Massage Professionals Article Archive

by Nicole Cutler, L.Ac.

A massage therapist’s practice is typically dominated by clients seeking to relieve some form of pain. Shiatsu is an effective, non-invasive massage style based on both Traditional Chinese Medicine (TCM) theory and Japanese massage techniques. The essence of this form of acupressure is the combination of diagnosis and therapy, allowing for a tailored treatment. While diagnosing a client’s condition in terms of Western medicine is beyond a massage therapist’s scope of practice, assessing a client’s imbalance in terms of TCM is well within a bodyworker’s realm.

Studying TCM theory is crucial for learning how to make an accurate diagnosis for shiatsu treatment. While this task looms large, a simplified guide in differentiating between excessive and deficient conditions can serve as solid starting point. In TCM, health is akin to balance. The energetic meridians traverse the entire body, and a balanced flow of energy within these meridians is analogous to a body free of pain. There is an old Chinese saying which roughly translates to:

“Where there is blockage, there is pain; where there is no blockage, there is no pain.”

A blocked meridian is an unbalanced meridian. While a majority of painful conditions are due to blockages within the meridian, there are many imbalances that can precipitate such a blockage. It is the Shiatsu practitioner’s job to uncover the primary imbalance causing the client’s pain. Once a proper assessment is made, a plan can easily be devised and applied to correct the imbalance. In the Institute’s Shiatsu Anma continuing education program, massage techniques to balance excess and deficient states are demonstrated. Choosing whether the primary causative imbalance is deficient or excessive in nature is the first step in choosing a treatment approach.

Blockages
A meridian blockage is considered to be an excessive imbalance. There are three main substances capable of congesting a meridian: qi (energy), blood or phlegm.

1. Qi Blockage: Although a blockage of qi can lead to blood congestion, qi congestion is associated more with distention rather than pain. If the pain is due to qi congestion, it moves around and will appear and then disappear. A pattern involving qi congestion typically involves depression, mood swings, frequent sighing and other emotional symptoms.

2. Blood Blockage: When it comes to painful conditions, blood congestion is almost always the culprit. Characteristics of pain due to blood congestion are pain that is fixed in one location, stabbing or piercing pain, pain aggravated by direct pressure, dark color in the area of pain and pain that worsens with inactivity.

3. Phlegm Blockage: Phlegm congestion is rarely responsible for pain, as it is mostly associated with internal organ disharmonies such as certain types of tumors, mucous congestion in the nose or lungs, obesity or gastrointestinal problems. An exception is headache, which can be due to phlegm congestion when the entire head feels heavy, the client is dizzy or nauseous, has low appetite and feels as if a vice is squeezing their head.

Differentiation
Although a majority of painful conditions are excessive cases of blood congestion, uncovering the reason for the congestion will give the practitioner a more accurate assessment of excess or deficiency. Because blood congestion can either be caused by an excessive condition or by a deficient condition, identifying the underlying imbalance is important for devising the best treatment plan. When aspects of both excess and deficiency are present, a practitioner must choose the most dominant pattern.

In general, a predominant presentation of excess is treated with dispersal and invigoration techniques, while a predominant presentation of deficiency is treated with warming and tonification techniques.

Blood Congestion Causes
While there are many causes of blood congestion causing pain, the ones most encountered in clinical practice include:

· Qi Congestion – An excessive condition, this is a common precursor to blood congestion. A basic premise within TCM is that qi moves blood, so if qi stagnates, eventually the blood will stagnate too. (See the above section for recognizing qi blockage.)

· Traumatic Injury – An excessive condition, the force of a local trauma causes a structural change that typically results in blood congestion. (See the above section for recognizing blood blockage.)

· Deficiency of Qi – A deficient condition, deficiency of qi that persists over an extended period of time may cause stasis of blood as the qi becomes too weak to move blood. Qi deficiency typically manifests with low energy, breathlessness, weak voice, loose stool, spontaneous sweating, and pain that worsens as the day progresses. This type of pain can improve with applied pressure.

· Blood Deficiency – A deficient condition, blood deficiency that persists over an extended period of time will cause qi deficiency. When the qi is too weak to move blood, blood congestion results. Blood deficiency typically manifests with pale complexion and lips, tightened and easily injured tendons, dizziness, poor memory, blurry vision, insomnia, amenorrhea and anxiety.

