Massage Professionals Article Archive

One of the primary reasons for client visits to clinically oriented massage practices is back pain. Recognizing the signs of kidney inflammation enables therapists to differentiate it from a muscular strain/sprain.

Often mistaken to be tense or strained back muscles, kidney inflammation's most prominent symptom can be back pain. Three kidney inflammatory conditions that can cause back pain are:

• Nephritis -- kidney infection
• Renal calculi -- kidney stones
• Polycystic kidneys

When a client complains of back pain, from the lower-thoracic to the mid-lumbar regions, it is important to rule out kidney inflammation. When the kidneys are not functioning optimally, the body's ability to manage fluid balance is impaired, often resulting in edema. Systemic circulatory massage is inappropriate for these individuals, as it would push more fluid through an already overburdened system. Additionally, if the kidneys are inflamed, they are more susceptible to injury from vigorous massage. The kidneys are vulnerable because they are only partially protected by the rib cage. The right kidney's location underneath the liver results in its position being slightly lower than the left kidney.

A solid, anatomical understanding of each kidney's location will contribute to accurate differentiation. The superior border of the kidney reaches the level of the 12th thoracic vertebrae. The inferior border lies just above the horizontal plane of the umbilicus, typically level with the 3rd lumbar vertebrae. The inferior border is one finger breadth superior to the iliac crest. The center of the kidney, where the ureter is attached, is level with the intervertebral disc between the first and second lumbar vertebrae. Therefore, pain originating in the kidney is typically felt in the upper lumbar region and can radiate to the upper right or left quadrant of the abdomen.

A thorough client history and intake is an essential component of safe practice, especially when evaluating back pain. To help the bodyworker identify kidney involvement, the three kidney inflammatory conditions previously listed are explained below.

Nephritis

Nephritis typically causes tenderness, pain and swelling in the back, below the costal margin and lateral to the vertebrae. The pain can be constant or sharp, and is typically unilateral. Other symptoms can include one or more of the following:

• Dark, red or foamy urine
• Decreased urine output
• Urinary urgency and/or burning
• Groin pain
• Fever
• Recent history of sore throat
• Abdominal pain or pressure

Severe infection may also include:

• High fever
• Chills
• Extreme fatigue
• Nausea or vomiting
• Confusion
• High blood pressure
• Edema

An individual with nephritis has an impaired ability to process fluids, contraindicating circulatory massage. However, non-circulatory techniques can offer substantial benefits without challenging fluid balance. If you suspect an untreated kidney infection, an immediate referral to a physician is warranted. Medical professionals take these symptoms very seriously, as an untreated kidney infection can have dire consequences.

Kidney Stones

A kidney stone is a solid deposit of crystalline substances inside the kidney. Stone size can vary greatly, ranging from the size of a grain of sand to a small pebble. When the stones are large enough, they scrape the delicate lining of the urinary tract, causing an enormous amount of pain. The intense pain, referred to as renal colic, comes and goes in waves, is typically unilateral, and is often likened to giving birth. Additional symptoms can include:

• Nausea and vomiting
• Back pain referred to the groin
• Frequent urination
• Blood in the urine
• Fever and chills, if accompanied by an infection

Those prone to kidney stones are excellent candidates for massage, as long as they are asymptomatic. If kidney stones are suspected, most sources suggest avoiding massage during the acute phase. However, some Asian styles of bodywork include specific techniques that may reduce the spasmodic pain of renal colic. These techniques involve bodywork on the following distal areas:

