Massage Professionals Article Archive

by Nicole Cutler, L.Ac.

A common injury from a motor vehicle accident, whiplash is a neck sprain resulting from the sudden forces typical of a car crash. After being evaluated by a physician, bodywork is one of the most recruited modalities to help this soft tissue injury heal. When applied carefully and skillfully, massage therapists can help clients with whiplash find relief and avoid a resulting chronic neck problem.

Although physicians sometimes refer to it as a neck hyperextension injury, whiplash is a fairly accurate mechanical description of how the neck injury occurred. Bending first towards and then away from the point of impact, whiplash is the consequence of the head moving in a whip-like motion. As the head moves rapidly in one direction, the muscles in the neck receive the message to contract. The momentum of the head can cause strain or sprain to the muscles and ligaments in the neck as the head reaches the end of its movement. Whether the head whips forward and backward or laterally, whiplash usually causes multiple neck injuries.

Symptoms
Evidence of whiplash can surface immediately following the neck’s whip-like injury, or it can creep up several days after. Aside from neck pain, additional symptoms of whiplash may include:

· Neck stiffness
· Headache
· Dizziness
· Hoarseness and difficulty swallowing and/or chewing
· Paresthesia
· Shoulder, back or arm pain

Assessment
A client who has neck pain following a motor vehicle accident must first be seen by a physician to rule out serious injury. In addition to soft tissue damage, doctors must determine if the whiplash has caused a concussion or nerve-root compression. Once massage therapy is deemed safe, bodyworkers must assess the injured musculature involved to formulate a treatment plan. In addition to taking a detailed history of the accident, muscle resistance testing can help the bodyworker pinpoint the muscles most in need of release.

According to Ben Benjamin, Ph.D., the following resistance tests should be included when assessing whiplash:

· Pain upon resisted neck rotation indicates injury to the sternocleidomastoids.

· Pain upon resisted side flexion of the neck indicates injury to the scalenes.

· Pain upon resisted neck flexion indicates injury to the sternocleidomastoids.

· Pain upon resisted neck extension indicates injury to the posterior scalenes, suboccipitals and/or erector spinae.

Bodywork
While a majority of people with whiplash improve within one month, symptoms sometimes persist longer. Most therapists agree that the sooner massage therapy is received, the quicker the person heals and the less likely they are to develop chronic neck pain. In general, any massage that relaxes the affected muscles will help relieve the pain and discomfort of whiplash. However, these three specific approaches are particularly therapeutic:

1. Myofascial Release – Myofascial release techniques can free restricted neck muscle and fascia to help restore fluidity, thus relieving the stiffness of whiplash. Additionally, myofascial unwinding can unlock dysfunctional fascial holding patterns established at the time of injury.

2. Static Compression – Applying static compression to affected trigger points creates an influx of oxygen that relaxes the contracted musculature. Since myofascial trigger points often develop in the cervical muscles following a whiplash injury, this treatment prevents prolonged muscular dysfunction that can linger for months or years after the initial trauma.

3. Deep Tissue Massage – Once the superficial muscles are relaxed, deep tissue work can liberate contracted deep fascia, adhesions and scar tissue. Making sure to stay within the client’s pain tolerance level, deep tissue massage can free tissue that had tightened around local nerves.

Proceed Carefully
Because of the neck’s delicacy, bodyworkers should always proceed cautiously with a whiplash injury. The following guidelines are intended to keep therapists mindful of the neck’s vulnerability:

· Since the anterior neck muscles are often injured in whiplash, be careful to avoid pressing on the nearby carotid artery.

· Wait until a few days after the accident before administering massage therapy so that the initial healing process is uninterrupted.

· A physician should always be consulted to determine if there is a fracture, concussion or other disc problem before attempting any bodywork.

· Make sure your approach is gentle enough to not cause the client any further discomfort than what they are already experiencing.

As long as a massage therapist uses caution when working with whiplash, their efforts can play a major role in recovering from this common injury. Especially beneficial when doing myofascial release, static compression and deep tissue massage, bodyworkers have the tools to ease muscle pain, induce relaxation and unlock the tension created by a whiplash injury.