As taught in the Institute’s Shiatsu Anma course, Shiatsu techniques differ, with dispersal and invigoration methods used for excessive imbalances, while tonification and warming methods are used for deficient imbalances. Practitioners of Asian bodywork who master this differentiation can really utilize the strengths of TCM; by tailoring each treatment to their client, enhancing a massage’s therapeutic value and successfully ridding their clients of pain.

Recommended Study:
Shiatsu Anma

References:

Maciocia, Giovanni, The Foundations of Chinese Medicine, Churchill Livingstone, New York, NY, 1989.

www.altmedicine.about.com, Blood Stagnation, Cathy Wong, About, Inc., 2007.

www.davidbole.com, Sports Medicine: A Chinese Medical Perspective, David N. Bole, PhD, AP, 2007.

by Nicole Cutler, L.Ac.

Leading medical experts agree that breath awareness and conscious breathing can be successfully applied in the prevention, intervention, treatment and recovery of numerous health conditions. Massage therapists who incorporate elements of conscious breathing into their sessions will promote their clients’ ability to experience more dramatic, healthful results than those who receive massage alone.

A human can survive several weeks without food, several days without water, but only a few minutes without air. Every cell in the body requires a continual exchange of oxygen and carbon dioxide to function properly. Breathing is this mechanism of exchange, feeding and cleansing the body’s cells with a continuous cycle of intake and exhaust. Breathing function can be impeded by restrictions in the air passages due to illness, injury, chronic weaknesses or blockage by foreign objects such as dust or mucus. Tense muscles, poor posture, tight clothing or emotional stress can also restrict breathing.

The two classifications of respiration are chest breathing and abdominal breathing. The distinction is in what muscles are used for breath inhalation and exhalation:

1. Chest breathing is when we solicit the upper chest muscles to open up the rib cage. This results in shallow breathing, where too little air is drawn into the lungs. Consistent chest breathing results in poorly oxygenated blood, prompting the heart to pump harder to feed the body’s cells with oxygen. Upper chest breathing fills only about one quarter of the lung’s capacity. Emotional stress is a common cause of rapid, shallow chest breathing and can be addressed by integrated bodywork techniques.

2. Abdominal breathing does not indicate filling the abdomen with air, but rather using the muscles in the abdomen, sides and back of the lower torso to permit the maximum lowering of the diaphragm, fully expanding the chest. When the lungs can be filled, up to eight times more air is recruited per breath than chest breathing. This increased air volume allows for greater blood oxygenation without stressing the cardiopulmonary system.

When we breathe fully and deeply, the belly, lower ribcage, and lower back all expand on inhalation, drawing the diaphragm down deep into the abdomen, and retracting upon exhalation. The vertical movement of the diaphragm combined with the horizontal movement of the belly, ribcage, and lower back during abdominal breathing helps detoxify the inner organs, promote blood flow and peristalsis, and pump lymph more efficiently through the lymphatic system. Each of these benefits mirror the goals of massage therapy. The combination of the two is an ideal union for enhancing health. Efficient abdominal breathing is supported by the following factors:

· Proper posture – Good posture allows the chest muscles to expand with minimal effort. Slouching forces the weight of the upper chest onto the abdomen. Poor posture demands more energy for respiration than when the back is straight and relaxed.

· Refraining from overeating – Overeating can extend the stomach to press on the diaphragm, hindering its movement. This restriction limits abdominal breathing.

· Relaxation – When we are tense, our muscles naturally contract. In addition to feeding the pain cycle, muscle tension inhibits abdominal breathing. Focusing on muscular relaxation allows for greater chest expansion while conscious abdominal breathing also helps relax muscles.

The use of breathing to relax muscles is a major component of many techniques for stress reduction and relaxation. All of the major exercise/relaxation techniques, such as yoga, qi gong, tai chi and meditation, utilize the benefits of abdominal breathing.

