April 30, 2007

As many massage therapists know, steroids are frequently relied upon to treat chronic pain. With the increased likelihood of seeing clients who have been prescribed these types of medications, it is important to learn about one of the most commonly used steroids for managing pain, its potential side effects and impact on massage.

by Nicole Cutler, L.Ac.

Prednisone, a corticosteroid, closely resembles a steroid naturally made by the adrenal glands. Converted by the liver into a steroid, prednisone is used for a wide range of conditions. Primarily administered to reduce inflammation and suppress the immune system, few drugs have saved as many lives as prednisone. Some of the conditions prednisone treats include:

· Autoimmune diseases
· Inflammatory diseases
· Kidney diseases
· Organ transplant rejection

Pain Management
A client coming to see you with arthritis or chronic pain may be taking prednisone or one of its derivatives. As a reliable method of reducing inflammation, many pain management centers incorporate the use of prednisone into their treatment plans. With a reduction in inflammation, pain is typically reduced allowing additional therapies to be tolerated. A massage therapist must be aware of the implications of their clients on steroids for the following reasons:

1. It is inappropriate to express disdain for this drug, as it may be bringing the client enormous relief and may discourage a client from taking it. Nobody should EVER stop using prednisone without proper physician approval and oversight.

2. Many side effects (some serious) can result from taking this drug, particularly for those who have it prescribed for a long time.

Dependency
Because the human body develops a dependency on prednisone, it must not be stopped without guidance from a doctor. A sudden withdrawal from prednisone may leave the body unable to synthesize natural corticosteroids, also known as adrenal suppression. This may cause symptoms such as extreme weariness, weakness, slowed movements, upset stomach, weight loss, changes in skin color, sores in the mouth, cravings for salt and may even be life threatening. Most physicians will monitor their patients as they progressively taper off prednisone. If you have a client feeling well enough to consider stopping their prednisone, explain how important it is that it be done gradually AND only under the care of a physician.

Bone Degradation
While steroids do decrease inflammation, they also decrease the formation of new bone, increase the breakdown of old bone and decrease the body’s absorption of calcium. Prolonged prednisone usage has been known to cause osteonecrosis; literally, bone death. Prednisone-induced osteonecrosis is especially common at the hip joint due to breakdown of the femoral head. This danger is why many people on long-term prednisone therapy simultaneously take another drug (such as Fosomax) to strengthen their bones. If a client demonstrates signs of osteoporosis or increasing hip discomfort while on long-term prednisone therapy, explain to them why they should review the side effects their medication may be exhibiting with their physician.

Immunosuppression
Immunosuppression is the act of reducing the activation or efficacy of the immune system. At first glance, reducing immune power may seem like an undesired phenomenon. However, deliberately induced immunosuppression can prevent the body from rejecting a transplant and is used to treat autoimmune diseases (such as rheumatoid arthritis), where the immune system attacks normal body tissue. Because prednisone is an immunosuppressant, it can render the body more susceptible to illness. Taking this steroid may make infections harder to treat. For this reason, clients should be encouraged to consult with their doctor as soon as possible if signs of an infection, such as sore throat, fever, sneezing or coughing are present.

Generalized Side Effects
A prednisone prescription requires constant feedback on its effects by the patient and subsquent fine-tuning by their physician to ensure its safety. The list of possible side effects is extensive and includes the following:

· Headache and dizziness
· Difficulty falling asleep or staying asleep
· Extreme changes in mood or personality
· Bulging eyes and increased perspiration
· Acne or thin, fragile skin
· Red or purple blotches or lines under the skin
· Slowed healing of cuts and bruises
· Increased hair growth
· Changes in the way fat is spread around the body
· Extreme fatigue and muscle weakness
· Irregular or absent menstrual periods
· Decreased sexual desire
· Heartburn

Any of the above side effects should be discussed with a physician. More serious side effects include:

· Vision problems such as eye pain, redness or excessive tearing
· Sore throat, fever, chills, cough, or other signs of infection
· Depression or confusion
· Loss of contact with reality
· Muscle twitching or tightening
· Seizures or uncontrollable shaking of the hands
· Numbness, burning or tingling in the face, arms, legs, feet or hands
· Upset stomach or vomiting
· Lightheadedness
· Irregular heartbeat
· Sudden weight gain
· Shortness of breath, especially during the night
· Dry, hacking cough
· Swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles or lower legs
· Difficulty breathing or swallowing
· Rash, hives or itching

These more serious side effects should be reported to a physician immediately.