Recommended Study:
Deep Tissue Massage
Myofascial Release

References:

http://www.amtamassage.org/etouch/etouch0205nm.html#1, Preventing Chronic Whiplash Syndrome with Massage, Dr. Leo B. Stouder, Retrieved July 3, 2008, e-Touch, American Massage Therapy Association, February 2005.

http://www.massagemag.com/Magazine/2003/issue104/assess104.2.php, Assess & Address: Whiplash, Whitney Lowe, Retrieved July 3, 2008, Massage Magazine, July/August 2003.

http://www.massagetherapy.com/articles/index.php/article_id/1107, Whiplash – How to Heal a Pain in the Neck, Hope Bentley, Retrieved July 2, 2008, Associated Bodywork and Massage Professionals, 2008.

http://massagetherapy.suite101.com/article.cfm/whiplash_neck_injuries_, Whiplash – Neck Injuries, Sylvia Carlson, Retrieved July 2, 2008, October 2006.

http://www.massagetoday.com/mpacms/mt/article.php?id=13653, Successfully Treating Cervical Trauma Using Deep-Tissue Techniques, Don McCann, Retrieved July 2, 2008, Massage Today, July 2007.

http://www.massagetoday.com/mpacms/mt/article.php?id=13699, Whiplash, Ben Benjamin, PhD, Massage Today, retrieved July 3, 2008, October 2007.

http://www.spineuniverse.com/displayarticle.php/article107.html, Whiplash: Neck Trauma and Treatment, Todd Albert, MD, Retrieved July 3, 2008, SpineUniverse.com, 2008.

by Nicole Cutler, L.Ac.

Routinely taught as one of the premiere contraindications for massage therapy, cirrhosis is commonly encountered in mainstream society. Unfortunately, the likelihood of harboring a health condition that can develop into cirrhosis is on the rise. Learning about the ailments that can cause this advanced stage of liver disease helps healthcare workers realize its growing prevalence. Additionally, understanding how liver disease progresses to cirrhosis helps caregivers envision the process that affected clients endure.

As the body’s largest internal organ, the liver is essential for many life-sustaining functions. A few of the liver’s responsibilities include:

· Removing or neutralizing toxins, viruses and bacteria from the bloodstream
· Producing immune agents to control infection
· Making proteins to regulate blood clotting
· Manufacturing bile to help absorb fats and fat-soluble vitamins

When a person has chronic liver disease, the liver is likely to become increasingly damaged. A basic progression of liver disease is described below:

· Inflammation – As the liver battles infection, excessive toxicity, fatty tissue or other insults, it becomes inflamed, tender and enlarged.

· Fibrosis – Persistent inflammation causes the liver to scar. The accumulation of scar tissue replaces previously healthy cells and can cause a reduction of liver function. As one of the few organs capable of regeneration, new liver cells can grow if there is enough of an inflammatory respite.

· Cirrhosis – When the liver becomes so fibrotic that it can no longer heal itself, cirrhosis has occurred. Disrupting the flow of blood, the severe scarring of cirrhosis prevents the liver from completing its important tasks. Due to this mechanical restriction on hepatic blood flow, increasing the circulatory demand on an already cirrhotic liver can cause a dangerous backup of toxins in the bloodstream. The potential for an overwhelming toxin load explains why cirrhosis contraindicates many kinds of massage.

· Liver Failure – If the liver completely loses its ability to function, the life-threatening condition of liver failure occurs.

While there are dozens of chronic liver disease causes, the following are the most common culprits for developing cirrhosis:

1. Viral Hepatitis C – With about four million infected Americans, Hepatitis C accounts for approximately 25 percent of chronic liver disease cases. Currently, the standard treatment for Hepatitis C can only help approximately 50 percent of infected people overcome the virus.

2. Alcoholic Hepatitis – Alcohol abuse is one of the most common causes of liver disease in Western societies. In the United States alone, alcoholic liver disease affects more than two million people. However, the true prevalence of alcoholic hepatitis, especially in its milder forms, is unknown because patients may be asymptomatic and never seek medical attention.

