Massage Professionals Article Archive

by Nicole Cutler, L.Ac.

Realizing clients may faint during massage therapy does not mean you possess the confidence to handle the real, live situation. A formal massage education does not include an emergency room internship, where challenging experiences take place under the watch of a professional. Often, the first time a client faints during massage, the practitioner is on their own.

Why do Clients Faint?
Fainting, or syncope, is a sudden, brief loss of consciousness. Someone who faints may only pass out for several seconds or for as long as an hour. There are hundreds of possible causes of syncope, most of which are due to the vasovagal reflex, where blood vessels relax and dilate, causing a sudden drop in blood pressure.

Some of the most common reasons clients faint include:

· Low blood sugar (hypoglycemia), common in early pregnancy and diabetes
· Anemia
· Heat stroke or heat exhaustion
· Dehydration
· Eating disorders such as anorexia, bulimia
· A sudden change in body position like standing up too quickly (postural hypotension)
· Extreme pain
· Sudden emotional stress or fright
· Anxiety
· Taking some form of prescription medication. Examples include medicines that lower high blood pressure, tranquilizers, antidepressants, or excessive use of some over-the-counter medicines.
· Being in a hot, stuffy room or hot, humid surroundings
· Alcohol consumption

Fainting Prevention
The number one way to prevent client syncope is through being prepared and communication with clients.

· Be familiar with the medications clients are taking, including new medications and anything that may lower blood pressure.
· If your client has just come from physical activity and is overheated, allow them to cool down and re-hydrate.
· Know if your client has a history of orthostatic hypotension, fainting or dizzy spells.
· Be aware if your clients are diabetic and make certain they have checked their blood sugar or have sugar pills, juice or cookies available if necessary.
· If your client is hypoglycemic, or hasn’t eaten within the past five hours, provide them with a light snack or refuse treatment.

Foreshadowing
Even if you have no reason to suspect that a client may faint, there are a few signs that may precede a temporary loss of consciousness. If any of these signs appear, verbally check with your client to see if they are okay prior to continuing a session.

· The skin becomes hot and sweaty or cold and clammy.
· A client suddenly becomes fidgety.
· Complaints of dizziness or light-headedness.
· The person lifts their head out of the face cradle to yawn or take a breath. According to David Palmer, this is an involuntary reaction to not getting enough oxygen to the brain.

What to do
Although a client becoming fully unconsciousness is rare, it is best to be prepared. The following is the preferred order of steps to address syncope:

1. Be Calm - The number one thing to remember if a client loses consciousness is to remain calm.

2. Proper positioning - If the client is not lying down, assist them into a position where they can’t fall, their head is below their heart and the legs are elevated. This position promotes blood flow to the brain. If a victim who is about to faint can lie down right away, he or she may not lose consciousness. Call for assistance if you need help in accomplishing this, but do not leave the client’s side.

3. Check breath and pulse – If there are no sounds of breathing, make sure the airway is open and begin rescue breathing. If there is no pulse, begin CPR. Look for a medical identification bracelet, necklace or card that identifies a medical problem, such as epilepsy or diabetes. In either case, have someone call 911 for emergency help.

If the client has a pulse and is breathing, it is not necessary to call 911 unless the client does not regain consciousness in a few minutes or if the person is diabetic. A diabetic may be in insulin shock, requiring additional support.

4. Comfort measures – Make sure there is no tight-fitting clothing around the client’s neck, that there is adequate air circulation, and keep the client from getting chilled.

5. Acupressure – Only after the first four steps have been taken, consider this age-old technique for fainting. Oriental meridian theory suggests applying firm pressure to the following locations to revive someone from syncope:

· Governing Vessel 26 - Located in the philtrum, about 1/3 the distance from the bottom of the nose to the top of the lip.
· 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.

Additional Tips
Upon fainting, a common mistake is to try to give the person something to eat or drink, including water. This gesture must wait until the client is fully conscious. Additionally, don't allow the person who's fainted to get up until the sense of physical weakness passes. Then be watchful for a few minutes to be sure he or she doesn't faint again. Once again, don’t leave your client’s side until they have fully recovered.

Other Reasons to call 911
If your client also has signs of a heart attack, call for emergency help. Such symptoms include:
· Chest pain or pressure.
· Pain that spreads to the arm, neck or jaw.
· Shortness of breath or difficulty breathing.
· Nausea and/or vomiting.
· Sweating.
· Rapid, slow or irregular heartbeat.

