Massage Professionals Article Archive

Fifty million Americans have chronic headaches – they are one of the most common physical problems in the range of human experience. Muscular tension, sinus infection, vascular spasm/dilation and chemical imbalances can all contribute to a headache. A headache can range in degree from irritating to debilitating. Massage therapists have the tools to significantly help someone who suffers from the more common types of chronic headaches.

The first step in the assessment of a client with a headache is to rule out any dangerous physical causes, such as a tumor, meningitis or aneurysm. Some questions during your performance of an intake that could ascertain these are:

• Is this the first headache you’ve ever had?
• Is this the worst headache you’ve ever had?
• Is this noticeably different from your usual headaches?
• Do you also have high fever, aches and pains, earache, dizziness or fainting?
• Could this be the result of a head trauma?

Yes to any of these questions should yield an immediate referral to the client’s physician. Massage is contraindicated in the case of a headache due to an infection or a central nervous system injury.

Another important question to ask is:

• Could you be dehydrated?

Many headaches are caused by the chemical imbalance resulting from dehydration. With a lack of water, the salinity, and therefore osmotic pressure, of the cerebrospinal fluid in the cranium rises. This painful head pressure can be relieved with adequate hydration.

Once you’ve established that you are not dealing with a headache stemming from a physical cause, determining the type of headache will help you select the most effective treatment for your client. In general, there are three types of chronic headaches:

1. Tension Headaches – These are the most common type of headache and they are characterized by tension, soreness and pain in the neck, shoulders, head and face. It can feel like a vice gripping the entire head.

2. Vascular Headaches – These are headaches where the pain comes from excessively dilated blood vessels in the meninges. The pain throbs with the client’s pulse. Common vascular headaches include:

A. Migraine Headaches – These headaches can be disabling. These begin with vasoconstriction followed by extreme vasodilation. They are usually one-sided and typically include intense pulsing and pounding in the head accompanied by nausea, vomiting and mood, visual and sound disturbances. Migraines can last for hours, days or weeks.

B. Cluster Headaches – These are the least common type of headache and they come in clusters. The clusters can be grouped over a short or a long period of time. They can be several times a day for a couple of days, for a few weeks or they can appear yearly. The symptoms of a cluster headache include a stabbing sensation in one eye, with tearing of that eye and that sided nostril, as well as agitation.

3. Sinus Headaches – This often accompanies an illness such as a sinus infection or sinusitis. Pain is generally around the eyes, cheeks, nose and forehead. The pain is deep and constant, and movement usually exacerbates it.

Massage therapy offers some important benefits to headache sufferers. Massage can help:
 relieve actual headache pain.
 prevent headaches by reducing tension and improving circulation.
 realign a structural imbalance.

A structural imbalance is often the root cause of chronic headaches. While massaging tense muscles can bring temporary headache relief, correcting a structural cranial imbalance can bring headache relief for good. The relaxation garnered from a massage can bring a great deal of relief to a headache sufferer. While easing stress can benefit most types of headaches, there are two additional factors that come into play in a successful treatment.

1. Release of contracted muscles: A skilled massage therapist will be able to recognize and effectively release the contracted musculature contributing to the headache. The tops of the shoulders and back of the neck are typical areas of tightness in headache sufferers. The blood vessels supplying oxygen to these muscles are constricted, and so the muscles are working with an inadequate supply of nutrients. This combination of muscle spasm and inadequate blood supply is the main cause of pain in tension headaches.

2. Structural Alignment: If a therapist only works with the back of the neck and shoulders, he/she will be encouraging the structural imbalance which may be the original culprit of the headache. Techniques to move the head, neck and shoulders back into structural alignment are best employed prior to extensive muscle release work for long lasting benefits. After correcting the alignment, addressing the causative postural deviation may be the lifestyle change necessary to prevent future headaches.

o According to Don McCann, MA, LMT, LMHC, in the May/June 2004 edition of the Massage Message, “When the head, neck and shoulders are released back into an improved structural alignment, the musculature in the back of the neck and tops of [the] shoulders will have already relaxed because it is no longer compensating for the forward head posture. The work on the soft tissue of the back of the neck and tops of shoulders can then be deeper and more effective.”

o For a vascular headache, a structural alignment has the additional benefit of improving the flow of cerebral spinal fluid and circulation of blood to the cranium. This can have long lasting benefits for the relief of a migraine or cluster headache.

Muscular Release for Headaches

Below is an ordered series for muscular release that a massage therapist can follow to effectively assist and/or create a structural change. This headache protocol is suggested by McCann.

1. Release the anterior shoulder and neck muscles. Have the client lie supine and work the pectoralis major and minor and then the subclavius directly under the clavicle. Then work the sternocleidomastoid and the three scalene muscles. This reduces the pull on the cervical vertebrae allowing them to shift back into alignment. While working the scalenes, rotate the head and work anterior and progress posteriorly. This will restore range of motion in head rotation, and allow a full release of the tightened musculature. WHEN TREATING THE NECK AREA, THERAPISTS MUST BE AWARE OF THE CAUTIONS AND CONTRAINDICATIONS ASSOCIATED WITH THIS REGION.

2. Release the top of the shoulder. Have the client lie on one side. Traction the shoulder and release the top of the shoulder and supraspinatus by working from the coracoid process to the superior angle of the scapula. Do not put a shearing pressure on the cervical vertebrae in this position - the pressure is directed toward the feet.

3. Massage the posterior fibers of the neck. Work from the base of the cranium into the tops of the shoulders by starting with the splenius capitus, then the levator scapula and then the trapezius. Again, do not put shearing pressure on the cervical vertebrae, but rather, apply pressure toward the feet.

