Skip to main content


Everyday science in the world around us: Making chocolate (#24/31)

There is no better, there is no more open door by which you can enter into the study of natural philosophy than by considering the physical phenomena of a candle.--Michael Faraday, The Chemical History of a Candle


Michael Faraday was right. Everywhere we look, the world around us contains so many possibilities for understanding natural philosophy (the old name for science), because we use it in our lives in so many ways every day.

Faraday was focused on the numerous processes at work in a candle; we're going to take the same approach in a somewhat different venue. And if, in addition to reading along, you replicate the steps described here, at the end, you're going to have a treat to reward yourself with.

Interestingly, you can find chocolate massage at some spas, so there is actually an even more direct connection between chocolate and massage than we're exploring here.

Source: accessed 24 August 2012


Our connection to it here in this post is just as a very nice part of the larger material physical universe that we're engaged in; maybe we'll talk about chocolate massage some other time.



Making vanilla-cream-infused chocolate balls

To make chocolate balls, we have to decide what we're going to do about their inside and their outside.

For this recipe, we're going to have a ganache inside--a smooth, soft mixture of chocolate and cream, infused with fresh vanilla.

The outside will be, for simplicity's sake, premade hollow chocolate shells. The reason I'm going premade on this is that I don't want to discuss tempering chocolate yet--that's a big enough topic that I want to treat it later on its own.

Here are all the ingredients that I'm going to use in this recipe.

The cream in the background, and the chocolate buttons in plastic bags and the vanilla pod lying on a saucer in the foreground are going to become the inside of the chocolate balls.


The hollow chocolate shells lined up in plastic trays in the center of the picture are going to become the outside of the balls. I buy mine at a nearby chocolate store; depending on where you live, this may or may not be an option.

Later, we're going to talk about how to make them entirely from scratch. But as I mentioned, there is enough to learn about that process that I want to get back to it later, so that we can quickly get to making some confections now.

Ingredients to start:

  • 8 ounces chocolate buttons or other kinds of chips or shaved or chopped chocolate for the ganache
    • Either dark or milk is ok, whichever you prefer. White may work every bit as well as milk or dark does, but since I don't have very much experience with white chocolate, I can't speak to it out of real experience.
    • You don't have to seek out buttons, but you do want as much surface area (the "amount" of exposed surface [Wolfram MathWorld, "Surface Area" accessed 24 August 2012]) as possible exposed, so that when you add the boiling cream, it melts reasonably evenly. You don't want to pour boiling cream over a chocolate slab. If you start with a block of chocolate, chop it or shave it so that you have lots of smaller pieces, exposing more surface area for the cream to contact.
    • You'll have ganache left over from this much chocolate for other uses--more chocolate balls, cake frosting, other treats.
  • 2 ounces extra chocolate for sealing off the filled chocolate balls
  • 1 cup pasteurized heavy whipping cream
    • This proportion of cream to chocolate is not absolute. When you try it, see what you think about the resulting ganache. If you find it too liquidy, you can fix that by adding more chocolate. If it's too stiff for your taste, you can make it more liquid by adding more cream to  the mixture. This proportion is a good first approximation, but feel free to vary the proportions to get the ganache to be the way you like it.
  • 63 hollow 3/4" chocolate shells
    • 3/4" inch is a very good size, since we're putting a creamy filling inside a crisp chocolate shell. If the person eating the chocolate eats it in two bites, the filling has the potential to leak out (especially later, when we're going to be doing other, very liquid, fillings, such as liqueurs). This small size is convenient for people to just pop in their mouths and eat in one bite, so there's no danger of the filling leaking out uncontrolled.
  • 1 vanilla pod
Microbiology of this photograph

The chocolate in the center and the foreground, for all practical purposes, do not support microbes, and are safe for storing at room temperature. They're best used within 18 months from manufacture, for the sake of taste, but as long as they're stored in a hygienic way, straight chocolate is a very safe food.

The biologicals in this photo, the vanilla pod and the cream, are where any practical risk of food spoilage is going to come in. Before it's been used in cooking, the dried vanilla pod can be stored at room temperature in a dark place out of direct sunlight for at least 6 months--some sources say for up to a year. If it dries out, or has visible signs of stinky mold, then you have a problem, but most of the time, it should stay moist and workable for 6 months.

After you've used it to make a ganache, you can reuse it a few more times, but it needs to be fairly soon--the cream that it is boiled in will determine its remaining shelf life. Before it's ever used, you should store it at room temperature; after boiling it in cream, you should store it in the refrigerator, and any reuse should take place soon after.

The cream is a good source of bacterial growth, because it's a great food source for them, but we're going to thwart that by boiling it, killing any microbes that may have been in it. Of course, others can establish themselves later, so we'll definitely practice safe food handling practices with it. The cream is the most immediate weak link in the food safety chain of chocolate confections, and it's the one around which we'll plan our safe food handling.

The reason I put such emphasis on safe food handling is this: Not only is it a matter of professional ethics; it is also one of respect.

A couple of years ago, I read of a benefit being put on at the Dkhw’Duw’Absh (Duwamish tribe) longhouse cultural center, to raise funds for their legal struggle for federal recognition of their tribal status.

The tribe is suing the federal government for recognition--asking to reverse a 2001 Bureau of Indian Affairs decision that the tribe had gone extinct.

--Duwamish tribe, "Duwamish Fight for Federal Recognition" accessed 24 August 2012


I emailed them to ask if they'd be interested in having me set up my massage chair at the event, and donating all money I earned from massage there to the legal fund that the benefit was set up for. They liked the idea, and so I showed up at the agreed-upon day and time.

While setting up my massage chair and learning my way around the center, I talked to others working at the event.

The woman managing the kitchen mentioned that they often used the longhouse dining room to put on philanthropic and other service events, but no matter what the event, anyone working in the kitchen has to have a food-service license that shows they are trained in the basics of safe food-handling. No exceptions.

Even if it's charity, anyone eating there has the right to expect that the people serving them a meal are doing it at a professional level of standards. No one, even at a charitable event, is expected to settle for less-than-professional quality of service.

As the woman explained, "It's a matter of respect.".

