healing arts.
Two hypotheses should be tested: first, that
the biofield is a field in physics other than an already known
field, and, second, that the biofield is bioelectromagnetism. One
approach that would support the first hypothesis would be
development of a device (transducer) that would react with the
biofield so as to exclude the possibility of bioelectromagnetism.
Research projects in China have shown that application of the
biofield affects lithium fluoride thermolumi-nesence detectors,
polarized light beams, Van de Graff generators, and silicone
crystal plates (Proceedings, 1988). These preliminary experiments
suggest possible approaches toward further characterization.
Research design considerations.
should be considered in planning well-designed studies to
evaluate potential effects of biofields on health:
Mental healing techniques. Since mental
healing techniques are often mixed with biofield techniques, care
must be taken in all research designs to separate out the two
factors. Unless this is done, unclear results will prevent
Sham treatments. Unlike placebo pills,
biofield healing cannot be faked. According to the observations
of practitioners, it is not possible to touch subjects in a
clinical study in a purely physical way for any period of time
without resulting in some effect from the practitioner's
biofield. Nor is there a way to shield the biofield emitted by
one person from another person's; this renders the notion of a
"sham control" meaningless. This particular confounding
factor has adversely affected results in several studies of
biofield therapeutics (Beal and Pavek, 1985; Meehan, 1988;
Parkes, 1985; Quinn, 1989). In these studies, controls were
established by effecting a mimic, or sham, of the primary method.
The practitioners' hands were brought into close proximity with
the subject in a "sham treatment." In all such cases,
some positive effect was obtained with the mimic or sham
treatments that was greater than could be reasonably expected
from no-treatment controls.
Double-blind studies. Although it is not
possible for a biofield healing practitioner to perform in a
strict double-blind situation, it is possible to design studies
in which the evaluators are blinded to the treatment method and
subjects are blinded to the method and to the specific intended
Science and metaphysics. Because the
metaphysical model lies, by both definition and practice, outside
the usual confines of science, research on metaphysical
explanatory models will be difficult. However, outcome studies of
clinical effect could be designed and executed.
Collaborations. The process could be speeded
up if experienced researchers sympathetic to energy healing work
together with researchers experienced in developing appropriate
criteria. These criteria must (1) provide the established medical
and health communities with valid, reproducible data and (2) be
constructed so as not to negate the operative treatment
Barriers and Key Issues
Hindrances. For various reasons, biofield
healing has been hindered from reaching its fullest potential.
Principal among these reasons are the following:
* Until recently, few testable hypotheses.
* Few theoreticians who are also practitioners.
* The disdain of currently established
* Lack of a solid research base.
* Lack of an adequate outcomes database.
* Unsystematic accumulation of empirical
* Obscuring of the extent of efficacy by a
plethora of conceptual confusions and conflicting claims as to
causal factors, best methods, and procedures.
Placebo and efficacy. Some people have
attributed any successful applications of biofield therapeutic to
a high probability of placebo effect. This assumption has
inhibited reviewers and editors from accepting as valid the
usual, smaller pilot studies that would be acceptable for other
types of therapy.
No studies that have been done, however,
indicate that placebo factors are any higher with biofield
therapies than with other healing methods. In fact, a number of
situations in which placebo effects would have been highly
unlikely cast doubt on the concern. Some such studies have had
marked, positive results (Benor, 1992) with animals and with
small children below the age of reason. There are also numerous
anecdotal reports of children receiving treatments while asleep
and awakening with marked change. Fevers have broken during such
treatments, panic attacks have ceased, and comas have ended
Such evidence suggests that the reason why
biofield treatments are effective is other than the placebo
Peer review. At this time, there are no peer
review groups that actually include "peers." True
peers, who have a hands-on understanding of biofield
therapeutics, should be included on review committees. (See the
"Peer Review" chapter.)
Because the stigma associated with "faith
healing" has been attached to biofield therapy, it has not
been seriously considered as a viable treatment method.
Consequently, the discipline languishes in a research doldrum.