If your client also shows signs of a stroke, call for emergency help. Such symptoms include:
· Numbness or weakness in the face, arm or leg.
· Temporary loss of vision or speech, double vision.
· Sudden, severe headache.

Confidence
While episodes of syncope in the massage setting don’t occur every day, most massage therapists may encounter a few in their career. A thorough intake will provide the therapist with the information to prevent such an episode by alerting them to a fainting possibility, discovering if the client hasn’t had anything to eat or drink prior to a session, or by prompting modification of the session. Such modifications include avoiding strokes or techniques that further lower blood pressure or those drawing energy away from the head. Reviewing the causes of syncope, including these warnings and procedures, will build your confidence so if you do encounter syncope, you are both calm and prepared.

Massage professionals interested in enhancing their knowledge on this subject would benefit from the Institute's Pharmacology for Massage distance learning program. This 13-credit course covers different medications that may render clients more susceptible to fainting and also suggests massage strokes to use to counter this tendency.

Editor’s Note: This information is for education purposes only, and is not intended to replace professional medical care. If not completely sure of your client’s well being, seek emergency medical help.

Recommended Study:

Pharmacology for Massage

References:

Palmer, David, Fainting and Chair Massage, Massage & Bodywork, June/July 2000.

Shanghai College of Traditional Medicine, Acupuncture: A Comprehensive Text, Eastland Press, 1995: 572-3.

www.healthy.net, First Aid for Fainting, American Institute for Preventive Medicine, 1996.

By Nicole Cutler, L.Ac.

The jaw or temporomandibular joint (TMJ) is a major target for an array of joint disorders. Disorders of the jaw are typically referred to by the same name, TMJ. The temporomandibular joint connects the mandible to the skull’s temporal bone and contributes to the acts of biting, chewing, swallowing, speaking and making facial expressions. The National Institutes of Health (NIH) states over 10 million people in the United States suffer from TMJ problems.

Symptoms
Pain is the most common TMJ symptom. The pain is often described as a transient, dull ache in the jaw joint and nearby areas, including the ear. Instead of pain, some sufferers only have problems in the use of their jaws. Additional symptoms of TMJ can include:

· Inability to open the mouth comfortably
· Clicking, popping or grating sounds in the jaw joint
· Locking of the jaw when attempting to open the mouth
· Headaches
· A bite that feels uncomfortable or “off”
· Neck, shoulder and back pain
· Swelling on the side of the face
· Tinnitus or ear pain
· Dizziness

TMJ symptoms often improve without treatment in a matter of weeks to months. However, some individuals experience an increase in symptom severity, and may develop long-term chronic jaw pain.

Cause
TMJ can be caused by a number of factors, including:

· Local injury
· Dental work/oral surgery
· Whiplash
· Arthritis
· Widespread joint pain from another condition
· Sinus or ear infections
· Headaches
· Bruxism (teeth grinding and clenching)
· Stress

Although teeth grinding and stress are not the leading causes of TMJ, difficulty relaxing may be a common cause many sufferers are unaware of. Holding the body tout, including the jaw, is a common response to stress. Whether metaphorical for “keeping one’s mouth shut”, a result of the incredible strength and control we have over the mandible, or due to another reason, emotional tension can easily be reflected in the temporomandibular joint.

Treatment
Many types of healthcare professionals can be involved in TMJ treatment. This spectrum includes, but is not limited to, physicians, pain specialists, chiropractors, physical therapists, acupuncturists, dentists and bodyworkers. In certain cases, a splint or mouth guard is crafted specifically for the individual to prevent the TMJ from slipping out of place. Reconstructive jaw surgery is rarely employed for TMJ and is typically the very last resort. Some self-help suggestions to offer clients suffering with a painful jaw include:

· Maintain good posture while working at a computer, watching TV and reading. Pause frequently to change position, rest hands and arms, and relieve stressed muscles.

· Make a habit of relaxing the facial and jaw muscles throughout the day.

· Avoid chewing gum and eating hard foods.

· Apply moist heat to increase the circulation around tense jaw muscles.

· Use relaxation techniques to reduce overall stress and muscle tension in the entire body.

Bodywork is an ideal modality to relieve the pain of TMJ. According to medical massage proponent Boris Prilutsky, “Massage therapy should be focused toward the reduction of tension in the masticatory muscles, releasing tension in fascia, and elimination of trigger points. Post-isometric relaxation is an extremely important tool for the restoration of the range of motion.”

