Massage Professionals Article Archive

by Linda Fehrs, LMT

Every 45 seconds someone in the U.S. has a stroke. It is the third leading cause of death behind heart disease and cancer and the number one cause of adult disability. Eighty percent of strokes are preventable, according to the American Stroke Association.

Depending on the severity, recovery can be long and difficult. A major stroke can result in a person being unable to walk or speak; a mild stroke makes recovery easier and resulting disabilities are barely noticeable. Quick intervention, within 48 hours, is most effective in reducing the negative impact of damage to the brain. Unless you work in a hospital setting this is difficult but, as doctors become aware of how massage helps, this may change.

Causes
The causes of stroke, or cerebrovascular accident (CVA), include:

· Cerebral thrombosis, which is caused by a clot lodged in a cerebral artery and accounts for about 88% of strokes.
· An embolism, similar to cerebral thrombosis, differs in origin. Inefficient pumping of the heart allows blood to thicken, forming clots in the left atrium, which then enter the bloodstream and, ultimately, the brain.
· Cerebral and subarachnoid hemorrhages are caused by ruptured blood vessels as a result of uncontrolled chronic hypertension, head trauma or malformed blood vessels, which produce tissue death in the brain.

The extent of damage depends on the part of the brain affected, how much of it and for how long. Motor damage can be seen in either partial or full paralysis on one side of the body (hemiplegia), a loss of language (aphasia), personality changes and/or loss of memory.

Symptoms
Massage therapists offer a first line of defense in helping to recognize the symptoms of stroke and later, during recovery, to reduce its effects.

If a client appears to have a sudden onset of numbness in one arm, speech is slurred or difficult to understand, if they cannot repeat a simple phrase, or their face appears to droop on one side, it is time to call 911.

Prompt intervention is the best treatment, including administration of anticoagulants for blood clot reduction, except in strokes caused by a hemorrhage. Massage would typically not be introduced into the recovery regimen for several weeks or months and requires approval from the attending physician.

Massage Reduces Anxiety and Pain
In a 2004 study, Hong Kong Polytechnic University, Department of Nursing and Wong Chuk Hang Hospital in Hung Hom, Lowloon, Hong Kong, found that slow-stroke massage on elderly stroke patients treated for anxiety and shoulder pain resulted in significantly lower pain, anxiety, blood pressure and heart rate. The subjects had an average age of 73 and received no other pain relief measures. They received ten minutes of slow-stroke massage prior to bedtime for seven days and an evaluation before receiving massage on the first day, again on the last day of the study, and three days after the sessions ended.

The authors, Esther Mok and Chin Pang Woo, wrote “the results of this study support the view that [slow-stroke back massage], as an alternative adjunct to pharmacological treatment, is a clinically effective nursing intervention for reducing anxiety and shoulder pain in elderly stroke patients.”

As the study indicates, slow-stroke massage reduces two of what may be the most important factors in stroke recovery – pain and anxiety. Deep or vigorous strokes are counterproductive and may cause more harm than good. Slow, soothing techniques and gentle stretching help with flexibility and proprioception.

3 Complementary Therapies for Stroke Rehabilitation
In addition to slow-stroke massage techniques, a client’s recovery may also be helped by the use of familiar complementary therapies such as reflexology, aromatherapy or shiatsu.

1. Reflexology might be used if Swedish massage is inappropriate. It gently helps the body recover from a stroke. Clients are helped without using techniques that increase blood flow, and contraindicated in someone with blood vessel weaknesses.

2. Aromatherapy is also helpful. Using an essential oil such as lavender helps relieve stress, while oils of rosemary and lemon may help circulation.

3. Another option is shiatsu. In Chinese medicine, chronic weakness of Qi blocks the blood flow to the brain, causing strokes. Shiatsu helps restore this flow, offering a session that is both rehabilitative and relaxing. Using points known as Four Gates (LI4 and LV3) relaxes tension in the head, reduces pain and calms the mind. GB20 improves circulation to the head, thus bringing much needed oxygen to the brain.