The following steps are recommended:
1. The biofield should be characterized.
Reasonable approaches exist, some of which have been described in
2. Simple and appropriate instruments should be
developed to begin the process systematically collecting clinical
data. With properly designed forms, individual case studies could
be statistically sorted and grouped by disorder, treatment
process, and results. This sorting would begin to establish
relative efficacy in the various categories, suggesting
productive avenues for future research. To implement this
process, OAM should establish a small study group, including
members familiar with intake and outcome forms and data
collection and representative members of the discipline.
3. Studies should be undertaken to determine
how much of biofield therapeutics is attributable to mental
healing and how much is attributable to quantity and proper
directional application of the biofield flows.
4. Appropriate review panels with actual peers
should be established.
5. A number of open technical questions in the
discipline should be resolved. OAM should invite the leaders of
the various systems to a general meeting to discuss and compare
techniques and methods and to begin resolving these questions.
Resolving these differences will enhance the techniques of all
biofield healing methods.
6. A number of clinical studies that have been
done in Europe and in Asia could be replicated here. Replication
is necessary to assure the American research community that the
studies are valid and to point the way for further research here.
7. A wealth of serious study proposals are
available. These should be reviewed, and the most promising
should be implemented.
Biofield therapeutics and diagnostics have been
struggling to cross the border from metaphysics to physics and
gain mainstream acceptance for a long time. In spite of
considerable difficulties, biofield methods are gaining
acceptance from health professionals and the general public in
two areas--(1) the medical clinic and (2) hospital and psycho-
therapeutic settings. In both, biofield treatments are reported
to be of benefit for many people.
Biofield therapeutics are a low-cost,
noninvasive, nondrug approach, and applications have been
reported in many medical and health situations as alternatives or
as complements to mainstream medicine. The potential
reward-to-risk ratio is great, and relatively small amounts of
money are needed to start a validation process, which should be
done with dispatch.
Combined Physical and Biofield Methods
The following methods are described by their
practitioners as combining physical and biofield aspects. The
list, which is not all-inclusive, tends to be descriptive; little
research is available as a basis for judging the usefulness of
these methods. Most of them would benefit from research on their
efficacy and their scientific bases.
Applied kinesiology, or "touch for
health," consists of both a diagnostic method of determining
dysfunctional states of the body and related therapeutics. Based
on principles of physiology and the meridian system mentioned
earlier, it was developed in the 1960s by George Goodheart. It
uses both the meridian qi and the biofield qi in its diagnostics
Neurolymphatic holding points, neurovascular
holding points, meridian holding points, and the biofield
external qi are all said to be incorporated in the process. A
session starts with various "muscle testings" that are
used to determine the state of qi flow through the meridians.
Muscle testings give an indication of the area to be worked on
and are a necessary part of the treatment.
A number of applied kinesiology practitioners
use the process in conjunction with more established practices,
such as chiropractic.
Network Chiropractic Spinal Analysis
Network chiropractic spinal analysis (NCSA)
merges conventional chiropractic mechanical or structural
approaches with biofield approaches to evaluate and correct
anomalies of the spine and nervous system. At the clinical core
of NCSA is the classification of spinal subluxations into two
categories: (1) structural subluxation that involves mechanical
dislocation of spinal sections and (2) soft-tissue subluxation
that involves tension in the muscles and other soft tissue
connected to the spinal sections. NCSA does not address
structural subluxations until after a reduction of soft-tissue
subluxations has occurred. (It has been noted that structural
subluxations often self-correct shortly after soft-tissue
subluxations have been adjusted.) Application of the biofield is
included for the soft-tissue adjustments and is applied first.
