March 22, 2007
Contraception Poses Blood Clot Risk |
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Dislodging a blood clot represents one of the most potentially dangerous consequences of massage therapy. Learn how a client's choice of contraception can affect massage and how to avoid a potentially risky situation.
by Nicole Cutler, L.Ac.
As an increasing number of people seek their services, the profile of massage therapists will continue to grow within the medical community. Delivering therapeutic results while maintaining the safety of each session are the backbone of bodywork’s value within medicine. As such, it is the responsibility of bodyworkers to stay current on factors that may pose an additional risk to the work they perform.
While energizing blood circulation can relieve pain, relax muscles, flush accumulated toxins out of the body and infuse new healthy cells to areas in need, enhancing circulation can also initiate an embolus. According to medicinenet.com, an embolus is: Something that travels through the bloodstream, lodges in a blood vessel and blocks it. Depending upon the location, an occluded blood vessel can have dire repercussions by lodging in:
· the lungs, causing a pulmonary embolism
· the brain, causing a stroke
· the heart, causing a myocardial infarction
Being prepared to recognize what may pose a risk can help massage therapists avert a potentially lethal combination of performing circulatory massage on a client at high risk for an embolus. While there are many health problems that predispose a person to developing a blood clot, there are also seemingly innocuous lifestyle choices fostering the same predisposition.
The Pill
The oral contraceptive pill is the leading method of birth control in the United States. Approximately 12 million American women (19% of those aged 15-44) use the birth control pill. Historically, oral contraceptives have posed a considerable risk of emboli development. This risk is the reason women with other predisposing factors for blood clots, including smoking, hypertension or being over age 40, are encouraged to find other methods of birth control. By using lower doses of the active ingredients, safer oral contraceptive options have become the norm.
New Options
In addition to the birth control pill, two newer contraceptive options are increasing in popularity:
· Transdermal contraceptive patch (the patch) – The contraceptive patch (brand name: Ortho Evra) is placed on your upper arm, buttocks, stomach or chest (but not on the breasts). It releases birth control hormones in a method similar to birth control pills.
· Vaginal ring – The vaginal contraceptive ring (brand name: NuvaRing) uses the same hormones as most birth control pills. This flexible ring is inserted in the vagina, where its ring releases hormones that prevent pregnancy.
Ring and Patch Blood Clot Risk
Because they are relative newcomers to the contraceptive market, assessing the risk of a blood clot for the transdermal patch and vaginal ring hinges on the most recently published research. According to reputable studies published in 2006, the transdermal patch demonstrates a significantly higher risk of blood clots compared to oral contraceptives.
In the July 2006 issue of American Journal of Obstetrics and Gynecology, researchers reported that when comparing a contraceptive vaginal ring with an oral contraceptive, the ring does not pose a higher risk of causing a blood clot. On the other hand, research on the patch revealed a different level of blood clot safety. In September 2006, the US Food and Drug Administration updated the warning label on the Ortho Evra transdermal contraceptive patch, cautioning users about the higher risk of blood clots associated with its use. The study, commissioned by drug manufacturer Johnson and Johnson, revealed that patch users faced twice the risk of clots in the legs and lungs compared to women taking traditional birth-control pills. Dr. Daniel Shames, the acting deputy director of FDA's Office of Drug Evaluation in the Center for Drug Evaluation and Research, said, “Blood clots occurring in the legs or lungs are serious and rare events that are a potential risk for all hormonal contraceptive therapies.”
Applicability to Bodyworkers
For massage therapists, the implications for Ortho Evra’s higher blood clot risk lie in determining possible contraindications for a circulatory massage. This information also serves to expand a therapist’s questioning during an intake interview. While simply inquiring about a client’s medications is imperative to rendering a responsible massage, the news about Ortho Evra demonstrates the need to probe beyond medications. While asking whether a client uses any type of hormonal contraception may accurately cover the contraceptive patch, a client may not consider it to be a medication since it’s not taken orally. With the reported increase of risk for developing blood clots in Ortho Evra users, a responsible massage therapist must ask all of the appropriate questions to determine whether their clients are exposed to this risk.
