Massage Professionals Article Archive

by Nicole Cutler, L.Ac.

Scars develop on the skin’s surface as the result of burns, deep lacerations or a variety of other injuries that penetrate or interrupt the skin’s integrity. Possessing an amazing capacity to heal and regenerate, the skin forms a scab over a wound within three to four days following an injury. By day ten the scab typically shrinks and sloughs off as the body focuses on laying down collagen fibers to strengthen the former site of injury. The damaged tissue can be in recovery between three months to over a year before it returns to full strength. Additionally, some diseases or skin disorders (such as acne) may also result in scar tissue formation. While scars can result from a variety of traumatic events to the skin, they share some common characteristics. As a general rule, the earlier and more consistently scar tissue is exercised, massaged and warmed, the less possibility of developing any long-term concerns.

Scar Traits
While the degree of scar formation varies from person to person, there are some distinguishing characteristics:

· Becomes hard and non-pliable
· Bands of fibers on or below the surface
· Skin tightens or shortens. When crossing a joint, this contracture may limit range of motion, comprise function or cause deformity.
· Becomes dry and reopens to form a wound if not managed properly. This is especially true for skin grafts, which do not produce oil or sweat.

Long-Term Effects
While the body’s formation of scar tissue is an awesome demonstration of self-preservation, the resulting fibrous mass can set the stage for problems down the road. Composed primarily of collagen, scar tissue’s fibrosity prohibits adequate circulation. In addition to the physical limitations of collagenous tissue, the lack of blood flow and lymph drainage occurring in scar tissue makes it vulnerable to dysfunction. The resulting abnormal stress on a scar’s surrounding structures may include:

· Nerve impingement
· Pain
· Numbness
· Limited range of motion and flexibility
· Postural misalignment
· Muscle atrophy
· Tissue hypoxia
· An increase in potential for future injury

In fact, some professionals believe that scar tissue is the root of a majority of physical imbalances. Bodyworkers addressing scar tissue early in its development can help minimize any of the preceding secondary scar tissue problems.

Two Phases
A scar’s healing progression consists of two phases, immature and mature.

· Immature – Immediately after a wound heals, the scar is immature. During this period it may be painful, itchy or sensitive as nerve endings within the tissue heal. While it is typically red in appearance, most scars fade to normal flesh color with maturation. Exercise, massage and heat application will have the greatest positive effect on an immature scar.

· Mature – Depending on the size and depth of the wound, scar tissue will cease production 3 to 18 months following wound healing. When scar tissue is no longer produced, the scar is considered mature. While techniques to reduce scar tissue in a mature scar are effective, a more disciplined and vigorous approach is necessary.

Six Techniques
As soon as the wound is knitted, massage therapy can be performed. During the initial immature stages of wound recovery, it is imperative that a gentle approach be taken. The following six techniques are well-known ways bodyworkers can improve scar tissue:

1. Manual Lymph Drainage optimizes lymphatic circulation and drainage around the injured area. Gentle, circular, draining motions within the scar itself or a firm stretch to the skin above and below the scar, first in a straight line and then in a circular motion, are two drainage techniques. Placing the fingers above the scar, then making gentle circular pumping motions on the scar also helps drain congested lymph fluid. As the massage therapist gently works down the scar, the tissue will feel softer. Drainage techniques should not hurt or make the scar redden.

2. Myofascial Release helps ease constriction of the affected tissue. To stretch the skin next to the scar, place two or three fingers at the beginning of the scar and stretch the skin above the scar in a parallel direction. Then move the fingers a quarter of an inch further along the scar and repeat the stretch of the adjacent tissue, working your way along the scar. An alternative method is to follow the same pattern of finger movements using a circular motion instead of straight stretches. Work your way along the scar in a clockwise and counterclockwise fashion.

3. Deep Transverse Friction can prevent adhesion formation and rupture unwanted adhesions. Applied directly to the lesion and transverse to the direction of the fibers, this deep tissue massage technique can yield desirable results in a mature or immature scar. Never progress beyond a client’s comfort level.