Helping a client learn abdominal breathing will directly benefit muscles that have been working too hard to lift the ribs. However, when instructing a client, make certain that your directions are not misinterpreted. Some new students of abdominal breathing overemphasize the new pattern, losing the ability of the chest to expand. Not only should the belly expand on the in-breath, but the breath should then continue up past the costal arch, expanding the ribs as well. Since many deep breathing techniques exist, look for one that is most congruent with your style. Here is one exercise to get clients breathing the right way:

· Have your client lie on their back comfortably.
· Place their hand on their stomach, just below the belly button.
· They should take a deep breath in through their nose, and then hold it for a moment.
· Then, they should slowly exhale through their nose.
· When the client thinks all of the air is expelled, instruct them to open their mouth to let the rest out.

For more abdominal breathing suggestions, reference the article Diaphragm Strengthening for Neck and Shoulder Pain from well-known therapist, Doug Alexander.

Massage focusing on the chest area and abdominal muscles can relax the muscles used for conscious respiration, paving the way for clients having difficulty with breathing exercises. Practitioners must be patient and communicative with their client as changes to breathing patterns are attempted.

With conscious effort, breathing is a task anyone can control. By instructing your clients on the benefits and techniques of abdominal breathing, you are giving them a self-empowering tool to change their life. Through the increased amount of oxygen supplied by abdominal breathing, massage therapists can amplify the benefits of their work.

Recommended Study:
Advanced Anatomy and Physiology
Integrative Massage: Fire

References:

Grant, Keith Eric, PhD, NCTMB, Breathing Fresh Air, Massage Today, September 2002.

Gustin, Libby and Andrew Gustin, Rosen Method: A Listening Hand, Massage and Bodywork, April/May 2004.

Lewis, Dennis, Integrating the Breath, Massage and Bodywork, June/July 2004.

www.breath.org, Better Health Through Diaphragmatic Breathing and Abdominal Breathing, Dennis Lewis, 2007.

www.fibromyalgia-symptoms.org, Trouble Breathing?, Hearthstone Communications, Ltd., 2007.

www.holisticonline.com, Treatment of Fibromyalgia, ICBS, Inc., 2007.

www.islandnet.com, Breathing the Air, Living Gently Quarterly, Keith C. Heidorn, PhD, 2001.

www.massagemag.com, Acupressure, Breath Awareness Help Diabetes Patients, Massage Magazine, Inc., July/August 2000.

www.womentowomen.com, Deep Breathing – The Truly Essential Exercise, Marcelle Pick, OB/GYN, NP, Women to Women, 2007.

by Nicole Cutler, L.Ac.

In general, those who choose massage therapy as a profession share a genuine desire to help people. Wanting to help others is the cornerstone of compassion, defined by freedictionary.com as “deep awareness of the suffering of another coupled with the wish to relieve it.” When it comes to relieving the suffering caused by muscular dystrophy, massage therapists have the opportunity of a lifetime.

Describing over 30 genetic diseases characterized by progressive weakness and skeletal muscle degeneration, muscular dystrophy (MD) can occur in infancy, childhood or adulthood. The disorders differ in terms of the distribution and extent of muscle weakness, age of onset, rate of progression and pattern of inheritance.

The primary types of MD include:

· Duchenne – This is the most common form of MD and primarily affects boys. It is caused by the absence of dystrophin, a protein involved in maintaining the integrity of muscle. Onset is between 3 and 5 years and the disorder progresses rapidly. Most boys are unable to walk by age 12, and later need a respirator to breathe.

· Becker – Becker MD is very similar to, but less severe than Duchenne MD. Those afflicted with Becker MD have faulty or not enough dystrophin. This form generally affects older boys and young men, and progresses more slowly, usually over several decades.

· Facioscapulohumeral – Also known as Landouzy-Dejerine disease, this form of MD usually begins in the teenage years. It causes progressive weakness in muscles of the face, arms, legs, shoulders and chest. It progresses slowly and can vary in symptoms from mild to disabling.

· Myotonic – Also known as Steinert’s disease, this MD is the most common adult form and is typified by prolonged muscle spasms, cataracts, cardiac abnormalities and endocrine disturbances. Individuals with myotonic MD typically exhibit long, thin faces, drooping eyelids and a swan-like neck.

