Massage Professionals Article Archive

by Nicole Cutler, L.Ac.

Ergonomically, the human form is a curious creation. We walk upright on two of our limbs, while a long curvaceous bony structure extends upwards to balance the head. By throwing gravity a couple of curves, the natural bends in the lumbar and cervical regions of the spine help maintain stability. Although this ingenuous structure characterizes our evolution and allows us to perform a vast range of functions, it also primes human beings for injury.

Shock Absorption
Acting as shock absorbers, intervertebral discs lie between each spine segment to cushion our movements. Known as herniation, these discs can create an enormous amount of pain when they deteriorate, are compressed or get pushed to one side. Technically, a herniated disc describes the extrusion of the soft inner core of the intervertebral disc (nucleus pulposus) through the disc’s outer fibrous core (annulus). Symptoms appear when this extrusion places pressure on the corresponding nerve root.

In the lumbar area of the spine, the most common sites for a herniated disc are between lumbar vertebrae four and five (L4-5) and between lumbar vertebrae five and the top of the sacrum (L5-S1). Herniations in these areas typically result in sciatica, where back pain progresses to pain and/or numbness radiating down the posterior and lateral leg, occasionally traversing the knee to the lower leg.

Assessment and Differentiation
Since a massage therapist is not qualified to diagnose the condition, it is important to have a physician determine the etiology of a client’s back pain. Attempting to work with a client in pain without knowing its cause can be dangerous when cancer, cauda equina, osteoporosis, fracture or infection is at the pain’s root. However, being familiar with signs of a herniated disc are helpful if the cause of back pain is unknown.

A challenging aspect of evaluating clients with symptoms of a herniated disc is differentiating between a low back strain and a herniated disc. According to the American Academy of Family Physicians, there is a general rule of thumb applicable to assessing back pain. Typically, pain caused by a low back strain is exacerbated by putting the affected muscles under stress (standing and twisting motions) while pain caused by disc herniation is worse in positions increasing pressure on the disc (sitting and bending). Inquiring about whether the client’s pain worsened while driving to your session may be a revealing question to pose to a client during the interview process. For safety purposes, even the most astute palpation and interviewing skills must be supplemented by a doctor’s evaluation.

Signs and Symptoms
Typically originating from a herniated disc at L4-5 or L5-S1, sciatica can cause both sensory and muscular abnormalities in the legs and thighs. Common symptoms of sciatica include:

· Deep, severe pain starting low on one side of the back
· A cramping sensation of the thigh
· Shooting pains from the buttock, down the leg
· Tingling, or pins-and-needles sensations in the legs and thighs
· A burning sensation in the thigh
· Leg or foot numbness

Additionally, people with sciatica may notice a worsening of their symptoms during movements increasing the pressure around the sciatic nerve such as squatting, sneezing, side-bending, laughing or coughing.

Massage Therapy
Massage professionals offer one of the most effective treatments for relief of a herniated disc. Two large government-funded studies released in November 2006 concluded that back surgery for painful herniated disks provided no greater benefit than other, less-invasive forms of treatment. Due to the side effects and risks associated with surgical intervention, this research supports the use of safe complementary therapies, such as Neuromuscular therapy, for disc herniation pain.

Neuromuscular therapy (NMT) is a style of massage that restores homeostasis between the central nervous and musculoskeletal systems. Ideal for addressing disc herniation, NMT can desensitize the extremely painful symptoms associated with this condition. Characteristics unique to NMT offer therapeutic relief for sciatica sufferers:

· The NMT technique of milking the nerve’s myelin sheath gives fast pain relief and reduces nerve inflammation. Nerve inflammation and pain are hallmark symptoms of sciatica.

· NMT alleviates involuntary muscle contraction and tissue congestion resulting from nerve conditions. Involuntary muscle contractions are spasms that typically accompany sciatica.

· NMT’s techniques can change chronic structural deviations of the body responsible for causing and perpetuating mechanical stress injury. A herniated disc causing sciatica is a structural deviation that can be affected with NMT.

