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Speaker 1:
Welcome to the Rub, a podcast about massage therapy. I'm your host, kori Rivera, licensed massage therapist and information magpie. In today's episode, we're going to talk about massage tools and massage robots. Before we jump into the world of robots, I'd like to explain a change I'm making to this podcast. From now on, any massage activity that doesn't meet the definition of massage therapy will, as published by researcher Dr Anne Blair Kennedy in 2016, using data gathered from 32 experts in the massage therapy profession and as paraphrased by me is.
Speaker 1:
Massage therapy consists of rubbing, and it also includes health promotion and educational messages. It is for both self-care and health maintenance. The results of massage therapy depend on therapeutic relationships and communication. The results also depend on the training, skill and experience of the therapist. The setting of the treatment, such as a spa, hospital or shopping mall, may have an influence on the results. In short, massage therapy includes rubbing, but rubbing is not necessarily massage therapy. I first heard someone express true concern about massage robots in October of 2023. I can be precise because it was an interview and I have a recording.
Speaker 2:
It was one guy there from California. He was in the beauty world, but he dropped some gems too. He told us that they're already like working on ways to replace massage therapists with robots.
Speaker 1:
I was a little surprised and honestly kind of brushed it off. Massage therapy is too complex for a robot. But then I heard concern about robots again about a month later, and then a study titled Robotics in Massage came out of Mayo Clinic. And when a major hospital system that takes pains to be seen as a leader in their field publishes about massage robots, you've got my attention. So this is the first episode about what people are calling massage robots.
Speaker 1:
Let's start simple. All robots are tools, but not all tools are robots. I looked up several definitions of tool and my favorite is the use of physical objects other than the animal's own body or appendages as a means to exert the physical influence realized by the animal. The definition says animal because it's from a 1973 paper called Toolmaking and Toolusing in the Northern Blue Jay, which immediately brought to mind images of blue jays wearing tiny construction helmets and high visibility jackets. So a tool is a simple machine. It doesn't have sensors or electricity. It's usually designed for a specific job, but versatility is great too. My favorite tool is a nice set of tongs to use in the kitchen. I'm a short human and reaching across a hot stove with my little T-Rex arms can be hazardous Bonus. With tongs, you can click them at people to get them out of the kitchen while you're working.
Speaker 1:
Humans have been using tools to assist with rubbing for thousands of years. China was using jade, marble and basalt stones for hot and cold treatments, at least as far back as 2000 BC. Nowadays, thanks to modern manufacturing, we have a wide assortment of options, many of which look like small pieces of modern art. Some of these tools are for self-rubbing. There's a flock of wooden foot rollers that look like giant, chunky Pandora bracelets or something your toddler might pull around on a string. There's the Theracane and Backknobber, both curvy plastic sticks with balls on the ends to help the people who are trying to use that door jam to reach that really awkward place between their shoulder blades. Other rubbing tools exist to make a massage therapist job easier. The Thumb Saver, which looks like a bright red plastic holster for your thumb, helped support my ligaments until I was able to figure out better techniques to protect myself. Eventually, my elbow game caught up to my thumb game better techniques to protect myself. Eventually, my elbow game caught up to my thumb game. My admittedly pointy elbows were just as sensitive and controlled as my thumbs, and while elbows are not very useful for delicate places like necks. They are dynamite for larger muscles. Until my elbows were up to the job, the Thumb Saver really did save my thumbs.
Speaker 1:
The cool thing about these manual tools from the Thumb Saver to hot stones and even tools unrelated to rubbing like knitting needles or pencils is that the more you practice with them, the more you can feel through the tool. When you first begin working with a rubbing tool, it's like you put on a pair of heavy work gloves and you really have to focus, like the way you did at the beginning of your massage education. Eventually, your nervous system fine-tunes itself to the tool. You can use it as an extension of your hand, including feeling tissue changes. The science on how this works is pretty split. One study found that fluency with a tool only happened when you were doing the task specific to the tool. If you used a tool for something new, say if you used a knitting needle to dig a hole, the connection wasn't the same. Another study looked at parts of the brain that process vision and unexpectedly found that the more people used a tool, the more their brain identified it as something different from their hand. People regularly report this feeling of oneness with tools, but figuring out what happens in your brain is another matter.
Speaker 1:
I'd like to make a very special honorable mention to a tool that gained a lot of popularity a few years ago the Fascia Blaster. The Fascia Blaster, which retails at 140 bucks, is a white rod with a row of four plastic flower shaped pieces. Fascia itself is a wonderfully complex topic, but the short version is that it's a web of connective tissue that runs through your body in a continuous network. In order to properly talk about the Fascia Blaster, I enlisted the help of HealWell friend Kathy Ryan.