Physiology
Both the Duchenne and Becker forms of MD revolve around a problem with, or the absence of, the protein dystrophin. Dystrophin is necessary for normal muscle tissue function. Here is a quick refresher to help place dystrophin’s role in muscle physiology. Myosin, the muscle’s thick filament, pulls on actin, the thin filament, by swiveling its head. This causes the actin to slide towards the M line, (the center of the muscle’s sarcomere), shortening the muscle. Dystrophin has many spider-like links to actin, attaching actin to the endomysium (part of the muscle’s tendon). Therefore, when actin slides towards the M line, the dystrophin pulls on the bone-surrounding endomysium, which ultimately creates movement. Therefore, a deficiency or lack of dystrophin has devastating effects on muscle movement, control and health.

Signs and Symptoms
Signs and symptoms vary according to the type of muscular dystrophy. Typical symptoms include:

· Muscle weakness
· Lack of coordination
· Progressive crippling
· Involuntary muscle contractions
· Loss of mobility

Many specific signs and symptoms vary from among the different forms of MD. Each type is different in the age of onset, what parts of the body the symptoms primarily affect and how rapidly the disease progresses. For example, signs and symptoms unique to Duchenne MD may include:

· Frequent falls
· Large calf muscles
· Difficulty getting up from a lying or sitting position
· Weakness in lower leg muscles, resulting in difficulty with running and jumping
· Waddling gait
· Mild mental retardation (in some cases)

Treatment
There is no specific treatment to stop or reverse any form of MD. Treatment plans are designed to help prevent or reduce deformities in the joints and spine and to allow people with MD to remain mobile as long as possible. While not curative, typical treatment approaches utilize medications, physical therapy, respiratory therapy, speech therapy, orthopedic appliances used for support, and corrective orthopedic surgery. Drug therapy includes corticosteroids to slow muscle degeneration, anticonvulsants to control seizures and muscle activity, immunosuppressants to delay damage to dying muscle cells and antibiotics to fight respiratory infections.

A host of alternative treatments are often turned to for periodic, symptomatic relief for muscular dystrophy. In particular, massage therapy has been reported to ease a wide range of MD’s symptoms including:

· Relieving muscle pain
· Relaxing tight or contracted muscles
· Increasing circulation in a deprived area
· Restoring some range of motion

Since the goal of all bodywork is analogous to its application for muscular dystrophy, it almost appears massage is designed specifically for MD’s symptoms. While never intended to replace or supersede a physician’s advice, adding regular massage therapy sessions to a MD management plan can help reduce spasms, ease chronically tightened muscles, and improve the person’s quality of life. By seeking to help those with muscular dystrophy, a practitioner’s compassion can go a long, long way.

Recommended Study:
Anatomy and Pathology
Anatomy and Physiology
Pharmacology for Massage

References:

Osborn, Karrie, Sea of Calm, Massage and Bodywork, February/March 2003.

www.thefreedictionary.com, Compassion – definition, Farlex, Inc., 2007.

www.massagetherapy101.com, Deep Muscle Therapy, massagetherapy101.com, 2007.

www.mayoclinic.com, Muscular Dystrophy, Mayo Foundation for Medical Education and Research, 2007.

www.muscular-dystrophy.org, Alternative Therapies, Muscular Dystrophy Campaign, 2007.

www.ninds.nih.gov, Muscular Dystrophy Information Page, National Institute of Neurological Disorders and Stroke, 2007.

www.wellingtoncollege.com, Dystrophin – The Connective Tissue Link, Wellington College, May 2006.

by Nicole Cutler, L.Ac.

In our ever-evolving, computer-literate society, technology assisting healthcare is an inevitable union. When it comes to helping professionals and their clients manage chronic pain, the call for help has been loud and clear. Experts estimate that between one-third and one-half of Americans are affected by chronic pain and, unfortunately, there are no simple solutions. However, a new Internet concept is attempting to make managing chronic pain easier, both for patients and their caregivers.

About Chronic Pain
According to an exclusive 2005 survey by ABC News, USA Today and the Stanford University Medical Center, just under half of adults have experienced pain in the last two weeks, and nearly four in ten experience pain on a regular basis. A normal physiological response, pain is the body's way of telling its owner that something is amiss. While it is normal for pain signals to transmit during illness or injury, it is not normal for the pain to linger afterwards. In a chronic case, pain can continue for weeks, months or years after a person has recovered from the original illness or injury. Additionally, some people develop chronic pain unexpectedly, without precipitating injury or illness to trigger pain signals.