4. Work the occipital ridge. Working the tightened fibers just under the ridge of the occiput will release the occiput, the atlas and the axis.

5. Massage the cranium. Carefully work the soft tissue that encompasses the head, being careful not to pinch any cranial nerves. Be sure to include massage around the sutures and the temporalis muscle.

6. Follow with lengthening strokes along the back. This is a nice way to finish, using long strokes down the entire back to reduce any additional pulling on the back of the neck and shoulders.

Structural Alignment for Headaches

Cranial-sacral therapy (CST) is the ideal modality massage therapists can use to obtain structural realignment. Not only can cranial-sacral therapy reduce the symptoms of headaches, but it can also create the structural change necessary to prevent future ones from occurring.

One of the founding principles of CST is that the bones of the cranium are not static, but are created for movement. The sutures that bind the skull bones together are not completely fused, but actually allow for slight movement in response to intracranial pressure. The structural shifts that occur with cranial-sacral work increase the flow of cerebrospinal fluid around the cranium, down the spinal column and around the sacrum, which can effectively reduce intracranial pressure that causes headaches.

These recommendations assume that the practitioner uses cranial-sacral therapy in his/her practice. If you are not educated in this modality, we suggest appropriate training before attempting to mobilize the cranium. The following guidelines are courtesy of the Institute for Integrative Healthcare Studies’ Cranial-Sacral Therapy Manual by Mary Sullivan, L.Ac. and Real Bodywork.

 A majority of headache sufferers will present with an occiput that is immobile. Using cranial-sacral techniques to mobilize a restricted occiput will result in a softening of tissue at the base of the occiput and free up movement of the atlas and axis.

 Headaches that are more prevalent on the side of the head and/or are associated with temperomandibular joint syndrome (TMJ) can benefit greatly from cranial-sacral techniques that release the temporal bone and the mandible.

 Headaches that are related to the sinuses can benefit greatly from cranial-sacral techniques that release the maxilla, the zygoma, the frontal bone, the palatines, the sphenoid and the vomer bones. Sinus headaches are likely caused by fluid pressure that stretches the small nerves in the sinuses. Sinuses appear to be the primary outlet for built up cerebrospinal fluid.

 Cranial-sacral techniques that align the parietal bones can be very helpful for headaches on the vertex of the head and for clients that are easily angered.

 Cranial-sacral techniques that free the sphenoid bone can be the key to migraine relief. Migraines may be due to membrane restriction that squeezes minor blood vessels in the cranium. The sphenoid bone is referred to as the keystone of the skull, and its release can create a major structural realignment.

 Eyestrain and forehead headaches respond well to the cranial-sacral techniques that adjust and decompress the frontal bone.

 All types of headaches can be assisted by basic cranial-sacral techniques including release of the cranial base, the 4th ventricle hold and still point induction.

With the correct combination of techniques, a skilled massage therapist can provide his/her clients with significant headache relief. A diligent intake is critical in screening out headaches that need to be assessed by a physician and headaches that can simply be relieved by drinking water. Comprehensively inquiring about your client’s symptoms will guide you to choose the most beneficial muscular releases and cranial adjustments.

Using this dual approach model allows the massage therapist to proceed in a holistic manner — by addressing the symptoms and the origin. Headache symptoms are the manifestations of an imbalance, and muscular release techniques can effectively address these symptoms. A structural misalignment is a typical root cause, or origin, of chronic headaches. Research has shown that seeking proper postural education is an effective way to implement the lifestyle changes that will allow this dual approach treatment to hold. Incorporating these skills into your treatment protocol will allow you to confidently welcome headache sufferers into your massage practice.

Recommended Study
Cranial Sacral Fundamentals

Premenstrual Syndrome (PMS) is characterized by a set of hormonal changes that trigger disruptive physical and emotional symptoms in women for up to two weeks prior to the onset of menstruation. Premenstrual symptoms usually taper off with menstruation and women remain symptom-free until the two weeks (mid-cycle) or so prior to their next menstrual period.

Mild to severe disruptive symptoms brought on by hormonal shifts prior to the onset of menses occur in an estimated 40 million women. More than 5 million require medication for marked mood and behavioral changes. The symptoms of PMS vary from woman to woman and from cycle to cycle, with intensity ranging from mild to moderate to incapacitating. Researchers estimate that about 20 to 40 percent of women who have PMS experience symptoms that make life difficult; another 2.5 to 5 percent report that their PMS is debilitating.

More than 150 symptoms of both physical and emotional origin have been associated with PMS. The most common physical symptoms include headache, migraine, fluid retention, abdominal cramping, fatigue, food cravings and breast tenderness. Common emotional symptoms include uncontrollable crying spells, anxiety, anger, irritability, depression, panic attacks and poor concentration. Symptoms may vary from month to month and there can even be symptom-free months.

Hormonal levels play a key role in PMS. The hormone estrogen begins to rise following menstruation and peaks around mid-cycle, or at ovulation. If pregnancy does not occur, estrogen levels rapidly decline following ovulation and then rise again just before the onset of menstruation. Since estrogen tends to attract fluids in the body, bloating usually occurs during estrogen peaks. In addition, blood sugar reduction and salt retention occur during estrogen peaks. The hormone progesterone is produced by the corpus luteum after ovulation and is purported to balance the effects of an increased level of estrogen. Some experts believe that high levels of stress yield high levels of cortisol, which blocks the progesterone from reaching its receptors. This equates to a predominance of estrogen in relation to progesterone.

Researchers are pursuing clues to explain what may cause the susceptibility to PMS in some women, but not in others. One possibility now being investigated is genetic differences in the sensitivity of receptors and related messenger systems that relay sex hormone signals within cells. Other clues include possible differences in patients' histories of other mood disorders or in serotonin function.