It's out of that spirit of respect for anyone that we served food to that I present the food-safety information here. Taste and enjoyment are very important, but keeping each other safe to continue to enjoy it is a foundational principle.




Step 1: Prepare the vanilla for infusion

Vanilla pods are really fruits of the vanilla orchid. The shiny textured pods contain the tiny black seeds of the orchid. We're going to include both the contents of the pod and the pod itself in our infusion.


The first step is to slice open on side of the pod and flatten it out. Then you can scrape out the seeds and other contents of the pod. They're seen on the right side of this saucer, beside the knife.


The seeds and the pod are going to go into the cream to bring to a boil on top of the stove.

Once the pod is used in this way, it still retains a great deal of flavor. You can reuse the pod 5 or 6 more times, but remember that--now that you have cooked it in cream--you need to store it in the refrigerator, rather than at room temperature, and you need to use it sooner than the 6-month-or-more shelf life a dried pod would have.


This is also your opportunity to put other flavorings in the ganache. I've just suggested vanilla here, but you're certainly not limited to that--you can put in other herbs and flavorings, to suit your taste. Your imagination is the limit here, as long as it's something you can safely eat or drink.



VERY IMPORTANT SAFETY NOTE: Never use essential oils of any quality less than food-grade essential oils for flavoring, whether you're making chocolate or any other food.

Because I as an MT, as well as the MTs in the reading audience, work with essential oils, it is critical that we be very clear on that distinction. We may often use the term "essential oils" to refer to topical products that we apply to clients' skin.

We must always make sure not to confuse the essential oils we use in massage with food-grade essential oils that we use in cooking or other ways of making food--no exceptions at all.

Many of the essential oils that we use in massage or aromatherapy are actively harmful or toxic if eaten or drunk.

Never, ever eat or drink any essential oil unless you are absolutely positive that it is a food-grade essential oil and nothing else. When purchasing it, unless you are absolutely positive from the label, never hesitate to feel free to ask the merchant you are purchasing from if it is food-grade essential oil, and safe to use in food and drinks.





Step 2: Infuse the flavorings in the cream

Put the seeds and the pod in the cream (plus any other flavorings if you've decided to use them), and bring them to a boil on top of the stove.



When the cream comes to a boil, we're going to pour them over the chocolate, so have the chocolate nearby and ready to go when the cream is ready.


Step 3: Melt the chocolate in the boiling cream

When the cream is boiling, pour it over the chocolate and stir to mix it thoroughly.



As the chocolate begins to melt, you'll see small chunks start to appear in the cream.


It will get browner and more evenly spread out as the hot cream comes into contact with the surface area of all the chocolate, melting it more and more.


When it's thoroughly melted, and you can't see any more white cream visible, then--if all has gone well--the shiny glossy surface of the mixture tells you that an emulsion of liquid melted chocolate suspended (or dispersed) in liquid cream is present.

This emulsion is the completed ganache.


Put the ganache aside to cool. Chocolate has a very low melting point; you've probably experienced having chocolate melt from just holding it in your hand. Chocolate's melting point is very close to human body temperature, so you don't want to put this hot chocolate in the chocolate shells right away.


Step 4: Fill chocolate shells with ganache

Once the chocolate has cooled to the temperature that you want to work with it at, you'll fill the chocolate shells with the ganache.


How do you know that the ganache is at the right temperature? You want it to be cool enough to put in the chocolate shells without melting them, yet not so cool that it becomes solid, stiff, and difficult to work with.

As you're working, you may find that the chocolate grows colder and becomes harder to work with than you want. You can always pop it in the microwave for 15-20 seconds, to make it more liquid again without heating it up too much.

What do you fill the shells with? You can using a frosting piping bag (my teacher's preferred method) or a food-grade syringe (my preference).

Fill up the shell's interior, but only up to the interior rim. You don't want to fill them up all the way, because you need to leave room to add a solid chocolate barrier to seal the creamy ganache inside.




Step 5: Sealing off the chocolate balls

Melt the remaining 2 ounces of chocolate to use to seal off the hole in the ganache-filled chocolate balls.

You can apply the chocolate with a piping bag or syringe to close off the balls in the same way you filled the balls, if you like, but I like to do this part by hand.

Of course, I make sure to wash and scrub my hands thoroughly before this step--20 seconds (time to sing the "Happy Birthday" song twice) under warm water, washing, scrubbing, and rinsing all exposed surface areas of the hand, shows care and respect for the well-being of the people to whom you're going to present these chocolates.

Dry your hands thoroughly before dipping them into the chocolate--not only is that an important part of handwashing hygiene, but you don't want to introduce water into your chocolate.

It sounds funny to say that melted chocolate is a very dry liquid--it sounds like a contradiction in terms. And yet, if you think about what "wet" means, it starts to make sense.

Melted chocolate is the same material as solid chocolate--it has just changed physical state, but there has been no chemical change. It's still exactly the same material.

When it was solid, it didn't have water in it. Adding heat to melt it gives the chocolate molecules energy to get further apart from each other. Because they don't hold on to each other as tightly as they did when it's a solid, it's softer and more pliable. But there's still no water in it, any more than there was when it was solid.

But if you add water to the melted chocolate, a chemical change occurs. It's no longer the same compound as it was, and it's not going to work the same way it did before the water was added.

Joe Pastry's blog shows what chocolate looks like when it seizes.

Source: Joe Pastry, "How to 'Un-Seize' Chocolate" accessed 24 August 2012


You can avoid this problem by not letting water get into your melted chocolate.

However, if water does get in, don't panic and throw away perfectly good chocolate!

It can't go on to become tempered chocolate or anything like that, but you can make chocolate syrup out of it by adding more liquid (more water, cream, and so forth). Seized chocolate changes from its original form, but it can be salvaged.

Joe Pastry's blog shows what the process looks like, and you can find detailed directions at the blog itself.

Source: Joe Pastry, "How to 'Un-Seize' Chocolate" accessed 24 August 2012


But let's try not to need to salvage the chocolate by not getting water in it in the first place.

After you've melted the 2 ounces of chocolate, you can dip your clean, dry finger in it to dab melted chocolate onto the open hole of the filled shells.