• The kidney area is on the sole of the foot. In reflexology, this point is near the center of the sole of the foot, level with the arch. In acupressure, this point is in the center of the width of the foot, one-third of the way down from the toes, just proximal to the distal pad of the foot. Stimulation of this area may ease kidney pain.
• According to Chinese Medicine, Stomach 36 is widely used for invigoration. This invigoration is gentle, so as not to overload the kidneys, yet effective. Stomach 36 is located four finger breadths below the eye of the knee, one finger breadth lateral to the anterior crest of the tibia, in the tibialis anterior.
• According to Chinese Medicine, Urinary Bladder 39 opens up water passages in the lower part of the body. Urinary Bladder 39 is located in the transverse crease of the popliteal fossa, lateral from the center, on the medial border of the tendon of the biceps femoris. While deep pressure should not be applied to the back of the knee, energy techniques can be employed.
• Gently massaging the entire Kidney meridian can relax its associated organ's tissues, calming renal colic. The Kidney meridian begins under the little toe, crosses the sole of the foot, ascends along the medial aspect of the leg, follows the postero-medial aspect of the thigh to the tip of the coccyx, and goes up the anterior aspect of the abdomen and chest to just below the clavicle. Meridian work on the foot and lower leg will have the greatest affect on the kidney.
• The Four Gates are four points used in Chinese Medicine to ease pain. Simultaneously apply pressure to Large Intestine 4, located on the dorsum of the hand, in the center of the 2nd metacarpal bone on the radial side, and Liver 3, located on the dorsum of the foot in the depression distal to the junctions of the 1st and 2nd metatarsal bones. If you have access to an assistant, it is ideal to stimulate all four of these points at the same time.

Polycystic Kidneys

Polycystic kidney disease (PKD) is an inherited disease where sacs of fluid (cysts) grow in the kidneys. If too many cysts grow or if they get too big, the kidneys become damaged. The cysts may also cause pain or may get infected.

The most common symptom of PKD is high blood pressure. Other symptoms include:

• Pain in the back and side
• Abdominal pain
• Increased abdomen size
• Blood in the urine
• Frequent kidney infections

Abdominal massage is contraindicated for polycystic kidney disease. In an effort to remove toxins from the body and to prevent an excessive circulatory load on the kidneys, lymphatic drainage massage is an excellent choice for someone with PKD.

As an increased number of people with complex medical disorders seek the benefits of massage therapy, bodyworkers need to have a basic understanding of the conditions they may encounter. Practitioners should never assume back pain is due to a muscular imbalance and should have a screening process to rule out kidney inflammation in place. Taking the extra time during a client intake will enable you to administer a condition-appropriate massage, prevent symptom exacerbation and could even lead to a referral your client will be extremely thankful for.

References

Premkumar, Kalyani, The Massage Connection: Anatomy and Physiology, Lippincott Williams and Wilkins, 2004.

Werner, Ruth, A Massage Therapist's Guide to Pathology, Lippincott Williams and Wilkins, 2005.

www.merck.com, Kidney Infection (Pyelonephritis), Merck and Co, Inc., 2006.

Athletes and those who treat their injuries are all too familiar with the surge of strains, sprains and tears associated with the first few weeks of athletic training. Common among runners, anterior shin splints are one of the most prominent early season injuries. Anterior shin splints can develop gradually over a period of weeks to months, or may occur after a single, excessive bout of exercise.

Definition
Often occurring bilaterally, anterior shin splints typically involve inflammation and/or small tears in the tibialis anterior muscle where it is attached to the tibia. The pain is usually noticeable when exercise begins, then decreases as exercise continues. Often experienced as a burning sensation, the pain worsens after exercise or the following morning.

Due to the tearing of muscle fibers away from the periosteal attachment, anterior shin splints manifest as bumps and tender areas on the anterior leg. As these fibers heal, they become fibrotic, making it difficult for the muscle to lengthen normally. The fibrotic patches weaken the muscle by restricting movement, perpetuating the probability of future shin splints. Additionally, untreated shin splints place the individual at a greater risk for developing stress fractures.

Cause
Since the tibialis anterior muscle controls the lowering of the foot upon heel strike, stressing this movement can increase chances of injury. Activities leaving individuals susceptible to anterior shin splints include:

• Beginning a running program
• Excessive downhill running
• Sports requiring rapid starts and stops

Additional conditions which can increase the chances for shin splints are:

• Running on hard surfaces, or wearing shoes without adequate shock absorption
• Over-pronated (flat) feet, which increase stress on the lower leg muscles
• High arched feet due to their inability to absorb shock
• Excessive jumping, which places disproportionate stress on the toes

Prevention
According to James Mally, ND, instructor of the Institute for Integrative Healthcare Studies' Sports Massage continuing education program, “The best ways to avoid shin splints are to warm-up well; stretch; run on soft surfaces as much as possible; avoid major changes in training, and ice at the first sign of discomfort. Orthotics may be necessary if there is inadequate arch support.”

