The headaches wouldn’t stop. Amy Finsilver had been in a horrific car crash while on a business trip, and for weeks after, it felt like her brain was about to burst.
“They had given me Percocet, Vicodin, Flexeril, everything,” she said. “Nothing worked. Nothing.”
Specialists at Brigham and Women’s Hospital determined that she had sustained a severe concussion during the crash, and now she was plagued by constant headaches and fatigue.
The doctors at the Brigham put Finsilver through a battery of cognitive tests, ranging from solving simple arithmetic problems to rattling off as many words as she could that start with the letter F. The 51-year-old self-described workaholic tried her best to follow their orders—she didn’t go into the office, she scaled back on email, she watched fewer hours of TV, she rested mentally and physically whenever possible. She was prescribed more drugs. They made her thirsty and caused her heart to race but did nothing for the pain. She was given a paper log to keep track of her headaches.
Weeks passed and the pressure in her head didn’t diminish. She supplemented her care with acupuncture—whatever benefits she felt were short lived. After approximately two full months of around-the-clock anguish, Finsilver received a call from an old friend who works for the New England Patriots. He suggested she go see Alex Guerrero. “He’s Tom Brady’s body coach,” her friend explained, going on to note that Guerrero had a knack for helping people recover from concussions.
Finsilver was ready to try anything. She spoke with Guerrero on the phone for 20 minutes and explained what had happened. “He basically said ‘I can help you, can you come in tomorrow?’” The next day Finsilver traveled to TB12 Sports Therapy Center, a gleaming storefront facility at Patriot Place in which Guerrero and Tom Brady are business partners.
On that first visit, Guerrero and Finsilver spoke briefly about the accident and her streak of suffering. Guerrero and another staff member looked over some of her scans and X-rays and conducted an initial assessment. Then Guerrero got to work, vigorously manipulating the muscles around Finsilver’s jaw, head, neck, and face. It was unlike anything she had ever felt—he worked his strong fingers into the nooks and crannies under her jaw. It was an intense sensory experience, and not particularly enjoyable. “It was very painful,” she says.
But soon after, Finsilver felt reborn. For the first time in months, the fog that had enveloped her brain had lifted. Guerrero wasn’t done. He had her walk on a treadmill with special equipment to monitor her gait, he gave her dietary recommendations that included cutting out soy, he had her do balance exercises, and he assigned her computerized brain games to play at home for 15 minutes a day.
Finsilver expressed her concerns. She told Guerrero that the doctors at the Brigham had imposed strict limits on using computers. “Alex had a totally different opinion,” she says. Guerrero told her that she had rested her brain for long enough. In order to start recovering, he said, she needed to use what had been damaged.
Since that first visit to TB12, Finsilver says her recovery has been nothing short of remarkable. Seven months after the accident, the daily headaches have vanished.
And she’s not the only one who attributes a dramatic turnaround to Guerrero’s hands. A young man who contacted Boston said he suffered a stroke and aneurysm at age 19 that impaired the entire left side of his body. Physical therapy helped him get to the point where he could walk with a cane, then with a limp, but it wasn’t the life he had imagined for himself.
“I went to TB12 every day during the summer of 2014. I worked hard, I drank more water than I thought possible, I was massaged until I was bruised, I walked on ‘opti-gates’ (sic), played brain games,” the young man wrote in an email. “When I first went into TB12 I could not run, I could walk with a limp. When I left TB12 I felt like I could fly.”
Even Comcast SportsNet writer Tom Curran has attested to Guerrero’s abilities, recalling how Guerrero helped clear up his nagging hip pain. “Guerrero laid me on a table and attacked my hip flexor with a massage so deep I was on the verge of tears and laughter,” Curran wrote. “He broke up the scar tissue. Then he made me sit on the edge of the massage table and kick my leg as fast as I could. He was ‘reprogramming the muscle.’”
As inspiring as these tales of recovery are, they invite questions about the state’s regulatory environment. Guerrero is not licensed in Massachusetts as a massage therapist or an athletic trainer. Moreover, TB12 is not a licensed medical facility, physical therapy facility, or massage therapy facility, according to state records.
Despite a reputation as one of the most tightly regulated states in terms of medical care, it is apparently lawful in Massachusetts to have a business that evaluates and treats concussion-related brain injuries in athletes and non-athletes alike without any state-issued license pertaining to health.