4. Lubrication of the scar helps soften and increase its pliability. Mediums such as lotion, castor oil, vitamin E oil or other oil can prevent the scar from drying out and re-opening.

5. Stretching aids in increasing range of motion. This is most important when approaching scars that cross over a joint. Scar tissue will lengthen after being stretched, especially if the stretch is sustained for several seconds and is combined with massage.

6. Heat Application helps the pliability and flexibility of the scar. Common tools used to apply heat are paraffin wax, moist heat packs or ultrasound.

Cautions
Massage therapists must use their training and best judgment when deciding whether or not to proceed with scar massage. While treatment is most effective when a scar is still in its immature phase, it is also a wise time to seek physician permission. A few additional cautions for immature scars include:

· Take extreme care with radiated tissues, as the skin is delicate and can break easily.

· Aside from friction massage, do not continue if your actions cause pain or increase tissue redness.

· Never perform massage on any open lesions.

· To prevent accidental sliding of the fingers, apply a lubricating medium after your primary work.

As a massage therapist, always keep in mind that scar tissue may be at the root of the physical imbalance you are preparing to address. If a scar is found to play a part in your client’s dysfunction, consider combining the six scar-reducing techniques described earlier. Not only can you minimize a scar’s appearance with bodywork, yet you can therapeutically correct the cause of your client’s physical ailments.

Recommended Study:
Neuromuscular Therapy
Lymphatic Drainage
Myofascial Release

Recommended Products:
Hot Pack
Paraffin Wax

References:

LaFrano, Chuck, Scar-Tissue Massage, Massage Magazine, May/June 2001.

www.abcn.ca, Massage Therapy for the Treatment of Scar Tissue, Sandra MacDonald, RMT, Atlantic Breast Cancer Net, November 2004.

www.harcourtassessment.com, Scar Management, Ed Rauschuber, OTR, CHT, Therapy Skill Builders, 1998.

www.lufkinhbo.com, Myofascial Release, Julietta Planchart, PT, Cralle Physical Therapy, 2006.

www.lymphnotes.com, Scar Therapy and Lymphedema, Lymph Notes, 2006.

www.ombregt.be, Deep Transverse Massage, L. Ombregt, MD, www.ombregt.be, 2006.

by Nicole Cutler, L.Ac.

Menopause is a normal aging process, occurring naturally in 25 percent of women by age 47; 50 percent by age 50; 75 percent by age 52; and 95 percent by age 55. However, menopause can occur at earlier ages as a consequence of chemotherapy, hysterectomy or other medical interventions. Although menopause is official when a woman has not menstruated for 12 consecutive months, the discomforts accompanying menopause typically begin well before this point.

Hormones
Physiologically, menopause is a decline of a woman's reproductive hormones. As a woman's egg cell supply diminishes, menstruation ceases. This change causes the ovaries to manufacture less of estrogen and progesterone. During a woman's reproductive years, estrogen and progesterone regulate the monthly cycles of ovulation and menstruation and prepare the uterus for pregnancy.

Estrogen is essential to the development and maturation of the female reproductive system, giving women their characteristic shape. This hormone stimulates skeletal growth, helps maintain healthy bones and plays an active role in protecting the cardiovascular system by increasing HDL (high-density lipoproteins, the "good" cholesterol) levels. Through its influence on the brain, estrogen is thought to be important in memory and healthy functioning of nerve cells.

Progesterone is manufactured in the ovaries and the adrenal glands. It stimulates the growth of the uterine lining to support a fertilized egg, helps in the production of breast milk and maintains pregnancy. Progesterone has many metabolic influences, enhances mood elevation, is a calmative, helps reduce premenstrual syndrome and menopausal hot flashes, regulates fluid balance, encourages thyroid hormone activity and normalizes blood sugar levels. Progesterone also plays a role in restoring and maintaining libido, and helps build bone mass.

Stages of Menopause
Because the process takes place over years, menopause is commonly divided into the following two stages:

1. Perimenopause - This is the time a woman begins experiencing menopausal signs and symptoms, even though she is still ovulating. During this normal process of four years or more, hormone levels rise and fall unevenly.

