In the 1984 film “The Karate Kid,” martial arts sensei Mr. Miyagi heals his wounded disciple Daniel by rubbing his hands together vigorously and massaging Daniel’s battered leg.
Fanciful as that scene might be, it’s not as far-fetched as it seems. In Japanese texts and artwork dating back hundreds of years, deep tissue massage was often used to speed up injured martial arts fighters’ recovery, according to Yoichiro Tsujii, a renowned physical therapist from Japan.
Back in the 1970s, Tsujii studied various forms of pain treatment therapy then in use and found many of the techniques were “already developed in Japan, especially among the martial arts practitioners in (the) Edo era (1603-1867) or long before,” he said in an email. Tsujii trained extensively in Japan, the U.S. and Canada before completing his Ph.D. in neuroscience at Nagoya University in 1996, serving on its faculty during and after his studies.
The principles behind those therapies formed the basis for a treatment Tsujii developed and has been promulgating for about the last 40 years. Called myotherapy, it is a deep, soft-tissue massage that targets muscular pain by loosening scarred muscle tissue with the aid of a vibrating metal instrument, thereby stimulating blood flow to nerves in afflicted areas.
Hawaii’s only practitioner of myotherapy is Craig Nagata of Orthopedic Rehabilitation Specialists, a licensed physical therapist who studied with Tsujii in the early 1990s.
“There’s lots of other soft-tissue treatments out there,” said Nagata, who co-wrote a paper on the subject with Tsujii for the Journal of Manual & Manipulative Therapy. “We’ve had a lot of success with this treatment. People with chronic headaches, lower back pain, plantar fasciitis, any kind of ‘itis’ of the muscle, myotherapy treatment has been pretty effective at reducing pain, promoting healing and getting people back.”
Nagata said his interest in myotherapy stemmed from the early years of his practice when he noticed that his conventional training, which focused on conditions such as bulging discs and aching joints, was not giving patients long-term recovery. He started his own therapy procedures based on working with soft tissue, or muscle, and had good results with patients. He wound up taking some courses with Tsujii that confirmed his beliefs, and “then he taught me a better way of doing what I was doing.”
Nagata has patients who swear by myotherapy, such as pro golfer Mari Chun. The 2005 Kamehameha Schools graduate played for Stanford University’s prestigious golf program, but during her sophomore year she sustained a left shoulder injury and was sent to Nagata for treatment. She recalls getting “some bruising” during her first treatment, “which showed that my muscles weren’t very healthy,” she said. “Over the course of his treatment, I started getting some normal form in my muscles.”
Chun would go on to make the All-American second team at Stanford and win the Hawaii State Golf Association’s Women’s Open in 2013. Her injury was later traced to a chronic spinal condition, so she’s continued to get treatment from Nagata most summers except during the pandemic. She recently started getting myotherapy from him again as she pursues her golf career.
“Craig has been saving me a lot, because I’d go, and then I’d kind of get hurt, and then I’d see Craig, and he’s really helped me resolve a lot of these issues that I’ve been having,” she said in a phone call from Texas, where she was competing. “He helps release a lot of that tightness … to the point where it’s able to heal.”
A careful diagnosis
Tsujii, who now runs two myotherapy clinics in Japan, taught his techniques to several local physical therapists including Nagata during the early 1990s, but Nagata is the only one to continue with it. In those early years, Nagata said myotherapy was physically demanding on the therapists, requiring strength, flexibility and endurance in their hands and arms. Since then, Tsujii has invented the vibrating device, called a MyoVib, that makes the treatment less taxing on the therapist.
Tsujii said that instrument is the main difference between myotherapy and other forms of deep tissue massage.
“Any kind of massage and/or manual therapy is for the improvement of the blood supply to the part you treat,” he said. “Myotherapy uses the vibrator to increase the blood supply to the nerve roots.”
Nagata stresses that myotherapy should not be seen as a panacea for all pain; it is designed specifically for pain in the muscles. He himself has arthritis in his knees, which hurt when he stands or walks too much. “I could do myotherapy as much as I like, but it’s not going to make much of a difference because my problem is not primarily a muscular problem, it is primarily a joint problem,” he said.
Dr. Henry Lew, a professor at University of Hawaii’s John A. Burns School of Medicine and the director of Rehabilitation Medicine Education, while unfamiliar with myotherapy, said the concepts behind it sounded consistent with those of another therapy, extracorporeal shockwave therapy, which he has researched and found effective.
“The overriding theory is that you improve circulation, you reduce the spasticity, the spasm, because spasm causes pain,” he said. “It appears that although a physician would use shockwave and Craig would use myotherapy, although it’s different mechanisms, they achieve similar things.”
A careful diagnosis is required for myotherapy to be effective. Tsujii said that sometimes muscular pain manifests itself in places seemingly unrelated to injury. After a knee injury, for instance, “your back muscles and related viscera, like the intestine, will get stiffened, which will further tighten those muscles which create more bad circulation to those organs,” causing more pain.
“Pain is the sign of lack of blood at the (injured) part and the nerves that supply the pain region,” said Tsujii, who in addition to teaching physical therapy in Japan for 30 years also worked at hospitals in Philadelphia and Canada.
Nagata said that myotherapy requires entire muscle groups, or chains, to be worked on.
“We can’t just do spot treatment,” he said. “If somebody comes in and says, ‘Treat right there. I only want you to treat right there,’ then I probably wouldn’t treat them, because it’s not going to help them. … We have to treat the part above the injury, and below the injury to effect systemic change.”
Nagata said patients usually need three to five sessions to start feeling better, with most patients getting seven to eight sessions to get maximum benefit. “We rarely go 10 to 12 sessions,” he said. “If I gotta go that long, the patient’s usually not going to get better. It will get better to a point, but it stays at that baseline level.”
Alternative approach
Antoinette Nip, 61, an office worker for her husband, Dr. Vincent Nip, started suffering neck pains that she blames on marathon workouts, crouching over her computer and a meticulous housekeeping routine that has her “cleaning down to the baseboards.” She even had back surgery to alleviate her pain but has found myotherapy to be more effective. She tries to see Nagata on a monthly basis for “maintenance” purposes.
“I’d go for treatment, and then he’d tell me what to do and then I wouldn’t listen, but I’d be good to go for months,” she said. “And then it would happen again — I’d start getting tight, I couldn’t turn my head, so I’d go back to him.”
“Four treatments, and I’m good to go,” she said, adding that her husband, a plastic surgeon, also has started getting treatment from Nagata upon her recommendation.
Myotherapy also might be preferred for people who don’t want to take medication or undergo surgery.
“It’s an option, just like people go to acupuncture or chiropractic care,” Nagata said. “Like if I had back pain, I don’t think I’d want to have surgery right away. Would I try alternative treatments? Heck yeah.”
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Myotherapy
The treatment is offered at Orthopedic Rehabilitation Specialists. It is covered by most health insurance plans; a physician’s referral is required.
>> Where: 1600 Kapiolani Blvd. (Pan Am Building), Suite 600
>> Info: 808-979-0700