Moreover, Guerrero—a man who is under a permanent consent decree from the Federal Trade Commission for selling a bogus cancer cure on TV while being described as a doctor, and who was investigated as recently as 2012 for marketing a drink that he falsely claimed could help cure concussions—is free to work the muscles of injured clients and dispense recommendations for treating brain injuries without a license.
TB12 and Guerrero have survived scrutiny by state agencies. According to documents obtained by Boston, the Division of Professional Licensure, or DPL, opened an investigation into Guerrero and TB12 in October 2013. The agency was acting on a tip that alleged Guerrero had practiced massage in Utah without a license and that he faced several lawsuits involving a startup company. As Boston uncovered earlier this year, Guerrero has twice been accused of fraud in Utah, and he settled both complaints out of court.
Housed within the Office of Consumer Affairs and Business Regulation, the DPL is a patchwork of 28 different boards that license professions ranging from barbers and funeral directors to podiatrists and psychologists. Rules and requirements vary widely.
Consider that for athletic training, which is regulated under the Board of Allied Health Professions, the division that led the investigation into TB12 and Guerrero, only the individual practitioner needs to be licensed, not the business.
While TB12 employs licensed athletic trainers, Guerrero is not one of them. According to clients, Guerrero is interacting with clients and advising them, but he has never been a licensed athletic trainer. And while “athletic training” falls under the purview of the Board of Allied Health Professions, TB12 refers to itself in marketing material as a “sports therapy center,” a term that does not appear to be defined or regulated by the DPL or the Department of Public Health.
The DPL’s Board of Allied Health Professions covers athletic trainers, occupational therapists, and physical therapists, but it does not cover massage therapists. That’s up to the DPL’s Board of Registration of Massage Therapy, which requires both the business and the individual who is putting his or her hands on clients to be licensed. Even though the original tip about Guerrero included accusations of unlicensed massage work in Utah, the Board of Registration of Massage Therapy never investigated Guerrero.
State regulation of massage is fairly recent. Up until 2006, massage therapy was regulated by cities. Then the DPL took control of oversight and crafted a definition for massage therapy, which includes what some consider a gaping loophole exempting “bodywork” and dozens of other alternatives from regulation. Some police departments and local legislators have argued that these exemptions allow unlicensed businesses—including fronts for prostitution—to flourish under the guise of bodywork. A few cities have gone so far as to create local ordinances to more tightly control such establishments.
“We realized it was a problem several years ago,” says Daniel McCormack, director of the Weymouth Health Department. “It created a growing industry…of bodywork establishments that could come into municipalities with no license at all.”
In 2014, McCormack helped craft a city-level regulation that requires anybody who is operating a bodywork business to obtain a license for the establishment. In addition, each individual practitioner must also be licensed. The applications go through the Weymouth health department and include criminal and sexual offender background checks.
Weymouth is an outlier, though, and most cities—including Foxboro, home to TB12—rely on the state’s definition of massage and depend on the DPL to investigate potential violations.
All of this is to say that TB12’s hybrid approach, which weaves elements of bodywork, exercise training, brain games, and dietary guidance doesn’t fit neatly into one area of regulation or the state’s definition of these activities.
Importantly, the business doesn’t have ultrasound devices or tools to electrically stimulate muscles—hallmarks of physical therapy facilities. It doesn’t call itself a massage therapy facility or a concussion clinic. In media interviews, Guerrero is often referred to as a “body coach,” a phrase that’s absent from the state’s regulatory lexicon. And reporters have struggled to describe the services provided by TB12. Mark Leibovich of the New York Times Magazine wrote: “Body work’ is Guerrero’s preferred term for his massagelike ‘technique.’ …it is hard to describe what exactly TB12 is — not a gym, not a group practice of personal trainers, not a nutrition or massage-therapy center.”
To the average consumer, such as Tom Curran—who referred to Guerrero as “a physical therapist/massage guy” in his column—such distinctions may not be readily apparent.
Throughout the course of the DPL’s nearly 14-month-long investigation, the agency interviewed several members of the New England Patriots staff, including Joe Van Allen, the team’s director of rehabilitation. Van Allen told DPL investigators that he witnessed Guerrero “perform soft tissue massage on New England Patriot players at the team’s facilities.” Guerrero has never had a Massachusetts massage therapy license, according to state records, but the investigators didn’t bother checking because that’s the business of the massage board. It ultimately didn’t share the findings with the massage board even though they’re both within the same agency.
“Since the Board of Allied Health Professions does not have jurisdiction over the practice of massage therapy and the scope of the allegations contained in the complaint were focused primarily on allegations of the unlicensed practice of athletic training, the complaint was not referred to the Board of Registration in Massage Therapy,” the DPL said in a statement provided to Boston.