3. Non-Alcoholic Fatty Liver Disease – This buildup of fat in the liver may be associated with diabetes, protein malnutrition, obesity, coronary artery disease and certain medications. A recent study estimates that 25 percent of American adults have some degree of fatty liver disease.

4. Viral Hepatitis B – Although there is a vaccine to prevent its acquisition, there are an estimated 1.5 million American carriers of Hepatitis B and 300 million carriers worldwide.

5. Autoimmune Hepatitis – The prevalence of autoimmune hepatitis in the United States remains uncertain because it tends to be grouped with other diagnoses. However, the surge of autoimmune disease findings suggests this problem is on the rise.

6. Bile Duct Obstruction – When the ducts that carry bile out of the liver are blocked, bile backs up and damages liver tissue. The most common cause of this is primary biliary cirrhosis, which is estimated to affect one in every 3,500 people.

7. Inherited Liver Diseases – Alpha-1 antitrypsin deficiency, hemochromatosis, Wilson’s disease, galactosemia and glycogen storage diseases are among the inherited diseases that interfere with the way the liver produces, processes and stores enzymes, proteins, metals and other substances the body needs to function properly.

A person with chronic liver disease may or may not be aware of how far his or her condition has progressed. Especially crucial for cases advanced to cirrhosis, administering bodywork should be carefully considered, and consent from the client’s physician should precede any sessions. In addition, all applied techniques must be gentle and non-circulatory to prevent a toxin overload.

Recognizing the various etiologies of cirrhosis raises a bodyworker’s awareness of this condition. Whether a client just learned he or she has Hepatitis C, is trying to manage fatty liver disease or struggles with alcoholism, responsible practitioners must inquire about the staging of their client’s liver disease. Armed with this information, therapists are better able to appreciate the severity of an illness and assess the safety of any given bodywork application.

Recommended Study:
Advanced Anatomy and Pathology
Infectious Disease: Hepatitis

References:

Braun, Mary Beth, Stephanie J. Simonson, Introduction to Massage Therapy, Lippincott Williams and Wilkins, 2007.

http://digestive.niddk.nih.gov, Cirrhosis of the Liver, National Institute of Diabetes and Digestive and Kidney Diseases, 2008.

http://en.wikipedia.org, Primary Biliary Cirhosis, Wikimedia Foundation, Inc., 2008.

http://pubs.niaaa.nih.gov, The Epidemiology of Alcoholic Liver Disease, Robert E. Mann, Ph.D., Reginald G. Smart, Ph.D., and Richard Govoni, Ph.D., National Institute on Alcohol Abuse and Alcoholism, 2008.

http:///wiki.answers.com, Can you have a massage if you have cirrhosis of the liver?, Answers Corporation, 2008.

www.allabouthepatititisc.com, Hepatitis C Statistics, Schering Corporation, 2008.

www.emedicine.com, Alcoholic Hepatitis, WebMD, 2008.

www.medscape.com, Autoimmune Liver Disease, Current Opinion in Gastroenterology, 2003.

www.redorbit.com, 1-in-4 U.S. Adults Has Fatty Liver Disease, redOrbit.com, 2008.

www.umm.edu, Liver Disease, University of Maryland Medical Center, 2008.

www.wrongdiagnosis.com, Prevalence and Incidence of Alcoholic liver disease, Adviware Pty Ltd., 2008.

by Linda Fehrs, LMT

Being prepared in advance is the best tool in an emergency. It helps take the fear out of unexpected situations and may allow you to help others. As massage therapists we learn a lot about health and wellness, and we get first aid training. Natural disasters like hurricanes, floods and forest fires make us aware of the need to know more, including how to protect our clients, families, and ourselves, and reduce the possibility of serious injury or even death.

What to Have on Hand
It is important to get together both a to-go kit and a stay-put kit for emergencies. The to-go kit is something light that you can locate and grab quickly in case you need to evacuate on short notice. The stay-put kit is a three-day supply of water, food and other necessities to help if you will be staying at home.

