Out of scope of practice or just politics?

Part 1 

by Boris Prilutsky

As you may know, some time ago due to complaints Massage Magazine requested, to remove my article Specially designed medical massage protocol is the most powerful methodology for management of concussions symptoms and much more.

The main complaints were:

  1. All the information I'm presenting in my article is out of massage therapy scope of practice.
  2. Massage therapists cannot treat psychiatric disorders and certainly can't promote themselves as mental health professionals.
  3. Only healthcare providers can address concussions, massage therapists have no business in this cases.
  4. I didn't include references, supporting my statements.

Regrettably, Massage Magazine decided to give up. “Regrettably”, because if we would discuss the issues stated in this complaint, I am positive that everyone would be able to learn even more about our scope of practice and about other aspects of massage practice that could have arisen in a professional discussion.

Again, regrettably, and despite my promise to provide references, Massage Magazine didn’t allow me to respond to these complaints and removed my article. As far as references are concerned, I always had them. Only, in this case, I elected not to include them.

I have a friend, who is an MD, neurologist, and sports medicine expert, as well as Ph.D., and a great hands-on massage therapist.  He was a student as well as the right hand of Prof. Dembo. Much older than me, during the 1970s, he was my mentor and then took me to work in his group.  Almost 10 years later, he proposed me a partnership in private practice. We still are very close friends.

When I shared my frustration with him, he asked me whether within the editorial board of massage Magazine there were any professionals in our field, and if so, why didn't they allow me to answer to the allegations?  I had no answer for him at the moment. However, later, contemplating on the issue, I surmised that the magazine was subjected to so much pressure that the editorial board chose this way of handling the situation.

In my view, the magazine’s refusal to publish my rebuttal is a detrimental practice, not worthy of democratic society standards. I remember publishing a short article in “Massage Today.” It included the proposal to address trigger points. One lady disagreed with my approach. “Massage Today” published her disagreement and published my rebuttal a well. It so happened that my opponent agreed with me, but our personal agreement or disagreement was of little significance. More importantly, the readers of this professional massage magazine could learn from our discussion.

Having said all of the above, I actually want to compliment Karen on her courage in allowing me to clarify the situation by posting my reply on Massage Magazine FB page. Even though most likely, the amount of subscribers to a printed magazine is much greater than Facebook membership, it is some reconciliation after all.  Therefore, I will use this opportunity to present my position regarding allegations stated above.

1. All the information I'm presenting in my article is out of massage therapy scope of practice.

The concussion-rehabilitation protocol is nothing more than a massage protocol – a sequence of massage manipulations – effleurage, friction, petrissage, tractions, massage techniques to accelerate lymph as well as cerebral spinal fluid drainage etc. that I like any other massage therapist use in massage therapy procedures.  Those of you, who rented my instructional videos know that I perform all stated above techniques. If massage technique that I am proposing as a part of this protocol is out of massage therapy scope of practice then we all practice out of the scope of practice.

As for the protocol itself –it was developed by Professor Dembo and his research group in 1964 for a use of massage therapists just like any other massage protocol of Medical Massage.

The concepts presented in my article I learned in 1973 from the internal informative leaflet of Soviet Ministry of Health, the department number 4. In addition, I was trained in to perform hands-on massage protocol in the classroom.

2. Massage therapists cannot treat psychiatric disorders and certainly can't promote themselves as mental health professionals.

I never presented or/and promoted myself as a mental health professionals.

As you can find out from reading my above article, I didn't discuss psychiatric disorders in general, as well as, in no case, presented myself as a mental health professional. Obviously, the complainers neither read my article carefully nor did they listen to my video presentation. In the article, I talked about post-concussion psychiatric behavioral disorders as a result of post-concussion brain dysfunction. All the protocols that I propose were developed by scientists, clinically proven, and on top of this were proven many times by my personal clinical experience.

The following is an excerpt from my blog:

”The hands-on protocol starts from combining massage techniques for acceleration of cerebral spinal fluid drainage, lymph drainage massage techniques. It is followed by the lateral neck compression massage techniques, acupressure techniques for tension headaches and the full body medical stress management massage. To understand why this protocol is utilized with repeated success, I am referring you to how the biomarker was established, and summarize that the concussion biomarker is irregularities of the autonomic nervous system. After accelerating drainage of an excessive amount of cerebral spinal fluid, we immediately increase much-needed blood supply to the brain. However in order to sustain the normal cerebral circulation, normalization of autonomic activities is a must. No other methodology but massage therapy possesses this significant power/effect to balance sympathetic and parasympathetic activities. Again, the post-concussion conditions developing vicious cycle, such as secretions of excessive amounts of CSF, following by Insufficient blood supply along with dysfunctional mitochondria – intracellular source of reactive oxygen species, Programmed cell death and more, immediately reflecting in autonomic irregularity. In order to achieve sustainable results, a therapist must perform all techniques I mentioned above in order to restore blood supply and at the same time, stimulate autonomic activities to achieve the maximum possible balance.”