Training in the following five modalities is particularly valuable when treating jaw pain:

1. Neuromuscular Therapy - The application of ischemic pressure to trigger points in the jaw muscles (temporalis, masseter, lateral pterygoid, and medial pterygoid) can help relieve their spasms.

2. Cranial-Sacral Therapy - In addition to activating the classic stillpoint, adjustments to the mastoid, temporal, zygomatic and sphenoid bones can provide enormous TMJ relief.

3. Post-Isometric Relaxation – Using isometric contraction to actively stretch tensed muscle fibers, adding minimal resistance for a further stretch, followed by relaxation allows for enhanced relief of the targeted muscle. This technique can restore the range of motion that typically regresses with TMJ disorders.

4. Acupressure – Massaging the meridians, both distally and locally, that wind around the jaw can bring increased circulation and thus relief to TMJ. The primary meridians to the jaw are Gallbladder, Stomach, Large Intestine and Triple Warmer.

5. Swedish Massage – The relaxation that results from a full-body Swedish massage should not be underestimated. Since stress is a major contributor to TMJ disorders, initiation of the relaxation response can have a significant impact in reducing tension held in the jaw.

For bodyworkers, TMJ is no mystery. Many clients present jaw pain as their primary complaint, or as a secondary nuisance. Approaching TMJ pain by utilizing techniques from the described five modalities provides an inclusive, holistic and effective treatment.

Recommended Study:

Neuromuscular Therapy, Cranial-Sacral Therapy, Swedish Massage

References:

Lewit, K, DG Simons DG., Myofascial pain: relief by post-isometric relaxation, Arch Phys Med Rehabil., 1984 Aug;65(8):452-6.

Prilutsky, Boris, Medical Massage for Jaw-Joint (TMJ) Disorders, Massage Today, 12/04.

www.nlm.nih.gov/medlineplus, TMJ Disorders, A.S.A.M., Inc, 2005.

www.tmj.org, Basics, TMJ Association, Ltd., 10/31/05.

by Nicole Cutler, L.Ac.

Auriculotherapy is reflexology of the ear. The auricle of the ear (the external, protruding portion), can be viewed as a microsystem representing the entire body. Microsystems are valuable in many disciplines, including neuroanatomy, foot and hand reflexology, face and scalp acupuncture, and iridology.

The first defined microsystem is a figurative representation of the human body mapped in the brain’s cortex. Called somatosensory mapping, a distorted human figure reflects the corresponding body parts in the sensory and motor cortex. Also known as the cortical homunculus, this figure has disproportionately large lips, hands, feet and genitals, reflecting the larger cortical area allocated for the innervation of these body parts.

Similar to the cortical homunculus, the ear has been mapped in detail to reflect associated areas with the entire human body. Due to its high level of accessibility, this auricular microsystem can be used to treat health conditions affecting all parts of the body. Stimulating points on the ear can alleviate problems associated with nearby regions of the face and head as well as relieve pathological disorders in the chest, abdomen, lower back, and feet. According to microsystem theory, there are no direct connections between the ear and specific distal body parts. Rather, nerves from the ear connect to reflex centers in the brain that send neurological reflex pathways to the spinal cord, which in turn, sends them on to the neurons reaching distal body parts.

While ear massage can be used to address a countless array of health issues, musculoskeletal pain and addiction have demonstrated some of the most dramatic responses to auriculotherapy.

Pain
Regardless of the mechanism, applying pressure to the ear in specific locations has been found to relieve distal body pain. Ear massage triggers the release of the body’s natural painkillers, endorphins. Studies have demonstrated that ear stimulation increases levels of endorphins in both the blood and cerebrospinal fluid.

Ear massage also aids in breaking the pain-spasm-pain cycle. Most chronic pain is due to the constriction of connective tissue surrounding muscles in spasm. Muscles remain in spasm when the brain instructs motor neurons to initiate and sustain their contraction. The stimulation of ear reflex points connected to the brain can reset the brain’s electrical prompts, stopping unwanted activation of spinal reflexes. According to Oleson, “Pain sensations that are due to irritated nerves can be relieved by the normalizing of pathological, hypersensitive reflex pathways that interconnect the ear microsystem and the somatotopic brain.”

Consult an auriculotherapy map to locate the correct reflex area to address a specific painful body part. Identification of a tender area on the ear typically corresponds with the most beneficial point to relieve the distally located pain.