· NMT prevents further aggravation of referred nerve symptoms. Through using trigger point locations for treatment, NMT helps relieve the referred pain defining sciatica.

When it comes to herniated discs, there is a tremendous demand for effective and safe therapy. Because our spine’s shock absorbers are prone to occasional misalignment, the skills to assess this common occurrence and apply appropriate treatment can make an enormous contribution to healthcare. NMT’s balancing of the nervous system with the musculoskeletal system makes it the logical choice when addressing sciatica.

Recommended Study:
Neuromuscular Therapy

References:

Curnett, Michael, Mary L. Karlton, SciatiCare: Hands-On Technology for Healing Spinal Disc and Nerve-Impingement Conditions, Massage Magazine, January 2006.

www.aafp.org, Clinical Evaluation and Treatment Options for Herniated Lumbar Disc, S. Craig Humphreys, MD, and Jason C. Eck, MS, American Academy of Family Physicians, February 1999.

www.emedicinehealth.com, Sciatica, WebMD, 2006.

www.massagebyben.com, Neuromuscular Therapy, History and Uses, Peter Lane, CMT, CNMT, massagebyben.com, 2006.

www.mayoclinic.com, Herniated Disc Guide, Mayo Foundation for Medical Education and Research, September 2005.

www.news.yahoo.com, Studies: surgery no better for sciatica, Carla K. Johnson, The Associated Press, November 2006.

by Nicole Cutler, L.Ac.

Statistics show that one out of every three U.S. adults will experience arthritis as they grow older. Researchers at Beth Israel Deaconess Medical Center (BIDMC), an affiliate of Harvard Medical School, have found that baby boomers have significantly higher rates of arthritis than their parents’ generation. “Baby boomers are just approaching the age when arthritis rates begin to rise dramatically. Many baby-boomers have lived with obesity for much of their lives. We can expect to see the health and functional consequences of this epidemic in the coming decades,” says Suzanne Leveille, PhD, senior author of this BIDMC study.

Caused by the deterioration of joint cartilage, osteoarthritis is the most common type of arthritis resulting in pain, swelling, and decreased range of motion. Repetitive stress injuries and excess body weight are considered two of the most avoidable causes of osteoarthritis. Also known as degenerative joint disease, osteoarthritis causes the cartilage cushioning the surfaces of bones to wear out, causing crepitation, or the grinding of bones against each other. As a result of using our hands for nearly every daily task, osteoarthritis of the hands is among the most prevalent sources of discomfort for baby boomers.

While medications such as Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) have been the primary choice in treating osteoarthritis, their accompanying side effects and limited benefit often makes these medications less than desirable. According to the Arthritis Foundation, an increasing number of doctors are recommending massage to their arthritis patients for pain and stiffness relief. In addition to bodywork, heat-based therapies and detoxification protocols are exhibiting exciting results in reducing arthritic complaints.

One Heat-Based Therapy
For many years, paraffin wax has been used as a health treatment due to its effectiveness in transferring heat to the skin and joints. Warmed paraffin wax dips expand blood vessels which serves the following therapeutic functions:

· Increases circulation
· Draws nutrients to the skin’s surface
· Flushes toxins out of the skin

Paraffin wax’s very high heat capacity is a unique characteristic enabling absorption and retention of a great amount of heat. When used on the hands, the heat required to melt the wax is released after it solidifies into a custom-fitted, warm glove. This glove transfers the heat deep into the hand.

A 2006 Cochrane review reported positive results for paraffin wax baths for arthritic hands. When comparing various heat therapies, researchers concluded that paraffin wax treatment was especially helpful for arthritic hands on objective measures of range of motion, pinch function, grip strength, pain on non-resisted motion and stiffness compared to control (no treatment) after four consecutive weeks of treatment.