Speaker 3:
I am Kathy Ryan. I'm a registered massage therapist and self-proclaimed Fascia nerd.
Speaker 1:
Kathy is the author of Traumatic Scar Tissue Management Principles and Practice for Massage Therapy. She's attended every international fascia research congress since the first one in 2007. Fascia is Kathy's jam. Kathy had this to say about tools in general.
Speaker 3:
So I mean for me as a practitioner, anytime I'm trying to make a clinical decision about how to use my hands or a tool or whatever, or a tool or whatever, I always begin with trying to figure out what the situation is and having a good pathophysiological understanding of what it is or what the situation is, before I try to decide what I'm going to do about it. Because without that understanding, it's kind of like, you know, poking around in the dark trying to find the light switch or whatever the case may be to. You know, figure out what I should be doing.
Speaker 1:
The Fascia Blaster's marketing makes claims about, quote, regenerating fascial tissue and quote bringing fascia care to the world and oh, by the way, casually mentions it will get rid of the cellulite on your thighs. You use the blaster by dragging or scraping the plastic flowers across your skin with a fair amount of pressure to quote break up the fascia. Please don't try to break up fascia. Deforming fascia by even 1% takes over two tons of pressure. Breaking it requires a scalpel. Both of these things will cause trauma to the tissue and a massive amount of pressure. Breaking it requires a scalpel. Both of these things will cause trauma to the tissue and a massive amount of inflammation. Kathy had this to say about cellulite.
Speaker 3:
I think the most common thing that's agreed upon out there is that we don't fully know yet what exactly causes cellulite. So if we don't know exactly what's causing it, I think it makes it more challenging for us to come up with effective ways of treating it. Because I think the biggest thing out there is that there are different ways of treating cellulite, but it doesn't seem like the effects are very long, lasting, so there's a sustainability component to it.
Speaker 1:
If you or someone you know has a fascia blaster, I recommend you repurpose it, maybe to hang wind chimes or tenderize those chicken breasts you're having for dinner. If talking about tissues is something you'd like to do more of, kathy would like to extend a direct invitation for you to Hewell Homecoming this September.
Speaker 3:
Well, HealWell Homecoming is coming up and lovely HealWell people have provided me with an opportunity to just do my fascial blah, blah, blah for four hours at Homecoming and then, on the heels of that, follow up with a two day scar tissue workshop where there will be some more fascia chat, you know. So people have questions, more questions about cellulite and fascia blasting. Well, we can probably chat about it in September.
Speaker 1:
Also, I've put Kathy's extended description of cellulite and inflammation at the end of the episode for all you other fascia nerds. To hear Back to tools A bit further down the path towards robots are electrified tools. The electrified tool that probably comes to your mind is a percussion rubber, the most popular of which is the Theragun, which debuted in 2008. Theraguns are a triangle-shaped handheld device with a blunt jackhammer-like knob, and the first Theragun sounded like a jackhammer too like a jackhammer too. There was a lot of customer feedback about the noise, and now they sound like this.
Speaker 1:
The first percussion tool was created in the 1950s by a man named Dr Robert Fulford, who was an American osteopath. The idea was that the tool would mimic to popement, a technique that's often seen during massage and movies, because it involves using your hands to create rhythmic whacking motions and thus is visually interesting. Percussion tools can be fine-tuned to pummel people with specific speed and pressure, and the tool can whack much faster and for longer than a human can so much faster that percussion therapy performed with an electric tool is sometimes discussed as vibration instead of percussion. The main difference between vibration and percussion is how deep the tool presses into the muscle, so a percussion tool will push inward toward the bone more than a vibration tool. Just what physical effects percussion results in is kind of up for debate. People who are interested in athletic performance are very keen to find out. I found a study that said percussion tools could increase range of motion but not increase muscle contraction. Another said that the tool increased muscle strength, explosivity and flexibility. A third said a percussion tool could help with recovery and muscle stiffness, but wasn't actually great for increasing performance. All of these studies were under 20 people, so it's not surprising the results were varied.