2. Postmenopause - Once 12 months have passed since a woman's last period, she has reached menopause. The ovaries produce much less estrogen and progesterone, and they don't release eggs. The years that follow are called postmenopause.

Signs and Symptoms
While every woman experiences menopause differently, the most common physical and emotional changes include:

· Irregular periods
· Decreased fertility
· Vaginal and urinary changes; like dryness and incontinence
· Hot flashes
· Dry skin and headaches
· Insomnia and other sleep disturbances
· Night sweats and heart palpitations
· Changes in appearance, primarily fluid weight gain
· Emotional and cognitive changes including mood swings, depression and forgetfulness

Massage therapy has the unique ability to improve many of these symptoms without the side effects of western medicine's pharmaceutical solutions.

Massage Therapy
While many consider menopause to be a right of passage, each woman must cope with its physical and emotional manifestations. Bodyworkers are in an ideal position to listen to their clients during this change, present relevant facts they have learned and offer a supportive and nurturing touch. Bodywork has the potential to cause a release of good-feeling endorphins, alleviate headaches, reduce stress, help regulate the body's fluid balance and re-balance hormone levels. Several styles of massage therapy provide significant therapeutic value to counter menopause's hormonal shift:

· Swedish Massage - Research has demonstrated that the more stress in a woman's life, the more severe her menopausal symptoms. This modality's relaxation qualities make it a top choice to include for a menopausal client.
· Reflexology - Some of the points used in foot reflexology may help restore hormonal balance: kidney, adrenal gland, pituitary, brain, uterus, thyroid, heart and liver.
· Acupressure - Traditional Chinese Medicine views menopause as a natural decline in Kidney and Spleen energies. Acupressure to tonify these meridians can bring the client back into hormonal balance. Additionally, working on the liver meridian will enhance overall energetic flow, thus reducing stress.

While various types of alternative treatments can support a woman through her menopausal transition, few cover as many aspects of health as massage therapy. The easing of stress, reduction in fluid imbalance and the balancing of hormones as a result of regular, nurturing, massage sessions can make this natural process a positive and powerful experience for your menopausal clients.

Earn continuing education credit for this article contained in our Women & Massage - Menstruation Through Menopause series. Click here to enroll.

Recommended Study:
Swedish Massage
Reflexology
Shiatsu Anma

References:

Knittel, Linda, Making Friends with Menopause: Addressing Your Skin in Transition, Skin Deep, 2005.

Milo, Moryt, Massage Eases the Journey Through Menopause, Massage Magazine, May/June 2001.

Osborn, Karrie, Massage and Menopause: Traverse this Rite of Passage with a Helping Hand, Body Sense, Fall 2002.

Stillerman, Elaine, LMT, Menopause, Part I, Massage Today, October 2004.

Stillerman, Elaine, LMT, Menopause, Part II, Massage Today, December 2004.

www.mayoclinic.com, Menopause, Mayo Foundation for Medical Education and Research, 2006.

www.tcmadvisory.com, Menopause, Guilin Sino-western Joint Hospital Chinese Medicine Advisory Department, 2003.

by Nicole Cutler, L.Ac.

Rooted in the central nervous system, epilepsy is a relatively common seizure disorder. Typically diagnosed by a physician after a person has had at least two seizures, epileptic seizures are not caused by a known medical condition like alcohol withdrawal or extremely low blood sugar. Seizures can be genetic, related to a brain injury, or due to an unknown cause.

Affecting how a person feels or acts for a short period of time, a seizure is a sudden surge of electrical activity in the brain’s outer rim, called the cortex. Ranging from mild to totally disabling, there are many possible symptoms of a seizure. While not everyone experiences these, some of the more typical seizure symptoms include:

· Blacking out
· Confusion
· Feeling spacey or dizzy
· Sensation of being out of the body
· Convulsions or twitching
· Feeling of fear
· Loss of motor control
· Difficulty talking
· Eyes rolling up into head
· Incontinence
· Drooling, teeth clenching, or tongue biting
· Memory loss

Seventy percent of those with epilepsy can control their disorder with medications, however the remaining 30 percent are not as lucky. Additionally, the medications for epilepsy can have severe side effects. Although a massage therapist should never advise a client to abandon their prescription, regular bodywork and communication with a client and their doctor could lead to a physician-guided reduction in medication.

