Touchy Topic Tuesday: What About This Four-Cups-of-Coffee Bombshell?

It’s been all over the news: a study published last week in Mayo Clinic Proceedings indicates that drinking more than four cups of coffee a day may be hazardous to your health, particularly if you are under 55.

The researchers found that younger men who passed the 28-cup weekly threshold – which works out to about four cups per day – had a 56 percent increased risk of death from all causes. Younger women who were heavy coffee drinkers had a greater than two-fold increased mortality risk. A cup was defined as eight ounces of coffee.

“The older people, over 55, were not affected by these high amounts of coffee,” study co-author Dr. Chip Lavie, a cardiologist at the in New Orleans, said in a video statement.

This directly contradicts oodles of other recent studies, which have linked a regular coffee habit to a range of benefits — from a reduced risk of stroke and Type 2 diabetes, to a protective effect against Parkinson’s disease.

So what’s that about?

Scientists, of course, are cautious, as are all the journalists who reported last week on this startling bit of news. Here at Practical Bodywork, however, we dare to speculate. And our totally un-researched, gut response was: Duh.

Because drinking coffee isn’t lethal. STRESS is lethal. If you are drinking thirty-two ounces of coffee, every single day, I may know nothing about you, but I can make a few guesses. Just by sheer statistical implication, it’s likely that:

This is assuming you’re not troubled with insomnia, headaches or anxiety, in which case, why are you even THINKING of drinking coffee?

No, assuming that you are a relatively healthy person without a trace of masochism, who savors her daily dose of mild stimulant, there is no reason for you to panic. But if you’re showing signs of even one of the bullet points above, you’re like the race-car driver who cleverly decides to cut his overhead by firing his pit crew.

In plain terms: when you are resting, that’s when your body does preventive maintenance. It uses sleep time, relaxation time and adequate vitamins to check the belts and hoses, change the oil, upgrade the transmission and clean the spark plugs. If you’ve got your foot on the gas, seven days a week, fifty-two weeks a year, I can guarantee you that something is getting overlooked.

Interestingly, the selfsame study disclosed that people over 55 can drink an unlimited amount of coffee with no statistical ill effects. I can only suppose that these people won the BMWs of the genetic lottery; revving their engines only tunes them up.

So coffee almost certainly isn’t Satan. Quitting coffee for the sake of quitting coffee makes no sense unless you’re allergic. But if you’re using ANY substance as a means of ignoring your body’s perfectly reasonable needs, that’s just asking for trouble.

The Traps of Treating Pain

Doctors admit that there are sometimes few good options for treating chronic pain:thistle-819x1024

Doctors hate pain. Let me count the ways. We hate it because we are (mostly) kindhearted and hate to see people suffer. We hate it because it is invisible, cannot be measured or monitored, and varies wildly and unpredictably from person to person. We hate it because it can drag us closer to the perilous zones of illegal practice than any other complaint.

And we hate it most of all because unless we specifically seek out training in how to manage pain, we get virtually none at all, and wind up flying over all kinds of scary territory absolutely solo, without a map or a net.

Is it any wonder that a plethora of alternative practices have sprung up for pain management, as well as a thriving industry in semi-legal pharmaceuticals? The author goes on to discuss the difficulties of managing pain in the standard way–escalating from non-narcotic to narcotic, prescribing as much as is needed to eliminate the pain, without “becoming the patient’s parole officer.”

This is an impossible line to walk. Missing in most of these discussions is the question: What’s causing the pain?

Because pain is ‘wild and unpredictable.’ It is highly individual; although it operates in patterns, it is unique to the person. We are beginning to suspect that it has as much do with the history of trauma, mental and emotional as well as physical, as it does with a specific injury or configuration (such as a ‘bad back.)

What’s your pain about?

The Five Stages of Healing (Bodyworker Edition)

Like a lot of other practitioners, I tend to suffer from bodyworker machismo. I spend my days treating other people’s pain, and ignoring my own. Which is exactly what I advise my clients not to do.

Woman and Snake

Recently, I hurt my foot. The technical description of what I did was tearing the plantar fascia on my right heel, after changing my running gait from heel-strike to ball-strike, and then doing yoga with a calf muscle in spasm. But that wasn’t my experience. My experience was that I got out of bed one day and my foot hurt.

So, for your edification and amusement, here are the five stages of Macho Bodyworker Healing.