Specific Massage Considerations
For clients taking prednisone, a gentle approach is often required. Prednisone can create a disturbance in fluid balance, resulting in abnormal swelling. Because the body’s circulatory system may be overloaded, a massage therapist should not attempt to dramatically shift the balance of fluid. Gentle work will minimize any dramatic fluid changes.

Another side effect of prednisone is the thinning and fragility of the skin. For a client with this manifestation, vigorous massage such as deep pressure or friction should be avoided to prevent tearing of the skin. Additionally, the immunosuppressant action of prednisone will hamper the skin’s healing ability.

Pros and Cons
Pain management specialists often use the reliable drug prednisone to control symptoms of chronic pain. Although most physicians convey the side effects and the need for patient-doctor communication, many people are not in close contact with their doctor. For healthcare professionals who typically see clients managing chronic pain, familiarity with prednisone’s pros and cons can facilitate your client’s reporting of important issues to their physician. This enforcement of communication serves your client by instilling their confidence in your knowledge and of course, by looking out for their safety.

Recommended Study:
Anatomy and Pathology
Pharmacology for Massage Therapy

References:

Walton, Tracy, LMT, MS, Medical Conditions in Massage Practice, Part III: Interviewing for Medications, Massage Today, August 2005.

www.healthtalk.com, Ask the Doctor, Tina Chadha Bunch, MD, HealthTalk, October 2006.

www.ibdcrohns.about.com, Side Effects-Prednisone, Prednisone: Frequently Asked Questions, Steroid-Induced Osteoporosis, Amber J. Tresca, About, Inc., 2006.

www.nlm.nih.gov, Drug Information: Prednisone, National Institutes of Health, October 2006.

www.wikepedia.org, Prednisone, Wikimedia Foundation, Inc., 2006.

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April 27, 2007

The unexpressed trauma of past experiences stored in the musculature and connective tissue of our bodies creates tension, blocks circulation and can ultimately lead to pain and disease. Learn what you can do as a massage therapist to unlock and free clients of these tissue memories.

by Nicole Cutler, L.Ac.

Many scholars believe that pain and trauma are incidents prevented from being completed. These can be single damaging events such as a car accident, continuous bombardments requiring emotional defenses, or over-training of isolated muscles that lock the body into a recognized pattern. Traumas can be considered anything that keep us locked in a physical, emotional, behavioral or mental habit. Recovery from trauma is the process of the body finding balance and freeing itself from constraints. All too often, the recovery process is halted, preventing the traumatic occurrence from completing.

There are many reasons traumatic incidents cannot be completed, creating stagnation and causing a cascade of physiological protective mechanisms to separate the trauma from affecting everyday functioning. Because our bodies and emotions can only safely handle a limited amount of stress, trauma results whenever an experience exceeds our abilities to handle and cope with its consequences. The energy of the trauma is stored in our bodies’ tissues (primarily muscles and fascia) until it can be released. This stored trauma typically leads to pain and progressively erodes a body’s health.

Feelings
Emotions are the vehicles the body relies on to find balance after a trauma. Feelings represent the accumulation of incomplete events and the body’s attempt to complete them. By strengthening our inner resources, we are capable of processing these feelings, releasing stored traumas, and increasing our ability to handle stress with greater ease.