One Detoxification Solution
Elimination of toxins is an important avenue for realigning arthritic clients with their health. Toxins can accumulate and crystallize throughout the body in various tissues including:

· Blood
· Nerves
· Fascia
· Muscles
· Joints

This accumulation creates toxic congestion, lending the body susceptible to arthritis. As the body's primary vehicle for waste elimination is the digestive tract, taking a detoxification supplement can have a profound effect on preventing and reversing toxic waste stagnation. Liv.52 is an ideal example of a supplement designed for body detoxification, and can be a valuable addition to an arthritic client’s repertoire.

While pharmaceuticals have real, but limited ability to help the millions of arthritis sufferers in the world, alternative therapies are showing increasing promise. Without the side effects associated with NSAIDS or other medications, treatments such as massage therapy, paraffin wax dips and detoxification supplementation are forging ahead of conventional treatment in bringing baby boomers the relief they need for painful, arthritic hands.

Editor’s Note: This information is for educational purposes only. As laws differ between occupations and locations, therapists are advised to operate solely within their scope of practice.

References:

Osborn, Karrie, Seeking Alternatives for Arthritis Sufferers, Massage & Bodywork, June/July 2005.

Robinson VA, Brosseau L, Casimiro L, Judd MG, Shea BJ, Tugwell P, Wells G, Thermotherapy for treating rheumatoid arthritis, The Cochrane Database of Systematic Reviews, Issue 3, 2006.

www.healthbanks.com, Paraffin Wax for Osteoarthritis, HealthBanks, Inc., 2006.

www.pacificcollege.edu, Massage Therapy for Arthritis, Jeff Denny, Pacific College of Oriental Medicine, 2005.

www.seniorliving.about.com, Arthritis Increasing in Baby Boomers, Sharon O’Brien, About, Inc., 2006.

by Nicole Cutler, L.Ac.

Two leading massage modalities cover an even broader range of applicability when fused together. At its very essence, integrative medicine consists of combining therapeutic approaches to yield a more effective outcome. Integrating hot stone massage with the meridian principles of Traditional Chinese Medicine (TCM) exemplifies how the sum can be greater than its parts.

Massage therapists are becoming increasingly adept at fusing different bodywork styles. Using different techniques from various schools is how therapists can create a signature massage. While there seems to be no end to the combinations, some provide more benefits than others. Even while working simultaneously with stones and meridians, massage professionals can imprint their own unique flair. However, a comprehensive grasp of both modalities is required before uniting stone massage with meridian work.

Hot Stone Massage
Hot stone massage is a form of thermal hydro-therapy. Using smooth, warmed, heat-retaining stones as extensions of the hands, clients receiving a well-administered hot stone massage will seek it again and again. For some, stone therapy brings unrivaled deep tissue release and alignment. For others, the heat of the stones gently softens muscular tension and melts away emotional stress. On a spiritual plane, the stones are from the earth and have an extremely grounding quality adored by many. Grounding can be very helpful to individuals struggling with issues related to sleep, headaches, dizziness, anxiety or feeling overwhelmed or scattered.

The heat of the stones, combined with the soothing gliding massage movements, warms and relaxes the muscles to a much greater extent than what can be achieved by massage alone. Proponents claim the following benefits of warmed stone bodywork:

· Increased circulation, lymph and vitality
· Release of excessive toxins
· Relief from tight muscles
· The weight and material of the stones function to ground the body
· Reduced ticklishness for many vulnerable clients
· Relaxed central nervous system (when stones are laid upon the spinal column)
· Added energetic quality to massage when incorporated with vibration (clicking or tapping of stones)

From active placement to active stone massage, there are many different ways to manipulate the stones on a person’s body. Using the heated stones to apply pressure to acupressure points, trace or rub meridians is one way to amplify the therapeutic efficacy of a treatment.

Meridian Bodywork
A part of TCM, massage along the body’s energy-containing meridians can have many therapeutic uses. According to the 3,000 year-old practice of TCM, energy that is deficient, excessive or stagnant within the body’s meridians results in imbalance and eventually, disease. By breaking up blockages and promoting energy’s free and easy flow, acupuncture and acupressure are common modalities used to influence the health of energy flow throughout these meridians. Because meridians connect every part of the body to every other part, bodyworkers are able to address all types of pain and illness at easily accessible body locations. Once the affected meridian is properly assessed, bodywork on that meridian can have seemingly miraculous results – including restoring vitality, stopping pain and restoring blood sugar levels.