Documentation
Documentation through accurate and thorough SOAP notes is an important factor in the treatment of stroke victims. You will most likely be working in conjunction with other health care professionals, and sharing the outcomes of your sessions provide important evidence of a client’s progress. While initial intake is important in determining the type of massage treatment, ongoing notes will record the client’s improvement, help to update the primary care physician and demonstrate how massage can be an effective and valuable tool in the rehabilitation of stroke survivors.

While there may be no definitive studies proving the efficacy of massage in preventing or reducing strokes, it has been shown to positively affect predictors such as improving circulation and lowering stress and blood pressure. The effects of stroke continue to be one of the most debilitating disability issues. Massage therapists may help prevent stroke in those who are most vulnerable, and help victims recover with dignity.

Recommended Study:
Aromatherapy Essentials
Ethical Case Management
Reflexology
Shiatsu Anma Therapy

Resources:
www.haleclinic.com, Ailments/Stroke, Hale Clinic, London, UK, 2008.

http://holistic-online.com, Jacob, Dr. George, Alternative and Complementary Medicine for Stroke, 2008.

Massage Benefits Stroke Patients Study: Originally published in Complementary Therapies in Nursing & Midwifery, 2004, Vol. 10, pp. 209-216.

www.massagetherapy.com, Stroke Rehab – Part I, An Overview, April/May 2000, and Stroke Rehab – Part II, Coming Back, June/July 2000, Massage and Bodywork Magazine, Miesler, Dietrich, M.A., C.M.T.

www.stroke.org, May is Stroke Awareness Month, National Stroke Association, 2008

www.pacificviewpress.com, The Practical Application of Meridian Style Acupuncture, Pirog, John E., Pacific View Press, Berkeley, C, 1996.

www.americanheart.org, Stroke Statistics, American Heart Association, 2008.

by Nicole Cutler, L.Ac.

As the predominant gender afflicted with fibromyalgia, more and more women are being diagnosed with this chronic pain syndrome. Even though an estimated two to five percent of our population lives with this painful disorder, Western medicine can only offer side-effect laden symptom relief for a relatively small portion of those affected. As an alternative to taking prescription drugs, the pain identifying this ailment can be reduced by safe, non-invasive bodywork techniques. For those interested in a natural approach, massage therapists are one of the most likely sources a person with fibromyalgia will tap to fulfill their pain relief needs. As such, practitioners who include Therapeutic Touch in their treatments have a proven practice for providing relief to those suffering from this condition.

Because bodywork is being increasingly recognized by the healthcare community as a means to reduce pain, massage therapists are often recruited for fibromyalgia. However, the complexity of fibromyalgia requires extensive knowledge and skills to competently address it. Knowing about its nuances means understanding that having one set massage regimen for people with fibromyalgia is insufficient. Since the needs of a person with fibromyalgia can vary form day-to-day and from person-to-person, a practitioner must possess the following to be most effective:

· A variety of modalities mastered to choose from
· Good communication skills to adjust their treatment based on client feedback
· Flexibility to change their style mid-session
· A gentle, energetic approach for highly sensitive clients (or those having a highly sensitive day).

As published in the June 2007 edition of The Nursing Clinics of North America, researchers from Texas affirm that although the clinical proof is in the beginning stages, the value of energy therapies is promising. They confirm that studies of Therapeutic Touch, Healing Touch and Reiki suggest that these healing modalities are effective in reducing anxiety, improving muscle relaxation, aiding in stress reduction, relaxation, and sense of well-being, promoting wound healing and reducing pain.

About Fibromyalgia
Fibromyalgia is an illness that causes chronic pain in the soft tissues of the body. A person with this syndrome likely has pain in their muscles, ligaments and tendons. Most people with fibromyalgia report aching all over, often saying their muscles feel like they are pulled or overworked. Sometimes symptoms include muscle twitches and burning sensations. In addition to muscular pain and stiffness, this ailment can also cause fatigue, sleep problems, depression and an inability to think clearly.
Scientists have several theories but no concrete understanding of what causes fibromyalgia. While a simple blood test or x-ray will not indicate fibromyalgia, the American College of Rheumatology has outlined the requirements for a fibromyalgia diagnosis:

· Muscle pain must be present for longer than three months
· Pain must occur at 11 out of 18 specific tender points on the body.

