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June 27, 2005

Massage is the Future of Chronic Pain Treatment

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Following an April 2005 nationwide poll on pain, the prevalence of chronic pain has appeared in every major publication. Now that it is in the public’s awareness, a surge of interest in the treatment options for chronic pain has begun. Three massage methods are highlighted that can greatly increase the quality of life of someone afflicted with chronic pain.

Adapted from the June 2005 Special Report, “Treating Chronic Pain,” by the Institute for Integrative Healthcare Studies.

Pain is essential to our survival. The stabbing abdominal pain indicative of appendicitis or the crushing chest sensation during a heart attack prompts us to seek medical attention immediately. While acute pain can be excruciating, it also serves an important purpose. Acute pain is self-limiting and typically resolves following rest and/or appropriate treatment.

When pain persists over an extended period of time its usefulness comes into question, as it no longer serves as a warning of an underlying physical problem, but becomes the problem itself. The definition of chronic pain is pain that lasts for a period of three months or more and has a devastating effect on one’s quality of life. Every aspect of an individual’s being is touched by chronic pain: the physical, emotional, mental and spiritual.

A recent nationwide poll conducted by Stanford University Medical Center, ABC News and USA Today found that more than half of those interviewed suffer from chronic or recurrent pain. Of those surveyed, 25 percent reported back pain as their major disability, while 12 percent reported knee pain as predominant. This translates into more than 11 million Americans being significantly impaired by chronic and recurring pain and more than 2.6 million being permanently disabled by back pain alone. One national survey found that more than 700 million days are lost from work each year because of pain. This translates into a cost of $100 billion annually for disability compensation, attorney’s fees and loss of productivity.

The “gate control theory” of pain was first proposed in 1965 by Canadian psychologist Ronald Melzak and British anatomist Patrick Wall. This theory suggests that there is a gating system located in the central nervous system that opens and closes to either let pain messages through to the brain or to block them. Located at the back of the spinal cord, a structure called the dorsal horn acts as a gateway for all the messages that are trying to pass through to the brain. Once the nerve signals reach the brain, sensory information is processed in the context of one’s mood, state of attention and past experience. As this information is integrated, one’s perception of pain and response to it are influenced. The brain can then send a message back down to close the gate, blocking the reception of new pain signals or to open the gate wider, signaling an intensification of pain.

The pain-spasm-pain cycle is usually seen in cases of chronic pain. Tense or painful areas are often held in a prolonged flexed state. Muscles in prolonged flexion become ischemic (lack of blood and therefore oxygen). Ischemic muscles cause pain. When there is pain the muscle reacts by going into spasm thinking it is protecting itself. This causes more ischemia, pain from the ischemia, and then more spasm. In addition, pain can produce anxiety and thus muscle tension, which eventually produces spasms, causing more pain. This pain-spasm-pain cycle must be broken to stop the perpetuation of chronic pain.

Someone’s emotional state can have a great effect on the pattern of his or her chronic pain. Thoughts and emotions can directly influence physiological responses by stimulating muscle tension, blood flow and levels of brain chemicals that play an important role in the production of pain. If a sense of helplessness prevails, the sense of inner strength to fight against the pain can wane. Faced with painful episodes that are exacerbated from stress and a sense of “loss of control of the pain” and behavioral choices intended to “cope” with the pain, these feelings may unintentionally worsen it and create harmful patterns of coping. For example, someone with chronic low back pain may simply be tired of it and may reach for medication and/or alcohol to numb the pain. To further decrease the pain, they may refrain from certain enjoyable activities in anticipation of more pain. The result of this pattern is loss of muscle strength, tone, flexibility, endurance and the possible development of depression and addiction.

Most pain experts agree that almost all unexplained chronic pain, at least initially, was rooted in a physical problem. Although mental and emotional factors greatly affect pain and our experience of it, they are rarely the root cause of the pain.

Human touch is often a first response to ease our pain. When we hurt somewhere, we are inclined to rub or apply pressure to the area, seeking some relief from the pain. According to the book The Chronic Pain Solution by James N. Dillard, MD, DC, CAc, sensations associated with both pleasure and pain physiologically travel at different speeds along the nervous system. Dull pain, for example, travels at a relatively slow pace along the nerve, from half a mile to two miles per second. Sharp or burning pain can travel at a speed from five to 30 miles per second. The non-painful sensation of touch, including pressure and massage, travels the fastest, from 35 to 75 miles per second. Luckily, the gating mechanism in the spinal cord is triggered by relative speed, and when more than one sensation enters the dorsal horn simultaneously, the fastest one will block the transmission of the slower one.