Speaker 1:
The research on vibration is quite different, but before we talk about that, we need to talk about why research on vibration is tricky. There are a lot of vibration tools on the market and they all run a little bit differently, which means it's difficult to compare studies if they aren't using the same device. There are two important measurements when you talk about vibration Intensity, which is sometimes referred to as magnitude, and frequency, int and frequency. Intensity and frequency. If you've ever driven on a road that made your teeth chatter because it hadn't been resurfaced for a while, you felt both frequency and intensity. Frequency is how often your car hits a bump. Intensity is how jarring it is. You might have noticed that if you speed up because you're trying to get through that bad patch of road, the intensity gets worse.
Speaker 1:
We know that certain kinds of vibration are bad for humans. High-intensity, low-frequency vibration can be harmful. That's vibration that is slow but very powerful. This kind of vibration is often found in handheld construction tools and can be considered a work hazard. Low-frequency vibration can also cause motion sickness.
Speaker 1:
But low-intensity, high-, high frequency vibration so fast but less powerful is used in medical treatments. Vibration might be applied by a handheld device or it might involve the patient standing on a platform that vibrates their whole body, handily known as whole body vibration. These treatments are being studied for a wide variety of uses, including pain management, but the one I think is really cool is to simulate exercise. Our bodies need exercise for a lot of reasons, but when it comes to bones and muscles we need the controlled stress called loading that exercise causes to maintain bone and muscle strength. But if you're medically frail or have problems like balance issues, it can be difficult and even dangerous to exercise. Whole body vibration therapy can simulate the loading of that muscle and bone that happens during exercise and it's been shown to increase oxygen consumption and blood flow. One study showed an increase in jumping ability in patients after the vibration therapy. You can find these whole body vibration machines at some gyms and of course they're advertised for weight loss, because really what isn't? But I don't believe that claim, and there's a lot of debate about commercial vibration platforms using the harmful kind of vibration.
Speaker 1:
Honorable mention in the not-quite-a-robot category goes to electric muscle stimulation. So I found this article that said the ancient Egyptians and later the Greeks figured out that electric fish could create shocks to relieve pain. Have a muscle ache, rub a fish on it. The most well-known electric muscle stimulation device today is not a fish, it is a TENS unit. Tens stands for Transcutaneous Electrical Nervous Stimulation. A TENS unit is a small device that sends out a low voltage current through electrodes that are lightly glued to the skin. Tens units treat pain, but we don't know for sure just how they do it and they don't work for everyone. The top two theories are causing a release of endorphins or possibly blocking nerve signals. We're not going to go deep into it today because it involves me saying things like voltage-gated sodium channels and muscarinic receptors and methionine and kafalin, and that's just boring. It's boring If all those words made you curious instead of bored? You can read the National Library of Medicine's TENS article link in the show notes. Tense units used to be very expensive and bulky, but my local pharmacy has ones that will fit in your pocket for about $40.
Speaker 1:
Like all treatments, they aren't recommended for everyone. Particularly people who are pregnant, have heart issues, cancer, deep vein thrombosis, epilepsy or bleeding disorders. So before you use the thing that delivers electrical shocks to your body, you should check with a physician, even if the device is sold over the counter or is a fish. And speaking of risks, nothing is perfectly safe, and that includes rubbing. Adding tools of any kind, particularly electrified ones, can increase the possibility of harm. There is a report of a vertebral artery dissection in a patient's neck after they had been using a percussion rubbing tool for a few weeks. Your vertebral arteries run through the outer parts of your spine and the word dissection means there's been a tear. Tears cause blood clotting and blood clots can cause strokes, which makes this a very serious concern. The case study said the patient reported neck pain, headache and dizziness, while percussion rubber disclaimers say you should not use these tools on your head, neck or near your genitalia. The people who make the percussion rubbers aren't very good at defining neck. A lot of their official demonstration videos show people using the device on what could anatomically be considered a neck.
Speaker 1:
Now let's get to the robots. What exactly is a robot? So a robot is a tool, but a tool is not necessarily a robot. As I said before, a tool is a simple machine designed for a set of tasks that don't have sensors or electricity. Okay, the term robot is super duper debated, especially right now with the advent of usable AI. For my purposes today, right this second, I'm going to say that a robot is a complex machine that does have sensors. Robots can move or manipulate objects, and they are at least semi-autonomous or maybe don't need human direction at all. Robots can often execute simple directions known as programs or protocols. Robots can use their sensors to adjust their programs to their surroundings. For example, a rubbing robot will have sensors that relay information about how much pressure it is exerting and will have a limit on how much force it's allowed to use. Due to their price tags, which can range upwards of $10,000, most rubbing robots of the past made their appearances in places like shopping malls and airports.