Conventional chiropractic adjustments follow, as required, for
The clinician uses a phased system to introduce
order to the subluxated segments. Since the body often creates
movement from a tense, restricted state, a spontaneous discharge
of tension often occurs as the spinal distortions are resolved;
this is a common occurrence. A wide range of responses is then
observed with certain common elements. Among the unique
individual responses typically seen is a period of deep and full
respirations; other responses include periods of muscular
movements and naturally occurring postures as the body and mind
seek to purge mechanical tension or stored memories of traumatic
Polarity therapy is a natural health system
based on the idea of a "human energy field." Drawing
from oriental and Indian sources, it asserts that well-being and
health are conditions determined by the nature of the flow of
this human energy field and that the flow can be affected by
various natural methods. Polarity therapy incorporates a variety
of strategies to enhance the flow of the energy field, including
touch, diet, movement, and self-awareness. (Polarity
practitioners generally believe that the energy field that they
are enhancing is electromagnetic, but this point has not been
The central concepts of polarity therapy are as
* All phenomena have a fundamental structure
involving charged particles in a relationship of
expansion-contraction or attraction-repulsion. In East Asia this
relationship is called the tao, or relationship of opposites (yin
* An "energy anatomy" precedes and
creates physical anatomy, and this energy anatomy exists in
several layers that are affected, and possibly distorted, by life
* These distortions may be corrected by several
methods, including touch, holding pressure points, and using the
practitioner's hands to link various "polarities" in
the client's body.
Commonly reported benefits of "polarity
energy balancing" include relaxation, pain reduction,
reduction of nervous conditions, heightened self-awareness, and
improvement in range of motion.
Polarity therapy was developed in the 1950s by
Randolph Stone, a chiropractor, osteopath, and naturopath. Today
the American Polarity Therapy Association, which was founded in
1983, organizes and supports training and certification of
practitioners; the association also is developing a research arm.
At present there are more than 500 practitioners of polarity
therapy, trained at several levels of proficiency.
Qigong Longevity Exercises
The qigong longevity or health exercises are a
fairly recent addition to alternative health practices in the
United States. Qigong exercises are similar in appearance to
tijijuan (tai chi chuan), a rhythmical nonaerobic form of
exercise; however, this appearance is only superficial. Qigong
movement exercises do not flow from one position to another as in
tai chi; they are done in shorter movement groups that are
repeated many times. This, however, is not the essence of the
practice, but only the visible form.
Qigong exercises combine repetitions of
coordinated physical motions with mental concentration and
directive efforts to move the qi in the body. During these
exercises, which are based on slow, repetitive movements of the
arms, legs, and torso, the exerciser's mind is focused on moving
the qi (biofield flux) through the meridian pathways and
nonmeridian pathways that were developed by the ancient Taoist
This mental effort is coordinated with specific
movements; for example, qi may be directed up the back as the
arms are raised and down the front as the arms are lowered. Large
amounts of internal qi are said to be developed in the process.
It is estimated that there are more than 100 different forms of
qigong health exercises. There are considerable differences in
the styles, but all consider the mental effort to be crucial.
Qigong exercises are used daily for health improvement by several
million Chinese, both in the People's Republic and in Chinese
communities throughout Southeast Asia.
Qigong exercises are also used by qigong
masters (see the "Biofield Therapeutics" section) to
increase the quantity of qi available for healing; some use it in
various forms of martial arts such as gongfu (kung fu).
In China, qigong exercises have been under
study for their long-term effects on a number of medical
conditions, such as cancer and arthritis, and for their effects
on general health. More than 32 studies were recently presented
at just one major conference on the effects on general and
specific states of health of exercises enhancing qigong qi
Several schools and organizations in this
country focus entirely on these practices. The principal ones are
China Advocates, the Chinese National Chi Kung Institute, the
Qigong Academy, and the Qigong Institute. The practice of qigong
is gaining in popularity in the United States, both with Asians
Craniosacral therapy is a gentle, hands-on
treatment method that focuses on alleviating restrictions to
physiological motion of all the bones of the skull, including the
face and mouth, as well as the vertebral column, sacrum, coccyx,
and pelvis. Concurrently, the craniosacral therapist focuses as
well on normalizing abnormal tensions and stresses in the
meningeal membrane, with special attention to the outermost
membrane, the dura mater, and its fascial connections. Attention
is also paid to alleviating any obstacles to free movement by the
cerebrospinal fluid within its membrane compartment and to
normalizing and balancing perceived related energy fields. This
approach is derived from experiments of John Upledger, an
osteopathic physician and researcher (for example, see Upledger,
1977a and 1977b, which are discussed below).