As part of its investigation, the DPL also sought written statements from a number of TB12 employees. Two of those employees said that Guerrero “counsels” TB12 clients, but neither made reference to him performing hands-on activities. Kris Thomson, a certified athletic trainer, described Guerrero as “the operations manager” who has “developed the techniques” performed on clients at TB12. David Merson, who holds a doctorate in physical therapy, used nearly identical language. “Mr. Guerrero is the operations manager of the facility,” Merson wrote, who has “developed the specific techniques and client education messages performed at TB12.”
Both men also specifically mentioned that Guerrero is a “Certified Fitness Trainer.” It is unclear what that means, how it is different from a personal trainer, and who the certifying agency or organization is. Guerrero did not respond to an emailed list of questions for this story.
After more than a year, the DPL closed its investigation without taking action against TB12 or Guerrero, though it noted that the case could be reopened.
But the state appears to have no jurisdiction to regulate Guerrero’s treatment of clients who have sustained serious brain injuries. In 2012, the Federal Trade Commission wrote a letter to Guerrero expressing “serious concerns” about a product he was allegedly marketing—and which was endorsed by athletes including Tom Brady and Wes Welker—called Neurosafe, a sports drink that boasted it was “the only preventative measure available to athletes to protect their brain,” and purported to help “to dramatically improve recovery from head trauma.” The FTC found no evidence to support those claims, and worried that users “might forego appropriate medical treatment and return to competition before they have adequately recovered from their injuries.” In declining to take action, the FTC noted that it was influenced by Guerrero’s decision to remove the product from the market and offer full refunds to anyone who’d purchased it.
That doesn’t mean TB12 has stopped treating concussions. Brady, Guerrero’s business partner and best friend, boasted in a recent WEEI interview that TB12 has had “incredible success” in treating “lots of people” with concussions.
TB12 isn’t unique in this manner. Concussion treatment businesses are a growing concern among some doctors. As Stat recently reported, “Hundreds of these clinics have sprung up across the country, some of them run by dermatologists, orthopedists, chiropractors, and physical therapists.” Experts worry that facilities lacking board-certified physicians who have training in brain injuries may not be well-equipped to deal with complex injuries that doctors themselves are still wrestling with.
“You can make people worse, and you need to be very quick to pick up if your therapy is aggravating symptoms,” says Robert Cantu, a professor of neurosurgery at Boston University School of Medicine who specializes in traumatic brain injury and is a senior advisor to the NFL Head, Neck and Spine Committee. “If these people are not with a proper background, they’re probably not going to be aware if they’re making someone worse.”
Guerrero does not have rigorous medical training. He does not have an associate’s or bachelor’s degree, according to a sworn deposition, yet he claims to have a master’s degree in traditional Chinese medicine from a school in California that no longer exists. That said, at least one TB12 employee, Merson, has a doctorate in physical therapy from Boston University.
For comparison, Cantu’s brain injury center at Emerson Hospital is staffed by himself—a board-certified neurosurgeon—a fellow doctor who is a board-certified neurologist, and a nurse practitioner. “The three of us see all the patients and then make the recommendations for the therapies,” Cantu says.
In recent years, according to Cantu, increased awareness of head injuries and increased concern among parents have fueled the proliferation of alternative and unproven concussion treatments. “Virtually every single one of these places have absolutely no research publications, obviously, or any kind of proof that what they’re doing makes any difference,” Cantu says.
Just like there was nothing affirmatively harmful about the vegetable vitamins Guerrero once claimed could cure cancer, it’s impossible to say if his approach to concussions is doing any harm or doing any good. Further complicating matters is the fact that post-concussion syndrome will improve with time in almost all patients. Unless there are bona fide clinical studies, it’s virtually impossible to determine whether the patient is improving from a massage technique or whether the tincture of time is responsible for his or her recovery.
“There are a tremendous number of emerging things that have really no science behind them,” Cantu says, who highlights the potency of the placebo effect when it comes to brain injuries. “There’s about a 30 percent placebo effect just from people laying on hands or giving people something they think is going to help them, so you really have to have double-blinded prospective studies.”
None of this matters to patients like Finsilver. For her, Guerrero and the TB12 team achieved what her doctors at the Brigham could not—relief.
While the daily headaches are a thing of the past for Finsilver, Guerrero and TB12 are now a regular part of her life. She recently started going to TB12 twice a week.
“If I hadn’t met him, I’d still be a mess,” she says.
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