There is no diagnostic test for PMS. Tests may rule out other conditions in women who experience severe symptoms, though emotional and physical changes in sync with a woman's menstrual cycle are usually a telltale sign.

A daily diary kept over the period of two to three months is one of the best tools to begin to identify and rate the severity of premenstrual symptoms. Begin by making two lists: the first includes three to five of the most acute physical symptoms and the second includes three to five of the most acute emotional symptoms prevalent during the two weeks prior to menstruation. On a daily basis, rate each symptom in both categories on a scale of 0 -10 (0 indicating no symptom; 10 indicating the most severe). Average each category daily and write the respective numbers on a calendar for that day. Keep track and note on the same calendar dates of ovulation and when menstruation begins. Doing this for several months provides an overview of when symptoms occur in relation to ovulation and menstruation, as well as their severity. Taking this information to a medical doctor can eliminate many unnecessary tests as well as provide valuable information leading to appropriate medical treatment.

Many experts recommend a multi-faceted approach for treatment of symptoms associated with PMS. The first line of treatment includes lifestyle modifications that can effectively reduce symptoms. These are:

• Diet - General guidelines for a healthy diet are recommended overall with elimination or reduction of the intake of caffeine, alcohol, sugar and salt during the 14 days prior to menses. Also a 2000 study reported that women who followed a low-fat vegetarian diet for two menstrual cycles experienced less pain and bloating and a shorter duration of premenstrual symptoms than those who ate meat. More than one study reported less menstrual pain with a higher intake of omega-3 fatty acids. Omega-3's are found in oily fish such as salmon, mackerel and tuna.

Studies have shown that increasing complex carbohydrates is helpful for PMS. Carbohydrates increase blood levels of tryptophan, an amino acid that converts to serotonin, the brain chemical important for feelings of well-being. Whole grains and vegetables are preferred over simple carbohydrates such as sugar and starch- heavy foods, such as pastas, baked goods, white-flour products and potatoes.

• Vitamins - According to British researchers, taking 50 milligrams of vitamin B6 daily may be effective in relieving the symptoms of PMS, including depression. The researchers reviewed nine published trials in which vitamin B6 was compared with (an inactive) placebo in more than 900 women with PMS. Doses of vitamin B6, up to 100 milligrams daily, were significantly better than placebo in relieving overall premenstrual symptoms and in relieving depression associated with PMS.

• Exercise - Aerobic exercise, say the experts, increases endorphins and improves mood. In one study, women who jogged an average of 12 miles a week for six months experienced reduced PMS symptoms while a comparable group of women who remained sedentary did not improve their symptoms. A 30-minute walk every day is also beneficial. Yoga is helpful in that it regulates breathing, releases muscle tension and reduces stress - all of which can improve PMS symptom severity.

• Massage and Bodywork - Research conducted by William Flocco and Dr. Terry Oleson in England found that foot, hand and ear reflexology reduced PMS symptoms by 46 percent during eight weeks of reflexology treatments. A reduction of symptoms continued for eight weeks following the treatments in 42 percent of participants and reflexology had none of the side effects of drugs used in other studies.

Dr. Tiffany Field of the Miami Touch Research Institute conducted a study that substantiates the successful use of massage as an effective long-term aid for pain reduction and water retention, a short-term aid for decreasing anxiety and improving mood and an overall benefit for women with premenstrual dysphoric disorder (PMDD), a severe form of PMS. Results indicated that the massage therapy group experienced a decrease in anxiety, depression, perceived pain and an overall reduction in PMS symptoms, including pain and water retention.

• Alternative Therapies - Acupuncture was found to be effective in alleviating the triple warmer-spleen imbalance associated with PMS when Spleen 6 and 10 were needled. The combination of Large Intestine 4 and Spleen 8 is also used to ease PMS pain. Acupressure on these points is also effective. Aromatherapy relieves menstrual cramps with essential oils of chamomile, lavender, marjoram and melissa. For depression associated with PMS clary sage is excellent, but neroli, jasmine and ylang-ylang may be just as effective. If water retention is a concern use grapefruit, carrot seed and juniper.

For best results, incorporate these lifestyle changes and track symptoms on a calendar for at least three to six months to get an accurate overall picture of the condition. If symptoms persist or become more severe, PMDD may need to be addressed. In PMDD, emotional symptoms such as antisocial behavior, depression, anxiety, persistent anger, rage and irritability interfere with relationships at home and at work. Physically, PMDD is accompanied by headaches, joint and muscular pain, bloating and breast tenderness that regularly interfere with daily activities, often causing absenteeism from work and social events.

Consultation with a physician may be appropriate in severe cases of PMDD, as antidepressants may be helpful in alleviating the emotional symptoms associated with this disorder. Initially, antidepressants known as serotonin-reuptake inhibitors (SSRIs) are taken only during the PMS phase. If this regimen fails to soften PMDD symptoms, daily doses of SSRI's can be administered. Progesterone therapy, either in a topical cream or orally ingested has gained wide acceptance by physicians as a treatment for PMS. Progesterone seems to be particularly helpful in controlling the emotional symptoms of PMS such as anxiety and mood swings.

Massage therapists are in the unique position to both educate and advocate for their female clients who are in the throes of PMS. Your support, through gentle touch of hand and heart, will go a long way in helping them navigate this rocky terrain successfully. As your clients take steps to manage their PMS by making the necessary lifestyle changes and seeking alternative and, if necessary, conventional therapies, their sense of self-awareness and empowerment will be strengthened.

Earn continuing education credit for this article contained in our Women & Massage - Menstruation Through Menopause series. Click here to enroll.