Addiction
Auriculotherapy is used throughout the world to reduce substance cravings and assist in the detoxification of addictive substances. Explanations for the effectiveness of auriculotherapy in facilitating drug independence derive from both a Western neurological conceptualization and a Traditional Oriental Medicine perspective. The first evidence of auriculotherapy’s in reducing substance cravings of drug addicts came from Dr. Wen of Hong Kong in the 1970s, and was expanded upon by Dr. Michel Smith, a physician who practices Oriental Medicine in New York City.

A Western neurological basis for using auriculotherapy as part of drug detoxification focuses on the area of the ear primarily used in addiction treatment, the concha. The two concave or hollow areas of the outer ear, the concha correspond to the autonomic nervous system via the vagus nerve and the brain’s hypothalamus. Influencing these nervous system components enhances relaxation and maintains balance. Auriculotherapy’s release of endorphins has the additional benefit of improving mood without the aid of the addicted substance.

Traditionally, five points are stimulated on the outer ear to aid the addiction recovery process. Possession of an illustrated ear map will facilitate locating each of the five points: Sympathetic, Shen Men, Heart, Liver and Lung.

Don’t skip the ears
While the majority of research has focused on ear acupuncture, auriculotherapy works with any type of ear stimulation. Many massage therapists include a general, feel-good ear rub at the conclusion of a session. However, learning the anatomy and body map of the ear can add a new level of healing to a massage. Since the ears provide direct access to the central and peripheral nervous systems, spending some time to focus on specific ear locations will benefit your client by amplifying the bodywork performed.

References:

Netter, MD, Frank H., Atlas of Human Anatomy, Ciba-Geigy Corporation, 1989.

Oleson, PhD, Terry, Auriculotherapy Manual, Health Care Alternatives, 1998.

www.auriculotherapy.com, FAQs, Terry Oleson, PhD, 2006.

www.brainconnection.com, Motor Humunculus, Scientific Learning, 2006.

www.emedicine.com, Massage, Traction, and Manipulation, J Michael Wieting, DO, MEd, 7/18/05.

by Nicole Cutler, L.Ac.

An increasing number of massage therapists are adding the use of essential oils into their bodywork sessions. Because of the ease of incorporation into a treatment, enthusiastic client appreciation and increased therapeutic benefits are all responsible for the increased inclusion of therapeutic essential oils into a bodyworker’s repertoire.

Whether using lavender to enhance relaxation, juniper to relieve arthritis pain or clary sage to ease depression, adding a few drops of a high quality essential oil to a carrier oil can add an entirely new dimension to somatic healing therapies. Aromatherapy is rooted in science, and intensive study of this field unveils its layers of complexity in botany, neurobiology and organic chemistry. While essential oils can be purchased anywhere and used by anyone interested, the use of high quality, 100 percent pure and unadulterated essential oils is recommended after acquiring in-depth, working knowledge of their therapeutic uses. The following tips will help those therapists with a basic foundational introduction to maintain essential oil safety and outcome optimization:

Do’s

1. Dilute - Always dilute an essential oil in a carrier oil prior to application. The vast majority of essential oils are too concentrated to apply directly to the skin, and some can cause serious irritation, such as cinnamon bark. However, dabbing lavender or tea tree oil directly on certain spots qualify as common exceptions. Examples of carrier oils are sweet almond, jojoba, apricot kernel, borage and grapeseed. A general rule of thumb is to mix 8-10 drops of an essential oil with one ounce of carrier oil.

2. Storage – Store essential oils in dark glass bottles, either amber or cobalt, in a cool, dark location. While high quality essential oils do not turn rancid, exposure to light, humidity, air and heat can break down the oil, reducing its therapeutic value. Keep them tightly capped. Most essential oils can remain at optimal potency for up to two years if kept chilled although, as a general rule, the citrus essential oils have a short shelf life and the florals the longest. In addition, essential oils are highly flammable, so keep them stored away from flames or other combustibles.

3. Test – Since the limbic brain anchors past experiences with associated aromas, and personal preferences vary, allow each client to take a whiff of an oil to determine his or her affinity for it. A negative emotional reaction to a smell will hinder any possible therapeutic benefits. In addition, by placing a drop of diluted essential oil on the skin, conduct a patch test for individuals with skin sensitivity. While this requires a 24-hour waiting period, you can determine if a client has sensitivity to the oil you wish to use during the following session.