Recommended Study:
Deep Vein Thrombosis
Pharmacology for Massage
References:
www.arhp.org, Choosing a Birth Control Method, Association of Reproductive Health Professionals, 2005.
www.familydoctor.org, Contraceptive Options Update, American Academy of Family Physicians, 2004.
www.hearthealthywomen.org, Oral Contraceptives, Cardiovascular Research Foundation Publications, 2005.
www.medicinenet.com, Definition of emboli, MedicineNet, Inc., 2006.
www.medindia.net, Contraceptive Patch Carries risk of Blood clots, MedIndia, 9/21/06.
www.pdrhealth.com, Oral Contraceptives, Thomson Healthcare, 2006.
www.prnewswire.com, Johnson & Johnson Sued Over Ortho Evra Damage; Texas Woman Says Drug Caused Life-Threatening Blood Clots, Miscarriage, Law Offices of John David Hart, 9/5/2006.
Posted by Editors at 09:28 AM
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March 21, 2007
The Benefits of Massage Therapy on Parkinson's Disease |
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In addition to its tragic impact on voluntary motor skills, Parkinson’s disease typically causes muscle stiffness and rigidity. Learn how bodywork can alleviate the symptoms of this increasingly common central nervous system disorder.
by Nicole Cutler, L.Ac.
Parkinson's disease, also called Parkinsonism, is a fairly common progressive degenerative central nervous system (CNS) disorder. Affecting about one in 1,000 people in the U.S., Parkinson’s disease is a dysfunction in the basal ganglia, an area of the brain that controls voluntary movement. Characteristic symptoms of this chronic, progressive neurodegenerative movement disorder include tremors, rigidity, slow movement (bradykinesia), poor balance and difficulty walking (called parkinsonian gait).
Parkinsonism results from the degeneration of dopamine-producing nerve cells in the brain. Dopamine is a neurotransmitter that stimulates motor neurons, the nerve cells that control muscles. When dopamine production is depleted, the motor system nerves are unable to control movement and coordination. People with Parkinson's disease have lost 80% or more of their dopamine-producing cells by the time symptoms appear. While symptoms may appear at any age, the average age of onset is 60 years old.
Western Medicine
In addition to not knowing the cause, there is also no cure for Parkinson's disease. Western medical treatment centers on the administration of medication to relieve symptoms. The Food and Drug Administration (FDA) has also approved a surgically implanted device that lessens tremors. Medication for Parkinson’s disease is a process of experimentation and patience, as its selection and dosage must be individually tailored. As the disease progresses, medications and their dosages will likely require modification.
Medications
Designed to influence dopamine levels, the mainstay medications prescribed for Parkinson’s disease are Levodopa and Carbidopa, or a combination of the two, Sinemet. Of primary concern to bodyworkers, hypotension is a typical side effect of these drugs. Any client at increased risk of hypotension (low blood pressure) requires extra attention during a position change or when rising from a massage table.
Alternative Medicine
Tolerance to these medications builds with time, rendering them less effective and opening up the possibility of new side effects or unpredictable responses. Just like with medications, surgical therapies are not curative and often treat only selected aspects of Parkinson's disease. It is no wonder that an increasing number of those affected with Parkinsonism are turning to complementary and alternative therapies for help.
Massage Therapy
The benefits of massage therapy have long been recognized by people with Parkinson's disease. Because Parkinson’s disease typically causes muscle stiffness and rigidity, bodywork’s ability to alleviate joint and muscle stiffness makes it a logical choice. As long as the client has sensation in the area being worked on, it is safe for bodywork. Communicating with a client throughout a bodywork session will ensure a positive experience. However, before working with a Parkinson’s client, bodyworkers must understand the following:
· Parkinson’s disease is a CNS dysfunction, and will not be completely resolved with bodywork alone.
· Work in cooperation with a client’s primary physician, as massage may impact the need for antidepressants and other medication.
· Since uncontrolled movement is characteristic of this disease, getting on and off a massage table may pose safety issues. Bodyworkers must predict this with Parkinson’s clients and either improvise or take extra cautionary measures to ensure the client’s safety.
