Massage Professionals Article Archive

by Nicole Cutler, L.Ac.

Most bodyworkers now perform a substantial intake evaluation prior to conducting their respective sessions. The interview process has become a requirement for conscious care, arising out of the profession's increased presence in the healthcare industry. Once a therapist has the informative details of their client's health, it is easier to create a customized treatment plan from the many possible massage therapy applications.

Acupressure practitioners are familiar with the meridians of the body, accessing the energy within these meridians to influence health. Out of the 12 primary meridians, the Urinary Bladder (UB) meridian is unique. With the most number of accessible points along its path, the UB meridian begins just medial to the inner canthus of the eye, ascends up the forehead, around the cranium, runs all the way down the dorsal surface of the body and finally ends at the lateral edge of the little toe. When this meridian descends along each side of the spine, UB points provide access to toning every organ system in the body.

Although not diagnosticians, bodyworkers can use the principles of Traditional Chinese Medicine (TCM) to offer particularly beneficial treatments to their clients. In TCM, an imbalance of health is characterized by a symptomatic pattern. Discover the most beneficial points to work on the UB meridian for the following three commonly encountered imbalances:

Heart Blood Insufficiency
The symptoms of this pattern are characterized by anxiety and insomnia. Additional symptoms may include memory and concentration problems, heart palpitations, pale complexion, dizzy spells, vertigo and blurry vision. This pattern can manifest after blood loss (examples include: giving birth, surgery, trauma or heavy menses), or can be a result of chronic disease.

Working with Urinary Bladder points 15, 17 and 20 can be useful in bringing about balance to heart blood insufficiency.

UB 15 is located approximately two finger widths lateral to the lower border of the spinous process of the fifth thoracic vertebrae, at the height of the paraspinal muscle. This is the Associated Point of the Heart, and is indicated for its calming properties and ability to strengthen heart insufficiency.

UB 17 is located approximately two finger widths lateral to the lower border of the seventh thoracic vertebrae, at the height of the paraspinal muscle. This is the Influential Point of Blood, and is useful to build and nourish the blood.

UB 20 is located approximately two finger widths lateral to the lower border of the spinous process of the eleventh thoracic vertebrae, at the height of the paraspinal muscle. This is the Associated Point of the Spleen, and is indicated because the spleen is the primary source of nourishment for making blood.

Liver Invading the Spleen
The symptoms of this pattern are characterized by abdominal distention and pain aggravated by emotional upset. Additional symptoms typically include alternating constipation and loose bowel movements, flank pain, decreased appetite, dysmennorhea, irritability, depression and fatigue. In TCM, unreleased emotions create stagnation in the liver, which in turn, disturbs the spleen's digestive functions.

Working with Urinary Bladder points 18, 20 and 25 can be useful in bringing about balance to a liver invading the spleen.

UB 18 is located approximately two finger widths lateral to the lower border of the ninth thoracic vertebrae, at the height of the paraspinal muscle. This is the Associated Point of the Liver, and is used to relieve stagnation in the liver.

UB 20 is located approximately two finger widths lateral to the lower border of the spinous process of the eleventh thoracic vertebrae, at the height of the paraspinal muscle. This is the Associated Point of the Spleen, and is indicated to strengthen the spleen's digestive functions.

UB 25 is located approximately two finger widths lateral to the lower border of the spinous process of the fourth lumbar vertebrae. This is the associated point of the Large Intestine, and can help regulate the intestines.

Lung and Kidney Yang Deficiency
The symptoms of this pattern are characterized by asthma and coughing with watery sputum. Additional symptoms typically include a sensation of cold throughout the body, lower limb edema, low back cold and pain, fatigue, desire for warm beverages and breathlessness. In TCM, when the kidneys are lacking their life-giving fire and lung energy is weak, the body fails to transform fluids and warm itself. This pattern is commonly seen in chronic disease and the elderly.

Working with Urinary Bladder points 13, 23 and 43 can be useful in bringing about balance to lung and kidney yang deficiency.

UB 13 is located approximately two finger widths lateral to the lower border of the spinous process of the third thoracic vertebrae. This is the Associated Point of the Lung, and is useful in strengthening the lung.

UB 23 is located approximately two finger widths lateral to the lower border of the spinous process of the second lumbar vertebrae, on the quadratus lumborum muscle. This is the Associated Point of the Kidney, and tonifies kidney yang.

UB 43 is located approximately four finger widths lateral to the lower border of the spinous process of the fourth thoracic vertebra, on the spinal border of the scapula. This point is commonly used in chronic conditions where the lung and kidney need strengthening.

