Massage Professionals Article Archive

by Nicole Cutler, L.Ac.

Riding the heat waves of a long summer has likely taken a toll on many previously unaffected clients. While intense hot spells are often a concern for the young and elderly, just about anyone lingering in hot weather is prone to its ravages. Muscle cramps are most common for people who become dehydrated or participate in physical activity in high temperatures. Bodyworkers can directly help a client overcome a painful cramp or educate their clients on its prevention.

Electrolyte Imbalance
Suddenly emerging as a sharp pain, a muscle cramp is a sustained muscular contraction. While there are several possible triggers for muscle cramps, an electrolyte imbalance is often the cause when a person is overheated. The physiology of muscle contraction centers on the interplay between positive and negative charges activating muscle tissue. Charge-carrying electrolytes, namely potassium, sodium, calcium and magnesium, enter muscle cells, initiating either a state of contraction or relaxation.

Caused by hot temperature or excessive activity, perspiration is the loss of body fluid through the skin. Because sweat is laden with electrolytes, excessive perspiration can result in an electrolyte imbalance that can delay muscular relaxation, causing a sustained muscular contraction.

Cramp Locations
While different muscle groups can cramp, the calf and foot are most common affected. Abdominal cramps can accompany a gastrointestinal problem or a painful menses. To rule out a myocardial infarction, cramping in the chest or upper body should always be referred to a physician. Another client requiring referral to a physician is a person experiencing habitual muscle cramps. Habitual cramping may signify a more serious metabolic condition.

Hands-on Cramp Help
A client who is prone can easily experience muscle cramps during a bodywork session. A therapist can help its dissipation with the following methods:

· Massage – Massaging the cramped muscle increases circulation in the tissue, providing a rush of new fluid to bathe and relax the tense muscle. Swedish, neuromuscular and myofascial release techniques are particularly effective. However, a therapist must be aware that a client with a cramped muscle may be in too much pain for physical manipulation of the muscle.

· Reciprocal Inhibition – Commonly used in sports massage, reciprocal inhibition is the application of resisted tension to the opposing muscle group. By activating the opposing muscle group, reciprocal inhibition forces the contracted muscle to relax. For example, a cramp in the posterior, lower leg can be relieved by applying resisted tension to the anterior, lower leg muscles.

· Hot Pack Application – While not hot enough to cause perspiration, the radiance of a hot pack applied to a cramping muscle can enhance circulation. In addition to potentially alleviating the cramp, this technique is particularly soothing.

Cramp Prevention
If a client reveals a tendency towards muscle cramps, or experiences one during a session, suggested preventive care tips could be welcomed and of great benefit. As long as it is within your scope of practice to mention these tips, consider imparting the following information to clients:

· Hydration - In hot weather, stay hydrated. When overheated, carrying around and sipping from a water bottle is one way to cool off. For excessive perspiration, an electrolyte-containing beverage can not only re-hydrate, but also prevent the imbalance caused by electrolyte loss.

· Stay cool – During a heat wave, encourage clients to seek a cool location and refrain from strenuous activity outdoors during the hottest times of day.

· Eat a banana – Bananas are loaded with potassium, and can give the body enough potassium to counter what is lost during perspiration.

· Stretching – Stretching the legs and feet prior to, and after physical activity lengthens and bathes the muscles with oxygen-rich blood. This circulation enhancement method provides substantial fluids which can prevent cramping.

Another Consideration
In Traditional Chinese Medicine (TCM), those prone to recurrent muscle cramps may be experiencing an imbalance known as Liver Blood Deficiency. Other symptoms falling into a Liver Blood Deficiency pattern include fatigue, thirst, muscle spasms, dry eyes, headaches and insomnia. While only a qualified professional can diagnose this pattern, being aware of its existence could lead a massage therapist to offer a valuable referral. If liver blood deficiency is confirmed by a TCM practitioner, the following acupressure points can benefit this client:

· Gallbladder 34 – Located in the depression anterior and inferior to the head of the fibula.

· 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 muscle.

· Liver 3 - Located in the web on the dorsum of the foot, in the depression distal to the junction of the first and second metatarsal bones.

· Spleen 6 – Located four finger breadths directly above the tip of the medial malleolus, on the posterior border of the medial aspect of the tibia.

· Spleen 10 – Located with the knee flexed, the point is two and a half finger breadths above the bulge of the medial portion of the quadriceps femoris muscle.

Through the direct application of bodywork methods or the sharing of information, massage therapists can take an active role in eliminating muscle cramps.

Recommended Study:
Myofascial Release, Neuromuscular Therapy, Sports Massage and Swedish Massage for Professionals

References:

Liangyue, Deng, et al., “Chinese Acupuncture and Moxibustion”, Foreign Languages Press, Beijuing, 1987.

www.mayoclinic.com, Muscle Cramp, Mayo Foundation for Medical Education and Research, July 2006.

www.sportsmedicine.about.com, Muscle Cramps, About Inc., 2006.

by Nicole Cutler, L.Ac.