Speaker 1:
The first working rubbing chair is widely credited to Nobuo Fujimoto, a Japanese bathhouse worker. He invented it in 1954. It was made of wood and massage balls that made a kneading motion and moved up and down your spine. It was controlled using a handle on the side of the chair. His company, now called Fujiroki, still exists and is still making rubbing chairs.
Speaker 1:
Modern rubbing chairs have newer features that earn them the robot title. The massage balls can rub your back, spine and maybe your arms, which is marketed as 3D technology. A few can change speed, which is marketed as 4D technology, and since time is the fourth dimension, I guess that makes sense. But I was a little disappointed. The modern rubbing chair looks like it's designed to envelop you. Honestly, they look more like stasis pods on a spaceship than a chair.
Speaker 1:
The other rubbing robot you might have seen at the mall is a large human-sized blue tube with water in it, known as the dry water massage machine. Far from the almost accidental sci-fi look of a modern rubbing chair, the dry water machine leans hard into the futuristic aesthetic. The water is fully contained within the tube and in order to get inside, the tube rises up, much like the doors of the DeLorean in Back to the Future. The client slides onto the table beneath fully clothed and an attendant lowers the tube on top of them. What proceeds is essentially a human car wash. The water tube contains jets that pummel your body much like they would in a jacuzzi, but with you clothed and probably within smelling range of Auntie Anne's pretzel store.
Speaker 1:
A relatively low-end rubbing chair costs about $5,000. If a one-hour massage a week done by a human costs $100, a client could get a massage almost every week for a year for the same price. But there are certainly benefits to owning a chair. It's located in your home, you can sit in it for a few minutes. At the end of the day you don't need an appointment and if you're really enterprising you can charge your friends to use it when you throw parties. The tools that don't bother me tend to be the ones designed by massage therapists or used by therapists to do the job they're trained for. The thumb saver doesn't give me any bad feelings. The Theragun makes me jumpy when a client uses it on themselves, but it seems perfectly sensible when wielded by a professional who understands the nuance of their work. Rubbing chairs and dry water tubes are novelty toys For all their complicated moving parts, programs and price tags. Up to this point, rubbing robots have just been big toys, and a toy can't provide care.
Speaker 1:
And this is the part of the episode where I admit to you that when I started on this massage robot journey, I thought it would be a matter of interviewing some people making robots and seeing what the robot could do and then explaining it to you. But in trying to answer the question on everybody's mind will a massage robot take my job? I started running smack into ideas I've been grappling with for a while, ideas that I will now have to face head on instead of putting them aside for another day. Ideas like why are some massage jobs so different from others and who is controlling the narrative of massage therapy and why is it them? And what makes massage therapy so special, and could a robot imitate that?
Speaker 1:
I have a lot of ideas and I don't have answers for you yet, but I've decided that being confident in my words is more important than releasing episodes on a schedule, so I will continue to release news updates each month to keep you informed about the massage therapy profession. However, topical episodes will be released when they're ready, because both you and I deserve better than hasty conclusions. I'm Kori Rivera, massage therapist correspondent and information magpie. Thank you for listening and stay tuned. I didn't forget about all you fascial nerds. Here's a special moment from Kathy Ryan. Here's a special moment from Kathy Ryan.
Speaker 3:
But if one of the issues with cellulite is fibrosis of the septa, so there's like these little vertical type strands of tissue that go from the dermis down to the superficial fascia, down into the deeper tissue, kind of connecting all the way down.
Speaker 3:
And when it's really fibrotic, meaning that the collagen is very stiff and unyielding, it has a tendency that that's what's kind of causing that puckering or dimpling that we see.
Speaker 3:
So if fibrosis is kind of what's driving part of what the issue is with cellulite, in addition to a higher percentage of larger types of fat cells and it appears that the larger type of fat cells are there's usually a bit more of a definite separation between the dermis and the subcutaneous or the, you know, adipose layer of tissue and you see these larger fat cells that are betraying into the dermal layer and you see this pulling down of those septa and that's what creates the dimpling and puckering.
Speaker 3:
That's kind of what the more current science seems to imply. So you know, if fibrosis is one of the issues you know from the work in scar tissue that I do I know that in order for us to treat fibrosis we have to figure out who the influencers are, what causes fibrosis to happen in the first place. That's, I think, a more effective way of going about working with the tissue. Inflammation, excessive or prolonged inflammation, is known to be one of the primary drivers of fibrosis. If that is a factor in cellulitis, why would I want to pummel tissue to the degree that it's bruising and inflaming? And if there's something going on in that individual that they're predisposed to that anyway, you take the risk of making the problem worse rather than helping the situation.