Dab enough melted chocolate to close the hole completely.


Remember, pure chocolate doesn't support microbial life. The cream, on the other hand, does, although it's temporarily free enough of microbes, since we boiled it. But other microbes can live in it after it cools, so sealing it off from the outside world, using pure chocolate, protects it from that possibility.

If you seal the ganache off totally, these chocolate balls can be stored safely at room temperature for several days.


The melted chocolate used to seal off the chocolate balls wil grow solid as it cools. If you're in a hurry, though, you can take advantage of the fact that changes in temperature can accelerate changes in physical state. You can stick them in the refrigerator or freezer to accelerate the melted chocolate turning solid.

You'll notice that there is unevenness and asymmetery in the finished balls, where I dabbed them with my finger to close them. That's fine; they're homemade--they shouldn't look as perfectly spherical as ball bearings, or as machine-produced chocolates.



As soon as the chocolate seal is solid, you can eat them, although some people prefer to wait a day or so, as the infusion continues to diffuse flavor in the ganache.

The best flavor is within 1-3 days of making them, although as mentioned, they'll actually last longer than that--either at room temperature, or in the refrigerator.

For serving them, though, the plastic tray the shells come in is very floppy, and can lead to dropping the chocolates.

Before moving the filled and sealed chocolate balls anywhere (whether to the refrigerator to speed up the sealing, or to the table for serving), I always slip a baking tray or other support under the plastic tray, or else I transfer the chocolates to a serving plate. I don't try to move the plastic tray unsupported, as that always ends in tears.

If you try this, I hope you enjoy it, and that you let us know in the comments how it turned out for you.




What flavorings do you like in chocolate?

Did you try making these chocolates?

Please tell us in the comments.



Delicious science: Making chocolate, by way of jawed fishes (#15/31)

Gnathostomata is the group of vertebrates [back-boned animals] with jaws. The term derives from Greek γνάθος (gnathos) "jaw" + στόμα (stoma) "mouth". Gnathostome diversity comprises roughly 60,000 species, which accounts for 99% of all living vertebrates. In addition to opposing jaws, living gnathostomes also have teeth, paired appendages, and a horizontal semicircular canal of the inner ear, along with physiological and cellular anatomical characters such as the myelin sheathes of neurons. Another is an adaptive immune system that uses V(D)J recombination to create antigen recognition sites, rather than using genetic recombination in the Variable lymphocyte receptor gene.

The group is traditionally a superclass, broken into three top-level groupings: Chondrichthyes, or the cartilaginous fish [sharks and rays]; Placodermi, an extinct clade of armored fish; and Teleostomi, which includes the familiar classes of bony fish, birds, mammals, reptiles, and amphibians.

The Gnathostomata first appeared in the Ordovician period (about 450 million years ago) and became common in the Devonian period (about 360 million years ago).--Wikipedia, "Gnathostomata" accessed 15 August 2012


Fast-forward about 360 million years to France, where, as the story has it**, a young apprentice chocolate maker accidentally pours boiled cream into a batch of chocolate, provoking his master to fly into a fury, and to rebuke him for being a slack-jawed moron--a "ganache", since they were, of course, speaking French.

But the apprentice was redeemed--long after his abusive master has been forgotten, "ganache"--that versatile mixture of chocolate and cream--lives on in confections worldwide.

** Is this legend true? No idea, but it's a widely-told story in chocolatier circles, in any case.


The word "ganache" is rooted in the Greek γνάθος (gnathos) "jaw", and that's how fossilized jawed fishes are connected indirectly through a fluke of history to delicious chocolate treats.


How to make chocolate ganache

A good working ratio is 8 ounces of chocolate to a cup of heavy cream, but this isn't brain surgery, or even baking--chocolate is tolerant of variation, and you can use more chocolate/less cream to make it firmer if you like, or less chocolate/more cream to make it more liquid.

Before you start, you should decide what you want to use your ganache for.

You can frost a cake with it,

Source: accessed 15 August 2012


or you can dip other things in it to serve as fillings (like this peanut-butter fudge),

Source: accessed 15 August 2012


or you can roll them into truffles and dust or dip them in combinations of chocolate and other toppings,

Source: accessed 15 August 2012



or you can flavor the ganache and enclose it in hollow chocolate shells,

Source: The Chocolate Man, accessed 15 August 2012



just to name a few of the things you can create.



For this introduction to ganache, let's just keep it simple and make a filling for hollow chocolate shells.




Should you wait 24 hours after scuba diving before getting a massage?


There are at least three issues involved in deciding how long to wait between massage and scuba diving, either massage before diving, or massage after diving.

  1. Does massage make DCS (decompression sickness, "the bends") more likely to happen, or does it make it worse if it does happen?
  2. Does massage cause a situation that makes false positives for DCS more likely, meaning that resources are used unnecessarily to diagnose and treat suspected cases that are not really DCS?
  3. Does massage cause a situation that makes false negatives for DCS more likely, meaning that real cases of a potentially life-threatening condition are ignored or missed?

There are theoretical scenarios for "yes" answers to all 3 of those questions that are all physiologically plausible, although there is no evidence yet to quantify what the real clinical risk from those theoretical risks are.

However, the safest way to practice is to wait 24 hours after getting a massage before scuba diving, and to wait 24 hours after scuba diving for getting a massage.

If the--admittedly very low--probability of DCS actually does turn into a case:

  1. The MT will never be able to prove that the massage did not cause, worsen, or mask the symptoms of DCS, and
  2. If the case turns adversarial and legal, there is information on record from Divers Alert Network DAN, the pre-eminent diving medicine research and education organization, where MDs and physiologists recommend waiting as the safest principle. A lawyer will be able to point to that recommendation, and argue that the MT violated standards of practice, such as they exist, by not waiting according to that recommendation.

For these reasons, POEM recommends spacing massage and scuba diving at least 24 hours apart in each direction as the safest course to follow.


Over at Massage Practice Builder's Wall on Facebook, an MT asks:

Years ago I recall reading somewhere that massage is contraindicated within 24 hours after scuba diving. In searching now, I'm finding contradictory information. Anyone have a reliable source re this? Thanks!