4. Specific health concerns – For specific health concerns, consult an aromatherapy text, seek the advice of a certified aromatherapist, or take a NAHA-approved educational course, such as the Institute’s Aromatherapy Essentials for the Massage Therapist. Conditions such as epilepsy, asthma and high blood pressure warrant specific training in the safe use of essential oils. While some oils may exacerbate these conditions, others may provide substantial benefits. Research extensively and continue to study aromatherapy to learn as much as you can before addressing specific health concerns.

Don’ts

1. Pregnancy – Safety is key. Do not use certain essential oils topically on a pregnant woman. Several sources conclude that the following oils may be harmful during pregnancy and should be avoided in any form whether topical, diffused, or in hydrotherapy: bitter almond, basil, cedarwood, cinnamon, rosemary, peppermint, rose, sage, thyme, wintergreen, clary sage, cypress, hyssop, clove bud, marjoram, myrrh, juniper, geranium and fennel. If using any essential oils during pregnancy, first assess safety.

2. Mucous membranes – Because they are potent and can be highly irritating, do not allow any essential oils to make contact with eyes or other mucous membranes and wash hands after handling. This includes refraining from rubbing one’s eyes or touching genitalia with any essential oil residue on the hands. Be aware the undiluted essential oils can damage the surface of furniture so clean up spills promptly. Rubbing alcohol can be an effective aid for such clean ups.

3. Ingestion – Do not ingest essential oils. Many are toxic when taken internally, and an attempt to ingest essential oils should only commence under the direct advice and care of a highly competent, experienced, certified aromatherapist with medical training.

4. Sun exposure – Some oils, especially in the citrus family, can render the skin photosensitive and cause pigmentation. Do not apply to uncovered areas prior to sun exposure, especially if there is a history of melanoma. Oils known to have this effect include bergamot, lime, cumin, mandarin, lemon, tangerine, orange, verbena, angelica, caraway, cassia, cinnamon bark, grapefruit, honeysuckle, laurel leaf, patchouli, cedarwood and dill weed.

The above tips serve as a guide to help a novice safely experiment with essential oil use. To fully incorporate aromatherapy into your practice, a comprehensive NAHA (National Association for Holistic Aromatherapy) approved course such as Aromatherapy Essentials, is highly recommended. After mastering these basic safety aspects of aromatherapy, you’ll appreciate the simplicity of including therapeutic oils into a massage session. Clients love the smell and additional dimension of healing experienced with aromatherapy. The advantages of essential oil massage is steadily catching on in the bodywork community, heightening the demand for educated, skilled aromatherapy practitioners.

Recommended Study:

Aromatherapy Essentials

References:

Ark Creative, Aromatherapy Oils, Top That! Publishing, Valencia, CA 2003.

www.aromaweb.com, Aromatherapy Tips for Beginners, AromaWeb, 2006.

www.candledance.com, Cautions on Oil Use, CandleDance, 3/19/06.

www.joellessacredgrove.com, Essential Oil Tips, Joelle Miller, 2001.

by Nicole Cutler, L.Ac.

Most therapists understand that they jeopardize their own emotional well-being when they intimately encounter the pain of others. –Jeffrey A. Kottler

The intimacy of bodywork requires not just firm professional boundaries, but also practiced energetic separation. The intimacy of a massage session is unrivaled, due to client expressions during history-taking and the physicality of touch during treatment. Clients typically share their innermost feelings with their therapist – and some powerfully exude their energy. Regardless of the vehicle, massage therapists are vulnerable to absorbing their client’s afflictions.

Caregivers
Choosing the profession of bodywork implies possessing a genuine interest in helping people. Typically, caregivers find pleasure in making a positive difference in people’s lives. Filled with compassion and empathy, bodyworkers can easily extend themselves too far. Although it may not loom in the conscious mind, healing can be perceived as the removal and absorption of other people’s pain. Arriving at the understanding that even as compassionate bodyworkers with the best intentions, we are unable to fix someone else’s pain. Only the person living in their body is capable of healing themselves. It is important for the massage therapist to recognize their role in healing as a separate entity, acting as an informed facilitator.

Burnout
Next to overworked hands, the most common cause of practitioner burnout is absorbing clients’ negative energy. Just as a massage therapist must pay attention to the care and protection of their hands for professional longevity, they also must be aware of their own energy, and protect it from taking on their client’s issues. Some indicators of taking on a client’s negative energy include:

· Becoming nauseous or dizzy during or after a session
· Feeling the anxiety, anger or depression your client entered with
· The development of discomfort non-existent prior to the session
· Feeling physically exhausted or emotionally drained after a session

These examples of energy transfer occur very easily, especially when the practitioner does not take separative and protective measures.