1) Denial.

All I need to do is warm up, give my foot a rubdown, and it will go away. Like, in ten minutes. In a day or two. In a couple of weeks. Don’t mind me, I’m walking very slowly today. I’ll just stop running until this gets better. Dammit.

2) Bargaining.

I can’t afford to get this treated. I know all about plantar fasciitis, from that two-year bout with it I had, a decade ago. It’s not THAT bad. I’ll stay off of it for a weekend, roll my feet, wear my arch supports. Do some self-treatment on my gastrocs and soleus every morning, and evening, and several times during the day. See? All better!

3) Desperation.

It’s not getting better. I can’t afford to be crippled for two years, again. I can’t afford NOT to get this treated. I’ll call that Rolfer, what was his name? Brian Stern! He’s expensive, but so what? I’m crippled! My body is my livelihood! I have to keep up with two kids in the Franklin Institute! Help!

(Brian Stern is excellent at what he does. He restored considerable articulation to a pair of malformed ankle joints which were rusted stiff. Also, he is warm, approachable and sympathetic. Don’t you hate it when you go to a doctor, in desperate pain, and you get the sense that you are a boring nuisance to said doctor, and to most of his staff? That’s one nice thing about bodyworkers–most of them genuinely like people.)

4) Resignation.

Okay, that was great. My foot still hurts, though. I’d better do the foam roller every day, twice a day, and some gentle yoga. In fact, I should not skip the yoga even when I stop hurting. Because that’s what started this problem in the first place.

5) Exhibitionism.

All better! Mostly. I can walk right-left, right-left again, instead of thump-drag, thump-drag. I’ll do the foam roller for another week before I resume running. Meanwhile, I’ll describe this process in excruciating detail on my blog, so that others may learn from my foolish suffering.

Foam Roller Therapy: Why It’s Awesome

Practical Bodywork is thrilled to bring you this guest post by Jesse James Retherford of TAO-Fit.com.

Anyone who knows me is aware that I am a huge advocate of foam roller therapy, and for a good reason: it works. In my personal and professional life I have found that foam roller therapy is an incredibly valuable practice. It is an absolutely vital component of a well designed holistic fitness and health routine.

What is Foam Roller Therapy?

Foam roller therapy is simply one of the best methods available to treat and prevent injury. If you don’t own or spend any time using a foam roller (the main tool used in foam roller therapy), then get one. Start.  A foam roller is, in my opinion, one the best investments of time and money you can make when it comes to your long term health and fitness.

Foam roller therapy is the use of a foam roller for self massage. There are many different kinds of self massage tools out on the market.  Finding the right one can be a confusing and expensive process. I prefer to keep my tools super simple, inexpensive, and effective.  The self massage tools that I most often recommend and use are a Trigger Point Grid foam roller, lacrosse ball, golf ball, and a softball.

Foam roller therapy helps break down dysfunctional tissue caused by poor movement patterns, i.e. poor form.  It increases joint function, mobility, and range of motion. It reduces acute pain, speeds up recovery and healing, and it reduces injury.

Foam roller therapy gives you access to the powerful healing of deep tissue fascial massage, all at a very low price, and at any time of day, every day. Integrating foam roller therapy into your weekly routine will help you not only prevent pain and injury, but treat and quickly recover from an injury. It speeds up the recovery process between workouts and reduces the total amount of time you spend lame from an injury.  Using a foam roller after a hard workout is like injecting pure recovery directly into your tissue.  It allows you to have a challenging workout routine, while at the same time, minimizes the pain and injury cycle.

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Rolling your back

Want to read something that goes into a bit more detail about how foam roller therapy works? Want to learn how to do it? Read this.

When is the best time for Foam Roller Therapy?

Just about anytime is a great time for foam roller therapy. You can do it in the morning. You can do it in the evening. It’s great before a workout. It’s great after a workout. An important time for foam roller therapy is when you hurt. The best time for foam roller therapy is when you don’t hurt, because it really does help prevent you from hurting in the first place.

This is what this looks like for my clients: I often have a client who comes in for a workout session complaining about some minor pain in their knee, hip, back, or shoulder. These can be very frustrating sessions for the client. Whatever kick-butt workout I had planned gets ditched, because I don’t teach or train clients to exercise through the pain. If your knee hurts, then you can’t lunge or squat. If your shoulder hurts, then you can’t push or pull. The rule is: if it hurts to do… don’t do.