Divers Alert Network (DAN), the go-to site for medical information about diving, doesn't answer the question directly, but sketches out some of the issues involved.

A DAN physician recommends against deep-tissue massage before diving, but says nothing about it afterwards:

Massage & Diving

I've been told not get a deep tissue massage the same day as diving because it can cause DCS. Is this true?

You raise an interesting question about the possible association between massage and DCS risk.


* DCS = decompression sickness, colloquially called "the bends".

Wikipedia's article on DCS provides a very good summary:

Decompression sickness (DCS; also known as divers' diseasethe bends or caisson disease) describes a condition arising from dissolved gases coming out of solution into bubbles inside the body on depressurisation. DCS most commonly refers to a specific type of underwater diving hazard but may be experienced in other depressurisation events such as caisson working, flying in unpressurised aircraft, and extra-vehicular activity from spacecraft.

Since bubbles can form in or migrate to any part of the body, DCS can produce many symptoms, and its effects may vary from joint pain and rashes to paralysis and death. Individual susceptibility can vary from day to day, and different individuals under the same conditions may be affected differently or not at all.


Source: Inside the underwater caisson--building the Brooklyn Bridge, accessed 4 February 2012


DAN's article continues:

Some have cautioned against massage before diving. The clearest justification is to avoid muscle pain that might be attributed to DCS.


So he's not saying that massage makes a diver more likely to actually get the bends; he's saying that the massage may cause slight soreness afterward that can confuse the diver and the healthcare team into thinking it's a case of the bends: a false positive for DCS.

The other possibility, which the DAN physician doesn't address here, is that the diver could actually get the bends, but ignore the symptoms and fail to seek medical attention for a serious condition, thinking that the soreness comes just from the massage: a false negative for DCS. We'll discuss this more later on in this post.

A more speculative [theoretical, not yet backed up by evidence] concern is to minimize the development of micronuclei [micro-bubbles filled with gas, less than 10 µm in diameter: less than 1/8 the width of a human hair].



Source, first picture:, accessed 4 February 2012

Source, second picture:, accessed 4 February 2012


The nature and action of micronuclei has not been confirmed, but it is believed that they are the seeds from which bubbles form. There is a theoretical concern that tissue massage may induce [bring about] micronuclei formation and thus precipitate [promote] bubble formation. Tissue stimulation could also increase blood flow which may either positively enhance tissue gas elimination or precipitate problematic bubble formation.


See how things are interconnected? The claim that massage increases blood flow is problematic, but whatever the evidence that emerges for or against that claim, it can play a role one way or another in whether or not massage increases the risk of DCS.


As you can see, there is no clear sense of what massage might do and this effect would likely vary depending on dive profiles and intensity of the massage. We should note that massage has not been confidently associated with any of the cases of DCS that have come to us, and we are not aware of any study done to address this question. The clearest piece of advice is that deep tissue massage should probably be avoided, so that the potential of post-dive pain and diagnostic confusion are minimized.

Dr. Nick Bird MD.


A physiologist at the DAN site reiterates the precautionary principle:

Decompression safety, as with many things, is a matter of balancing strings of decisions so the net outcome is in your favor. My approach is to stack as many factors as feasible in my favor to compensate for the Murphy effect or chance that we see frequently in decompression sickness.

Neal W. Pollock, Ph.D.



What are some of the factors involved in decompression sickness?

In general, being at a healthy weight works in your favor, while being overweight is thought to slightly increase your risk of DCS. Exercise, especially forms that put strain on the joints, is discouraged right after diving, as it's considered a slight risk factor.

Dehydration is thought to raise the risk of DCS as well. so the tradition of encouraging people to drink plenty of water after a massage cannot hurt, and may provide a tiny bit of protection.

The prohibition against flying or mountain climbing within 24 hours after diving is a result of the way the gas laws work in physics.
The ideal gas law (the description of the way gases work) is:
PV = nRT
The (P)ressure times the (V)olume of the gas equals the (n)umber of molecules [amount] of the gas times a constant R times the (T)emperature.
(V)olume [the size of the nitrogen bubbles that migrate to the joints and cause the bends] is what we care about, so let's isolate that variable on one side of the equation.
So the behavior we care about is described by:
V = (nRT)/P
The (V)olume 
1. goes up as the amount of gas (n) goes up;
2. goes up as the (T)emperature goes up;
3. goes down as the (P)ressure goes up, and vice versa.
Since massage cannot add to the amount of nitrogen in the body, and in fact during the massage, the body will continue to shed excess nitrogen, I hypothesize that (1.) is not an issue.
Massage does raise skin temperature, so if you want to take a 100%-risk-avoidant path, you could say that the slight theoretical risk of that gain in temperature means that it's absolutely contraindicated. However, my experience in anatomy and physiology leads me to think that the distribution of the nitrogen bubbles throughout the entire circulatory system is not likely to be affected enough by local changes in skin temperature for that to be a significant risk. I hypothesize that the theoretical risk of (2.) is not going to make a real clinical difference.
(3.), in my opinion, is, of all the risk factors, the most likely to have an effect. I honestly don't know whether BP-lowering effects of massage could make the bubbles large enough to create a real increased risk. That would however, make an excellent study.
That was as far as I was able to take it with my basic physics; since I was rapidly getting in over my head (ha!), I put out the bat signal for someone with specialized knowledge on both sides of the question: physicist/MT Keith Eric Grant.
He was able to clarify the question more:
Like you, I can see the basis for diving and flying, but not for massage. Massage may change skin temperature, but I think that's mostly by dilating superficial capillaries; i.e. not an actual change in blood temperature. Nor would I expect that massage would create anymore of a change in pressure than moving around or sitting down.
The real issue here is solubility. Gas solubility does decrease with temperature, but your body is simply not going to let that change.
The pressure dependence of solubility isn't the ideal gas law per se but Henry's law.
That law states that the concentration of the dissolved gas will be proportional to the pressure. As I recall, commercial airlines pressurize to about 7000 ft.
I would think that the greater danger would be not from the massage but from not recognizing symptoms of the bends and doing a massage in their presence rather than referring to medical care.
I remember Donald Schiff talking some years back about a pilot coming in for a massage and referring him to emergency care.
I agree with his point about the risk of not recognizing decompression sickness.



