Introduction

The medical benefits of massage therapy in cases of musculoskeletal abnormalities are gradually gaining recognition from health practitioners. However, one of the major benefits of Medical Massage is its clinical effect in cases of various inner organ disorders. In an attempt to bridge this gap, I, with the cooperation of Victor Gura, M.D. (Associate Clinical Professor, UCLA School of Medicine), have conducted a pilot study using 6 patients with a diagnosed arterial hypertension. Ross Turchaninov, M.D. advised on the protocol of this project.

Hypertension and control of increased arterial blood pressure are very important medico-social problems. Hypertension is considered to be a major cause of heart attacks and strokes. An interesting fact, however, is that out of all hypertension cases, only 10% of patients have an established cause explaining their condition. For example, narrowing of the aorta, adrenal tumors or glomerulonephritis produce hypertension secondarily. In 90% of patients the cause of hypertension is unknown. In such cases the patient has a so-called “Essential Hypertension” (EH). Modern conventional medicine recognizes a misbalance between the sympathetic and parasympathetic divisions of the autonomic nervous system as the initial trigger of EH. An increase in sympathetic tone produces arteriolar vasoconstriction with a following increase in the peripheral vascular resistance. At the onset these changes exhibit a transient character and the body uses self-regulatory mechanisms to restore the proper relationship between sympathetic and parasympathetic tones. This is why in earlier stages there are episodes of increased arterial blood pressure, without symptoms of hypertension. With time and repeated episodes of hypertension attacks, the body resets special receptors called baroreceptors in the arterial circulation to the new level, and elevation of arterial blood pressure becomes sustained. As you will see below, a correctly formulated protocol of Medical Massage therapy may play a critical role in controlling arterial blood pressure in some patients with EH.
First, I want to quickly review how methods of Medical Massage therapy affect the arterial blood pressure in patients with EH. There are three major mechanisms which practitioners should use to help patients with hypertension: balancing the sympathetic and parasympathetic divisions of the autonomic nervous system, vasodilating the vertebral arteries, and reducing peripheral vascular resistance. These three mechanisms are very intimately correlated. That is why I will discuss them together as parts of the same process.

The vertebral arteries arise from the subclavian arteries. They ascend through the cervical vertebrae and enter the skull where they unite to form the basilar artery, supplying the posterior part of the brain. The vertebral arteries also give off important arterial branches, which supply the entire spinal cord: the anterior spinal artery and two posterior spinal arteries. The pathway of the vertebral arteries through the cervical vertebrae is quite complex. The vertebral artery passes through the transverse foramina. Cervical vertebrae are positioned on top of one another such that these openings form a bony canal through which the vertebral arteries ascend.

Vertebral arteries have a very unusual innervation. The walls of vertebral arteries have their own sympathetic plexus innervation. This plexus regulates the constriction and dilation of the vertebral arteries. It follows that any irritation to this plexus may result in the constriction of the vertebral arteries. Even a minor facet joint subluxation (which may not even be visible by radiographic means) can produce such an irritation by slightly compressing the vertebral arteries. This may lead to a reduced amount of blood supply to the brain, which as an act of defense, will cause a further increase in the blood pressure in an attempt to compensate for a compromised perfusion volume. The result of this is an inevitable increase in blood pressure, or in other words, essential hypertension.