Special considerations
Bodyworkers may note an imbalance between the weaker anterior leg muscle group and the larger and stronger posterior group. Tightness of the posterior muscle group can further aggravate anterior shin splints.

Prior to working with sharp anterior leg pain, the bodyworker should rule out a tibial stress fracture. A positive test for a stress fracture is eliciting pain at the fracture site when placing a vibrating tuning fork directly on the tibia. Refrain from local massage and refer to a physician if a stress fracture is suspected.

Another condition that may mask itself as shin splints is compartment syndrome of the lower leg. Also induced by exercise, compartment syndrome involves swelling, pain, parathesia, and can ultimately decrease leg motor function. Also requiring a referral, compartment syndrome demands medical evaluation.

Treatment
Orthopedic specialists agree that the most important treatment for shin splints is rest. If the activity aggravating the tibialis anterior continues prior to the tissue healing, damage to the muscle will ensue. Additionally, directly icing the shin after activity will minimize tissue damage.

Massage is a valuable tool when recuperating from anterior shin splints. Bodywork can drastically reduce the tightened and fibrotic muscle tissue typical of this injury.

In the Institute's Sports Massage continuing education course, Dr. Mally teaches two methods to decrease shin splint pain:

1. In the supine position, slightly rotate the leg medially to provide better access to the tibialis anterior. Work your way up the tibialis anterior with the heel of your hand or with your proximal forearm.

2. In the prone position, increase the tension on the tibialis anterior by bending the client's knee and grasping their toes to plantar flex the client's ankle. In this position, the therapist can maximize the depth of work on the tibialis anterior muscle.

In the August/September 2000 edition of Massage and Bodywork, Zhenya Kurashova Wine imparts information on Russian sports massage for running injuries. Wine clarifies the reasoning for the upward stroke direction when addressing anterior shin splints, “To reiterate, it is very important not to apply any downward pressure since this will increase the chance of edema, hemorrhage and possibly more tissue damage.”

Additionally, Wine suggests a conservative approach for anterior shin splints, by beginning massage on the posterior leg before progressing to the anterior leg. By massaging the muscle antagonist first, the injured area is flooded with circulation to prepare for direct manipulation.

Acupressure practitioners work two important points near the tibia to increase circulation for enhanced tibialis anterior healing:

• Stomach 36: Located four finger breadths below the eye of the knee, one finger breadth lateral to the anterior crest of the tibia, in the tibialis anterior.
• Spleen 9: On the lower border of the medial condyle of the tibia, in the depression on the medial border of the tibia.

Rehabilitation
Once the tibialis anterior muscle has healed, another step is necessary before engaging in the original offending activity. No different than any other sports related injury, the anterior leg muscles must be progressively stretched and strengthened to prevent re-injury. The key to successful rehabilitation is a gradual increase in its intensity.

A certified athletic trainer and strength and conditioning specialist, Benny Vaughn, LMT, suggests resistance exercises using rubber tubing or bands. Performing resistance exercises consisting of ankle dorsiflexion, plantar flexion, eversion and inversion can lengthen and strengthen the lower leg muscles, providing added insurance against future shin splints.

Review
Anterior shin splints are a common injury, with every sports training facility seeing its fair share of painful tibialis anterior muscles. The massage techniques discussed here will maximize a bodyworker's role in reducing anterior shin splint pain and damage.

The number one reason for recurring shin splints is an athlete's impatience with the healing process and the premature return to activity. Educating these clients about the how, what and why of their anterior shin splints will facilitate prevention, healing and rehabilitation, paving the way for their full recovery.

Recommended Study:

Sports Massage

Resources:
Lowe, Whitney, LMT, NCTMB, Shin Splints or Compartment Syndrome?, Massage Today, December 5, 2005.

Mally, Dr. James. Sports Massage, Abundant Health Resources, 2002.