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Rolling your quads: scrumptious!

What does a workout look like if we can’t work out?

These are actually my favorite sessions to teach! I love it when someone shows up in pain.  Pain time is learning time.  These sessions are an opportunity to show them where their pain is coming from.  I can teach them how to treat and heal themselves. Instead of going through their regular workout, I pull out the foam roller and show them what and how to work on themselves specific to what they are feeling. I show them where the pain pattern is originating and how to help break it down.

Then we get them back on their feet and have them do the same exercise that was causing the pain. Nine times out of ten, they can perform the exercise with no pain. In the rare case that the pain doesn’t go away, I pull out the massage table and do deep tissue fascial massage. I follow up with corrective exercises to train their body to stabilize and move without pain. These are the most valuable sessions I offer. Teaching people how to move efficiently without pain. And more importantly, empowering them with knowledge, understanding, and tools in which they can integrate into their personal routine.

Foam roller therapy is a powerful tool in your fitness, health, and wellness arsenal. With consistent practice you can perform roughly 80% of the massage work that I do… on yourself. Eighty percent! That is powerful stuff. It means feeling better, better movement, getting more out of your workouts, improved posture, less time in pain, less time on the massage table, and you get more out of a professional massage since you are doing so much of the work on your own. When combined with a holistic training program, the benefits of foam roller therapy is well worth the effort.

This is from an email I recently received:
“I am told by 2 surgeons that I need hip surgery due to bone spur on right hip. Also have tight IT band. I am trying to avoid surgery and be pain free… Since I stumbled onto your website and started to do the foam rolling on all body parts I am pain free… Last surgeon said I have a tight IT band. Physio was targeting just the IT band and after reading what people have posted about rolling everything it made sense.  I have been doing physiotherapy for close to a year and this is the first time that I have found relief.”

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Rolling your IT band: not so much!

 

Interested in learning more? Check these out:
Foam Roller Therapy For Beginners
How To Treat and Prevent Injuries
Foam Rolling The IT Band
A Common Cause Of Sciatic Pain – Self Treatment
Self Treatment For Plantar Fasciitis

In the interest of full disclosure, I am an affiliate for Trigger Point Therapy. This means that if you purchase one of their products after clicking one of these links, I will get a small commission. That said, the only reason I am an affiliate for their products, primarily The Grid, is because I believe in it 100%.

Jesse James Retherford is a coach and therapist in Austin, TX. He helps his clients heal from the dysfunction of chronic pain and injury, recover and rebuild pain free posture and function, and propels them into the best condition of their lives so they can thrive physically, mentally, emotionally, and spiritually in all aspects of their career and life.  Find out more and sign up for his blog over at www.TAO-Fit.com

What to Do When You Can’t DO Anything

As many of you know, my brother-in-law, Leif, is currently battling a rare form of cancer called mantle cell lymphoma. He’s young, formidably strong and has one of the healthiest lifestyles of anyone I know. We went up to Maine to visit him last week.

Rain

It’s impossible to describe what it’s like to watch someone you love go through a terrible experience. As far too many of us already know, cancer treatment is not only brutal, but chronic; it just goes on and on. Coping with chronic is qualitatively different from coping with a crisis, like getting hit by a bus; getting hit by a bus has a narrative arc that you can move through. Getting cancer is like setting up house in the middle of a freeway.

Most of us, of course, want to be able to walk into a crisis and fix it. Feeling helpless in the face of suffering is thus one of the most difficult states of mind we endure. So what can we do about that? Here are a few suggestions.

•  Never underestimate the healing value of mundane service. Wash dishes, clean floors, do laundry, run errands, cook a healthy meal. These tasks are particularly helpful by virtue of the fact that they are infinitely renewable, and can be done without thinking too hard.

• Just be around. Send notes, send gifts, make phone calls. They’re appreciated.

• Don’t say, “If there’s anything I can do, give me a call!” Instead say, “Would it be helpful if I brought a meal, did laundry?” People under stress are often too overwhelmed to be proactive in asking for help. Use your common sense, double-check, and listen to the answers.