Research
According to a 2002 study conducted by the Touch Research Institute at the University of Miami, along with staff from the university's neurology department and Duke University's pharmacology department, Parkinson's disease symptoms are reduced by massage therapy. In this study, the group of adults with Parkinson’s disease who received two massages a week for five weeks experienced improved daily functioning, increased quality of sleep and decreased stress-hormone levels. The massage consisted of 15 minutes in the prone position, focusing on the back, buttocks, ribs, thighs, calves and feet; and 15 minutes in the supine position, focusing on the thighs, lower legs, feet, hands, forearms, upper arms, neck, face and head. The study's authors reported, "These findings suggest that massage therapy enhances functioning in progressive or degenerative central nervous system disorders or conditions."
While several different massage modalities have been quantifiably researched in the context of Parkinsonism, including Trager, Alexander Technique and Swedish massage, all modalities report improvement in function, from the reduction of rigidity and improvement of sleep, to the reduction of tremor and increase of daily activity stamina.
Don’t be afraid of working with clients suffering from Parkinson’s disease. The pathology of this condition and the success reported with massage therapy make physical manipulation of the musculoskeletal system an ideal Parkinsonism management component. Being familiar with this disease and welcoming those affected can bring an enormous amount of satisfaction to any compassionate bodyworker.
Recommended Study:
Anatomy and Pathology
Pharmacology for Massage
Swedish Massage
References:
Massage Reduces Symptoms of Parkinson’s Disease, Massage Magazine, January/February 2003.
Slavin, John, PhD, LMT, Massage and Parkinson’s Disease: A Few Lessons Learned, Massage Today, October 2006.
Werner, Ruth, LMP, NCTMB, Parkinsonism, Massage Today, March 2005.
www.medterms.com, Definition of basal ganglia, MedicineNet, Inc., 2006.
www.neurologychannel.com, Parkinson’s Disease, Healthcommunities.com, Inc., 206.
www.parkinson.org, Complementary Therapies and Parkinson’s disease, Melanie M. Brandabur, MD, Jill Marjama-Lyons, MD, The National Parkinson Foundation, Inc., 1994.
Posted by Editors at 09:28 AM
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March 20, 2007
2 Natural Topical Pain Relievers |
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Chronic muscular pain is the number one complaint encountered by bodyworkers. Learn what two natural substances are considered to be superior pain-relievers by both the Western and complementary medical communities.
by Nicole Cutler, L.Ac.
Massage therapists typically rely on muscular relaxation, stretching, mobility and circulation enhancement to achieve pain relief. All kinds of healthcare practitioners - ranging from osteopathic physicians, to chiropractors, to acupuncturists, to massage therapists – include using topical applications as an adjunct to their primary modality of delivering pain relief. While many natural substances have been hailed for their pain relieving properties, two substances standout. That is why wintergreen and menthol are the star ingredients in a wide range of topical pain-relieving products.
Temperature
On a molecular level, American researchers have uncovered one of the reasons behind the success of gels using wintergreen and menthol in battling pain. Application of either compound to the skin causes a visceral temperature change. This is apparent when a product containing either substance, such as Ben-Gay or Icy Hot, is applied to the skin and causes a cold or hot sensation. According to Ardem Patapoutian, associate professor at Scripps Research and Genomics Institute, “Because our ability to sense temperature is closely linked to our ability to sense pain, it is not surprising that the misregulation of temperature-activated ion channels can result in chronic pain syndromes.”
Our experience of temperature is determined by long, specialized neurons connecting to the brain through the spinal column. These neurons have nerve endings embedded in our skin, where they detect temperature and communicate this information to the brain. The combination of pain and temperature sensation is well established. Try holding an ice cube where it’s so cold that it hurts. This is a logical protective mechanism where extreme freezing or scorching hot temperatures depend on our ability to sense pain and react accordingly. In the researchers’ identification of cold-sensing nerve receptors, it appears that those same receptors communicate pain. This could be the molecular basis for understanding how wintergreen and menthol ease pain. By stimulating temperature nerve receptors with a specific intensity, these topical ingredients may block or interrupt the pain signal.