Dive Injury Case Report


Case 8 – A diver with back trouble developed pain and motor weakness in his back and legs after 11 dives over three days complicated by altitude exposure. He had partial resolution during a long series of recompressions.

A 63-year-old male divemaster had made 50 dives during the past year and more than 200 lifetime dives. He had a history of degenerative lumbar disc disease and hypothyroidism for which he took synthetic thyroid hormone. He was on a liveaboard vacation and had made 11 dives over a 3 day period with a maximum depth of 128 fsw [feet of salt water] (39 msw [meters of salt water]) and a last dive depth of 100 fsw (30 msw). All dives were uneventful and used 32% nitrox [nitrogen-oxygen combination] with dive times according to an air computer.

He performed five dives the first day, four the second, and two morning dives on the third day. He stated he was well hydrated, well rested and had not consumed any alcohol. While returning to the boat after the second morning dive, he developed pain in his lower back consistent with his pre-existing disc condition, but he was able to climb onto the boat without assistance. He did not make another dive but opted to rest, have a back massage, and eat lunch. Feeling better, he participated in a walking tour of a local island which took him to an altitude of about 2,000 ft (610 m). During the tour, the back pain returned, and he had difficulty walking due to numbness in his legs but was able to return to the vessel where a physician also on vacation was concerned that might have neurological DCS. They informed the boat captain who placed the diver on first aid oxygen while they traveled to a nearby island with a hyperbaric chamber [where the air pressure can be increased or decreased in a controlled way].

Upon evaluation, the hyperbaric [high-pressure] physician found the diver had abnormal skin sensations bilaterally from his navel down to his toes, exhibited profound difficulty walking, and unsteadiness while standing. The diver was recompressed on Table 6 ["tables" here are hyperbaric medicine compression/decompression protocols] with extensions but had minimal improvement of his symptoms. Another Table 6 administered the following morning provided only slightly greater relief. Given the history of disc problems, the hyperbaric physician arranged for transfer to a hospital with greater diagnostic capability than on the island. As weather delayed air evacuation until the third day, the diver was treated again on a Table 5.

He was taken by air ambulance pressurized to one atmosphere to a larger hospital, but further diagnostic tests were inconclusive, and it was decided to continue hyperbaric therapy. The day after arrival, the diver received two treatments at 33 fsw (10 msw) for two hours with no improvement and later that day, a Table 6. Over the next seven days, he received 1-2 wound-care hyperbaric treatments (33 ft/10 msw) for 2 hours during which he reached a clinical plateau with no further improvement. His symptoms decreased over the next few months but intermittent symptoms continued, perhaps because of the existing disc problem.


Massage doesn't appear to have made the DCS worse--but can you think of any other role it could have played in this case?

If you work with scuba divers, it's useful to know the symptoms of decompression sickness. If a diver client mentions any of these symptoms, referring them to seek medical attention is the appropriate thing to do.
Signs and symptoms of decompression sickness
DCS type Bubble location Signs & symptoms (clinical manifestations)

Mostly large joints

(elbows, shoulders, hip, wrists, knees, ankles)

  • Localized deep pain, ranging from mild to excruciating. Sometimes a dull ache, but rarely a sharp pain.
  • Active and passive motion of the joint aggravates the pain.
  • The pain may be reduced by bending the joint to find a more comfortable position.
  • If caused by altitude, pain can occur immediately or up to many hours later.
Cutaneous Skin
  • Itching, usually around the ears, face, neck, arms, and upper torso
  • Sensation of tiny insects crawling over the skin (formication)
  • Mottled or marbled skin usually around the shoulders, upper chest and abdomen, with itching
  • Swelling of the skin, accompanied by tiny scar-like skin depressions (pitting edema)
Neurologic Brain
  • Altered sensation, tingling or numbness paresthesia, increased sensitivity hyperesthesia
  • Confusion or memory loss (amnesia)
  • Visual abnormalities
  • Unexplained mood or behaviour changes
  • Seizures, unconsciousness
Neurologic Spinal cord
Constitutional Whole body
  • Headache
  • Unexplained fatigue
  • Generalised malaise, poorly localised aches
Audiovestibular Inner ear [10][note 1]
Pulmonary Lungs

I'll let Neal Pollock of Divers Alert Network have the last word, as I can't possibly improve on the way he said it.


I end with the discussion of the capriciousness of decompression sickness to remind you of the power of the old adage of an ounce of prevention being better than a pound of cure. You are ahead of the game by asking the question. You should now think about all the little things that can all work together to keep your risk at a comfortably low level.

Neal W. Pollock, Ph.D., Divers Alert Network

A response to Fritz' blog post "Energy Based Methods"

This is a topic which always inspires a lot of passion, so I'll just remind everyone once again of the discussion policies here at POEM.

You are free to hold any opinion you want, and you won't be censored simply for disagreement (although you may well be challenged to show your evidence and connect the dots), but you do have to express yourself in a civil, appropriate, and professional manner.

This is a place that represents massage to all stakeholders in the community; for that reason, I don't permit it to degenerate into bar-fights that diminish our efforts to become a healthcare profession.

Professionals can have different, even opposite, opinions on issues and still respect each other. I have a great deal of respect for Sandy Fritz; I just disagree with her on the issue of energy-based methods.

If I did not respect her and my audience's ability to understand the arguments I am making, I would not spend the time and effort to spell out my thought process to consider and respond to. That engagement and reciprocity is the opposite of negativity; I consider not engaging with others in the realm of ideas a much worse snub than simply disagreeing.

I refer to her by last name when I mention her directly in the post; that is not rude, abrupt, or brusque. It is an accepted form of professional discourse which levels the playing field by not implicitly favoring people with titles such as "Dr." over others, concentrating instead on the issues, facts, and evidence that they bring to their arguments.


Sandy Fritz has written a blog post about energy-based methods in massage, available by clicking here. She has clearly given a great deal of thought to these issues.

A thoughtful post deserves a thoughtful response, so I am taking the time and effort to respond clearly and in detail to the points she is raising.