In the last decade, massage therapy has been the subject of many studies that substantiate its beneficial impact upon the nervous system – the very place where pain resides. Massage has been shown to have a dually beneficial effect on pain: it increases endorphins (our body’s natural painkillers) and depletes substance P (the neurotransmitter that helps communicate pain). The entire nervous system and the brain are positively affected with massage, improving cognitive functioning, reducing stress and battling fatigue with more restful sleep.

Three of the many methods that are excellent to include in the treatment of chronic pain are:

Myofascial Release: Myofascial Release is a gentle blend of stretching and massage that releases restrictions in the myofascial (muscle and fascial tissue) network. Abnormal pressures may tighten or bind the fascia to underlying tissues, causing adhesions that cling to muscle fibers. These adhesions can stiffen joints or contribute to painful motions. Like a pull in a sweater, the effects of tension and strain can snowball after time. Because fascia links every organ and tissue in the body with every other part, the skillful freeing of tissue that occurs with this technique can be instrumental in chronic pain relief.

Neuromuscular Therapy: Neuromuscular Therapy (NMT) is a specific and scientific approach to muscular pain relief that brings about balance between the musculoskeletal system and the nervous system. NMT can break the pain-spasm-pain cycle by utilizing pressure on identified trigger points to relieve nerve impulses to the spinal cord. This reduces the intensity of the sympathetic nervous system response and activated injury patterns. This therapy can dramatically affect flexibility, balance and strength by interrupting the pain pathways and improving circulation in and around the affected musculature. The American Academy of Pain Management recognizes this form of massage therapy as an effective treatment for chronic back pain caused by soft tissue injury.

Aromatherapy: Aromatherapy is moving to the forefront of integrative medicine. This modality can be combined with any other modality and can be either massaged into the skin, inhaled directly or diffused to scent an entire room. Aromatherapy is used for pain relief, tension alleviation, alleviation of fatigue and entire body invigoration. Essential oils that are inhaled in to the lungs influence the limbic system in the brain to offer both psychological and physical benefits. Essential oils applied to the skin are absorbed into the bloodstream and bring that oil’s healing properties to the organs, muscles and joints. The cells of the olfactory membranes in the nasal cavity directly influence the central nervous system, making each breath of the aromatic potentially healing. The many dimensions of suffering that accompany chronic pain, ranging from depression, fatigue, hopelessness and, of course, physical pain, all can be aided by the addition of aromatherapy to a session.

Manual therapies performed by massage therapists can help chronic pain because of their ability to reduce tension and stress, break the pain-spasm-pain cycle, increase endorphins, reduce the transmission of substance P and promote overall health. As the nationwide epidemic of chronic pain is realized, comprehensive pain management programs will continue to emerge. Considering the value a massage therapist can add to the treatment of chronic pain, it won’t be long before pain management centers actively recruit members of our profession that specialize in the debilitating burden of chronic pain.

Recommended Study
Aromatherapy Essentials, Myofascial Release, Neuromuscular Therapy

Posted by Nicole at 10:55 AM | Comments (0)

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Diaphragm Strengthening for Neck & Shoulder Pain

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Clients that breathe by lifting their shoulders to their ears need more than a massage to relax their neck and shoulder muscles. Learn how to help them strengthen their diaphragm to change breathing patterns and relax their body.

Strengthening muscles that normally receive little attention can make a monumental impact on your client’s health. For example, it is common to encounter an athlete with a chronic ankle problem. Every time that athlete injures an ankle, he/she goes through the process of healing and usually follows with a series of stretches to lengthen the injured tissue. Heat and massage are beneficial components of this recovery because they are key contributors to relaxation and circulation of and around the injured ankle. However, if this athlete does not continue his or her care with an ankle strengthening program, then he/she is sure to re-injure that same ankle. Strengthening is not something that applies only to athletes, it applies to everyone. Muscle development and strengthening are key to ensuring the integrity and longevity of our lymph and circulatory systems, our internal organ functions, our axial skeleton and our overall health.