Self-awareness
The first step in maintaining energetic boundaries is to care for and be tuned in to your own body. It is crucial for therapists to pay attention to their own issues, so they are aware of the ailments, feelings and issues belonging to them. Being clear on what emotions are yours will help differentiate that which are not yours. Tending to one’s physical and emotional health is paramount in avoiding practitioner burnout.

Grounding
The second step to maintaining energetic boundaries is to ground yourself prior to each encounter. Grounding can be accomplished in a myriad of ways. Some practitioners meditate or perform qi gong exercises to connect them to the earth. The purpose of grounding exercises is to give the practitioner access to universal energy, instead of using their own personal stores.

A simple grounding technique is to take a few moments, stand upright with feet shoulder width apart, vertically align the spine, reach your hands up to the sky and visualize yourself as a tree. Imagine your feet as stable, healthy roots reaching deep into the earth. This gives you access to the earth’s grounding energy. Feel your hands as the ends of the tree’s branches, reaching up into the sky, giving you access to heaven’s intuitive energy. Tapping into the resources of heaven and earth will maintain your role as a facilitator, where universal energy flows to your client, instead of drawing from your own personal stores.

Protection
The third step in keeping your energy separate from your client’s is protection. According to Jeffrey A. Kottler, professor of counseling and educational psychology, “Physicians take careful steps to protect themselves from the infection, disease, and suffering of their patients. Rubber gloves, surgical masks, and probing stainless steel instruments keep germs at arm’s length.” There are as many techniques to protect you from negative energy transfer as there are methods of administering massage.

This easy visualization technique is best employed prior to and during a bodywork session. Imagine yourself surrounded by a force field where energy can flow out from you, but cannot be penetrated to reach you. Your imagery can include body armor, a one-way mirror or a ring of light where you can reach out to your clients, but their energy cannot reach or affect you. The more detail envisioned in this force field, the more effective it will be for its creator.

Cleansing
The fourth step to maintaining energetic boundaries is cleansing. After each session (and during if necessary), time must be preserved to shed any energy unintentionally picked up from a client. Again, there are many ways to energetically cleanse to shed anything unwanted.

Some therapists claim rituals such as hand-washing in cold water or feet stomping to be sufficient in metaphorically rinsing or shaking off negative energy. Many Asian bodywork practices include meridian brushing after a session. In meridian brushing, a hand traces meridians proximally to distally in a sweeping motion, brushing off any negative accumulation. Regardless of the chosen technique, cleansing is important to prevent carrying around any absorbed negative energy.

Bodyworkers will enjoy a healthier existence, be more effective with their treatments and can avoid practitioner burnout when the four steps of energetic separation are ritualistically adhered to. Any caregiver hoping to really make a difference in their client’s lives will treasure how practices of self-awareness, grounding, protecting and cleansing maintain energetic boundaries.

References:

Hycner, Richard, Between Person and Person, The Gestalt Journal Press, Inc., Highland, NY, 1993.

Kottler, Jeffrey A., On Being a Therapist, Jossey-Bass, Inc., San Francisco, CA, 1993.

by Nicole Cutler, L.Ac.

Bodywork is perfectly suited for reducing the symptoms of Attention Deficit Hyperactivity Disorder (ADHD). ADHD is a condition typically appearing in young children, although teenagers and adults may also be affected. Someone with ADHD has difficulty controlling their behavior and/or paying attention. It is estimated that between 3 and 5 percent of children have ADHD, or approximately 2 million children in the United States.

Symptoms
The principal characteristics of ADHD are inattention, hyperactivity, and impulsivity. Symptoms begin over the course of many months, often with impulsiveness and hyperactivity preceding inattention, which may not emerge for a year or more. A child who "can't sit still" or is otherwise disruptive will be noticeable in school, but the inattentive daydreamer may be overlooked. The impulsive child who acts before thinking may be considered a "discipline problem," while the child who is passive or sluggish may be viewed as unmotivated. Each of these children may have different types of ADHD.

All children are sometimes restless, sometimes act without thinking and sometimes daydream. When the child's hyperactivity, distractibility, poor concentration, or impulsivity begin to affect performance in school, social relationships with other children, or behavior at home, ADHD may be suspected. Because the symptoms of ADHD vary so much, ADHD must be diagnosed by a professional. Primarily consisting of stimulants, pharmaceutical intervention is the first choice in treating ADHD. In an effort to control affected individuals, an increasing number of school age children are regularly medicated.