TCM understands the human body as a microcosm of its surrounding environment. As such, factors affecting the environment also affect the body. Forces such as heat, cold, dryness, dampness and wind have specific implications to a person’s health. A host of common TCM pathologies evolve when excessive amounts of cold influence the urinary bladder, lung and kidney meridians. These are the meridians most easily affected by cold temperatures. A practitioner can recognize whether cold is cause of an imbalance when the following symptomatic patterns emerge:

· a preference for warm beverages
· frequent sensations of cold or being chilled
· a worsening of painful symptoms in cold conditions
· pale facial complexion
· profuse and watery urination

Once it is understood that cold is a culprit, using heat becomes a logical therapeutic choice. A common TCM technique, moxibustion is the burning of an herb over an acupressure point or meridian to impart warmth. While admittedly beyond the scope of practice of most massage therapists, there are other methods of warming a chilled meridian. Using hot stone massage is an alternate technique to warm and invigorate the energy within a meridian.

The Union
Continued education fuels creativity. Knowing how to give a skilled hot stone massage and combining it with meridian massage will enhance your sessions. Once you are aware that a client could use some energetic warming, the treatment you can capably provide will rival any of the most respected therapies available.

Recommended Study:
Stone Massage
Shiatsu Anma Therapy

References:

Alexandra, Sonia, LMT, Stone Massage Therapy: A Catalyst for Health, Massage Today, November 2003.

Baltz, Bruce, Deep Tissue Healing: The Art of Stone Massage, Massage Today, January 2005.

www.ezinearticles.com, Hot Stone Massage Guide eBook, Kareen Fellows, Ezinearticles.com, 2006.

www.hb.syl.com, A Stone Massage Description - Useful Knowledge for Self-Maintenance, www.syl.com, March 2006.

www.neholistic.com, The Breath in the Stone, Karyn Chabot, D.Ay., LMT, The North East Directory of Holistic Resources, 2006.

www.nhi.edu, Hot Stone Massage: An Ancient Tradition That Still Rocks! Upasana Titterington, National Holistic Institute, 2006.

by Nicole Cutler, L.Ac.

Most common in the elderly and marked by a progressive decline of brain function, dementia is the impairment of reasoning, memory and other cognitive abilities. This decline eventually impacts daily activities, limiting everything from driving to bathing to feeding. About 4 to 5 million people in the United States have some degree of dementia, and that number is estimated to increase over the next few decades as the population ages. The most well known form of dementia is Alzheimer's disease. While there is no cure for dementia or Alzheimer’s disease, evidence suggests that alternative therapies can improve their symptoms and greatly benefit a person’s quality of life.

Dementia Symptoms
The most common characteristics of dementia are:

· Memory loss
· Impaired concentration and comprehension
· Depression
· Deterioration of basic social skills
· Hallucinations, delusions, psychosis
· Aggression, agitation, anxiety, restlessness
· Accusatory behaviors
· Withdrawal, disinterest, hostility, loss of inhibitions
· Insomnia or disturbances in sleep patterns

The Power of Touch
As somatic healthcare practitioners, we have the opportunity to make contact with a person struggling with dementia unlike any other caregiver through our attention, communication and fostering a sense of overall well-being.

Attention – Between the decline of performing everyday activities and maintaining interpersonal relationships, the ramifications of deteriorating brain function are very frightening. A caring individual capable of focusing their non-judgmental attention on a person with dementia eases the fear of losing touch with society. This attention may be the only source of social interaction this person has.

Communication – The anxiety and frustration typical of dementia is amplified by the person’s inability to verbally communicate. Bodywork’s utilization of healing touch serves as a form of nonverbal communication capable of bridging the isolation typically experienced with a loss of cognitive abilities.