While arriving at the correct TCM diagnosis is complex, the key to this analytical process is looking at the pattern from an overarching perspective. There are at least five or six possible imbalances each for anxiety, stomach pain and asthma, so investigate further to see if a client's additional symptoms fit the rest of the pattern as described. If the imbalance seems to fit the presented case, working with the UB points listed abovie will aim your client in the direction of healing and recovery.

Caution
Do not press on disintegrating discs or fractured or broken bones. If your client has a weak back, use caution with a stationary, light touch. If you have any questions or need medical advice, seek permission to discuss your client's health with their physician.

Editor's Note
For more information on acupressure, read the article, Ten Highly Effective Acupressure Points

References
Flaws, B., Finney, D., A Compendium of TCM Patterns and Treatments, Blue Poppy Press, 1996.

Lade, A., Acupuncture Points: Images and Functions, Eastland Press, 1989.

Liangyue, D., Chinese Acupuncture and Moxibustion, Foreign Languages Press, Beijing, 1993.

Maciocia, G., The Foundations of Chinese Medicine, Churchill Livingstone, 1995.

by Nicole Cutler, L.Ac.

Bodyworkers are one of the many types of professionals who physically and repeatedly rely on hand strength and dexterity for optimal work performance. Knuckle cracking is an unconscious custom practiced by many who rely on their hands in an attempt to loosen or relax the phalanges.

Controversy has long surrounded the benefit and/or detriment of knuckle cracking. While some claim the end result of knuckle cracking is arthritic hands, others tout it as a completely normal and healthy act. Whether you do it yourself, administer treatments to or simply care for a chronic cracker, being familiar with the anatomy, physiology and possible pathology of this habit can help in sorting out the details of this on-going debate.

What occurs during knuckle cracking? Research on joint cracking is sparse. A joint capable of cracking is a diarthrodial joint, where two bones contact one another at their cartilage surfaces. These surfaces are surrounded by a joint capsule, which is filled with synovial fluid to lubricate the joint. Synovial fluid contains dissolved gases including oxygen, nitrogen and carbon dioxide.

According to Raymond Brodeur on the Ergonomics Research Laboratory at Michigan State University, "As the joint capsule stretches, its expansion is limited by a number of factors. When small forces are applied to the joint, one factor that limits the motion is the volume of the joint. That volume is set by the amount of synovial fluid contained in the joint. The synovial fluid cannot expand unless the pressure inside the capsule drops to a point at which the dissolved gases can escape the solution; when the gases come out of solution, they increase the volume and hence the mobility of the joint. The cracking or popping sound is thought to be caused by the gases rapidly coming out of solution, allowing the capsule to stretch a little further."

This predominant theory alleges that a pulled finger stresses the joint capsule's capability, triggering a change in the synovial fluid for increased volume. The synovial fluid's air bubble forms and quickly bursts, making the characteristic ‘cracking’ sound.

Brodeur adds, "If you take an x-ray of the joint after cracking, you can see a gas bubble inside the joint. This gas increases the joint volume by 15 to 20 percent; it consists mostly (about 80 percent) of carbon dioxide. The joint cannot be cracked again until the gases have dissolved back into the synovial fluid, which explains why you cannot crack the same knuckle repeatedly."

According to Jonathan Cluett, MD, an orthopedic surgery fellow in sports medicine and arthroscopy in California, a cracking joint can also be due to the tendons and ligaments crossing over a joint. Ligaments and tendons crossing over bones may produce a pop or cracking sound as they tighten and snap over a moving joint. This is the likely mechanism responsible for inadvertent crackling hands of a massage therapist, or in any other manually demanding occupation.

Does knuckle cracking actually loosen the finger joints? As Brodeur explained, knuckle cracking does temporarily widen the joint space between phalanges. However, it does not lengthen and relax the muscles of the hands and fingers. Peter Bonafede, MD, medical director of the Providence Arthritis Center, suggests replacing knuckle cracking with the more useful practice of bending and stretching out of the fingers. When hands get cramped or tired, finger bending and stretching serves to oxygenate and lengthen fatigued muscles.

WebMD suggests trying the following hand, wrist and finger exercises for increasing flexibility and strength:

1. Rotating your wrist up, down, and from side to side.
2. Stretching your fingers far apart, then relaxing them, then stretching them again.
3. Squeezing a rubber ball.
4. Wrist curls and extensions with a light weight.

Is there any danger to knuckle cracking? This question evokes the most controversy. Most knuckle crackers support their habit by citing a mid-1970s study of 28 people concluding that knuckle cracking does not cause or lead to arthritis. Many specialists in this area claim no harm is being done, as long as there is no pain, swelling or mobility restriction associated with the cracking.

A 1990 study published in the Annals of Rheumatic Diseases evaluated 300 participants. The authors came to a similar conclusion, where the prevalence of arthritis in habitual knuckle crackers was comparable to those not identified as habitual knuckle crackers. However, a significantly greater number of knuckle crackers suffered from decreased hand function and reduced grip strength.