All the items in a to-go kit should be able to fit in a backpack or small rolling suitcase. It should be small and lightweight enough for anyone to carry easily and should be located in an easy place to find. Keep it filled with the supplies and check twice a year to make sure they work and have not passed expiration dates.

Some items to store in a to-go kit include:

· Drinking Water
· Food – energy bars or meals-ready-to-eat
· First Aid Kit
· Rain Poncho
· Flashlight
· Sanitation Supplies – toilet paper, soap, etc.
· Portable Radio – battery or crank powered
· Extra Batteries
· Copies of Vital Documents – driver’s license, passport, insurance documents, medical information
· One Change of Clothing
· Blanket or Sleeping Bag

If you are staying at home during an emergency you should be prepared for a minimum of 72 hours. Emergency rescuers may not be able to reach you right away, but by three days' time it is likely either the emergency is over or you will have been evacuated.

In addition to what is available in your to-go kit, make sure you have these items on hand for your stay-put kit:

· Water – It is advised that you have a minimum of one gallon of potable water per person, per day.
· Food – Enough non-perishable food (such as canned soups, canned vegetable and fruits, peanut butter, etc.) equaling approximately 2000 calories per person per day. Avoid food that will make you thirsty, requires refrigeration or needs a lot of preparation.
· Manual Can Opener – If your electricity is out and the only can opener you have is electric, there could be a problem!
· Telephone That Does Not Require Electricity – Most corded phones will still work if the electricity is out.
· Tools to Shut Off Water or Gas

If you go camping you may already have a means for cooking without your kitchen stove. Make sure you have enough charcoal, propane or other fuel on hand. Having a portable stove also means you will be able sterilize water by boiling it.

Remember to keep any important documents, such as insurance papers, medical information, financial records, etc. in a waterproof, fireproof container.

Make a Plan
Get together regularly with family, friends, neighbors and business associates to discuss emergencies that might happen and how you can prepare for them. Whether at home or in your office, you should make sure you have some sort of plan for letting others know you are safe.

· Choose a place to meet after a disaster. One should be near your home, and the other further away in case you cannot return to your neighborhood.
· Have an out-of-state contact, a friend or relative who you can call. Should you get separated, another person can be informed that everyone is OK and relay messages to the others.
· All household members should know where emergency plans and to-go kits are kept.
· Practice getting out of your home or office in emergency situations at least twice a year. Plan a primary evacuation route and an alternate route, and drive it several times under various conditions.
· If you don’t drive, learn what public transportation will be available in your community during emergency situations.
· Contact local officials to learn what plans are in force for emergency situations, such as shelter locations, evacuation plans, medical assistance, etc.

Be Informed
· Know what disasters are likely in your community. Some emergencies will affect only you and your family such as a home fire, while some will involve neighborhoods, towns or states – including floods and storms.
· Find out how local authorities will notify you during a major disaster. This might vary depending on if you live in an urban, suburban or rural area.
· Take a class in CPR, first aid or emergency preparedness. Many states require massage therapists to have training in CPR in order to qualify for licensing.

Volunteer
Volunteering to help is one of the best ways to learn and practice emergency preparedness. Organizations such as the Red Cross offer free training to volunteers. There are also government organizations such as the Citizens Corps and the Community Emergency Response Team (CERT) that are somewhat similar to what used to be the Civil Defense, and offer various courses of training in emergency preparedness.

There are also several websites that can connect you to volunteer opportunities both in the non-profit sector (www.volunteermatch.org and www.volunteersolutions.org) as well as government-sponsored venues (www.volunteer.gov and www.usafreedomcorps.gov).

Volunteering not only makes you feel better, but also connects you to your community and allows you to help others in a positive way.

These are just some of the things you can do to be prepared. For more detailed information, contact the Red Cross (www.redcross.org) or the Federal Emergency Management Agency (www.fema.gov).

References:

“Are You Ready? An In-depth Guide to Citizen Preparedness.” 22 August 2004. Department of Homeland Security. 19 Aug 2008 .