Wine, Zhenya Kurashova, Running Injuries, Massage and Bodywork, August/September 2000.

www.biotone.com, Vaughn, Benny, LMT, CAT, CSCS, Massage Therapy Makes the Difference in Sports and Exercise Benefits, 2006.

During the second week of February, we typically turn our focus toward the fourth chakra, the heart. Snuggled tightly inside the chest cavity, the heart is a wondrous organ, responsible for pumping blood through our vessels and for experiencing feelings of compassion and love. Provide your clients with extra care by supporting this organ critical to our well-being.

The physical and emotional connections found within the fourth chakra are apparent to those tuned into their body. Feelings of despair or anger can coincide with chest pain, while stretching and relaxing chest muscles is often accompanied by positive emotions such as peace and freedom. According to Traditional Chinese Medical Theory, emotional distress patterns commonly evolve into heart meridian (channel) stagnation. In alternate terms, stress and anxiety can manifest as a blood flow disorder. Therefore, ensuring smooth and uninterrupted circulation serves two purposes:

• Support cardiovascular health
• Assist emotional well-being

Bodyworkers may even detect inhibition in the heart chakra through simple observation techniques. Clients experiencing chest restriction physically protect the area by concaving the chest, protruding the shoulders forward and rounding the upper back. A consequence of these protective measures is congestion in the heart chakra, compounded by strained musculature of the upper back and shoulders. As a massage therapist, it is important to recognize and attend to this restriction with anterior and posterior upper torso work.

Maximize the role you play in your clients' heart health by emphasizing the importance of unimpeded circulation. Below are five significant ways you can contribute to a healthy fourth chakra – either with bodywork or through the power of suggestion:

1. Suggest a natural supplement to reduce blood coagulation. Breaking down plasma fibrinogen in the blood reduces coagulation within blood vessels. Scientific research demonstrates that Nattokinase, an enzyme extracted and purified from natto (a popular, Japanese, fermented soybean food), effectively breaks down plasma fibrinogen, preventing hardening of the arteries. (1)

*Editor's note: It is important for all therapists to solely operate within their scope of practice. Additionally, anyone adding a supplement to their regimen must check with their physician first. Nattokinase in particular is contraindicated with some health conditions and interacts with some medicines.

2. Discuss the importance of eliminating artery-clogging fats from one's diet. Trans-fats are the most implicated factors in sluggish circulation. Thanks to new regulations by the Food and Drug Administration, manufacturers are required to list any trans-fats on food labels as of January 1, 2006. The American Heart Association urges consumers to read food nutrition labels to reduce their intake of trans-fats, saturated fats and cholesterol. (2)

3. Perform massage to increase circulation. Most therapists are familiar with massage's benefits, and are not surprised to learn massage positively effects circulation and in turn, relaxation. A 2002 study investigating the effect of myofascial trigger-point massage therapy on cardiac health concluded that it caused a significant decrease in heart rate and blood pressure while improving muscle tension and emotional state. (3)

4. Review the cardiovascular health benefits of a regular exercise program. Numerous studies and reports concur that more active or fit individuals develop less coronary heart disease than their sedentary counterparts. Exercise improves the ability to handle stress by increasing blood flow to the heart muscle and strengthening it, while also maintaining blood vessel elasticity.

5. Encourage positive thinking and laughter. Enhanced cardiovascular health has been documented by researchers studying people with an optimistic outlook on life. Participants with the highest levels of optimism had dramatically reduced risks of coronary heart disease. (4) Additionally, researchers at the University of Maryland School of Medicine found that laughter, along with an active sense of humor, may help protect against a heart attack. (5) All the more reason to joyfully chuckle.

When considering therapy for the fourth chakra, keep in mind the many aspects involved in heart health. The phenomenon of blood flowing easily and unobstructed through blood vessels can be encouraged in many ways; internally through ingestion and emotion, and externally via passive and active applications. The greatest outcomes of an open, disease-free, loving, heart chakra are achieved when all of the resources contributing to heart health are recruited.