It’s no secret that advanced age comes with a greater propensity toward health deterioration. While this may be accepted in the western world, it is not necessarily so in some Asian cultures.

Seekers of the ‘fountain of youth’ have investigated some of the cultural aspects of living in China, based on the preponderance of healthy and animated Chinese elders. Due in part to this investigation, many Chinese practices have been studied and incorporated into healthy lifestyles in the West. Chinese herbs, acupuncture, qi gong, tai chi and meditation are some of these adapted healthful customs. Now there is scientific evidence that one more Chinese tradition contributes to healthful and graceful aging.

It is common to observe people exercising, dancing and walking back and forth over traditional stone paths in China. Behavioral researchers from the Oregon Research Institute undertook a study to determine if there were health benefits of walking on these rocks. According to an Associated Press report on July 12, 2005, by William McCall, “The path to better health and lower blood pressure may be paved with cobblestones.” This study showed that when people over 60 walked on smooth, rounded cobblestones for just a half an hour a day over four months, they significantly lowered their blood pressure and improved their balance.

The researchers in Eugene, Oregon simulated the rounded, river rock cobblestones with a specially designed mat that subjects walked on in bare feet or with socks for 30 minutes every day. These people were compared with a control group who walked for an hour, three times a week on a regular surface. The results, published in the “Journal of the American Geriatrics Society,” showed that all participants felt better after exercise. However, according to lead researcher John Fisher, only the people that walked on the stones showed significant improvement in balance, measures of mobility and blood pressure.

Walking on rocks likely stimulates reflexology and acupressure points on the feet – where distant and seemingly unrelated areas of the body are linked. This comes as no surprise to practitioners and/or proponents of these systems of bodywork. According to acupuncture (or acupressure) meridian theory, the kidney channel begins on the sole of the foot. Stimulation of this area, known as Kidney 1 or “Gushing Spring,” is said to bring excess energy down from the head. This has the physiological effect of lowering blood pressure.

Fay Horak, an Oregon Health and Science University neurophysiologist who specializes in balance, said the study is evidence that finding ways to maintain mobility and balance can delay and even prevent the effects of aging. According to Horak, “The body relies on two complex methods to maintain balance – the vestibular system in the inner ear and the somatosensory system that connects skin and muscles.” When the ground is uneven, the body relies more on the vestibular system in the inner ear for balance control. As we age, we lose receptors in the inner ear. This is one of the contributors to an increase in falls in the elderly. When the challenge of walking on rocks, an uneven surface, is presented, subjects use the working portion of their vestibular system. Horak suggests that challenging the vestibular system is likely to improve its function.

Proof of improving balance and lowering blood pressure is a big deal. The implications of this finding can be widespread; from foot massages in nursing homes to landscape design (building cobblestone paths), to the creation of shoe inserts. While walking on rocks doesn’t hold the same image of ‘the fountain of youth,’ it is a practice that can participate in enhancing the length and quality of life.

A growing awareness is emerging among massage therapists and other healthcare workers that traumatic experiences are widespread. It is very common for people who have been traumatized to develop medical and psychological symptoms associated with their experience. People that experience or witness life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents or violent personal assaults often re-live these experiences over and over again. This can occur through:

• Nightmares
• Flashbacks
• Difficulty sleeping
• Feelings of detachment or estrangement
• Development of physical pain from the mental/emotional impact of the event

One’s life is usually significantly affected and impaired when post-traumatic symptoms are chronic and severe.

Known as Post Traumatic Stress Disorder, or PTSD, the stress caused by trauma has a neurobiological basis that can disrupt and alter brain chemistry, influencing one’s behavior, feelings and thought processes significantly. An estimated 70 percent of adults in the U.S. have experienced a traumatic event. Of these individuals, about 8 percent of men and 20 percent of women go on to develop PTSD following a traumatic event. Roughly 30 percent of these individuals develop a chronic manifestation that persists throughout their lifetimes. Without any treatment for this disorder, many people may continue to have PTSD symptoms even decades after the traumatic event.

The PTSD Alliance, a multidisciplinary group of professionals and advocacy organizations, state that three categories or “clusters” of symptoms are associated with PTSD. They are:

1. Re-living the event through recurring nightmares or other intrusive images that occur at any time. Extreme emotional or physical reactions such as chills, heart palpitations or panic when faced with the memory of the event. One or more of these symptoms must be present for diagnosis.

2. Avoiding reminders of the event including places, people, thoughts or other activities associated with the trauma. Feelings of emotional detachment, withdrawal from friends and family, and loss of interest in everyday activities. Three or more of these symptoms must be present for diagnosis.

3. Being on guard or hyper-aroused at all times, including feeling irritable or sudden anger, having difficulty sleeping or lack of concentration, being overly alert or easily startled. Two or more of these symptoms must be present for diagnosis.

A diagnosis of PTSD, according to the Alliance, may be considered if:

• A specific number of symptoms from each of three clusters have lasted for one month or longer
AND
• The symptoms cause severe problems or distress in personal life, at work or, in general, affect daily life.

Massage therapists and other bodyworkers are in the position to recognize physical symptoms and emotional issues affecting one’s basic needs in those with PTSD. Frequent physical complaints include chronic pain, fatigue, stomach pains, respiratory problems, headaches, muscle cramps, muscle aches or low back pain. Further indicators of PTSD include emotional absence and/or unresponsiveness, depression, exaggerated startle responses or extreme ticklishness, numbness or hypersensitivity to touch over parts or all of the body, migrating symptoms of physical pain, disassociation from self, actions or parts of the body, irritability and/or outbursts of anger or crying. In “Transforming the Pain: A Workbook on Vicarious Traumatization”, Saakvitne and Pearlman state that five basic human needs are undermined by the traumatic experience:

1. The need to be safe.
2. The need to trust.
3. The need to feel some control over one’s life.
4. The need to feel of value.
5. The need to feel close to others.