As usually practiced, this therapy is a
noninvasive treatment process that requires an uninterrupted
treatment session of at least 30 minutes; often the session is
extended beyond an hour. Practitioners indicate that successful
treatment relies largely on the therapist's ability to facilitate
the patient's own self-corrective processes within the
craniosacral system. Postgraduate training in craniosacral
therapy has been undertaken by a wide variety of physicians,
dentists, and therapists. In the United States during 1993, 2,738
health care professionals completed the Upledger Institute's
introductory-level workshop and seminar; 1,827 received training
at the intermediate level, and 80 completed the advanced level.
Training outside this country is available through the Upledger
Institute Europe in the Netherlands and on a smaller scale in
Japan, New Zealand, France, and Norway by American Upledger
The most powerful effects of craniosacral
therapy are considered to be on the function of the central
nervous system, the immune system, the endocrine system, and the
visceral organs via the autonomic nervous system. This therapy
has been used with reported success in many cases of brain and
spinal cord dysfunction. Although these successes have not been
documented in formal studies, they have been observed
subjectively or anecdotally by both patients and therapists. Most
prominent among these success reports are cases of brain injury
resulting in symptoms of spastic paralysis and seizure. Other
areas of claimed success include cerebral palsy, learning
disabilities, seizure disorders, depressive reactions, menstrual
dysfunction, motor dysfunction, strabismus (a vision disorder),
temporomandibular joint problems, various headaches, chronic pain
problems, and chronic fatigue syndrome.
Research on tissues has documented the
potential for movement between skull bones in adult humans, and
pilot work with live primates has shown rhythmical movement of
their skull bones. Interrater reliability studies, which look for
correlations in the observations of two or more independent
raters (see the "Osteopathic Medicine" section), have
shown agreement between "blinded" therapists evaluating
preschool-aged children ("blinding" means that the
therapists making the observations did not know which children
had received craniosacral therapy, nor did they know the history
or problems of the children) (Upledger, 1977a). Controlled
studies have shown high correlation between schoolchildren with
various brain dysfunctions and specific dysfunctions of the
craniosacral system; that is, the craniosacral exam scores
correlated with recorded school teacher and psychologist opinions
of "not normal," behavioral problems, motor
coordination problems, learning disabilities, and obstetrical
complications (Upledger, 1977b). Moreover, Upledger reports that
a few pilot studies by dentists have demonstrated significant
changes in the transverse dimension of the hard palate as well as
in occlusion in response to craniosacral therapy.
At present, work is under way that appears to
demonstrate fluctuations in what are called energy measurements
in circuits between craniosacral therapists and patients. The
circuits are established by attaching electrodes to the patient
and the therapist with an ohmmeter and a voltmeter interposed in
the circuits. In observations with 22 patients, measurements have
ranged from more than 30 million ohms at the start of a treatment
session to 448 ohms with a brain-injured child; voltages have
fluctuated between 10 and 254 millivolts. Upledger's
interpretation is that the elevation in resistances read with the
ohmmeter correlate with the palpable resistances that
craniosacral therapists feel with their hands and that the energy
put into overcoming these resistances is reflected by elevations
in the millivolt readings. On the basis of these preliminary
studies, plans are under way to explore further whether the
energetic changes measured in the circuits accompany specific
landmarks in treatment processes.
Physical Therapy: An Example of Transition to Mainstream
Physical therapists are health care
professionals who diagnose and treat problems related to physical
function. While physical therapy is considered to be a part of
mainstream medicine in this country, its practitioners frequently
use manual healing methods that are categorized as alternative.
Many of the methods identified in other sections of this chapter
are part of the standard repertoire of physical therapy. The
development of the profession and its transition into mainstream
health care are discussed in this section. Some of the
alternative procedures and the difficulties encountered in
training for them are noted.