The Brain
The suggested etiology of ADHD consists of many proposed theories. Whether stemming from genetics, environment or trauma, most experts agree the brains of individuals with this condition function differently than those unaffected. Research scientists have learned a great deal about ADHD by using modern brain imaging technology. National Institute of Mental Health (NIMH) researchers found that children with ADHD had 3 to 4 percent smaller brain volume in several regions, than age and gender matched controls. According to Jay Gordon, MD, a "deficiency in central nervous system dopamine probably causes many, if not most, of the problems associated with ADHD.” It is no surprise that the most popular medications for this condition increase dopamine levels within the brain.

The Autonomic Nervous System
Two structures comprise our nervous system, the somatic nervous system and the autonomic nervous system. The autonomic nervous system assures proper functioning of involuntary actions, such as heart rate, dilation of blood vessels and our body’s secretion of chemicals. The autonomic nervous system has two sub-divisions, the sympathetic and the parasympathetic. The sympathetic system provides us with adrenaline (the fight-or-flight response), while the parasympathetic is responsible for relaxation.

The sympathetic portion of the autonomic nervous system appears to be the predominant force in ADHD, overriding the balancing role of the parasympathetic system. Bodywork can be a critical component of ADHD recovery because it accesses and initiates the parasympathetic nervous system response.

Proof
At the Touch Research Institute in Florida, a study was conducted to investigate the effect of massage therapy on ADHD. Thirty ADHD diagnosed students aged 7 to 18 years participated in the study where one group received massage therapy for 20 minutes twice per week over the course of one month. The researchers reported that the ADHD students in the massage group demonstrated improved short-term mood state and longer-term classroom behavior.

Methods
While there is no specific ADHD massage technique, certain methods will have a greater effect than others. The important concept to grasp is that stimulating the parasympathetic relaxation response is desired when working with this population. Clues for the therapist indicating parasympathetic response are slowed breathing, reduced heart rate and increased digestive sounds.

Since many styles of bodywork initiate relaxation, the following five suggestions for ADHD are not all inclusive:

1. Swedish Massage, particularly effleurage and other slow stroking movements have a sedating effect, leading to activation of the parasympathetic nervous system.

2. Because they encourage stimulation of the sympathetic nervous system, avoid fast and firm strokes, as well as percussive massage techniques.

3. Cranial-Sacral Therapy will free up any restrictions in the cranium or sacrum that could contribute to ADHD. Additionally, the movements used in this modality initiate the parasympathetic response.

4. Rooted in Osteopathic medicine, Myofascial Release bypasses the muscles by focusing on the fascia as one, large, connected system. Exceedingly gentle, the unwinding technique in myofascial release activates the parasympathetic system. Similar to cranial-sacral, this will free any restrictions inhibiting energy flow, leading to tension release.

5. Watsu is a deeply relaxing style of bodywork performed in a warm water pool. While specific training and equipment (a pool!) are needed to perform this therapy, it has been reputed to calm the uncalmable.

The diagnosis and treatment of ADHD is controversial, as parents are refusing to accept the habitual medicating of their children. Many have posed the hypothesis that ADHD is a natural evolution of our brains to keep up with the speed at which technology powers our world. Living in a calm and peaceful environment is now an exception, rather than the norm. Bodyworkers have the ability to introduce calm and peace to a client, regardless of their environment. By focusing ADHD treatment on the parasympathetic nervous system, massage therapy can be a crucial component of therapy for this condition.

Recommended Study:

Cranial-Sacral Therapy, Myofascial Release, Swedish Massage

References:

Khilnani S, Field T, Hernandez-Reif M, Schanberg S., Massage therapy improves mood and behavior of students with attention-deficit/hyperactivity disorder, Adolescence, 2003 Winter; 38(152):623-38.

Osborn, Karri, Attention Deficit Hyperactivity Disorder: Soma Brings Peace of Mind to Families, Massage and Bodywork, June/July 2004.
Soma Brings Peace of Mind to Families

Osborn, Karri, Sea of Calm: Water Therapy Touches Young Spirits, Massage and Bodywork, Feb/March 2003.

www.nimh.nih.gov, Attention Deficit Disorder, National Institute of Mental Health, 2/17/06.

www.realbodywork.com, The Nervous System, Sean Riehl, 2003.

www.drjaygordon.com, Attention Deficit Disorder, Gordon, MD, J., 2005.

by Nicole Cutler, L.Ac.