One of our forgotten, yet essential, muscles is the diaphragm. The diaphragm is the large muscle just posterior to the rib cage that is used for respiration, and it is often disregarded as an involuntary muscle. Doug Alexander reminds us about the connection between diaphragmatic breathing and our health in the article “Coaching Your Clients,” published in the Summer 2005 edition of The Massage Therapy Journal.

Mr. Alexander explains a typical pattern called “apical” breathing. This is a tense pattern of breathing in which the diaphragm muscle is used less, while the neck and shoulder muscles are primarily relied on for respiration. Apical breathing recruits the upper trapezius, levator scapula, scalenes and sternocleidomastoid muscles for every breath taken. Repercussions of this type of breathing can be decreased oxygen intake and tightened, and thus shortened, neck and shoulder muscles. As many massage therapists are aware, these tightened muscles can lead to temple headaches, upper back, neck and shoulder pain, and the emotional state of carrying the world’s stresses upon one’s shoulders.

Learning to use the diaphragm for respiration can add a great deal of benefit to the health of your apical breathing clients. “Diaphragmatic breathing is inherently relaxing. It slows the body’s metabolism down, and draws the nervous system into a rest and relaxation mode,” says Mr. Alexander. “Good times to practice diaphragmatic breathing are at the beginning and end of the day; it can help us start the day with a feeling of relaxation and ease. At the end of the day, diaphragmatic breathing releases tension and helps set the state for deeper, more restorative sleep. Without this diaphragmatic practice at bedtime, apical breathers will go to bed with tense neck muscles, and then spend all night using their neck muscles to breathe, rather than relax and recover from the stresses and strains of the day.”

Restoration of normal abdominal (diaphragmatic) breathing can be accomplished by coaching your clients to engage their diaphragm. Have your client in a supine position while he/she places one hand on his/her belly (below the umbilicus), and one hand on his/her chest. Upon inhalation, have your client focus on belly expansion by being aware of the belly hand rising. Inhalation continues until he/she feels movement of the other hand on his/her chest. During the exhale, have your client focus on belly deflation, with that hand sinking towards the spine. This exercise can help strengthen diaphragmatic breathing. However, it may not be enough to break the cycle of apical breathing. Many apical breathers have difficulty learning to use their diaphragm (and thus strengthen it), or they forget about breathing into their belly when under stress.

Donna Fahri found that strengthening the actual diaphragm muscle can effectively break the apical breathing habit. In Fahri’s book, The Breathing Book, she suggests a diaphragm awareness and strengthening technique called sandbag breathing. Sandbag breathing uses a soft weight such as a sandbag, bag of rice or soft ankle weight on the belly, just below the umbilicus. According to Mr. Alexander, this weight “…increases the pressure inside the belly and places a gentle stretch on the diaphragm, causing it to dome upward slightly further into the thorax.” With your client supine, instruct him/her to gently push the sandbag up towards the ceiling with each inhalation. After a series of 10 sandbag belly breaths, Mr. Alexander advises his clients to allow the bag to slide off their belly. At this point they usually notice that they are unconsciously using their diaphragm more with each breath they take.

This diaphragmatic strengthening exercise can be slowly increased to include more repetitions, and can even include more weight. Adding more weight to the sandbag must be done slowly and gradually, as the diaphragm can become sore and fatigued from this exercise. Mr. Alexander says that when his clients do this daily for a few weeks, they naturally use their diaphragm more consistently when breathing. The more belly (or diaphragmatic) breathing a client does, the more rigidity is unloaded from his/her neck and shoulder muscles. Rigidity is reduced because the neck and shoulder muscles contract less, and thus, relax more.

While most people may not think of strengthening the diaphragm as an important component of health, Mr. Alexander helps us see that it is. Regular belly breathing can originate with the practice of strengthening the diaphragm muscle, and its rewards are multi-faceted. The benefits of increasing lung capacity with the expanded breath of belly breathing and the non-recruitment and thus relaxation of the trapezius, levator scapula, scalenes and sternocleidomastoid muscles can positively benefit any client’s health – especially those that have neck and shoulder tension.

Posted by Nicole at 10:51 AM | Comments (0)

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Inspire Your Clients to Move That Body

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A slightly different perspective on exercise might be the impetus your client needs to leave inactivity behind. A massage therapist can be the ideal person to offer the encouragement and suggestions necessary to get his/her client active.