Massage Therapy for Chronic Pain
While an integration of various techniques can help chronic pain, massage is known to be one of the more effective approaches. According to a 2000 research study conducted by the Center for Health Studies in Seattle, Washington, massage therapy was found to be superior to acupuncture and self-care in pain relief for chronic low back pain. The massage modalities used in this study were Swedish and deep tissue massage, trigger-point therapy, neuromuscular therapy and movement education. Recognized by an increasing number of people, massage therapy is one of the first modalities considered for addressing chronic pain.

The Chronic Pain Challenge
When a practitioner chooses to treat a person suffering from chronic pain, they must first understand that recovery is typically a process of trial and error. There are so many different factors potentially responsible for chronic pain, that providers require continual feedback to adjust their treatment plan. Chronic pain may be caused by ailments such as:

· Nerve damage
· Injuries that have failed to heal properly
· Conditions causing aging
· Any type of arthritis
· Cancer
· Multiple sclerosis
· AIDS
· Gallbladder disease

However, many more reasons can fuel chronic pain. Back pain, for example, may be caused by a single factor, or any combination of the following:

· Years of poor posture
· Improper lifting and carrying of heavy objects
· Being overweight, which puts excess strain on the back and knees
· A congenital condition such as curvature of the spine
· Traumatic injury
· Wearing shoes without proper arch support
· Sleeping on a poor mattress
· Psychological issues
· Aging of the spine (degenerative changes)

In many cases, however, the source of chronic pain can be a very complex and even mysterious puzzle to untangle.

The challenge of helping a client reduce their pain goes beyond figuring out the best approach (or combination of approaches) to help them. Whether treatment is rendered by an osteopathic physician, neurosurgeon, acupuncturist, massage therapist, psychiatrist or chiropractor, managing chronic pain requires attentive charting to determine changes in the patient’s condition. Practiced by most healthcare givers for treating chronic pain, tracking changes every day in the pain’s quality and location, medications taken, exercises being performed and other relevant variables, are necessary for achieving success.

Innovative Charting
Monitoring the progress of a client’s pain can be challenging from both ends:

1. Healthcare practitioners often have a limited amount of time to receive and analyze information.

2. Clients often have a hard time recording the daily changes in their pain, medications and other pertinent variables.

These burdens hinder the communication necessary between client and practitioner to effectively manage chronic pain. Encouraging patients to keep a diary of their pain, the medications they take and other lifestyle changes, supports this process. An innovator in chronic pain management, www.reliefinsite.com has made a virtual diary to facilitate regular note-taking, benefiting both those treating, and those being treated for, chronic pain.

The user-friendly interface of this technology holds many potential benefits for a massage therapist:

· Simplicity – It is easy for clients to go online and quickly record and track their pain, medications and other relevant information. Due to its ease, this method is a major step forward for fostering patient compliance.

· Security – Users of this service can safely share it with their doctors, nurses, pain specialists, massage therapists, family members and friends. Upholding HIPAA standards, all of the information is stored on secure servers to ensure personal privacy.

· Better care – Since healthcare sessions are typically limited by time, the freedom to review a client’s progress notes at their leisure affords practitioners more time to analyze each chronic pain case.

This Internet tool’s ability to improve client-practitioner communication can make a big impact on managing chronic pain. Recognizing the impact of medication changes, treatment-related complications or new health routines, the detailed tracking of symptoms, medications, treatments and the impact pain is having on day-to-day functionality is crucial for fine-tuning a chronic pain treatment plan. As professionals desired to help the growing population of people suffering with chronic pain, massage therapists can make good use of this valuable new Internet tool.

References:

http://abcnews.go.com, Poll: Americans Searching for Pain Relief, Gary Langer, ABC News, May 2005.

Plews-Ogan, Margaret, MD, et al., A Pilot Study Evaluating Mindfulness-Based Stress Reduction and Massage for the Management of Chronic Pain, Journal of General Internal Medicine, December 2005.

www.linux-mag.com, ReliefInsite Launches New Web-based Pain Management Service, QuarterPower Media, August 2007.

www.massagemag.com, Chronic Low Back Pain Eased by Massage, Massage Magazine, Inc., 2007.

www.medtronic.com, What is Chronic Pain?, Medtronic Inc., 2007.

www.webmd.com, Chronic Pain, WebMD, Inc., 2007.