Massage therapy and other forms of bodywork can offer a profound sense of peace to those who are present in their bodies enough to let go, relax and receive. However, for those who have been traumatized, the intimacy inherent in a massage treatment may increase their sense of fear and/or trigger painful memories. Certain kinds of touch, even gentle and caring touch, can have unpleasant associations for the client, particularly if they are survivors of sexual or physical abuse. In these cases, clients may not even be able to feel certain parts of their body or be able to give feedback as to how they are feeling physically or emotionally. Those who have suffered traumatic accidents may have feelings associated with the event locked into the musculature along with the messages of physical pain.

Treatment considerations for those with PTSD involve obtaining and evaluating the information about the traumatic event specifically and how the symptoms may be manifesting in the client. The massage therapist must take into account and work with any scope of practice regulations that could influence this evaluation. In all instances, but especially with those with PTSD, establishing a sense of trust as the basis of the therapeutic relationship is paramount. A commitment between therapist and client to work together toward the client’s wellness by creating a caring and safe environment for healing as well as developing a treatment plan that is mutually agreed upon are essential components for any therapeutic relationship. For people with PTSD, communication about these components, along with a well-defined and predictable massage routine, increase the effectiveness of treatment and reduce the potential for conflict and inadvertent re-traumatization by the therapist.

In concert with the safe, trusting and therapeutic healing environment, there are several treatment protocols that may be effective when working with those with PTSD.

• Polarity Therapy is unique in its comprehensive exploration of multiple dimensions of the human condition, and in its effective bridging of the full spectrum of life experiences, including body, mind and spirit. Using an energy-based approach, Polarity Therapy offers very effective methods for supporting a safe and sound therapeutic relationship and helping the client build the inner resources necessary to manage their own stress and trauma.

Polarity sessions do not require disrobing and involve both touch and verbal interaction. According to Mary Sullivan, author of The Institute for Integrative Healthcare Studies’ Polarity Therapy Manual, Satvic touch, or touch that is very still and non-intrusive, is useful for PTSD. This type of touch is used in Polarity to bring about awareness of one’s resistance to letting go of the tension, pain and fear stored in the tissues as a result of trauma. Ms. Sullivan states, “When you touch a place that has held trauma for a long time, the psyche responds by remembering scenarios that have brought on the pain.” With the re-emergence of memories associated with the trauma, the client may feel uncomfortable with touch in that area. It is imperative to respect the client’s process and wishes and move on to related reflex areas. Maintain a conscious, loving intention in which unconditional acceptance of the client and where they are in this process are held constant. The fact that the therapist consistently remains present and accepting of the client will have an enormous impact on the ability of the client to release, balance and heal.

• Therapeutic Touch (TT) is a contemporary interpretation of several ancient energy healing practices, which consciously directs or sensitively modulates the client’s human energy field to restore health and well-being. Research has shown that TT not only alleviates pain, but also induces a relaxation response. This is known to ameliorate levels of anxiety or the situational occurrences of anxiety associated with prolonged states of fear or trauma. A series of TT treatments may help to diminish defense mechanisms that have been constructed to block awareness of physical and emotional trauma, and allow for a deeper sense of self-awareness and body consciousness.

• Myofascial Release and/or Myofascial Unwinding are techniques that initiate release in two ways:
1. Release of the fascial tissue restrictions held in the body from the trauma.
2. Release of the emotional origin of the physical holding patterns.

As a skilled therapist holds and unwinds these tissue tensions, memories begin to surface and release, causing the body to spontaneously "replay" body movements that are associated with the memory of the trauma. As the body relaxes and fascial restrictions release, the nervous system takes over and releases stored tensions like the uncoiling of a spring, allowing trapped nerves to elongate and restore normal function. Repressed memories are brought to conscious awareness allowing the client to look at them in a new way and experience the choice to transform them.

A holistic approach to therapy for recovery from PTSD is advantageous because instead of facilitating just a structural change in the body, it helps to create a whole-body centered awareness. This allows for positive personal growth and the possibility for a more total resolution of physical and psychological restrictions, emotions and belief systems that are impediments to one’s health and well-being. Massage therapists take the role of listener, teacher, coach and surrogate caregiver and, as such, must be educated and prepared for the commitment required to see someone with PTSD through their course of therapy. Supervision from a more experienced therapist can be of great assistance in helping a practitioner remain focused in his/her intent and clear any unconscious motivation that may surface for the therapist during treatment.

A skilled massage therapist who is willing and able to remain committed to the therapeutic relationship can help clients restore their most basic of human needs – for safety, trust, control, self-worth and intimacy. In the presence of the therapeutic relationship, the client is afforded the opportunity to learn the value of safe and caring touch and begin to re-emerge from the wounds of trauma.

Recommended Study
Healing Energy & Touch, Myofascial Release, Polarity Therapy

Sound healing, as the name implies, is a vibrational therapy where sound is used to create balance and alignment in the physical, emotional, mental and spiritual aspects of our being. In sound healing, music or tones are usually administered to an individual by assorted instruments or by the human voice coupled with the intention of creating health.

For centuries, sound was one of the predominant healing modalities in many cultures. Shamans chanted and drummed to heal people, while ancient mystery schools in Greece, Egypt and India developed sound into a sacred science. In the Bible, David played his harp to lift King Saul’s depression. Egyptian papyri over 2,600 years old refer to incantations as cures for infertility and rheumatic pain. The ancient Greeks believed music had the power to heal body and soul and used the flute and the lyre for treating illnesses such as gout and sciatica. Pythagoras used special songs and incantations with particular melodies and rhythms to cure diseases of the body and mind. The great Pyramids, some say, were constructed using sound.