Other mechanisms that may cause a decrease in blood flow through the vertebral arteries are cervical spondylosis, emotional stress, and physical overload of the neck and upper back muscles. As a result of these, a hypertonus develops in the cervical muscles. In order to maintain proper brain function, its daily blood perfusion has to be approximately 2000 quarts of arterial blood. This rate is regulated by special vascular receptors in the arterial structures of the brain. Even a minor reduction in the amount of blood circulation triggers compensatory reactions such as an increased heart rate, increased cardiac output, and most importantly, an increased peripheral vascular resistance.
Peripheral vascular resistance is a major opposing force to the heart’s work. Every time the left ventricle ejects blood, the force of the cardiac contraction has to overcome the resistance of arterial vessels (especially on the level of middle-sized arteries in skeletal muscles). Thus, an increased sympathetic tone triggers arteriolar vasoconstriction, which increases peripheral vascular resistance. This results in the heart having to work harder to pump blood against an increased resistance. The body has a protective mechanism designed to safeguard the blood supply to the brain. If circulation in the vertebral arteries decreases even slightly, peripheral vascular receptors report to the vasomotor center in the medulla oblongata, and the heart rate increases. At the same time motor (efferent) impulses are sent to the vascular structures in the skeletal muscles to constrict and decrease local arterial blood flow. This change allows for extra amount of arterial blood to be available for the restoration of brain perfusion. The combination of an increased heart rate and an increased peripheral vascular resistance triggers hypertension. With a more persistent vasoconstriction of the vertebral arteries, the arterial hypertension becomes more enduring. This results in higher systolic and diastolic blood pressure values. The preceding example is only one scenario of EH. However, if a patient develops hypertension as a result of the pathological abnormalities we discussed above, Medical Massage therapy can play a critical role in the control of the arterial hypertension.
The theory of Vertebral Artery Syndrome as an etiological factor in EH was first proposed by Professor Dembo of the Leningrad School of Medicine in 1973. His work paved the way for standardizing Medical Massage treatment protocols in cases of Vertebral Artery Syndrome.

Treatment Method and Approach: The main objective of this pilot study was to determine whether or not the elimination of somatic abnormalities in the reflex zones (as was reported in numerous publications) would bring about an elimination of pain symptoms (neck, upper back, and headaches), increased range of motion, and hypertension reduction. The study was conducted by Boris Prilutsky with the cooperation and under the supervision of Dr. Victor Gura. Six participants were involved in this pilot study:
A 54 year-old Caucasian female.
A 65 year-old Caucasian male.
A 34 year-old Caucasian female.
A 32 year-old African American male.
A 60 year-old Caucasian male.
A 42 year-old Caucasian male.

All the patients have been diagnosed with hypertension, combined with somatic abnormalities: headaches, dizziness, pain and tension in the cervical and upper thoracic
areas, referral of pain to upper extremities, and range of motion restrictions in the cervical spine and the shoulder joints. Diagnostic evaluation of somatic components revealed abundant abnormalities in the skin, connective tissue zones, skeletal muscles, and the periosteum in the neck, anterior, lateral, and posterior surfaces of the thoracic cage, as well as in the upper extremities. Each patient received a treatment every other day for a total of 15 treatments, followed by a 2-week break, followed by an additional course of 15 treatments. Hemodynamic examinations were conducted prior to the start of treatments, and upon their conclusion. Note: It is necessary to take a break after 15 treatments in order to reset the receptors’ (including baroreceptors’) threshold.

The protocol for each session included:

Introductory Phase: Treatment started by releasing tension in the cervical and upper shoulder muscles using Medical Massage techniques in the inhibitory regime. This was aimed at reducing the sympathetic tone and restoring the balance between the sympathetic and parasympathetic divisions of the autonomic nervous system.

Main Phase: Work then proceeded to cardiac reflex zones in the skin, connective tissue, skeletal muscles, and periosteum according to the zone map of Glezer and Dalicho. Direct massage influence was generated on the areas of the vertebral arteries. Peripheral vascular resistance (in the skeletal muscle groups of the upper and lower extremities) was reduced by using a combination of different kneading techniques especially designed for this purpose.

Final Phase: Post-isometric muscular relaxation of the cervical musculature was applied.

Please keep in mind that this pilot study was conducted to determine if more scientifically organized double-blinded study should be designed. Thus results were not statistically examined due to a small group of subjects. However, I still think that these results give practitioners important information to discuss with other health practitioners. This information can potentially contribute to one’s professional ability, as well as to his or her private practice.

Results and Discussion: At the conclusion of the course of treatment all patients reported the disappearance of somatic complaints. It was also evident upon palpatory examination that clinical symptoms were eliminated in reflex zones in the skin, fascia, skeletal muscles and periosteum. As originally expected, the elimination of somatic abnormalities was accompanied by normalization of blood pressure and restoration of proper hemodynamics in all participants.