Neuropathic Pain
The natural consequences of tissue injury, pain and tenderness typically abate as healing progresses. Unfortunately, some individuals experience pain without an obvious injury or suffer protracted pain that persists for months or years after the initial injury. This pain condition is typically considered to be neuropathic, accounting for a large number of people presenting to pain clinics with chronic, non–malignant pain. Rather than the nervous system functioning properly to sound an alarm regarding tissue injury, neuropathic pain occurs when the peripheral or central nervous systems malfunction and become the cause of the pain.
As a product of a constantly firing central nervous system, neuropathic pain is most likely to benefit from the activation of temperature nerve receptors. This is one way of understanding why topically applied menthol and oil of wintergreen relieve chronic pain.
Wintergreen
The main chemical constituent of wintergreen oil is a natural anti-inflammation compound, methyl salicylate. The body converts methyl salicylate to salicylic acid, otherwise known as aspirin. When applied topically, oil of wintergreen possesses two well-documented advantages over aspirin, with comparable anti-inflammatory results:
1. A topical application of methyl salicylate does not result in the stomach irritation or liver toxicity commonly associated with oral anti-inflammatory medication.
2. Methyl salicylate is better absorbed by muscle tissue than blood. Therefore, the active component is more effective when applied to the skin than where it can be filtered out by the blood supply.
Menthol
Menthol is a compound primarily derived from peppermint or other mint oils. It is a waxy, crystalline substance that is solid at room temperature. Similar to methyl salicylate, menthol is an anti-inflammatory and chemically triggers cold-sensitive receptors in the skin, causing the characteristic cooling sensation.
A study conducted on people with osteoarthritis showed improvement in the severity of joint pain when applying cetylated fatty acid cream topically. When menthol was added to this cream, pain and functional performance by people with knee, wrist and elbow osteoarthritis was even further reduced by a statistically significant margin.
Topical Application Cautions
There are several reasons why you should proceed with caution when using preparations with menthol or methyl salicylate, including skin irritation. First and foremost, thorough handwashing after application is essential to prevent contamination in unwanted areas. To avoid skin sensitivity and magnification of systemic absorption of menthol or wintergreen, do not cover the affected area with a tight bandage, use in conjunction with a heating pad or apply after strenuous exercise. Because methyl salicylate readily penetrates the skin after topical application, it should not be used on scraped, irritated or broken skin or near the eyes or mucous membranes. Due to the possibility of percutaneous absorption, methyl salicylate should be used with caution in individuals who are sensitive to aspirin or products containing aspirin.
Putting it to Use
Applying topical preparations, including the ingredients oil of wintergreen and/or menthol, can provide clients who experience chronic pain an additional layer of relief. While healthcare professionals have relied on these ingredients for years, understanding why they work may encourage their use by more therapists. Listed below are some tips for massage therapists looking to include topical applications in their treatments. Seek products with ingredients that:
· Come from a reputable supplier
· Are not greasy
· Will not stain clothing
· Have been recommended by other therapists/clients
· Have a liberal return policy
Try a few different formulations on clients with chronic pain, being sure to check for skin sensitivity, until you find one that works. By providing relief from every possible angle to yield the highest chance of success, it only makes sense to include topical pain relievers in conjunction with massage therapy.
Course Recommendations and Suggested Products:
Anatomy and Pathology
Herbal Heat
Herbal Ice
References:
Cross E. Sheree, et al., Topical Penetration of Commercial Salicylate Esters and Salts using Human Isolated Skin and Microdialysis Studies, British Journal of Clinical Pharmacology, Issue 46, 1998.
www.medicalnewstoday.com, Menthol Discovery Could Point Towards New Or Improved Pain Therapies, MediLexicon International Ltd, March 2006.
www.medicinenet.com, Methyl Salicylate and Menthol, MedicineNet, Inc., 2006.
www.research-innovation.ed.ac.uk, Topical treatment for chronic neuropathic pain, Edinburgh Research and Innovation Limited, 2006.
www.scripps.edu, Putting the Winter in Wintergreen, Jason Socrates Bardi, March 2004.
www.spineuniverse.com, Understanding Neuropathic Pain, Steven Richeimer, MD, Richeimer Pain Institute, 2006.
www.the-aps.org, Adding Menthol To Topical Creams For Osteoarthritis Provides Significant Pain Relief, Donna Krupa, The American Physiological Society, April 2004.
Posted by Editors at 09:40 AM
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