Physical therapy is a relatively young
profession in comparison with medicine and nursing, although its
roots lie in ancient Rome and Greece. Its modern embodiment
appeared at about the time of World War I, through the creation
of the Women's Auxiliary Medical Aides, renamed Medical Aides and
then again Reconstruction Aides, in the Office of the Surgeon
General of the Army. Physical therapy training programs existed
in France and England at this time under the name physiotherapy,
a term that is still used in most Western nations outside the
United States. It quickly became apparent that the United States
also needed to train its own people in new ways to assist the war
wounded. Few, if any, professionals who were trained in medicine
or nursing at that time could deal with physical, vocational, and
psychological problems associated with injuries sustained in war
Educational preparation in 1917 consisted of
4-month sessions after graduation from high school but quickly
moved to 12-month sessions that followed preparation in nursing
or physical education. Since the 1920s, preparation for practice
has shifted from an apprentice model to an academic model and
from clinic-based education to universities. Currently, 50
percent of entry-level degrees are awarded at the master's degree
level. Not included are master's degrees in physical therapy
awarded to people already trained in the field. The professional
doctorate--the D.P.T.--is available at three universities.
Adversity stimulated the growth of the
profession, with major spurts during both world wars and during
the polio epidemics in 1914, 1916, and the 1940s. Then a new
creativity in prosthetics and orthotics in conjunction with
physical therapy treatment evolved in response to the problems of
thalidomide-affected babies after the belated recognition in 1961
that thalidomide was a teratogen (a substance affecting embryonic
development). Thalidomide was given to pregnant women, primarily
in Great Britain, to treat nausea, or "morning
The startling growth of physical therapy as a
profession in the 1980s and 1990s may be explained by many
factors, including documented effectiveness of treatment of
patients of all ages. The targets of treatment include virtually
all problems affecting normal function resulting from trauma and
illness as well as those resulting from genetically transmitted
disease, trauma sustained in childbirth, developmental delay, and
normal and abnormal consequences of aging.
The number of schools in the United States
preparing men and women for the profession of physical therapy is
now 140, with approximately 5,000 graduates each year (American
Physical Therapy Association, 1993). There are additional schools
at various stages in the accreditation process. Previously made
up entirely of women from physical education and nursing, the
professional ranks today include approximately 30 percent men.
The curriculums draw applicants from a wide variety of academic
backgrounds, including fine arts, basic science, humanities,
behavioral sciences, engineering, and business. Membership in the
American Physical Therapy Association is approximately 60,000,
which is half the total number of practicing physical therapists
in the United States.
The number of graduates from academic programs
does not begin to meet society's need for physical therapy
services. Because professional practice is relatively autonomous,
physical therapists frequently work in private practice. Growing
sophistication and autonomy have led to a nationwide effort by
members of the profession to seek legislative changes in State
practice acts to permit practice without referral. Twenty-eight
States have enacted such legislation. Real shortages of physical
therapists exist in many health care institutions; it is one of
the professions having the greatest number of vacant positions in
Physical therapists are licensed health care
professionals. The therapist's normal scope of work for any given
client involves evaluating the patient, identifying potential
problems, and determining the diagnoses that are related to
physical function; then the therapist establishes objectives or
goals, provides treatment services, evaluates the effectiveness
of treatment, and makes any modifications necessary to achieve
the desired outcome.
Therapeutic interventions focus on posture,
movement, strength, endurance, cardiopulmonary function, balance,
coordination, joint mobility, flexibility, pain, healing and
repair, and functional ability in daily living skills, including
Among the therapeutic activities included are
therapeutic exercise; application of assistive devices; physical
agents, such as heat and cold; ultrasound; electricity, such as
electromyography and electrical muscle stimulation; manual
procedures, such as joint and soft-tissue mobilization;
neuromuscular reeducation; bronchopulmonary hygiene; and
ambulation training with and without assistive devices.
This professional activity may take place in a
wide variety of settings, including neonatal nurseries, intensive
care units, bedside acute care, rehabilitation units, outpatient
clinics, private offices, private homes, physical fitness or
sports facilities, and schools. In addition to providing direct
service, physical therapists are also involved in health
maintenance programs and illness prevention programs, health
policy development, administration, education, research,
consultation, and other advisory services.