Because the quality, location and severity of fibromyalgia pain is constantly changing, therapists dealing with this disorder must be equally adaptable.

Therapeutic Touch
Developed by Dolores Krieger, RN, Ph.D., and Dora Kunz in the early 1970s, Therapeutic Touch (TT) is an energetic style of bodywork adapted from several different healing traditions. Commonly applied by nurses for a wide range of health conditions, TT has been shown to help reduce the pain and anxiety associated with fibromyalgia:

· As published in the May/June 2004 issue of Holistic Nursing Practice, Kansas researchers tested the effectiveness of TT on the experience of pain and quality of life for people with fibromyalgia. Their findings demonstrated that those with fibromyalgia had a statistically significant decrease in pain and improvement in quality of life associated with each TT application.

· As reported in 2007 by the Midwest Nursing Research Society, medications, exercise and stress reduction is only moderately effective in controlling the pain of fibromyalgia syndrome. Lead researcher Cate Stiller, Ph.D., conducted a study comparing the effects of TT and placebo on the pain and anxiety of 46 participants with fibromyalgia. The investigators concluded that the most important recommendation for nursing is that nurses can help their fibromyalgia patients manage their pain and anxiety by recommending TT as an effective therapy.

With an estimated 5 million Americans living with fibromyalgia, massage therapists who are well-versed in this chronic pain syndrome are best equipped to help those affected. The inconsistency of fibromyalgia pain's location, quality and severity requires bodyworkers to have various skills ready to match their client's current experience. Especially appreciated when a person with fibromyalgia is particularly sensitive, practicing an energetic type of bodywork is often the best fit. When included in a therapist's repertoire, Therapeutic Touch can be a key modality for gently bringing pain relief to a fibromyalgia sufferer.

Recommended Study:
Fibromyalgia and Massage
Healing Energy and Touch

References:

Denison, B., Touch the pain away: new research on therapeutic touch and persons with fibromyalgia syndrome, Holistic Nursing Practice, May-June 2004.

Engebretson J, Wardell DW, Energy Based Modalities, The Nursing Clinics of North America, June 2007.

www.fmnetnews.com, Symptoms, Fibromyalgia Network, 2008.

www.intelihealth.com, Therapeutic Touch, Aetna Intelihealth, Inc., 2008.

www.nursinglibrary.org, The Effect of Therapeutic Touch on Fibromyalgia Pain and Anxiety, Cate Stiller, PhD, Virginia Henderson International Nursing Library, 2007.

by Nicole Cutler, L.Ac.

In the healthcare profession, hand washing is essential to stop the spread of potentially serious infections. To prevent transmitting pathogens, massage therapists are constantly washing their hands – before a client, after a client, before eating, after eating and after going to the bathroom. For a therapist who sees eight clients in a row, that can add up to over 20 hand washings during one day at work! While this habitual cleansing is mandatory for a healthy environment, it can also result in dry, chapped hands – which can eventually progress to dermatitis. To prevent the spread of germs and maintain healthy skin, bodyworkers have to pay extra attention to the condition of their primary diagnostic and treatment tool: their hands.

Skin 101
The largest organ of the human body, our skin protects us from our environment. With an outermost epidermal layer only 1/250th of an inch, and the dermis being only 1/50th to 3/25ths of an inch thick, the skin’s protective function can be interrupted without difficulty. Repeated hand washing easily leads to drying of the skin and microscopic cracks.

Since healthy skin has a slightly acidic pH, exposure to alkaline substances (such as many commercial cleansers and hand soaps) contributes to a disruption in the skin’s integrity. While a homeostatic repair mechanism repairs the skin’s barrier, continued exposure to alkaline substances will slow down this repair by inhibiting normal skin acidity. Used in most soaps, sodium lauryl sulfate is a foaming agent naturally derived from coconut and/or palm kernel oil. In its concentrated raw form, it has an approximate pH of 10, which is very alkaline and drying to the skin.

Once the top layer of the skin cracks due to recurrent wet/dry cycles, especially in conditions of low humidity where drying occurs rapidly, it results in inflammation. This is how irritant hand dermatitis begins. The swollen, reddened and itchy skin characterized by dermatitis is familiar to many frequent hand washers.