The cracking of finger and hand joints can be deliberate or unintentional. In either case, maintaining flexibility in the hand is governed by the health of its muscles, tendons and ligaments. Stressing the joint capsule may result in an audibly satisfying pop, but the long- term results show potential for tissue damage. If you or someone you know is a habitual cracker, or experiences inadvertent snapping with hand activity, periodic finger bends, stretches and exercises are the best preventative measure for maintaining hand health.

References:

Castellanos J, Axelrod D., Effect of habitual knuckle cracking on hand function, Ann Rheum Dis 1990; 49: 308-9.

Swezey R, Swezey S, The consequences of habitual knuckle cracking, WJM, 1975; 122: 377-9.

www.orthopedics.about.com, Cluett, J., Does joint cracking cause arthritis?, 2006.

www.providence.org, Bonafede, P., Knuckle Cracking and Arthritis, July 2004.

www.scientificamerican.com, Brodeur, R., What makes the sound when we crack our knuckles?, 10/26/01.

www.webmd.com, Exercises for flexibility and strength in your hand, wrist and arm, 2/4/05.

by Nicole Cutler, L.Ac.

During the winter, we draw our energy inward to reflect, rejuvenate and rest. As the season shifts into spring, energy bursts forth, like bulbs lying dormant throughout the colder months. As daylight lengthens, contained energy begins to flow instead of being stored. Nature’s activity during early spring can be witnessed everywhere, from newly composed avian harmonies to animal mating rituals. Projects sitting on hold jump to life and bodies that have been curled up on the couch itch to move. Spring is representative of transformation and growth, bringing renewed optimism, hope and life.

According to Chinese culture, humans are microcosms of the environment, and are equally affected by the change in season. The cyclical character of energy flow creates a predominance of energy in a paired organ system during a specified time of year. According to Chinese medical theory, the energy in the liver and gallbladder systems are most active in the spring.

In addition to viewing humans as mirrors of nature, Chinese medical theory also emphasizes the interplay of physical, emotional and spiritual aspects governed by each bodily system. Encompassing much more than the western medical model’s understanding of organ structure and function, each body system also governs emotion, cognition and spirit.

The cognitive responsibility of the liver is planning while the gallbladder oversees decision-making. When the energy in these two organ systems mounts, as it naturally does each spring, there can be two possible outcomes:

1. The desired outcome is an active outpouring of creativity, productivity and release of negative patterns.
2. The undesired outcome is energetic stagnation, or resistance to allowing this energy to flow.

Restricted liver energy manifests itself as anger, frustration, depression and irritability. Disease occurs when this energy is not expressed or freed. When energy remains stuck, it coagulates, becoming thick and heavy, hampering optimal body functioning. The inability to express spring’s active energy can lead to all sorts of illnesses including migraines, PMS, heart disease and even cancer.

Because the energy in the liver and gallbladder systems increase during the spring, people often experience an increase in stress, anger and anxiety during this season. When an outlet for this energy is found, these emotions can be transformed into creativity, opportunity and change. Springtime is ideal to convert these difficult emotions by focusing on their movement and release. Nature provides us this time of year to spring clean our stored emotions. Feeling these intense emotions is a healthy first step, and indicates readiness for the second spring cleaning step: release.

Emotional release can be achieved in many different ways, and each person must find the method that works best for them. Some methods that may be useful include:

· Engaging in physical activity
· Receiving bodywork
· Verbalizing emotions to a friend or professional
· Journaling or writing about one’s feelings
· Crying and/or laughing
· Meditation and/or visualization
· Using creativity as an emotional outlet

Bodyworkers can assist in this process by understanding the need for and paying extra attention to modalities encouraging emotional release. In general, relaxing massage strokes help clients shed tension and drop resistance. Techniques to invigorate the Liver and Gallbladder meridians are especially useful in facilitating the desired free and easy flow of energy. A specific acupressure combination to address this is called The Four Gates. While The Four Gates is typically used to reduce pain, its overarching purpose benefits both physical and emotional pain by invigorating and moving stagnation. For more specific information on The Four Gates, please see the previous article, Differentiating Back Pain from Kidney Pain, under bodywork techniques for Kidney stones.

Regardless of the method used, finding the path to emotional release keeps the body, mind and spirit healthy. The natural instinct to spring clean our homes and environment answers our spiritual yearning to clear away the cobwebs (stagnation) left over from winter. When spring cleaning is applied to emotional health, our ability to plan and make decisions blossoms, and we experience renewed optimism, creativity, hope and transformation. From the Chinese perspective, the free flow of liver and gallbladder energy is the number one disease preventative, and best way to guarantee a healthy and happy year.