I just taught a class on  incorporating energy based methods into massage.  Every time I teach this class I wonder why this area continues to be controversial.


The concept of "energy" as it is described and as claims are made about it is at the heart of the culture wars currently raging in massage.

These philosophical arguments have gone on for centuries, and we are not about to resolve them anytime soon. The only thing we can do is decide, as a developing profession, either to be on the same page about them, or to split and go our separate ways, because they are not reconcilable.

This irreconcilability is the reason that this area continues to be so controversial. The arguments that cannot be reconciled include:

  • dualism versus monism:
    • Dualism is commitment to the statement that things in the universe belong in two mutually exclusive categories--matter as opposed to spirit, for example.
    • Monism is commitment to the statement that all things in the universe belong to the same category--that there are not two different categories at all. 
  • vitalism versus materialism:
    • Vitalism is:
      • 1 : a doctrine that the functions of a living organism are due to a vital principle distinct from physicochemical forces
        2 : a doctrine that the processes of life are not explicable by the laws of physics and chemistry alone and that life is in some part self-determining [Merriam-Webster Free Online Dictionary: Vitalism accessed 8 December 2011]
    • Materialism, by contrast, holds that all things can be explained in terms of what we know about:
      • matter;
      • energy as it is understood in the scientific sense;
      • the interactions among those entities; and
      • emergent effects arising out of those interactions that are more than the sum of their parts.



I think it is the mystical factor when in reality there is no mystery at all. 


Here, I respectfully disagree.

The arguments linking thermodynamic energy to the energy healing concept all, universally, without exception, require a mystical leap of faith to make that connection. When we get there in her post, I will show where Fritz does exactly the same thing.

That metaphysical leap of faith contains the mystery associated with the energy healing concept, which some of us are happy to accept without questioning, and which others of us have a large problem with.

The energy healing concept cannot be directly connected to thermodynamic energy without that leap of faith, which is what makes this issue so irreconcilable.


" Energy work" is different than spirituality but the two are often interconnected.


Fritz is quite right here that the two are linked, although I would take it further and state that the two are always interconnected.

The fundamental question that lies at the center of the debate is whether the physical material world that we can directly observe is all that there is, or whether there is a spiritual world that lies beyond physics (metaphysics = μετά/meta, "beyond" + physics).


To understand the plausibility of energy methods it is necessary to understand more about physics. 


I agree on the surface with what Fritz says here, but I think we mean very different--even opposite--things by it.

Fritz has presented foundational information about physics in a way that she thinks obviously makes her case for the connection stronger.

I disagree with her interpretation about what the facts mean, and I think the disagreement arises out of the metaphysical leap of faith that she takes in conflating three things:

  • the well-understood facts about thermodynamic energy from physics;
  • the way that people in New Age circles talk about "energy"; and
  • emotions.


To ensure that we're all on the same page, the definition of "plausibility" is "seeming to be valid". A plausible explanation is an explanation that, on its face, makes sense or appears to be in accordance with what we know.

From the point of view of physics, whose specialty is the study of energy and matter, the energy healing concept is not plausible, because it contradicts so much of what we already know about physics.

Certainly, it is possible to find physicists who agree with New Age claims about energy, just as it is possible to find earth scientists who are skeptics about anthropogenic global climate change, despite the overwhelming consensus of scientists that it is occurring.

The point of evaluating a claim is not whether you can find a few individuals who agree with you; it's whether the claim holds up under scrutiny holistically--in light of the entire discipline and of the evidence. The way that the energy healing concept is expressed in New Age philosophy, it contradicts so much of the foundational knowledge in physics that the overwhelming majority of physicists do not find it at all plausible.

So the burden of proof that energy-healing advocates have set for themselves is not just to come up with plausible-sounding words, but to show that their hypothesis actually explains facts in the material physical world better than the consensus of mainstream physics, accumulated over centuries of observation and testing, explains them.

I also pose the question to our developing profession--how do we want to present ourselves to our potential colleagues on the healthcare team, such as medical physicists?

Do we accept and respect the work they have done to establish knowledge in their own specialties, or do we insist that we ourselves have the knowledge to evaluate the evidence in other specialist fields, and to insist on contradictory claims instead?

Which path does our profession choose, and why?

One of the e-Books under development at POEM is an introduction to foundational knowledge in physics. My intent is to provide you with the tools that--if you choose to make use of them--will equip you to evaluate claims in light of what we already know about physics, and of emerging evidence, and to determine whether those claims hold up when examined.


Here is my point. Machines that use energy waves are being studied.


Fritz is absolutely right on this point. Thermodynamic and electromagnetic energy is used in applications ranging from diagnostic medical imaging (X-rays, CAT scans, MRIs, and so forth) to ultrasound for pain relief to magnetism to treat severe depression, and much more.


Results are mixed. No one questions that humans have electrical fields.


I'm not sure what she means by "results are mixed", but it's true on many levels. For example, you can see soft tissues clearly on MRI images, not so much on X-rays.

But I think that I may be missing the point she wants to make here, and I welcome clarification.

And that human tissues have bioelectromagnetic properties is also indisputable. It's a fact that has been established decades ago.

The important question is, what is the significance of those electrical impulses? Is it nothing more than white noise, generated by millions of independent interactions at the subcellular level, or is it a top-down, coherent entity that has an independent existence and properties of its own?


Here is where Fritz takes the metaphysical leap of faith I mentioned earlier:

I think the big question is if humans can purposefully direct their energy fields.  Here is what I suggest- approach each client with  the energy of compassion, respect and  intent to help using solid massage application.


In the first sentence, she is speaking of objectively-detectable electrical activity at the subcellular level. In the second sentence, she is speaking of complex and sophisticated emotions and cognition that are not objectively detectable.

By juxtaposing the sentences, she is claiming that they are the same thing, but she is not doing the work to connect the dots to demonstrate that they are, indeed, the same thing. She is, implicitly, asking us to take the same leap of faith to consider the two phenomena (subcellular ionic activity and complex emotions/cognition) to be equivalent to each other.


Don't mix up your spirituality with your massage and respect each clients spirituality as sacred spaced.