Dermatitis
Affecting all types of healthcare workers, dry skin and dermatitis are two conditions linked to frequent hand washing. In fact, the National Institute for Occupational Safety & Health (NIOSH) states that skin injuries and diseases account for a large proportion of all occupational injuries and diseases. A recent study conducted in collaboration with NIOSH and the American Academy of Dermatology focused on 100 healthcare workers in Cleveland who washed their hands at least eight times daily. Participants completed questionnaires identifying the frequency of hand washing, family history of dermatitis and medical condition history. Researchers used patch tests to determine how easily detergents irritated the participants’ skin and to predict which patients were at risk for hand dermatitis.

According to Susan T. Nedorost, dermatologist and associate professor of dermatology at University Hospitals Case Medical Center in Cleveland, “Our findings confirm that healthcare workers who wash their hands repeatedly are at an increased risk of developing hand dermatitis, which can take months to heal. This knowledge can help workers at risk for the condition to practice good hand care and follow preventative tips to decrease their risk factors on the job.”

Of particular interest, analysis of the data highlighted that the most important factor in predicting those at risk for hand dermatitis was a reaction to the detergent sodium lauryl sulfate (SLS). Specifically, the large percentage of participants who reacted positively to SLS and developed hand dermatitis far outweighed the number of participants who did not react positively to SLS, but subsequently developed hand dermatitis. Considering the highly alkaline pH of SLS, it’s not surprising that it was associated with dermatitis in this study.

5 Solutions
Since repeated hand washing is required for massage therapists, taking good care of their hands is very important. Suggestions for preventing the damage to the skin typically inflicted by frequent hand washing include:

1. Choose your skin cleanser carefully. Make sure to use a pH-balanced skin cleanser and, if sensitive to SLS, use hand cleaners free of this foaming agent.

2. Especially important if not working with oils or lotions during a session, make sure to moisturize after every hand washing. Moisturizers coat the skin with oil, block evaporation of the skin’s natural moisture and trap water in its surface. While they can’t cure dry skin, moisturizers provide protection, relieve the dry, itchy feeling and reduce the tendency to crack. Although most of the water in the cream or moisturizer evaporates, the oil stays on as a lubricant, enabling the skin to retain moisture. In addition, apply a good hand cream every night before bed.

3. Give your hands a weekly paraffin treatment to help them recover from all of the hand washing. Paraffin is soothing to the skin because the wax is mixed with mineral oil. The heated seal that the wax creates allows the oil to penetrate the skin deeply for moisture restoration.

4. When not at work, protect hands from further damage. Minimize direct exposure to cold, dry weather by wearing gloves when submersed in these elements.

5. Maintain moisture inside and outside your body by drinking plenty of water and using a humidifier if the air in your home is dry.

As the single most important step towards infection control, healthcare professionals must wash their hands frequently. As such, massage therapists often encounter the consequences of washing their hands ten times a day or more. Make sure to pay extra attention to your hands’ moisture and periodically pamper your mitts. By making good hand health a priority, even bodyworkers can avoid dry, cracked, itchy and irritated hands.

References:

www.aad.org, New Study Finds Frequent Hand Washing Puts Health Care Workers at Increases Risk for Irritant Contact Dermatitis, American Academy of Dermatology, February 2008.

www.earthessentials.com, FAQ, Earthscience, 2008.

www.health.com, Heal Chapped, Dry Hands, Health Magazine, 2008.

www.infectioncontroltoday.com, Handwashing: Breaking the Chain of Infection, Amy Walker Barres, Virgo Publishing, LLC, 2008.

www.mayoclinic.com, Dermatitis, Mayo Foundation for Medical Education and Research, 2008.

www.medscape.com, What Should I Recommend for Severe Dry, Cracking Skin?, Margaret A. Fitzgerald, MS, APRN, BC, NP-C, FAANP, Medscape, 2008.

www.occupationalhazards.com, Excessive Hand Washing Linked to “Hand Dermatitis”, Laura Walter, Penton Media Inc., February 2008.