References:

1. Sumi H, Hamada H, Nakanishi K, Hiratani H., Enhancement of the fibrinolytic activity in plasma by oral administration of nattokinase, Acta Hamateol, 1990; 84(3):139-43.

2. www.americanheart.org, Trans Fat Overview, American Heart Association.

3. Delaney, J.P., Leong, K.S., Watkins, A., & Brodie, D, The short-term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects. Journal of Advanced Nursing, 37, 364-71, (2002).

4. Harvard University Gazette, Study: Taking heart leads to better heart health, November 29, 2001.

5. www.umm.edu, University of Maryland School of Medicine Study Shows Laughter Helps Blood Vessels Function Better, March 7, 2005.

Nothing says I love you like chocolate – dark chocolate, that is. With Valentine's Day fast approaching, why not buy your special someone something that not only promotes love but longevity as well. There are now more reasons than ever to give the gift of chocolate. Sure, it tastes good, and is great for a quick boost of energy during the mid-afternoon slump, but recent studies have shown that eating dark chocolate can have valuable health benefits. Believe it or not, that heart-shaped box of chocolates may actually be good for the very organ it resembles. That's news everyone will love.

Dark chocolate contains a high amount of flavonoids, antioxidant rich compounds commonly found in fruits, vegetables and plants. The primary sources of flavonoids are teas, wine, berries and chocolate. These flavonoids play a vital role in cardiovascular health, and may even help fight heart disease and lower blood pressure. Keep in mind that these flavonoids are specific to dark chocolate, as milk chocolate does not contain nearly the same levels of antioxidants, while white chocolate has none at all. According to Mauro Serafini, PhD, of Italy’s National Institute for Food and Nutrition Research, the reason dark chocolate has proven healthier than milk chocolate is because the milk in milk chocolate may actually interfere with the absorption of antioxidants, canceling out its positive benefits.

According to the American Journal of Clinical Nutrition, a study was done where participants were given 3.5 ounces of dark chocolate every day for two weeks, then went seven days without consuming any chocolate, followed by another two weeks of eating 3.2 ounces of white chocolate each day. The results showed that after the two-week period of consuming dark chocolate, blood sugar metabolism and insulin resistance were significantly improved. None of the same results were evident following the white chocolate period, demonstrating that flavonoids specific to dark chocolate provide a considerable benefit to fighting heart disease and diabetes.

Jeffrey Blumberg, PhD, a senior scientist at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston, conducted another chocolate study reported on by the American Heart Association. Results of this study proved that eating dark chocolate helps to substantially lower both systolic and diastolic blood pressure. In fact, Blumberg claims "three ounces of dark chocolate per day over several weeks reduced blood pressure in patients with essential hypertension and also seemed to provide a benefit on their insulin sensitivity." While these results may indicate chocolate as being healthy, Blumberg says, "The findings do not suggest that people with high blood pressure should eat lots of chocolate in lieu of other important blood pressure-reduction methods, such as medication and exercise." Even though dark chocolate appears to be cardiovascular-friendly, it should not be considered a substitute for a healthy, balanced diet.

While the findings of these studies are exciting, they are not a prescription for over-indulging in your favorite chocolatey snack. Chocolate is widely known to be high in calories and fat, and as with most sweets, should be consumed in moderation. A small piece of dark chocolate each day seems appropriate.

Now that you know about chocolate's potential health bonuses, you can enjoy your chocolate fix without guilt. With Valentine's Day just around the corner, show those you care about how much you really love them by giving them a tasty treat that's also advantageous to their health. Or, if you find yourself on the receiving end of this wonderful dark-chocolatey snack, say thank you – from the very bottom of your heart.

References

www.medicinenet.com, Reinberg, Steven, HealthDay News, Dark Chocolate May Sweeten the Way to Health, July 18, 2005.

www.webmd.com, DeNoon, Daniel, WedMD Medical News, Dark Chocolate Has Health Benefits Not Seen in Other Varieties, August 27, 2003.

www.webmd.com, Warner, Jennifer, WedMD Medical News, Eating Dark Chocolate May Also Fight Heart Disease and Diabetes, March 11, 2005.