I can totally agree with this statement, as long as it is extended to afford exactly the same respect to clients who do not have, and do not feel the need to have, any spirituality at all.

If we aspire to become healthcare providers, religious discrimination has no place in our developing profession. If we afford exactly the same respect to non-believers as to believers in the public therapeutic space, then I have no quarrel at all with people practicing their own private spirituality in their own way.

Requiring faith in untestable and unprovable metaphysical ideas as part of a healthcare profession is inconsistent with a mission to provide equal quality service to everyone who seeks it.

For that reason, the biopsychosocial model of massage, under development here at POEM, respects everyone's freedom of conscience as a human right in their unique personal space, but explicitly excludes metaphysical leaps of faith from the universally-accessible knowledge repository that is being built.


Keep an open mind -who knows what technological advances will be able to figure out. 


Fritz' principle is a good one to keep in mind, but consider this as well: many eager, earnest, committed people have been trying for decades, without success, to make the connection between the well-established principles of thermodynamic energy in physics, complex mental processes like emotions, and the concept of energy in New Age thought.

If they have spent this much time and effort in that effort without success until now, how likely is it that they are going to definitively succeed in future?

Where are our time and effort and resources, in an age of limits, best and most effectively allocated with the most likelihood of success?

At what point do we say that specific hypotheses have had a fair chance, and failed at it, to demonstrate that they work better as an explanation or a predictor of processes in the material world?


This is taken directly of the NIH web site.


At this point, Fritz is quoting someone else who wrote for the NIH website, so I am not engaging directly with her anymore, but with the anonymous author of the text at the site.


Some CAM practices involve manipulation of various energy fields to affect health. Such fields may be characterized as veritable (measurable)


Now this equivalence is not true--juxtaposing a term in parentheses with another term implies that the two terms are synonyms, but here, they are not. "Veritable" (L. veritatem [nom. veritas] "truth, truthfulness," from verus "true" Online Etymology Dictionary accessed 8 December 2011) does not mean "measurable"; it means "real", "true", "actual", or "genuine".


or putative (yet to be measured).


Whoever wrote this for NIH did the same thing with this definition as they did with the one for "veritable".

Putative means "claimed".

"Yet to be measured" is an equivocation that implies it can be measured; they just haven't gotten around to it yet. However, there are at least two other possibilities:

  • it is yet to be measured, and never will be, because it is inherently unmeasurable;
  • it is yet to be measured, because all attempts to do so have failed.


Reading that sentence as they wrote it, implying that the only difference between veritable and putative energy is whether it has been measured yet, is quite misleading.


A more accurate statement would be:

Such fields may be characterized as veritable (true/real) or putative (claimed).


But that comes across very differently than the other version, doesn't it?

This rewrite also serves to highlight clearly where the leap of faith occurs--between physics, which can objectively measure electromagnetic energy, on beyond physics into metaphysics, where claims are asserted, but cannot be objectively measured.


Practices based on veritable forms of energy include those involving electromagnetic fields (e.g., magnet therapy and light therapy).


Absolutely true. These kinds of therapy are solidly in the realm of physics, and while the principles understanding the forms of energy used in them are fairly well-understood from a physical point of view, new and exciting applications are being developed by researchers all over the world and applied in the clinic.


Practices based on putative energy fields (also called biofields) generally reflect the concept that human beings are infused with subtle forms of energy; qi gong, Reiki., andhealing touch are examples of such practices.


The practices reflect the "concept", or idea, of biofields. There is no mention of any empirical reality to justify the concept that they reflect, because research in these areas has stalled at still trying to demonstrate they exist--a state it's been in for decades now. The empirical reality does not yield results that advance the concept.

In real life, a dogwhistle makes a sound that it so high-pitched (high in the frequency of its energy) that human ears cannot hear it, although dog ears can.

Similarly, in rhetoric, the metaphor "dogwhistle" refers to a term or phrase that carries a hidden message, that some readers are able to pick up on, but which is undetectable to other readers.

The use of the term "subtle" in energy-healing contexts is a vitalist dogwhistle for "spiritual component". Readers who are familiar with vitalist writings recognize the appeal to the spiritual contained in the word; other readers interpret it as an adjective meaning "delicate" and do not recognize that this statement is a commitment to a vitalist metaphysics.


The 2007 NHIS found relatively low use of putative energy therapies. Only 0.5 percent of adults and 0.2 percent of children had used energy healing/Reiki (the survey defined energy healing as the channeling of healing energy through the hands of a practitioner into the client's body).


When we are working with survey definitions, we are still working with concepts, not with empirical physical reality. To say that energy healing is "the channeling of healing energy through the hands of a practitioner into the client's body" is not the same thing as to actually do it.

Energy healing research is stuck in the position of trying to prove it exists in the New Age conceptualization that its advocates promote, and as a result, it has not advanced in decades.

In my opinion, if its advocates would stop trying to force a dualist/vitalist explanation onto it, and investigated it in terms of psychological processes, they would get a great deal more traction, both in the laboratory and in the clinic.


When I was looking for some sort of current "energy healing" used in the health care world I found Pulsed RadioFrequency. Pulsed RadioFrequency (PRF) is a relatively new technique derived from a well established and proven intervention, thermal radiofrequency (RF).


PRF is well within the domain of physics, and the new derivation of PRF from thermal RF is an example of the advances and new implementations from research that are being delivered to the clinic from the material physical energy side of the discussion.


Both procedures are used in the treatment of chronic pain. Unlike RF treatment, PRF does no direct damage to the nerve. During PRF treatment, electrical energy is applied with a small needle to the affected nerve using a pulsed time cycle that delivers short bursts of RF current, any frequency within the electromagnetic spectrum associated with radio wave propagation. When an RF current is supplied to an antenna, an electromagnetic field is created that then is able to propagate through space. Many wireless technologies are based on RF field propagation. 