Thus accusing me of presenting myself as an expert for psychiatric disorders, is just as groundless as to blame me in proclaiming myself an expert in support and movement disorders, etc. I am a massage therapist, who possesses skills and knowledge in performing therapy by means of massage, which is the capability to address causes that produce pain and dysfunction. As human body has a potential to heal itself, by performing massage we stimulate this healing process.

3.   Only healthcare providers can address concussions, massage therapists have no business in this cases.

The answer to this questions has to do with the distribution of tasks.  Certainly, medical doctors have to diagnose the problem and prescribe the treatment plan.  However, it is the obligation of a massage therapist to execute the treatment.  The misunderstanding perhaps happen because the post-concussion rehabilitation protocol, so widely known and implemented for a long time in the Eastern Europe, is not very well known in the US.  So the permission to use the protocol comes down to the factor of its legitimacy.

I said earlier, it was developed by scientists and it has been tested by many years of implementation in the field.  Professor Dembo’s research established that the nature post-concussion biomarker was irregular autonomic activities.  It was a challenge to find references to support his research written in or translated into English. The best support for his research (in English) is this video that I discovered it accidentally, and very timely. Please watch the following video:

Autonomic Dysfunction and Concussion - Mayo Clinic

Random picked, 21 post-concussion patients demonstrated irregular autonomic activities. This is a very solid evidence. I would recommend reading the information scientifically based and clinically proven information on physiological effect of massage on human body.

Irregular autonomic activities are very sensitive phenomena.  When an individual suffers from a post-concussion encephalopathy, including irregular autonomic activities, he or she cannot control himself even under regular circumstances, which otherwise could be controlled by a healthy person.  Under these circumstances just an insignificant emotional or mental irritation can escalate into absolutely irrational behavior; to, what we would call, psychiatric behavioral disorder.

In a case of successful application of massage protocol, directed to address post-concussion phenomenon, including an approximate balancing or sympathetic and parasympathetic activities, in most cases, the development of brain dysfunction could be prevented, including movement disorders, dementia, as well as psychiatric behavioral disorder.

4. I didn't include references, supporting my statements.

Prior to answering the question of references I would like to post my own question to the complainers:  Will the list of references help a patient suffering from post-concussion encephalopathies?

The friend I mentioned earlier, told to me, that the first time Professor Dembo’s research paper was published in 1965 at “Physical Culture and Sports publications” and suggested that I could have given references to this publications. However, I wasn’t sure that searching in old Soviet magazines was the right approach in this case. At the time when Professor Dembo proposed the Post-Concussion Rehabilitative Medical Massage Protocol, the prevailing opinion in the contemporary scientific community was that the terms such as a stunned brain, hibernating brain cells, apoptosis or programmed cell death meant the same thing – a non-reversible cell death. That means that a reversible apoptosis as well as the post-concussion inflammatory response, weren’t possible because the brain was incapable of marshaling a post-concussion inflammatory response due to the selective permeability of the blood–brain barrier (BBB).

Today, 40+ years later many researchers support all that Prof. Dembo hypothesized and clinically proved. The outcomes were reproduced thousands of times.

At the bottom of my article, you can find limited but a pretty long list of references, supporting every sentence stated in my article.

However, my point still stands; will the list of those references help a patient suffering from post-concussion encephalopathies?

When Prof. Dembo proposed this concept and massage protocol, he was a maverick in this research and, therefore, couldn't offer any references because, as it was mentioned above, it was contrary to the prevailing opinion of the contemporary scientific community on the issue.  Yet has his method been less effective because of this?

In the interim, the friend I mentioned above, Dr. Ross Turchaninov, my kids, and my current partner convinced me to always present references, in order to avoid unnecessary “misunderstandings”. Ok, from now on I will always present references.  At the same time, I find this attempt to pretend, making a terrible disservice to our communities, including professional publications. Many times, following the given references within published articles, I discovered that they had nothing to do with presented subject relying on the fact that editorial board is not checking, or not  capable of check them. How about the readers? Do most of them ever follow or read references that come with each article?


When massage Magazine removed my article, without allowing me to reply to those complaints my partner wrote Karen Manahan editor in chief an emotional personal e-mail. To his and later to my surprise Karen decided to publish his letter.  To me, her decision seemed odd; to refuse me to publish a reply to complainers, and, suddenly, to agree to publish my partner’s letter? The readers might remember these sentences from his letter: ”Again, this information was classified. You actually might find some publications in some old Soviet scientific magazines, but it has never been published in English?" and, as a result, be left with the partial or wrong impression.

In my next post, I will include the text of his letter – the same text as it was printed in the editorial section of “Massage Magazine.”  My partner is not massage therapists or in any way connected to our field.  Therefore, in the next blog will offer my additional explanations and clarifications regarding the information he included into his letter.

Best wishes,

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