Physical therapists also apply many of the
therapeutic interventions identified and discussed elsewhere in
this chapter. Therapists using these procedures consider them
fundamental tools in their repertoire. Among these procedures are
acupressure, myofascial release, craniosacral therapy, massage
techniques, Alexander technique, Feldenkrais method, and
Such procedures are rarely included in the
academic preparation of physical therapy students. Rather, they
may be learned through special programs with a select group of
practitioners who conduct continuing education experiences
throughout the country. Perhaps the inclusion of these procedures
in the clinical practice of physical therapy is evidence of the
belief by a growing segment in the profession that mind and body
are connected, but we do not know or understand all the
Several of these systems seem to share common
threads. The therapy is aimed at restoring the homeostasis of a
person's body-mind-spirit, using a comprehensive and holistic
approach. The emphasis is on promotion of health, prevention of
illness, and education approaches.
The philosophy of physical therapy is based on
an educational model; the objective is to help individual
patients help themselves to attain the maximum level of function
they are capable of. The decisions about treatment--what to do,
when to do it, and how much--are not made only on the basis of
experience with what "works." A general understanding
of the effects of an approach for a given condition is not
adequate justification for applying that method.
The professional literature of physical therapy
that appears in several refereed journals documents evidence of
the efficacy, or lack thereof, of particular treatment
interventions. Both quantitative and qualitative research methods
are used with increasing sophistication. A major effort by
physical therapists in academic and clinical leadership positions
and by the professional association has contributed to the
prominence of this kind of documentation for a wide variety of
physical therapy interventions.
Responding to a research mandate may be
difficult for some physical therapists who are using procedures
that are less well-known and not generally included in the
traditional academic preparation (Hariharan, 1993). Research may
be even more difficult for therapists whose work is entirely
clinical and whose academic preparation did not include training
in research methodology appropriate for clinical practice
(Soderberg, 1991). Nevertheless, the research mandate for the
profession today is clear: do it if it works, document carefully
what has been done, develop careful research studies to determine
the mechanisms involved, publish the results, and continue the
research until everyone understands what is being done and why.
As a corollary, a corresponding need has arisen for physical
therapists to obtain training in research methodology.
Physical therapist researchers currently
publish in major medical journals as well as the journal Physical
Therapy. The research covers a wide range of subjects related to
clinical practice and the underlying mechanisms of function
(Bohannon, 1986). Recently published work on the following
subjects illustrates the range: physical therapy treatment of
peripheral vestibular dysfunction based on clinical case reports;
impact of three posting methods on controlling abnormal subtalar
pronation; a comparison of three different respiratory exercises
in prevention of postoperative pulmonary complications after
upper abdominal surgery; motor unit behavior in Parkinson's
disease; a study of age and training on skeletal muscle
physiology and on performance; a study of the factors associated
with burnout of physical therapists working in a specific work
environment; and a study of the discrete behaviors that
differentiate the expert from the novice physical therapist.
Physical therapy began with a few women who
trained briefly and learned on the job how to help care for
seriously injured soldiers. The group grew dramatically, and the
length of training increased as the scope of work became apparent
and the amount of knowledge to impart expanded. With the
knowledge and technology explosions, physical therapy became more
sophisticated and moved into the mainstream of health care,
contributing in significant ways to patient care and to the
literature of research and practice.
Research on manual healing methods is needed in
four parallel and interactive directions:
* To determine the range of clinical benefits
for the many common physical complaints and problems treated by
therapists using these methods (e.g., back pain, headache,
whiplash, and chronic fatigue syndrome).
* To determine the degree to which a general
sense of well-being is enhanced by the various manual healing
* To evaluate the effect of structural
manipulation on body awareness (both visceral and external);
regulation of motion; range of movement; ability to cope with
stress; muscle tone and flexibility; growth, development, and
aging; autonomic function (neural control systems); electrical
patterns in muscles; immune system response; and cardiovascular
and respiratory function.