Protection
When trauma occurs, our bodies activate a protective mechanism. A stressor that is too much for a person to handle overloads the nervous system, stopping the trauma from processing. This overload halts the body in its instinctive fight or flight response, causing the traumatic energy to be stored in the surrounding muscles, organs and connective tissue. Whenever we store trauma in our tissue, our brain disconnects from that part of the body to block the experience, preventing the recall of the traumatic memory. Any area of our body that our brain is disconnected from won’t be able stay healthy or heal itself. The predictable effect of stored trauma is degeneration and disease.

Memory Beyond the Brain
There is ample scientific evidence proving memory storage in locations other than the brain abound. Three examples of the body containing extraordinary memory capabilities are:

1. Immune system response is enhanced by memory T-cells maintaining information about previous attacks by specific foreign antigens.

2. Muscle memory improves the ability of top class sports people and musicians to perform optimally even under extreme pressure.

3. Genetic research has demonstrated that the matrix composing our body’s cells (DNA) possess a complex information storage system.

When considering the vastness of our body’s intelligence, it is no wonder that our muscles and fascia are capable of holding memories.

Unlocking Memories
Three things are necessary for the body to release stored trauma:

1. The inner resources to handle the experience that were not in place when the experience originally occurred.

2. Space for the traumatic energy to go when released. Being full of tension and stress does not allow space for the stored trauma to move into.

3. Reconnection of the brain with the area of the body where the trauma is stored.

Combining bodywork with verbal therapy can successfully bring a trauma to completion. Many types of verbal therapy are ideal for the development of a person’s inner resources for handling a traumatic experience. Certain bodywork styles effectively reduce stress and tension levels making room for release as well as function to reconnect the brain with the stored trauma.

Bodyworkers play a key role in bridging locked memories with the physical body. The techniques known as myofascial release or myofascial unwinding are hands-on methods for initiating traumatic memory release. Myofascial work locates and physically frees the restrictions in muscle and surrounding fascial tissue that house traumatic memories. As a skilled therapist holds and unwinds these tissue tensions, memories may surface and release, causing the body to spontaneously "replay" body movements associated with the memory of the trauma. This release initiates relaxation, unlocking the frozen components of the nervous system. Such a shift marks the reconnection of the brain with the tissue housing the trauma, allowing transformation and healing to ensue.

Seeking Support
Bodyworkers utilizing myofascial release techniques practice within the illuminating space between physical and emotional health. While developing the emotional resources to cope with a traumatic experience is best reserved for those specifically trained in verbal therapy, bodyworkers can effectively fill the gap of total health in traumatic recovery. As psychological counseling is beyond the scope of practice for most massage therapists, it is recommended to practice release techniques with a client who has sought, or is currently seeking support from a mental health professional. Meeting all three of the components necessary for unlocking and healing from stored trauma combines the work between client, mental health professional and bodyworker. With this holistic approach, traumatic events can go to completion, allowing the body to once again find balance.

Recommended Study:
Myofascial Release
Advanced Anatomy and Physiology

References:

Grant, Keith Eric, PhD, NCTMB, Mind and Body, Massage Today, July 2003.

www.alchemyinstitute.com, The Alchemy of Healing: An Exploration of the Meaning of Illness, David Quigley, the Alchemy Institute of Healing Arts, 2006.

www.anniebrook.com, The Physiology of Shock and Trauma, Annie Brook MA, LPC, Annie Brook, 2001.

www.cranialsacraltherapy.org.uk, Tissue Memory and Trauma, David Ellis, November 2005.

www.fnd.org, Writings on the Great Unwinding, Marvin Solit, DO, The Foundation for New Directions, February 2005.

www.integrative-healthcare.org, The Therapeutic Relationship in Post Traumatic Stress Disorder, Natural Wellness, July 2005.

www.positivehealth.com, Biodynamic Massage: A Truly Therapeutic Massage, Denise McCrohan, Positive Health Publications Ltd., 2002.

www.satyamag.com, Releasing Muscle-Bound Memories, David Drier, Stealth Technologies Inc., November 2001.

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