Well-being – Although each individual will have slightly varying symptoms, lacking a sense of well-being is universal in people with dementia. Some of the proven physical benefits of massage that contribute to a sense of well-being include:

· Stress reduction
· Deepened relaxation and breathing
· Lowering of blood pressure
· Circulation stimulation
· Pain relief
· Aiding in restful sleep
· Endorphin release
· Fear and anxiety reduction

Research
There is some compelling evidence demonstrating bodywork’s benefit for people with dementia:

· As published in the Cochrane Library in October 2006, Danish researchers confirm that massage may offer a drug-free way to treat agitation and depression among dementia patients. In two of the studies reviewed, hand massage and gentle touching during conversation helped ease agitation and restore appetite in dementia patients over short periods of time.

· According to a 2002 study conducted at Newcastle General Hospital’s Wolfson Research Centre, lotion containing essential oil of Melissa reduced agitation and increased constructive activity in people with severe dementia.

· In 1999, researchers at the University of Texas found that the more physical aspects of dementia-related agitation such as pacing, wandering, and resisting significantly decreased after participants received slow-stroke massage.

· In a one-year demonstration project at Schervier Nursing Care Center in Riverdale, New York, the facility offered a Tender Touch massage to residents. The findings indicated that massage therapy helped eliminate anxiety in residents with dementia.

Specific Concerns
When performing bodywork to reduce symptoms of dementia, therapists will likely be working with the elderly. The three special areas of concern specific to this age group that must be acknowledged by the therapist are modesty, health issues and medications affecting massage.

Modesty – Due to the cultural beliefs held by older generations, it is important for massage therapists to be sensitive to modesty issues. For example, a client may consider undressing for a massage to be immodest. If asked to disrobe without respectfully addressing their privacy, a recipient may experience the session to be uncomfortable and stressful. Giving plenty of time and privacy considerations will contribute to building a trusting therapeutic relationship.

Health Issues – When working with this population, it is important to be educated and sensitive to a wide variety of health conditions. Awareness of a client’s health issues is necessary prior to giving a massage so the technique can be customized to best fit the client’s needs. Special attention should be paid to issues related to blood clotting, vein inflammation, deep vein thrombosis, severe swelling, skin lesions, hematomas and abdominal aneurysm.

Medications – Therapists must know how to assess the medications taken by clients to determine any potential contraindications. Familiarity with the medications typically prescribed to a person with dementia, and how those drugs impact massage will assist the therapist in choosing the most appropriate strokes to administer a safe and supportive treatment.

Working with people suffering with dementia is an extremely rewarding niche. Due to their loss of cognitive ability, those with dementia are often segregated from the rest of society. In addition to providing a safe and caring method to reduce dementia’s symptoms, bodyworkers have the unique opportunity to be the only person capable of communicating with their client. When properly educated and prepared, bodyworkers have the power to convey compassion to a person with dementia through the power of touch.

Recommended Study:

Deep Vein Thrombosis
Pharmacology for Massage
Healing Energy and Touch
Ethics: Therapeutic Relationships

References:

Aromatherapy Eases Agitation in Severe Dementia, Massage Magazine, March/April 2003.

Nelson, Dawn, CMT, Growing Old with Massage in Facility Care, Dawn Nelson, CMT, Massage and Bodywork, February/March 2001.

Rowe M, Alfred D, The effectiveness of slow-stroke massage in diffusing agitated behaviours in individuals with Alzheimer's disease, Journal of Gerontological Nursing, June 1999.

Trombley, Jessica, Massage Therapy for elder residents, Nursing Homes, October 2003.

www.emedicinehealth.com, Dementia Overview, WebMD, 2006.

www.internethealthlibrary.com, Dementia Research: Diet and Lifestyle, Internet Health Library, 2006.

www.sbu.se, Touch Massage for Dementia, The Swedish Council on Technology Assessment in Health Care, August 2002.

www.umm.edu, Alzheimer’s Disease, A.D.A.M, Inc., 2004.

www.upi.com, Massage May Help Dementia Patients, Alex Cukan, United Press International, Inc., October 2006.