While the use of sound and music can be found in many spiritual and sacred cultural traditions, sound healing is a relatively new modality in the allopathic and complementary healing arts. The basic principle of sound healing holds that all matter is energy; this energy is eternal and in a constant state of vibration, or resonance. Unseen, this vibration, or subtle energy field, is primordial and the basic foundation for all existence.

Cymatics offers us the means to observe the behavior of energy fields. Dr. Hans Jenny (1904-1972) was an early sound healing pioneer who studied Cymatics, or how sound creates shapes. Dr. Jenny played pure tones, or sine wave vibrations, into a speaker with a metal plate covered with various inert powders, pastes, and liquids. When the tones were played into the speaker, the substances on the metal plate became life-like, flowing forms, which surprisingly took shapes that mirrored patterns found throughout nature, art and architecture. These cymatic images are truly awe-inspiring, not only for their visual beauty in portraying the inherent responsiveness of matter to sound, but also because they inspire a deep recognition that we, too, are part of this same complex and intricate vibrational matrix.

Cymatic therapy, developed further by physician Peter Guy Manners, M.D., is based on the principle of sound healing that every cell in the body is controlled by an electromagnetic field, which resonates at its own unique sound frequency. Taking this idea one step further, the entire body has a composite harmonic frequency with its own personal vibratory rate as unique as a fingerprint. Even our bones, organs and tissues vibrate at a unique frequency.

When these different parts of our body are vibrating at their normal, healthy frequency, we call this state “health”; when portion of our body begins to vibrate at a frequency that is not harmonious to us, we call this “disease”. Based on the science of Cymatics, if the diseased organ or tissue, such as a kidney or liver, is exposed over a period of time to the correct frequency of a healthy kidney or liver, it will cause the vibrational pattern of the diseased organ to correct itself and return to a state of health and harmony. This is an example of entrainment.

One aspect of resonance is entrainment. Entrainment is a phenomenon of sound in which the powerful rhythmic vibrations of one object will cause the less powerful vibrations of another object to lock in step and to vibrate at the first object’s rate. The principle of entrainment is universal, appearing in chemistry, pharmacology, biology, medicine, psychology, sociology, astronomy, architecture and more. The classic example shows that individual pulsing heart muscle cells, when brought close together, will begin to pulse in synchrony. This tendency of one field to call another into its resonance applies to all types of waveforms -- from heart and nerve cells to ocean currents and to the flights of birds. Nature always seeks the most efficient state; it takes less energy to pulse in co-operation than in opposition.

The ability of one sound to enter into the rhythm of another is at the heart of any therapeutic relationship, particularly bodywork. The principle of entrainment can be demonstrated in a simple acoustical experiment with two tuning forks calibrated to the same frequency. When one fork is struck and held in close proximity to the other, the unstruck tuning fork will begin to resonate and sound the same note. We humans are highly sophisticated tuning forks, capable of tuning ourselves, and each other, by intentionally aligning and sounding the frequencies of our unique patterning.

Jonathan Goldman, a leader in the sound healing field, states that intention is extremely important in any healing relationship, and that coupling intention with frequency creates the transformation experience that encompasses sound healing. The depth and variety of sound healing varies extensively and may include the following:

• Music in Imagery: A client listens to specific music while using imagery to open their psyche for self-discovery.

• Music Therapy: A therapist works with clients using songs and music to help elicit states of behavior modification.

• Cymatic Therapy: Specific frequencies are projected into a client's body via various instruments to create physiological, emotional and mental changes.

• Audio Tapes/CD’s: Specifically designed frequencies are created for a particular condition in a client.

• The Electronic Ear: A client listens to a program of specially filtered music via headphones, designed to open the ear and the brain to greater frequencies of sound and treat imbalances such as dyslexia and emotional issues.

• Toning and Overtoning: A client receives the vocally created sounds of a practitioner to balance and align the physical, emotional or etheric levels.

• Harmonic Resonance: A client is tested using kinesiology and receives frequencies from synthesized sounds to balance the physical body.

• Bio-Acoustics: The missing frequencies of a client's voice are found and played back via synthesized sounds.

• Hemi-Sync: A client listens to synthesized sounds designed to balance the hemi-spheres of the brain and induce altered states of consciousness.

• Mantra Chanting: A client sounds specific mantras designed to balance and align their etheric field, which influences the physical body over time.

• Tuning Forks: A client receives the frequencies from specially designed tuning forks that are placed on meridians, muscles, etc. for relaxation and to restore health.

• Vibro-Acoustic beds, chairs, etc.: A client sits or lays on a specially designed bed that projects music into their body.

Perhaps the supreme instrument of healing -- one that is both natural and cost effective -- is the human voice. Toning is a generic term that illustrates the use of the voice for releasing pain and stress and aligning imbalanced portions of the body with a healing frequency. Often, a sound healing practitioner will allow themselves to become a conduit for inspired sacred healing sound, voicing certain sounds based on their intuitive analysis of a client’s condition. This technique is identified as overtoning.

In overtoning, a sound healer uses their voice both to scan the physical body of their client and then to project vocal harmonics (overtones) into any imbalanced portion of the body, or etheric center that is identified. A siren-like sound is made, starting at the bottom of the client’s feet with a very low sound and continuing up the body, raising in pitch, until a very high sound is created at the client's head. The vocal timbre, or tone color, created by harmonics in the voice, actually change when the sound reaches a place of imbalance in the body. The healer projects a specific harmonic into this area until the harmonic becomes less audible or disappears and the tone becomes normalized.