Our bodies are glorious machines. Just like an automobile, we need regular operation to function optimally. If a car is not driven for an extended period of time, it won’t operate as smoothly as a regularly used vehicle. When an automobile runs, motor oil and gasoline are distributed throughout the engine, ensuring proper lubrication and fluid distribution. When it sits, these substances stagnate, and consequences result: rust, seal (gasket) deterioration and fluid thickening. Our bodies function in much the same way because, like automobiles, we are created for movement. Without movement, our muscles shorten, tighten and weaken, and our fluids (blood, lymph, synovial fluid) fail to circulate and deliver nutrients, lubricate muscles and joints and remove waste. The analogy of a car needing to be driven may help your clients that are disconnected with their body’s needs.

Living an active lifestyle can be like the Myth of Sisyphus. We all aspire to it, yet for many people, it seems to be just out of reach. Sitting in front of a computer all day, juggling the demands of career and family and the drain of fatigue all can contribute to someone’s lack of activity. Studies have found that the biggest health benefits come from transitioning from being sedentary to adhering to moderate and regular exercise. Overcoming the roadblocks to exercise can be as simple as finding an activity that brings you joy, doing it together with a friend or receiving a nudge from the right person.

As a member of the healthcare profession, massage therapists are in a unique position for administering advice. While you may be fully aware of the health benefits (physical and emotional) of physical activity, sharing this information with your clients can be the best prescription you can give. According to Dr. Weil in the August 2004 edition of Self Healing, he discusses the power of practitioner motivation in the article “Finding Joy in Movement.” He says that simply inquiring about your client’s exercise habits and encouraging them to find an activity that is appealing to them may be the closest thing to a “magic bullet” for health that is available. Research shows that the advice and motivation provided by a healthcare professional has the power of superseding any obstacles to client compliance.

Regular exercisers do it because it makes them feel good, and they have a good time doing it. If you inquire about your client’s personal joys, you might be better equipped to offer specific suggestions. Some ideas include dancing, yoga, tai chi, hiking, basketball, rowing, swimming or even walking in a favorite setting (a park, mall or neighborhood of Victorian houses). The more enjoyment a person receives from their exercise, the more likely they are to make it habitual. The bottom line is — find a method of movement that brings you joy because this body was made for moving!

Posted by Nicole at 10:48 AM | Comments (0)

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June 10, 2005

Fibromyalgia Relief with Massage

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Help your clients with fibromyalgia relieve their pain. Learn about this debilitating syndrome — and how massage therapists can make a tremendous impact on their clients with fibromyalgia.

Fibromyalgia, a syndrome with widespread chronic pain as its hallmark, is an enigmatic ailment with no known cause, no simple diagnostic test and no cure. While not a “cure”, massage therapy is an effective means for helping people manage their fibromyalgia. Most clients with fibromyalgia syndrome (FMS) say that they ache all over. They describe their pain in a variety of ways, such as burning, stabbing, gnawing, aching, stiffness or soreness. The American College of Rheumatology (ACR) estimates there are between three and six million people in the U.S. with fibromyalgia syndrome.

While the cause of FMS remains elusive, many believe that certain events may trigger this syndrome’s onset. Some of the trigger suspects include viral or bacterial infections, automobile accidents, rheumatoid arthritis and tragic events (physical and psychological). Many experts believe that an abnormally functioning central nervous system is at the root of FMS. Hormone and neurochemical imbalances are common findings during the medical evaluation of someone with fibromyalgia. The complexity of FMS may call for an entire medical team in the person’s care, including a rheumatologist, an endocrinologist and a neurologist.

Physicians often have difficulty diagnosing FMS because its symptoms have a high degree of variability and they overlap with a long list of other conditions. In 1990, the ACR listed two primary criteria for the classification of fibromyalgia. The first is a history of widespread pain involving all four quadrants of the body (right side, left side, above waist, below waist) for a minimum of 3 months. The second criterion which points to FMS is the presence of pain in at least 11 of 18 tender points when touched or pressed. It is suggested that a massage therapist confirm that his/her client received a diagnosis of fibromyalgia from a physician, to insure that something else isn’t the cause of the client’s maladies.

Clients with FMS not only report pain associated with specific “tender points” used for diagnosis, but also describe pain that is associated with myofascial trigger points. Pain originating from either source can fluctuate and is further aggravated by various physical, environmental and emotional factors. Fatigue, stiffness, poor sleep, and a host of other related symptoms often send fibromyalgia sufferers to seek relief from this disabling pain from a massage therapist. An ABC News/USA Today/Stanford University Medical Center April 2005 poll on chronic pain reported that more than half of Americans live with chronic or recurrent pain. According to this poll, 28 percent of Americans had tried massage therapy for relief of their chronic pain. Many fibromyalgia sufferers report massage as bringing them more relief than any other treatment prescribed by their physicians.