• Meditate. Here is Ken Wilber:

…Foremost among these practices is the one known as tonglen, which means “taking and sending.” The practice is as follows:

In meditation, picture or visualize someone you know and love who is going through much suffering–an illness, a loss, depression, pain, anxiety, fear. As you breathe in, imagine all of that person’s suffering–in the form of dark, black, smokelike, tarlike, thick, and heavy clouds–entering your nostrils and traveling down into your heart. Hold that suffering in your heart. Then, on the outbreath, take all of your peace, freedom, health, goodness, and virtue, and send it out to the person in the form of healing, liberating light. Imagine that they take it all in, and feel completely free, released, and happy. Do that for several breaths. Then imagine the town that person is in, and, on the inbreath, take in all of the suffering of that town, and send back all of your health and happiness to everyone in it. Then do that for the entire, state, then the entire country, the entire planet, the universe. You are taking in all the suffering of beings everywhere and sending them back health and happiness and virtue.

When people are first introduced to this practice, their reactions are usually strong, visceral, and negative. Mine were. Take that black tar into me? Are you kidding? What if I actually get sick? This is insane, dangerous! When Kalu first gave us these tonglen instructions, a woman stood up in the audience of about one hundred people and said what virtually everybody there was thinking:

“But what if I am doing this with someone who is really sick, and I start to get that sickness myself?”

Without hesitating Kalu said, “You should think, Oh good! It’s working!”

A strange thing begins to happen when one practices tonglen for any length of time. First of all, nobody actually gets sick. Rather, you find that you stop recoiling in the face of suffering, both yours and others’. You stop running from pain, and instead find that you can begin to transform it by simply being willing to take it into yourself and then release it. The real changes start to happen in you, by the simple willingness to get your ego-protecting tendencies out of the way.

–Ken Wilber, ‘Grace and Grit,’ 247-49

This doesn’t have to be a big dogmatic deal. You don’t have to let anyone know you’re doing it. It’s a practice that may help you to be more present, less anxious, and less visibly freaked out. Lots of us want to ‘be strong’ for our loved ones, but what does that mean? Stoicism? False cheer? Pretending nothing’s wrong?

Tonglen meditation can help you stop ‘doing’ and move into ‘being,’ which is where authentic connection lives.

The Smoking Gun

widely-reported study finally traces the mechanism by which massage therapy reduces pain and promotes healing:

They found that massage reduced the production of compounds called cytokines, which play a critical role in inflammation. Massage also stimulated mitochondria, the tiny powerhouses inside cells that convert glucose into the energy essential for cell function and repair. “The bottom line is that there appears to be a suppression of pathways in inflammation and an increase in mitochondrial biogenesis,” helping the muscle adapt to the demands of increased exercise, said the senior author, Dr. Mark A. Tarnopolsky.

When you reflect on the fact that non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen not only retard healing, but have been linked to severe gastrointestinal disorders, renal problems, heart attack, stroke, erectile dysfuntion, and other side effects including death, your cost-benefit analysis may be altered. It may be cheaper in the short term to pop a pill for pain relief, but getting regular massage could save a bundle on long-term health care.

The Roots of Chronic Pain

New research shows direct hormonal links between childhood trauma and adulthood disease:

There are two pieces of information that really provide the bridge to understand the connection between emotional trauma and adult disease, and the HPA axis is one of those pieces. The other is epigenetics. It starts with the hypothalamus in the brain, so that when we perceive any kind of threat to ourselves through the senses, through eyes or ears or nose or touch or whatever, that message comes into the brain and hits the hypothalamus. Then hypothalamus sends the message to the pituitary gland, which sits just below it, which in turn sends the message to the adrenal glands, which sit on top of each of the kidneys. This generates the flow of adrenaline and cortisol in the body. Adrenaline and cortisol are the hormones of stress. So there’s a connection between the hypothalamus, the pituitary, which is part of the endocrine system, and the adrenal gland, which is part of the immune system. That means that what happens to us emotionally affects our immune and endocrine functions.

When that happens early in life and chronically, it disregulates that whole system. “Trauma” means that stress is occurring over and over again chronically, so the HPA gets revved up and stays in the red zone. It upsets literally all of our physiology, activating the genetic proclivity we might have for whatever disease, setting the stage for it in the beginning, and oftentimes those systems don’t appear later in our lives until after our reproductive years. There is often a total disconnect between those diseases and its root in early chronic emotional trauma.