The results of overtoning can be quite astounding. Since sound can rearrange molecular structure, it is reasonable that seemingly miraculous things could occur; vertebrae align, muscles relax, chronic pains disappear, traumas and blockages release. Clients report feelings of being energized, ecstatic, light-headed, or drowsy following an overtoning treatment. Techniques such as overtoning are particularly effective when combined with various bodywork modalities, from massage to chiropractic to therapeutic touch. A skilled practitioner can create sounds to enrich their modality and enable their bodywork to reach new levels of effectiveness.

Sound as a healing modality is on the forefront of modern medicine. Dr. Mitchell Gaynor, MD, a prominent cancer specialist and leader in combining alternative therapies with mainstream medicine, has made listening to Tibetan and crystal singing bowls and mantra chanting a routine part of his cancer therapy. Gaynor believes that the vibrations created through these mediums affect the diosrhythmic motion found in cancer cells causing them to reorganize. Many of Gaynor’s patients say that the rich tones and frequencies from the bowls and chants resonate deeply to their core and that they feel in greater harmony with the universe following a treatment. These all-encompassing, trance-like states of consciousness, says Gaynor, are conducive to healing.

Fabien Maman, a French composer and bioenergeticist agrees with Gaynor. Maman experimented with the impact of sound waves on healthy cells and uterine cancer cells using a camera mounted on a microscope. When musical scales were sung to them, the diseased cells became disorganized. Maman further used these findings to support experiments with two breast cancer patients, each of whom toned for three and a half hours a day for a month. In one case, the tumor completely vanished, while the other woman had her tumor surgically removed. The surgeon observed the malignant tumor had shrunk significantly in size and there were no metastases; the patient recovered fully.

Dr. David Simon, medical director of neurological services at a San Diego hospital and at the Chopra Center, makes use of chanting to chemically metabolize the body into “endogenous opiates” that act as both internal painkillers and healing agents. Scientists at Michigan State University concur and demonstrate that simply listening to healing music significantly increases levels of interleukin-1 in the bloodstream. Interleukins are a family of proteins associated with blood and platelet production, lymphocyte stimulation and cellular protection against AIDS, cancer and other diseases. Participants in the Michigan study who listened to healing music reduced their levels of cortisol, a stress hormone that depresses the immune system, by as much as 25 percent.

The Heart/Math Institute in California verified that when two sets of sequenced tones are used together, heart and brain rhythms begin to work in synchronization; when this synchronization happens, healing is often the result. Hundreds of trials using sequenced frequencies with those individuals reporting various degrees of back pain support the conclusion that sound significantly decreased, and in a number of cases, completely alleviated pain for those participating in the research. Liz Longeran, RN and founder of the Body and Soul Health Clinic in Chicago used the sequenced tones on people with back pain and states, “We were astonished when degenerated discs began to restructure themselves after a patient started using the tones.” Now, these frequencies can be used as a preventative measure when back pain seems to be on the horizon for anyone.

Today, physicians, healers and therapists working with sound and music can follow the paths of the ancient shamanic traditions, combining the magic and mysticism of sound with science and technology. We are awakening to the knowledge that we are open instruments of energy, aware and interactive, from the most minute sub-cellular level of our own inner spaces to the far reaches of our universe. Healers and therapists using this knowledge will guide us back to the roots of the most ancient healing practices, and create a new frontier in the healing arts using sound as healer.

Editor's note: To explore various sound healing recordings, click here.

Carpal tunnel syndrome (CTS) affects approximately 10 percent of the United States population according to the American Academy of Osteopathic Surgeons. Second only to lower back pain as the most disabling and costly health problem in the country, up to one million surgeries for CTS are performed every year. As with lower back pain, massage therapists can help their clients who have Carpal Tunnel Syndrome.

Carpal tunnel syndrome is a common work-related, repetitive-motion injury that occurs more often in women than in men who work on factory assembly lines, with computers or in other jobs that require repetitive movements. Other professionals at high risk for CTS are massage therapists, bakers, cooks, string musicians, and check-out clerks. As the physical demands of many occupations have changed, many jobs have become more specialized resulting in performing repetitive movements. A person with numbness or tingling in his or her hands, fingers, or forearms may immediately think he/she has CTS because the syndrome is so well known.

The syndrome is present when the median nerve is compromised and compressed at the carpal tunnel due to mechanical or chemical means. By looking at the anatomy of the wrist one can see why CTS is so prevalent. Through the carpal tunnel – the area at the base of the anterior wrist between the carpal bones – nine flexor tendons and the median nerve pass. If any tenosynovial proliferation (hypertrophy of the tendon-synovial complex, which is made up of the tendons and joint-synovial tissues located in the carpal tunnel), joint abnormality, tumor, or muscular anomaly exists, there is a likelihood that CTS may result.

An acute injury may damage the tendons placing pressure on the median nerve. If untreated, the tension puts the patient into a cumulative injury cycle where isometric contraction, prolonged poor posture and decreased circulation resulting in hypoxia causes fibroblastic activity and subsequent adhesion formation. Repetitive motion causes increased tissue tension and decreased circulation to the area resulting in hypoxia and adhesion or fibrosis, with subsequent entrapment of the median nerve.

The earlier the diagnosis is made, the more carpal tunnel treatment will be successful. Numbness, weakness and pain contribute to a diagnosis of CTS. Clients who complain of numbness, burning, shooting pains, tingling, and pins and needles in their thumb, index and middle fingers and the radial half of the ring finger, weakness in their hand, and pain in their hand, forearm, elbow and shoulder may have CTS. Another sign a person may have CTS is wrist pain that wakes him/her up from a sound sleep.