Massage is an excellent way to decrease pain, relax muscles, improve circulation, passively stretch muscles and create an overall feeling of well-being. In 1994, research at the Touch Research Insititute, Miami School of Medicine demonstrated that fibromyalgia responds well to massage. Rheumatologists evaluating the participants in this study found that only those receiving massage reported decreases in pain, fatigue, stiffness and improvements in their quality of sleep.

With such a high degree of variability of FMS symptoms and a client’s preferences, communication during the massage process is essential. Encourage feedback from your client, and adjust your administration to maximize his/her comfort. Starting out slowly with some moist heat application or initially warming the muscles with light strokes can allow for the client to relax into your care and guide you toward his/her needs. When the practitioner begins slowly, it is easier to assess the client’s needs, sensitivity and tolerance levels.

Many forms of massage can ease fibromyalgia pain. While gentle techniques may be favored by some FMS clients, others may benefit greatly from deep work, such as penetrating ischemic work on trigger points. For some with FMS pain, low-force or non-force techniques help them the most — without overstimulating their already overburdened nervous system. Strenuous massage that uses deep tissue and/or neuromuscular techniques may possibly trigger flare-ups of muscular pain and make some FMS sufferers feel worse, which can exacerbate other symptoms associated with fibromyalgia like sleep problems, depression, lack of concentration and fatigue.

Following treatment, FMS clients should be instructed to take it easy for awhile. Soreness may be present the day after treatment, especially if trigger points were treated. After the massage, drinking plenty of water and soaking in a warm (not hot) Epsom salts bath, with a few drops of a muscle relaxing essential oil (such as lavender, bay laurel or white birch), can provide relief from soreness and promote restful sleep. If deep work was included in the session, it is especially important for your client to consume extra water, and having water on hand for the client at the close of the treatment, or sending your client home with a bottle of water can be a nurturing physical enforcement of your instructions to him or her. You might mention to your client that the enzyme bromelain, harvested from the pineapple stem, has been shown to reduce muscle and tissue inflammation. [Note: Use caution when combining bromelain with anticoagulants (blood thinners), such as enoxaparin or warfarin. This enzyme is a natural blood thinner and may increase the medication's effect.]

Elusive and debilitating, chronic pain associated with FMS affects all aspects of one’s life. Individuals with FMS and experts in the field agree that those who are most successful in controlling their symptoms utilize a comprehensive approach to their healing that integrates multiple modalities. Long term massage therapy has been shown to offer the most benefits for FMS and can enable you to successfully help your clients manage their pain and get control of their fibromyalgia.

Editor's Note: See the related article, "Fibromyalgia Part 2: Nine Massage Techniques".

Recommended Study
Fibromyalgia and Massage

Posted by Nicole at 09:50 AM | Comments (0)

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Chemical-Free Skin Care

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Products applied to the skin work their way into the body and affect our health. While some may be shocked at the thought of smearing rat poison all over their skin, they may be doing something very similar — and not even be aware of it.

Skin is the largest organ of the body. A living and breathing entity, skin is our physical barrier to all that we come in contact with. Products that we massage, rub, smear, draw or pat onto the skin are absorbed into our bodies; first through the layers of dermis, then into the capillaries of our circulatory system and eventually they are distributed systemically. While it is obvious that the food we ingest has a direct correlation to our health, the association between our health and what our skin absorbs is a relatively new understanding. Controversy around cosmetics and body products erupts when the applied products contain less than natural ingredients.

People who suffer with Multiple Chemical Sensitivity (MCS) are especially weary of what they put on their skin. One drop of lotion with a toxic ingredient can cause a substantial allergic reaction for these people. A major indicator of chemical sensitivity is multi-system disease: this is because once the chemicals enter the body, they enter the bloodstream and circulate to all parts of the body — including the brain. As industry continues to develop, and an increasing amount of chemicals and toxins are released into our environment, MCS is becoming more and more common. The U.S. Environmental Protection Agency reported that about one-third of people working in sealed buildings claimed to be sensitive to one or more common chemicals. MCS is thought to afflict somewhere between 2 percent and 15 percent of the American public, and appears to be increasing, according to a publication of the American Chemical Society.