This is something I’ve suspected for years. I’ve noticed a strong correlation between my clients with chronic pain conditions–fibromyalgia, migraines, PTSD, anxiety, and vague neurological disorders such as primary lateral sclerosis(PLS)–and explicit or implicit childhood trauma. Often these clients have been further abused at the hands of a Western medical system which dismisses their pain and disability as ‘psychosomatic’ because doctors cannot pinpoint a specific cause.

As the linked article goes on to discuss, it is much harder to reverse this process than to prevent it. But that doesn’t mean there’s no way of addressing it in adulthood. The nervous system is plastic; if it is possible to mess it up through repeated stress, it is also possible to re-wire it. Bodywork is an excellent place to start. Massage therapy, craniosacral therapy, andnetwork spinal analysis all work directly and gently upon the nervous system to stimulate release of trauma and deep relaxation.

This is not a rapid process. Generally speaking, the more deeply rooted the trauma, the longer it takes to unwind. Our ‘silver bullet’ medical system tends to want to treat everything with surgery or a pill; nobody likes to hear that chronic conditions are, well, chronic. On the other hand, spending an hour or four a month on a massage table is a lot more enjoyable than pills or surgery. Isn’t that a piece of good news?

A Tip for Young Healers

Several years ago, a guy from my yoga class offered me a ‘free nutritional counseling session.’ He was a student at a holistic health program and needed to get practice credits. I said sure, why not–even though I’m pretty confident that my nutritional needs get met, and have the bursting health to prove it, I can always learn something new. Besides, I was suffering from chronic tendonitis in my ankle at the time, and was consulting every available source for some insight into healing it.

When we set up a place and a time to meet, I told him about the ankle, along with some contextual information about the place and time of my Pilates class. It was obviously superfluous and boring to him, because after two more confirmation calls, he showed up in the wrong spot.

I was annoyed. So annoyed that I refused to reschedule an appointment, even though it was ‘free,’ and even though he wasn’t upset about our ‘miscommunication.’ Because it wasn’t a ‘miscommunication.’ The screw-up was entirely due to the fact that in the course of three conversations, he failed to pay attention to 95% of the words coming out of my mouth.

And in my opinion, listening is the most important skill an aspiring healer can practice. If you don’t do that, all your other skills are worthless.

Because however much you know, you don’t know more than a tiny fraction of the information out there. You don’t know what your client knows, or has tried. You don’t know what you’re doing, most of the time. Most problems are things you can’t fix. Very often, the only real service you can provide is to listen, with your full attention, to whatever your client needs to tell you.

This is a service because most people don’t get anywhere near the amount of attention they need. Particularly when you’ve got chronic health concerns, people don’t want to hear about them. It makes them uncomfortable; they want to fix it, they can’t, they get frustrated. Healthcare professionals are overscheduled, overworked and often underpaid.

One of the worst things about chronic pain and illness is the overwhelming sense of isolation it can induce. I was coping with that, in my bout with tendonitis–as a bodyworker living in a fourth-floor walkup in New York City, having chronic ankle problems was literally crippling, on many levels. The last thing I needed was for some jackass to come along and ‘help’ me by inundating me with first-year New Age nutritional information, most of which I’d known since the age of six. I just needed someone to listen to my long, boring saga of Pilates classes, acupuncture, MRIs, chiropractors, glucosamine, chondrotin, ankle braces, orthotics, pain, and loneliness.

That should have been easy. So if you’re getting into a healing profession in order to ‘help’ people by telling them all the brilliant things you know, examine your motives. Who are you really talking to?

When Stress Is The Problem

How many holistic healing practitioners have you encountered who piously urge you to ‘eliminate stress’? You’re not ‘living the life’ unless you’re ‘free from stress’!

Just makes you want to smack ‘em.

Because stress happens. If your life is entirely free from stress, you’re either a sociopath or you’re dead. You can eat healthy, exercise, meditate, get counseling, get a better job, live a ‘soul-centered life,’ and you are still no more immune to death, disease, anxiety, uncertainty, and sudden traumatic upheavals than anyone else. A huge problem with New Age evangelists is that they try to use their beliefs, habits and mantras as talismans against evil–if I just chant ‘Love is Everywhere’ often enough, everyone will love me and nobody will ever die!