To test for CTS have your client perform one of the following:

• Phalen’s test — In the Phalen’s test the client presses the backside of his/her hands together and holds them for about 60 seconds. If neurological symptoms are reproduced along the median-nerve distribution, there is a good indication the client has CTS.

• Tethered median-nerve stress test — In this test, the wrist is held in extension or partial hyperextension and the index finger is pulled into hyperextension as far as the client’s range of motion will allow. If this movement reproduces the client’s pain or neurological symptoms, it is considered a positive indication of CTS.

• Carpal-compression test — Carpal tunnel syndrome may also be diagnosed by applying direct pressure over the carpal tunnel to reproduce symptoms.

• Tinel test — In this test, tap the wrist while the hand is extended. If there is pain it may be due to CTS.

Once CTS is diagnosed, there are several treatments a massage therapist can use to help his/her client reduce pain and numbness. The January-February 2004 issue of Massage Magazine outlined several methods therapists can use to lessen their client’s pain, including:

• Myofascial stretching — In cases where nerve compression is not severe, myofascial stretching applied over the flexor retinaculum has proven helpful in reducing the aggravating symptoms of CTS. Flex the client’s wrist and with your thumbs stretch the transverse carpal ligament.

• Flexor work — Working on the wrist and finger flexor muscles is also helpful. If the condition is severe, the therapist should be gentle at first. More significant pressure may be used if the condition is not severe or during later stages of therapy.

• Stripping & compression — Deep longitudinal stripping and compression-broadening methods can be used on the forearm flexors to regain optimum tone in those tissues. To work the finger flexor muscle, use a thumb and strip the thumb up the forearm. To work the wrist flexor, place static pressure on the muscle while the client flexes his/her wrist.

In some cases the median nerve is entrapped in another location such as the pronator teres muscle. In the video, Heal Your Wrist Pain Naturally with Sean Riehl, Riehl explains various techniques a therapist could show his/her client to use at home, at the office in between visits, or techniques the therapist can do on him/herself. This includes massaging the pronator teres muscle. To do this, have your client apply static pressure to the pronator teres muscle with his/her thumb as he/she twists (turns) the wrist.

The video also shows techniques one can perform on the finger, thumb and wrist extensors and flexors, supinator and pronator muscles to further alleviate wrist pain by applying static pressure. For alleviating CTS pain Riehl suggests working the finger flexor muscles. Place static thumb pressure on these muscles while flexing the fingers.

If at any time during massage, your client experiences pain, stop, and try a different technique.

In addition to massage, educate your clients about an integrative approach. Tell clients to rest their wrists, or if they have to continue working to wear splints. Encourage your clients to consider taking vitamin B6, as a deficiency in this nutrient has been linked to CTS.

Carpal tunnel syndrome is a complex condition. However, once therapists know how to test for the syndrome they can help their clients by using the techniques listed above. Massage therapists can also use the abovementioned techniques on themselves if they are afflicted with CTS.

Editor’s note: For more information about Heal Your Wrist Pain Naturally with Sean Riehl, click here.

Summer is officially here, and that seasonal shift is felt by us all. As the environment affects the well-being of a plant, it too, affects our well-being. We are influenced by changes in climate, and living in harmony with those changes is the key to maintaining our longevity.

As the warmest months make their presence known, our bodies adapt and gravitate towards that which best nourishes it. Some people are not tuned in to these subtle changes and personal preferences, so being able to guide your clients toward that which benefits them the most will be greatly appreciated.

Logic and experience tell us that the heat of the summer sun will quickly wilt a flower. Shade and water will maintain it, and can possibly even revitalize it. Imagine yourself as that flower, and it will be clear how you can protect yourself from the brutal elements.

Practitioners of Oriental Medicine are trained to advise their clients on eating habits for each season. Courtesy of Healing with Whole Foods by Paul Pitchford, below are some of the summer guidelines that you can share with your clients:

1) Cook lightly. When sautéing, use high heat for a very short time. Steam or simmer foods quickly if possible. This prevents the loss of nutrients that can occur with longer cooking times.

2) Add a little spicy, pungent or fiery flavor to foods. At first, these spices increase warmth, but ultimately they bring body heat out to the surface to be dispersed. With heat on the surface, one’s body mirrors the summer climate and therefore will be less affected by it.

a. Hot peppers
b. Fresh Ginger

3) Use little salt and more water. Excessive salt causes water retention which contributes to feelings of puffiness, sluggishness, heaviness and fatigue. More water will keep you well-hydrated for optimal health in the summer heat.

4) Take advantage of the abundant variety of produce in season. Minerals and oils are sweated out of the body, and their loss can cause weakness if they are not replaced by a varied diet.

5) Drink hot liquids and take warm showers to induce sudden sweating and cool the body.

6) Cooling foods that are ideal to eat in the summertime are

a. Salads
b. Sprouts (especially mung, soy and alfalfa)
c. Fruit (especially apples, watermelon, lemons, and limes)
d. Cucumber
e. Tofu
f. Flower and leaf teas (especially chrysanthemum, mint and chamomile)

7) Limit very cold foods. While cool foods can balance summertime heat, very cold foods can weaken the digestive system (ice cream and iced drinks). Extremely cold items can contract the stomach and actually stop digestion.

8) Avoid heavy foods that can cause sluggishness such as

a. Meat
b. Eggs
c. Fatty foods

Following our body’s natural preferences will usually steer us in the right nutritional direction. During the hot months of summer, many people choose to eat smaller and lighter meals – simply because it makes them feel better. Unfortunately, a lot of other factors can play into the food that we eat, such as emotional connections with food or a disconnection from our bodily wisdom. According to the principles of Oriental medicine, eating in harmony with the seasons ensures harmony within ourselves.