Whether it’s a new or regular client, a tendency towards ticklishness can arise at virtually any moment. There are many interpretations of what ticklishness is, and what a massage therapist can do about it. Our experts have assembled the latest information to keep you informed and help you make the best decisions for your ticklish clients.

Why Are Some People Ticklish?
Ticklishness is a sensation and subsequent response separate from pain, itch or pressure. In general, touch receptors interpret skin sensation, by translating movement or distortion of the cell membrane. A lack of understanding surrounds the tickle sensation because it is not one of the currently known touch receptors, which include temperature, pain, light pressure and deep pressure.

Most sensation and perception scholars claim that the brain, not skin receptors, distinguishes tickling from other types of touch. Because you can’t tickle yourself, the evidence points to the brain’s responsibility for ticklishness. Touch receptors in the skin do not know the difference between your touch and someone else’s, but the brain is aware of whose hand is tickling you.

In addition to physical touch, the tickle response appears to require the brain’s interpretation of tension or suspense. In fact, tension or suspense is so important that some people react to the anticipation of being tickled in the same way as they do when actually being tickled. Again, this is suggestive of the brain’s role in perceiving ticklishness, since a tickle response from anticipation does not involve skin receptor stimulation.

Acquiring sensitivity to ticklish stimuli might have been useful in our evolutionary past, says Robert R. Provine, a professor of Psychology and Neuroscience at the University of Maryland. Highly ticklish locations are parts of the body most vulnerable to injury, such as our feet, neck, chest and armpits. For example, feeling a tickle would have warned us if a poisonous scorpion was crawling along our neck.

When it comes to a ticklish response during massage, a number of factors can come into play:

· Nervousness or discomfort with touch
· Anxiety or vulnerability with wearing no or minimal clothing
· Tension held in particular areas of the body
· Uneasiness with unknown or unpredictable touch
· Excessive or stagnant energy in the area being worked

Seven Tips
Communication, sequencing, pressure modification, pacing, stroke choice, emotional release or avoidance should all be considered when working with a ticklish individual.

1. Communication is the most important factor in administering massage to a ticklish person. Asking a client what their preferences are regarding their ticklishness will guarantee they have an optimal experience with you.

2. Sequencing can allow the recipient to relax into your touch before you reach more sensitive locations. The back is typically one of the least threatening areas for massage, followed by the limbs, neck and head. With thoughtful sequencing, the client is able to develop a level of comfort and safety by the time the therapist reaches more sensitive areas, such as the feet, legs, chest and abdomen.

3. Pressure modification can completely alter the course of a ticklish session. In general, broadening and increasing your pressure will reduce ticklishness. These modifications reduce the element of suspense that initiates many tickle responses. Additionally, the University of Miami Research Institute’s director, Tiffany Field, PhD, says, "The reason it seems moderate pressure is more effective than light is that light pressure is experienced like a tickle stimulus, it's arousing."

4. Slowing the pace of massage strokes is favored by many ticklish massage recipients. Moving quickly along the skin prohibits the client from predicting where the therapist’s hands are heading. Applying a stroke very slowly will immediately calm that apprehension. For the extremely sensitive client, it may be necessary to stop and simply hold the hands on one location for a few minutes.

5. Stroke choice is another consideration when working with a ticklish individual. Similar to applying broad pressure, choosing a stroke with large surface area contact reduces anticipation of the spot to be addressed next. Petrissage is a good stroke choice because its calming effect reduces tension and its application covers a broad enough area to reduce suspense.

6. Release of the emotional component creating the tickle response can be an extremely healing event. It is critical to approach this within your ethical boundaries and to have a willing recipient, requiring intensive communication between client and practitioner. In order for a client to request intensive work on their ticklish spots, they need to be emotionally prepared. Because ticklishness is often a protective mechanism, focusing on such an area can promote a powerful release. While most therapists are accustomed to emotional releases in the form of tears, laughter can be just as effective.

7. Avoidance of the ticklish area is typically a comfortable choice for both practitioners and clients. Again, this requires astute communication, to determine the location to work around and if avoidance is the client’s preference.

Understanding the physiological and emotional aspects of a tickle response can help any professional using touch within their line of work. Learn and experiment with the seven presented tickle tips to be proactive with your clients expressing issues around ticklishness. Learning how to work with each individual’s ticklishness will enhance your skills and benefit your practice.

References:

Vanderbilt, Shirley, Moderate vs. Light Pressure in Massage, Massage and Bodywork, April/May 2005.

www.boston.com/globe, Why are Some People Not Ticklish?, C.B. Peabody, The Boston Globe.

www.hhmi.org, Ask a Scientist, Neuroscience Question Archives, Lisa Catapano, Howard Hughes Medical Institute, 2006.