Beginning in 2002, freedom from chemicals and synthetics in personal care products had been easy to find, by looking for the U.S. Agriculture Department’s round, green “USDA Organic” label. Unfortunately, that green label will no longer appear on body products. The USDA’s National Organic Program department head, Barbara Robinson, says that “This is USDA — I don’t know anything about the cosmetics industry, or toothpaste, or body lotions and hand cream.” As reported on June 2, 2005 by the Associated Press, Robinson said that the law creating the organic program, the Organic Foods Production Act, was not intended to cover products besides food.

Federally mandated requirements to ensure consumer safety and accurate labeling for ingestibles has yet to apply to body products. The Campaign for Safe Cosmetics claims that loopholes in U.S. federal law allow the cosmetics industry to put unlimited amounts of chemicals into personal care products with no required testing, no monitoring of health effects, and inadequate labeling requirements. A recent study by the Environmental Working Group revealed that a third of 7,500 cosmetics and personal care products assessed contained chemicals that are linked to cancer.

The personal care and cosmetics industry is in a unique position, where the former “gold standard” of quality is no longer applicable. Easy recognition by consumers that a product contains organic ingredients will need a different avenue of support. That same pillar of support can lobby against the industry giants that are working hard to maintain the right to use less than natural ingredients in their products. Consumers must educate themselves on the value of chemical-free personal care products, and put pressure on the cosmetics companies. During the week of June 18th-26th, the Campaign for Safe Cosmetics has a goal to lobby American cosmetic companies to support two new important bills for safe cosmetic legislation. To find out how you can help, visit the site www.safecosmetics.org.

As a massage therapist, applying lotions, oils and creams to your clients exposes both you and your clients to skin absorption of the applied product. Your awareness of the ingredients you are applying is a proactive way to enhance the care you give. Choosing to use products that are made with natural ingredients supports the body’s healing process, not just for your client — but also for yourself.

Posted by Nicole at 09:46 AM | Comments (0)

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Book Review: "Massage for the Hospital Patient and Medically Frail Client"

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This new book by Gayle MacDonald is a cultural reflection of massage therapy’s new role in modern medicine.

Text: Massage for the Hospital Patient and Medically Frail Client by Gayle MacDonald, Lippincott Williams and Wilkins, 2005, 220 pages.

“Human touch,” says Gayle MacDonald, “is a vital component in caring for the sick.” In her new book entitled Massage for the Hospital Patient and Medically Frail Client, MacDonald examines the role of massage therapy both within the hospital setting and in a variety of private practices that focus on the medically frail. For the massage therapist, her book answers the question, “What knowledge and skills do practitioners need to safely administer massage to people who are experiencing ill health?”

Hospital based massage therapy is being offered in hospitals under such departments as Integrative Medicine, Complementary Therapies, and Holistic Health. MacDonald’s book successfully demystifies these medical settings by acquainting massage therapists with medical devices, medications, diagnostic tests, infection control and other safety procedures within these environments.

Throughout the text, valuable and comprehensive technical information is creatively interwoven with the healing aspects of massage to create a sensitive and grounded approach to working with this population in various settings, including the hospital. MacDonald offers tips to therapists in offset boxes on topics such as clinical massage considerations for different pathologies and anecdotes shared by students, therapists and patients. The text is illustrated with black and white photographs depicting patient positioning and massage technique modifications for a wide variety of pathologies and medical situations. Appendices list common abbreviations, define touch modalities and present a variety of sample intake forms and charts. An extensive glossary and detailed index complete this text.

Massage programs within unique medical populations are covered in the last chapter entitled, “Blazing New Trails.” For example, Jan Locke, LMT, shares her experience of performing massage in the emergency room setting and Lee Erman, on staff at Stanford Hospital and Clinics, describes massage during conscious brain surgery. Massage adjustments needed for pre- and post-organ transplant patients are also covered in detail.

The many benefits of massage therapy for those who are hospitalized or medically frail are successfully advancing the use of massage within mainstream medicine. One day, MacDonald states, it is conceivable that, “the scope of hospital massage will expand to include the use of bodywork as a treatment for medical conditions.” To this end, MacDonald’s text paves the way.

Editor’s note: This book available through the Institute for Integrative Healthcare Studies.

Posted by Nicole at 09:36 AM | Comments (0)

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