* To determine the physiological and
neurological mechanisms associated with specific manual healing
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Table 1. Some Equivalent Terms for Biofield
Ankh Ancient Egypt
Animal magnetism Mesmer
Arunquiltha Australian aborigine
Bioenergy United States, United Kingdom
Biomagnetism United States, United Kingdom
Gana South America
Life force General usage
M'gbe Hiru pygmy
Pneuma Ancient Greece
Qi (chi) China
Subtle energy United States, United Kingdom
Source: Provided courtesy of the Biofield
Table 2. Brief Features of the Major Biofield
Therapies in the United States
basis_Diagnostic procedures_Certification_Placement of
hands_Mental healing at a distance_Therapeutic intent__
Healing science_1978_Barbara Brennan_Open
system, incorporates chakras and psychic layers_High sense
perception_Yes, after completion of advanced study_Both on and
near the body_Yes_Treat the whole person and specific disorders__
Healing touch_1981_American Holistic Nurses
Association_Elements of therapeutic touch, healing science, and
Brugh Joy's and other work_Tactile assessment_Yes_Both on and off
the body_Yes_Whole person, specific disorders__
Huna_Traditional Hawaiian__Involves mana
(universal force) and aka (universal substance)_Various_No_Both
on and near the body_Yes_Heal mind and body__
Mariel_1983_Ethel Lombardi_Vibrational energy
is transmitted from a higher source through the practitioner to
the patient, affecting cellular memory and the endocrine
system_Tactile assessment_No_Usually off the body_Yes_Heal and
harmonize the life of the individual__
Natural healing_1974_Rosalyn Bruyere_Operates
on a belief in a universal principle of energy_Tactile
assessment_Graduates are ordained___Effect symptomatic relief,
assists in proper use of energy__
Qigong_Traditional Chinese__Qi flows through
the body in meridians and other patterns; Qi is delivered with
great force by many practitioners called qigong masters_Varies
with practitioners_Not usually_At the meridian points or at a
short distance from the body_Yes_Healing of biological
Reiki_Japan, 1800s; USA, 1936_Mikao Usui
(introduced by Hawayo Takata)_Spiritual energy with innate
intelligence, channeled through the practitioner; the spiritual
body is healed, it in turn is expected to heal the physical; Uses
rituals, symbols, spirit guides_Varies_Spiritual initiation
(i.e., the power to heal is given after training)_A few standard
hand placements (usually side by side; on the physical
SHENR therapy_1977_Richard Pavek_Biofield
conforming to natural laws of physics, with a discernable flux
pattern through the body_Conventional medical and psychotherapy
instruments with questions designed to discover repressed
emotional states_Yes, after internship. Practitioners meet
requirements of U.S. Department of Labor Occupational Code
076.264-640._Sequence of pairedhand placements, directly on the
body, arranged according to flux patterns, usually with one on
top and one underneath_No_Primarily emotional disorders and
Therapeutic touch_1972_Dora Kunz and Dolores
Kreiger_Practitioner restores correct vibrational component to
the patient's universal, unitary field_Tactile
assessment_None_Generally near the body_Yes_Nonprescriptive
healing of the whole person__
Note: Polarity therapy was omitted from this
table but is discussed in the "Combined Physical and
Biofield Methods" section of this chapter.
Table 3. Rough Equivalencies in Applied Physics
Physics Physicsa Electromagnetics Hydrodynamics
Air Qi Flux Liquid
Density Denseness Charge Viscosity
Wind Flow Current Stream
High pressure Sending handb Negative terminal
Low pressure Receiving handb Positive terminal
Friction Resistance Reluctance Friction
System Biofield Field Flowfield
Pressure Force Electromagnetic field Pressure
Pressure gradient Polarity Polar difference
Source: Provided courtesy of the Biofield
bIn some systems
Table 4. Controlled Studies of Biofield
Therapeutics With Humans
Subject No. of studies Significant resultsa +
Anxiety 9 4 (+2)
Hemoglobin 4 4
Skin wounds 1 1
Asthma and bronchitis 1 0
Tension headache 1 1
Postoperative pain 1 0
Neck and back pain 1 (?+1)b
Total 18 10 (2)
Percent of total 56% (11%)
Source: Benor, 1993.
aSignificance p<<.01; for values in
bPossibly significant results, but faulty
reporting or design prevented proper evaluation of the studies.