Most experts agree that while there is no definitive cause for epilepsy, seizures are provoked by stress. In vulnerable individuals, stress causes brain cells prone to hyper-excitability to fire abnormally. In addition to the logical conclusion of reducing stress through seeking avenues of relaxation, cranial-sacral therapy and aromatherapy have both demonstrated remarkable results for reducing seizure occurrence and severity.

Cranial-Sacral Therapy
The brain, the heaviest of our organs, floats within the sugar, salt and enzyme-rich cerebro-spinal fluid (CSF). This internal sea has its own ebb and flow which is normally between 10 to 14 cycles per minute. According to cranial-sacral therapists, a likely theory explaining epilepsy is the misalignment or compression of the skull bones and congestion within the CSF. Because fluid is a terrific conductor of sensations, any turbulence, erratic movement or asymmetry can reveal blockages within the enclosed cerebral-spinal system.

Many reported case studies claim that the application of cranial-sacral therapy helps clients with epilepsy. The release of stuck skull bones gently flushes the cerebral-spinal system with CSF. This circulation of fluid restores the skull’s internal sea flow and stretches the brain’s membranes just enough to release any restrictions or adhesions contributing to seizure activity.

Aromatherapy
Despite compelling research, conventional medical practitioners have not yet incorporated elements of aromatherapy into epilepsy treatment. In a study conducted at the University of Birmingham in England, Dr. Tim Betts revealed a successful treatment for those with intractable epilepsy. Comprising approximately 20 to 30 percent of all epilepsy cases, intractable epilepsy describes epilepsy that is unresponsive to drug therapy.

Dr. Betts trained 50 epileptic patients into learning self-hypnosis, designed to encourage relaxation at the start of a seizure. At first, the patients showed little, if any, improvement. Then, Dr. Betts arranged half of these patients to have aromatherapy massages with whatever essential oil the patient found to be most pleasant. These patients were then told to take a whiff from a bottle containing the chosen oil whenever they felt a seizure coming on. The patients using self-hypnosis alone continued to show no improvement, whereas all but one of those who had aromatherapy massages became completely seizure-free. Dubbed the “smell-memory technique,” the use of essential oils used in aromatherapy massage became a trigger for a conditioned relaxation response.

When choosing an essential oil for aromatherapy massage, there are some specific oils to avoid. Rosemary, sage, camphor, fennel and hyssop are known to have convulsant effects. Do not experiment with these oils on a person with epilepsy. Jasmine is a good essential oil to begin with, as it is known for its anticonvulsant properties.

For bodyworkers seeing clients with epilepsy, being familiar with the most effective techniques will increase the therapeutic value of your session. While a relaxation-based massage will have benefits of its own, adding techniques from cranial-sacral therapy or using aromatherapy can actually help clients with this potentially debilitating condition.

Recommended Study:
Aromatherapy Essentials
Cranial-Sacral Fundamentals

References:

Upledger, John DO, OMM, Easing Seizures, Massage Today, August 2006.

Williams, David, MD, Rubbing Out Epilepsy, Alternatives, October 1997.

www.acupunctureworks.co.uk, Cranio-sacral Therapy, Roisin Golding, Los Angeles Times Syndicate 2000.

www.epilepsy.com, Epilepsy, epilepsy.com, 2006.

www.epilepsy.org.uk, Complementary Treatments, British Epilepsy Association, June 2006.

www.essentialoils.co.za, Epilepsy and Essential Oils in Aromatherapy, Esoteric Oils CC, 2006.

www.healthy.net, Cranial Osteopathy, Leon Chaitow, ND, DO, MRO, HealthWorldOnline, 2006.