Journal of Manipulative and Physiological Therapeutics

2014 37:141. ^link

Graham Scarr

With reference to the recent paper by Kassolik et al. (2013) entitled ‘Comparison of massage based on the tensegrity principle and classic massage in treating chronic shoulder pain’, it would appear that there is some confusion between the treatment approach that considers shoulder mechanics from the perspective of the body as a functionally integrated unit, and tensegrity; although these two concepts are related they are not necessarily interchangeable.

Traditionally, orthodox medicine has considered joint function and treatment in an isolated, piecemeal-like way, using a system of levers and free-body analysis based on the workings of man-made machines described by Borelli in the sixteenth century, and that has not changed appreciably since (Ethier and Simmons, 2007); and it is refreshing to see shoulder biomechanics being applied from an ‘integrated function’ perspective in this paper.

The authors rightly point out that “according to the tensegrity principle, improper functioning of a single element of the shoulder system can cause disorders in other elements” (p 418), and their consideration of structures that are anatomically distant but mechanically linked to the shoulder is a reasonable approach to their formulation of a massage therapy. However, tensegrity is only part of the ‘integrated function’ perspective, and is actually a ‘structural design principle’ that recognizes tension and compression as being inextricably linked within the system and that should always be considered together (Levin, 1997, 2006; Ingber, 1998; Scarr, 2012). The title phrase: “massage based on the tensegrity principle” is thus misleading because tension pathways (fig. 5)¹ do not in themselves imply a tensegrity connection, compression elements have not been detailed (they are also more than just ‘bones’)⁶ and there is no evidence to suggest that the results had anything to do with tensegrity, as such; it is also unclear how the drawing in figure 1 relates to tensegrity.

While the authors clearly consider the shoulder to be part of a whole-body tensegrity configuration, it is suggested that this particular approach to treatment is primarily based on a view of the body as an ‘integrated mechanical unit’, and that the term ‘tensegrity’ is superfluous to this study. The sentence: “The tensegrity principle is based on directing treatment to the painful area and the tissues… that structurally support the painful area..” (p 418) is incorrect, because tensegrity is based only on the fundamental rules of physics (Levin, 1997, 2006); and there is also no such thing as a “tensegrity principle of massage” (p 418) or “tensegrity massage” (p 422), which do not mean the same as ‘massage based on the tensegrity principle’ in any case. Whilst all this might be considered as just splitting hairs, and it is recognized that these uses of the term ‘tensegrity’ may have been intended differently, they are frequently promulgated amongst clinicians and lead to a misunderstanding of what the (bio)tensegrity concept is really about. Tensegrity is part of the structural architecture of biology, from molecules to entire organisms(Levin, 1997, 2006; Ingber, 1998; Scarr, 2012), and is not a particular type of treatment but part of the basic science that should underpin what all clinicians do.

To conclude, the overall premise and methods that underlie this particular research do make a valuable contribution to our understanding and treatment of the painful shoulder, because it is considered in a wider anatomical and functional context than has often been the case in the past; but while a tensegrity-inspired approach to shoulder treatment is part of an ‘integrated function’ perspective, by definition, it is important that the distinction between these two concepts is maintained.

References:

Kassolik K, Andrzejewski W, Brzozowski M, Wilk I, Górecka-Midura L, Ostrowska B, et al. Comparison of massage based on the tensegrity principle and classic massage in treating chronic shoulder pain. J Manip Physiol Thera 2013;36:418–427. ^link

Ethier CR, Simmons CA. Introductory biomechanics: from cells to organisms. Cambridge University Press; 2007.

Levin SM. Putting the shoulder to the wheel: a new biomechanical model for the J Biomed Sci Instr 1997;33:412-7.

Levin SM. Tensegrity: the new biomechanics., in: Hutson M, Ellis R. (eds), Textbook of musculoskeletal medicine. Oxford University Press; 2006.

Ingber DE. The architecture of life. Scientific American 1998.

Scarr G. A consideration of the elbow as a tensegrity structure. Inter J Osteo Med 2012;15:53-65.