Table 5. Other Controlled Biofield Studies
Subject No. of studies Significant resultsa
Enzymes 8 3 (+2) (?+3)b
Fungus/yeast 6 4 (+1) (?+1)b
Bacteria 2 ?
Red blood cells 1 1
Cancer cells 3 1 (?+2)b
Snail pacemaker cells 4 4
Plants 10 7 (?+2)b
Flagellates 2 0 (?+1)b
Algae 2 1
Moth larvae 1 1
Skin wounds 2 2
Retardation of goiter
growth 2 2
Total 43 26 (3)
Percent of total 61% (7%)
Source: Benor, 1993.
aSignificance p<<.01; for values in
bPossibly significant results, but faulty
reporting or design prevented proper evaluation of the studies.
Robert Ward, an experienced osteopathic
physician-researcher, estimated that 10 percent of
osteopathic physicians use manual diagnosis and treatment
a great deal and that some 60 percent use them in
selected cases. Ward believes most patients receiving
primary care from osteopaths probably receive a
diagnostic workup involving manual diagnosis at some
time, particularly if neuromusculoskeletal problems have
been reported (Ward, 1994).
The energetic and oriental manual techniques are
categorized by some as massage techniques. However, in
this chapter the energetic techniques are addressed in
the "Biofields Therapeutics" section and the
"Combined Physical and Biofield Methods"
section, and the oriental techniques are addressed in the
remainder of the "Physical Healing Methods"
section. The energetic methods are considered to affect
the biofield--a field that is described as surrounding
and infusing the human body--by pressure and/or
manipulation of the physical body or by the passage or
placement of the hands in, or through, that energetic
field. These methods are based on traditional Ayurvedic,
Eastern or Western esoteric, modern therapeutic, or other
recognized and accepted systems of healing. Examples are
polarity therapy and therapeutic touch. The oriental
methods of treatment use pressure and manipulation based
on traditional East Asian medical principles to assess
and evaluate the energetic system (Jwing-Ming, 1992) or
to provide actual treatment that affects and balances the
energetic system. Examples are tuina (or tui-na),
shiatsu, acupressure, an-mo, and jin shin do.
These depictions can be seen in the Third Dynasty exhibit
in the National Museum, Cairo, Egypt.
The differences between direct and indirect contact are
analogous to the two methods of illuminating a neon
light. The first is to place the neon bulb in a strong
electromagnetic field. This is the simpler way, as it
requires no wiring or particular orientation; the bulb
will glow wherever it is placed. However, a great deal of
power is required for a given light output, and the light
fluctuates sharply with small fluctuations in the field.
The second method is to connect the neon bulb into an
electric circuit. This method requires wires and
knowledge of how to connect the bulb correctly; it
produces much more light with far less power, but the
light is less likely to fluctuate. Similarly, the
biofield is described as having both external field and
SHENR stands for Specific Human Energy Nexus. SHENR
therapy is described by Pavek as a biofield method of
treating the so-called psychosomatic and related
disorders by releasing repressed and suppressed
debilitating emotions directly from the body.
Qigong exercises are repetitive physical motions
coordinated with breath and mental efforts to move the qi
through meridians and other "channels." They
are gaining popularity in the United States. (See the
"Combined Physical and Biofield Methods"
Flow is much slower through human tissue and varies with
the person's health and emotional state.
An erroneous report, "New Technologies Detect
Effects of Healing Hands," in Brain/Mind Bulletin,
vol. 10, no. 16, contributed to this supposition when it
stated that one researcher, John Zimmerman, had measured
electromagnetic effects of healers' hands during healing
with a SQUID (superconducting quantum interference
device); actually, he made his measurements at the
healers' heads while measuring very low-amplitude
electromagnetic brainwave activity.
No one has yet been able to detect either current flow or
electromagnetic flux emanating from the hands of a
practitioner. Dry skin electrical impedance at the hands
is quite high, >10 megohms (10 million ohms).
Silver/silver chloride electrodes, as used in
biofeedback, measure skin conduction, not flux
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