Recently, dear friends, I left my day job to run my business full-time. In the space of two and a half months I came down with two colds, an ear infection, and lower back spasms that lasted two weeks. Luckily, I do not believe that ‘psychosomatic’ means ‘it’s all in your head, so just Think Good Thoughts!’ I have a realistic understanding of the mind-body connection, which dictates that emotional stress can lead to a less-effective immune system and a hyperactive nervous system, and there’s not always an easy way around it. So I followed my own advice, put my daughter in the stroller and walked for miles and miles. In a little while, the colds, ear infection and spasms cleared up, and I continued evangelizing. ;-)

So I prefer to talk about ‘stress management techniques’ rather than ‘living a stress-free life.’ That way, when you smash into one of life’s brick walls, you say to yourself, “Ah! A brick wall! Let me mix myself an iced tea while consulting a map,” instead of, “OMG! This wasn’t supposed to happen! I must be a Bad Person! Commence self-flagellation, or flagellation of others!”

I could go off on many Prescriptions for Life, since I’ve been signing up for a whole lot of holistic mailing lists lately, but in order to restrict myself to my purported area of expertise, I will confine myself to a few Tips for Stress-Induced Lower Back Pain.

  • When it’s in the acute stages, try to sleep on your back with a bolster under your knees, and a rolled-up towel behind your neck. This keeps your spine in a neutral position, and allows the spasming muscles to get over their freakout with a minimum of interference.
  • Hydrate. Drink a ton of ice water, lemon water, iced tea and diluted fruit juice. You can intersperse this with strong liquor (great muscle relaxant!) as long as you adhere to the ‘rinse cycle’ principle; one virgin cranberry seltzer for every alcoholic drink you consume.
  • Take it one day at a time. Walk as much as you can. Sit on a yoga ball and bounce; this loosens your hip flexors, which are key in stabilizing your lower back.
  • Get a massage! It won’t fix the pain right away, but it will address the spasming muscles, and send your brain into a theta-wave state which will reduce your stress reactions in the longer term.
  • Go to a yoga class, once the pain is less acute. Yoga will balance your body all over, releasing restrictions far from the area of pain which may be contributing to it.
  • Tylenol won’t kill you if you take a couple. Just don’t make a long-term habit of it.

Massaging the Violin

Science has finally come around to studying massage, sort of:

Massages Ease Low Back Pain – NYTimes.com.

…Each of the massage groups received 10 weeks of treatment, and at the end of that period, all three groups had some improvement, as measured by their answers to 23 questions about performing routine activities without help — for example, climbing stairs without using a handrail or getting out of an easy chair by themselves. They were also asked to rate the degree of their back pain symptoms on a 10-point scale.

Those who received massage scored significantly better on both symptom and function tests, and they spent less time in bed, used less medicine and were more satisfied with their current level of back pain.

As much as this supports my bias, I have a quibble with studies which look at ‘massage’ as a generic unit, as though it were the functional equivalent of taking a pill. All massages are not created equal, just as every body is unique. There’s as much difference between a rub-down by rote and a master massage as there is between a C-major scale and an encore by Itzak Perlman.

Recently I got a Swedish massage at a local spa, courtesy of Groupon. It was a screamingly frustrating experience. The therapist applied some standard moves to the surface of my skin, regardless of whether the muscles underneath were tense, knotted, spasming, or comparatively relaxed. Areas which needed little attention got far too much of it (why spend 10 minutes frictioning the iliac crest? Because it’s there?) whereas the problem spots felt all the worse for having been teased. The aggregate effect was to bring all my imbalances into sharp relief, and leave me feeling desperate for another massage.

This may be an effective marketing tactic, but it sells massage therapy terribly short. A good massage therapist will be able to feel those knots, adhesions and spasms, and perform any number of targeted actions to release them. As I havewritten at length, the area where a client hurts may not be the actual source of the problem; lower back pain can often be traced to restrictions in the legs, hips, chest and even the feet. Although it’s difficult to figure out where these restrictions might be from an initial assessment, it’s pretty obvious once you get your hands on them.

The article goes on to state, “It is unclear how massage eases back pain, but the researchers suggest it may stimulate tissue locally or cause a more generalized central nervous system response.” Hello? How much more vague can you get?Obviously massage is ‘stimulating tissue locally’ and causing a ‘generalized central nervous system response’ (it’s frequently called ‘sleep,’) but if the researchers can’t pinpoint anything more specific than that, there’s a communication breakdown somewhere. Either they’re not asking the massage therapists any questions, or the therapists themselves aren’t clear about what they’re doing.