The right musical selection can enhance the relaxing ambiance of a massage session. Massage therapists rely on client’s relaxation for optimal therapeutic results. Whether a client requests a session for relaxation, wellness, injury prevention or specific treatment, all types of bodywork are enhanced when the body is relaxed.

Listening to music that causes discomfort or irritation sparks the tightening of muscles, a programmed reaction meant to protect and mask our feelings. During massage, this type of response works contrary to the intended result. Whether conscious or unconscious, the clenching or tightening associated with a negative response will inhibit the body’s circulation, hindering the massage’s goal of releasing muscle tissue. If a client dislikes the music, then he/she will not be relaxed during a session, and the treatment will not have the full, desired effect. Massage therapists are typically aware of the direct relationship between relaxation and massage, often going to great lengths to bring comfort to their clients.

Everyone is different
When deciding what music to choose for a session, understand that peoples’ preferences for music run a wide gamut. This includes both the preferences of the therapist and the client. All massage therapists have different styles, thus finding tunes to meld with your work is going to be highly personal. Additionally, choosing music that your client enjoys, but you dislike, will also hamper the experience for both of you. Deciphering your client’s musical preferences may take some time, as many people are often unaware of the sounds that best suit them. Therefore, it is worthwhile to discuss musical preferences with your client before, during and after the session.

Tempo
As reported in the online publication Heart, Italian researchers reported; "Music induces an arousal effect, predominantly related to the tempo. Slow or meditative music can induce a relaxing effect; relaxation is particularly evident during a pause. Music, especially in trained subjects, might first concentrate attention during faster rhythms, then induce relaxation during pauses or slower rhythms."

Most experts suggest that music’s rhythm or beat unconsciously denotes its calming effects. Music with a slow rhythm (slower than the natural heart beat which is about 72 beats per minute), and a repeating or cyclical pattern, is found to be most effective in relaxing people. It is theorized that humans are influenced by the heartbeat of our mother while still in the womb. A relaxing response to certain music throughout life is perhaps associated with the safe, relaxing and protective environment provided by our mother.

Twelve Tips
1. When shopping for music online, take advantage of audio clips. Actually listening to as much of the recording as possible will give you the best idea of its suitability for massage.

2. Utilize a network of other massage therapists to share information about massage music preferences.

3. When purchasing a CD, choose a vendor that has a liberal return policy, in case the selection more closely resembles heavy metal than light and relaxing.

4. Search for albums long enough to play continuously without repeating for the length of an entire massage session.

5. Albums that evolve slowly during the session give the added bonus of allowing practitioners to maintain a subtle sense of timing during their work.

6. Though undoubtedly relaxing, water sounds (waterfall, babbling brook) may activate a urinary response. This can either interrupt the massage with a bathroom break, or cause the client to tense pelvic girdle muscles to hold it in.

7. Drumming may be trancelike for many of us, for others it is too stimulating for a massage.

8. While an instrument enjoyed by many people, the flute can sometimes reach very high pitches, which can be irritating and jarring to a relaxed client.

9. Massage music is typically located in the following categories: relaxation, stress management, meditation, new age or ambient. Note: Any of these categories may include portions inappropriate for a session.

10. Seek music without any obvious tune or pattern. This style seems to be more conducive to relaxation.

11. Music with words or a specific rhythm may be especially soothing for some people, while it may psychologically spark non-relaxing thoughts for others. (Relaxation classics may have emotional baggage attached for certain individuals.)

12. When screening music, look for the following characteristics: slow tempo, the lack of unexpected changes and music that flows smoothly from one track to another without an obvious break.

When a great musical selection is made, the massage experience is greatly enhanced. Determining the tunes that best fit your style, and melding them with each client’s taste is a trial and error process. If you don’t have the luxury of repeat clients, then you are left to make the best choices possible and be flexible to change music mid-session. Attention to musical detail displays your desire to provide high quality, considerate care to your clients.

Editor’s Note: To browse Natural Wellness’ relaxing musical selections, visit Natural Wellness Stress Management Music.

References:
www.medscape.com, Music May Be an Alternative Relaxation Technique With Cardiovascular Benefit, Heart, Laurie Barclay, MD, 9/30/05.

www.symbiosis-music.com, Choosing and Using Music for Relaxation and Complementary Therapies, Symbiosis Music Ltd, 2006.