These frequencies make up part of the electromagnetic radiation spectrum: 

  • Ultra-low frequency (ULF) -- 0-3 Hz
  • Extremely low frequency (ELF) -- 3 Hz - 3 kHz
  • Very low frequency (VLF) -- 3kHz - 30 kHz
  • Low frequency (LF) -- 30 kHz - 300 kHz
  • Medium frequency (MF) -- 300 kHz - 3 MHz
  • High frequency (HF) -- 3MHz - 30 MHz
  • Very high frequency (VHF) -- 30 MHz - 300 MHz
  • Ultra-high frequency (UHF)-- 300MHz - 3 GHz
  • Super high frequency (SHF) -- 3GHz - 30 GHz
  • Extremely high frequency (EHF) -- 30GHz - 300 GHz


This is excellent information, and I applaud Fritz for presenting it. I agree that we should know basic physics as foundational knowledge, both as MTs and as citizens who vote on policy issues, and that's why it will be included in POEM e-Books.

Source: accessed 9 December 2011


The details of specific imaging and treatment technologies are not so important for our information needs, but understanding at a very high level what other professionals on the healthcare team do will promote collaboration and communication with them for the benefit of the client.


Fritz includes some links to PubMed articles. These articles posted here can be categorized into two groups.

The explanatory mechanisms in this group of articles fall solidly into the domain of testable, observable, medical physics.

    Snidvongs S, Mehta V. Pulsed radio frequency: a non-neurodestructive therapy in pain management. Current Opinion in Supportive and Palliative Care. 2010 Jun;4(2):107-10.
    van Boxem K, van Eerd M, Brinkhuizen T, Patijn J, van Kleef M, van Zundert J. Radiofrequency and pulsed radiofrequency treatment of chronic pain syndromes: the available evidence. Pain Practice. 2008 Sep-Oct;8(5):385-93.
    Niemisto L, Kalso E, Malmivaara A, Seitsalo S, Hurri H. Radiofrequency denervation for neck and back pain. A systematic review of randomized controlled trials. Cochrane Database of Systematic Reviews. 2003;(1):CD004058.
    Rohof O. Intradiscal Pulsed Radiofrequency Application Following Provocative Discography for the Management of Degenerative Disc Disease and Concordant Pain: A Pilot Study. Pain Practice. 2011 Oct 19.
    Chua NH, Vissers KC, Sluijter ME. Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications-a review. Acta Neurochirugica (Wien). 2011 Apr;153(4):763-71.

The explanatory mechanisms in this group of articles, by contrast, fall into the domain of metaphysics:

Note the following sentence in the "Methods" section of the Abstract:

"METHODS...Subjects were also assessed on their awareness of their own biofields, and they filled out various questionnaires, including estimates of how well they thought they would do and their openness to spiritual beliefs and experiences."

If, as advocates claim, energy healing is independent of spirituality, why did they survey subjects on their openness to spiritual beliefs and experiences?

    Schwartz GE, Swanick S, Sibert W, Lewis DA, Lewis SE, Nelson L, Jain S, Mallory L, Foust L, Moore K, Tussing D, Bell IR. Biofield detection: role of bioenergy awareness training and individual differences in absorption. Journal of Alternative and Complementary Medicine. 2004 Feb;10(1):167-9.
Similarly, in the "Methods" section of this Abstract:

"METHODS...Twenty-seven (27) physicians, psychologists, and nurses participated in a 5-day intensive bioenergy healing training course with Rev. Rosalyn Bruyere."

If energy healing is indeed independent of spirituality, is it merely a coincidence that this course was taught by a minister?

When I saw the picture that Fritz closed her post with, I could almost feel the oxytocin (popularly called the "love hormone") mainlining into my blood as my pituitary cranked it up to 11.

That child in the angel costume, with the caption "Believe", is the most winsome and appealing child I have seen in some time. It is a lovely picture for a blog post.

But despite that, I cannot go along in good conscience with the caption.

I fully support Fritz' and everyone else's freedom of conscience to believe as they wish, and to practice any form of spirituality--or none at all--in their private life and space. That is not the issue here.

The issues that I am concerned with include:

  • How do we, as practitioners, provide a safe therapeutic space for all clients, without litmus tests for belief?
  • How do we, as educators, provide a safe learning space for all students, without litmus tests for belief?
  • What are the commitments to principles that we, as an evolving profession, wish to make, and what are the impacts of those commitments on collaboration and communication with other potential partners on the healthcare team?


I applaud Fritz for putting herself out there to engage on the issues, and for advocating for her point of view honestly and frankly. As I said previously, she has given these issues a great deal of thought, and she deserves a thoughtful and engaged response.

I see these issues of vitalism, dualism, and belief (for the profession as a whole, not for individuals' consciences) as a fault line along which massage is likely to split.

There are three outcomes that I can imagine coming out of this; there may be others that I have not thought of.

  1. We come to a working arrangement with a code of ethics that practitioners of all specialties can commit to working under, one which does not require forcing any particular belief or set of beliefs on students or clients;
  2. We agree that such a working arrangement cannot be reached, and the profession splits under mutual agreement into different areas of practice that commit to varying degrees of belief in vitalism/dualism;
  3. We do nothing, and the profession splits in an uncontrolled way along that fault line, with unpredictable fallout from that split. 

We need to have this discussion out in the open, as professionals, in order to decide what we want to do about these fault lines, or else history is going to decide it for us.



If this turns out to be true, it's a big deal

Posted in

While it won't immediately affect our daily practices, this news--if true--transforms the web of knowledge that we're building about the universe around us.

In today's Globe and Mail online:

Scientists at the world’s largest physics lab said Thursday they have clocked neutrinos travelling faster than light. That’s something that according to Einstein’s 1905 special theory of relativity – the famous E (equals) mc2[sic] equation – just doesn’t happen.


Mr. Gillies told The Associated Press that the readings have so astounded researchers that they are asking others to independently verify the measurements before claiming an actual discovery.

“They are inviting the broader physics community to look at what they’ve done and really scrutinize it in great detail, and ideally for someone elsewhere in the world to repeat the measurements,” he said Thursday.

Scientists at the competing Fermilab in Chicago have promised to start such work immediately.

“It’s a shock,” said Fermilab head theoretician Stephen Parke, who was not part of the research in Geneva. “It’s going to cause us problems, no doubt about that – if it’s true.”

The Chicago team had similar faster-than-light results in 2007, but those came with a giant margin of error that undercut its scientific significance.


Syndicate content