“Be Red Cross Ready” Pamphlet. May 2007. American Red Cross. 19 Aug 2008 "

Spigarelli, Jack A. Crisis Prepareness: A Comprehensive Guide to Home Storage and Physical Survival. 2nd. Alpine, Utah: Cross-Current Publishing, 2002.

Wiseman, John. SAS Survival Handbook. New York: Harper Collins, 2004.

Wiseman, John. SAS Urban Survival Handbook. New York: Skyhorse Publishing, 2008.

by Ernesto Ortiz LMT, CST

Bamboo is one of the must multifaceted plants on our planet. It has earned its reputation from its noble and soft appearance as well as its perseverance under harsh conditions. In the Orient, bamboo symbolizes strength, fertility, youth, prosperity and peace.

Bamboo is certainly one of the most versatile plants. It has spiritual, mythological and many practical applications. It is eaten, used in home construction and decoration, as well as for the creation of utensils and herbal remedies.

When I was in Bali about two years ago, I was walking one early morning in Monkey Forest in the town of Ubud. Monkey Forest is a park, a temple and the habitat for hundreds of monkeys that roam free and wild. It was around 6:30 am and there was no one there – just me and lots of monkeys. I noticed one of them rubbing a piece of bamboo against a stone. He was filing the rough edges – and then he started massaging his body with the stalk of bamboo!

My eyes opened so wide. But that is not all. Another monkey came over, asking the one with the bamboo stick to work on him. He turned his back to him and bugged and bugged him until the monkey with the stick started massaging him. I said to myself, “there is nothing more primal and natural than this!”

Tian Di Bamboo Massage
Tian Di in Chinese means heaven and earth; this gives the meaning and primary objective to this therapy. To develop this therapy, I have taken many concepts and basic principles from Traditional Chinese Medicine. As I was working on expanding this technique, I realized
it would be incomplete if only bamboo was used for the session. What bamboo will bring to the surface needs to be removed from the body. This is why other techniques were added.

Tian Di Bamboo Massage as a complete therapy is divided in three major segments: Massage with Bamboo, Cupping and Gua Sha techniques.

Massage With Bamboo
I call the bamboo sticks Cho sticks. Cho means bamboo in Chinese. They are the first instruments we use in the Tian Di session.

Bamboo is essential and unique because its walls are covered with silica. This creates an outer cover of tiny quartz like crystal matrixes that are activated when they encounter the right conditions of mechanical stress.

The two main properties of quartz are Piezo and Pyro electricity. This is what produces an energetic charge, so unique that science and industry, as well as the metaphysical world, have been interested and using it for many years. Piezoelectricity is activated with pressure, and Pyroelectricity with heat. As we work, we apply pressure to the body with the bamboo stick and the friction that is created will activate the molecular structure in the silica – and bang! We have a powerful tool that is charged and will create dramatic and permanent changes.

For massage clients, it is a new way of feeling. As they get worked on with the Cho sticks the energy that is contained within the walls of the bamboo is transferred to them, creating a series of unique sensations. Most people describe these as, “tingling all over”; “feeling like the bamboo is bending and conforming to the body”; “it is amazing how hot the bamboo gets as you were working on me.”

There are many benefits for the practitioner as well. Using the Cho sticks minimizes stressing and straining the hands and fingers while still allowing for deeply penetrating maneuvers.

· The Physical – When we apply the piezoelectric principles to the body, the electrical and thermal energy activates peripheral circulation. Enhanced circulation will remove stagnant toxins and move blood throughout the body, heart and lungs, improving internal respiration. Oxygenated blood will return nutrition and healing aid to the cells and tissues of the affected areas. This enables your work to be deeper, to relax and realign muscle fibers without causing micro tears.

· Mental/Emotional – Emotionally, this therapy provides a total sense of relaxation. Stagnant emotions will surface once the client feels relaxed, nourished and has reached a point of trust. The love that we, as therapists, bring to the session will encourage them to freely release and process all their “stuff.”

· The Spiritual – Tian Di Bamboo massage will reach whatever level of spirituality you’re at. If you don’t connect with the Cho sticks on a spiritual level, if you don’t bring that body/mind/spirit awareness to your session, two people are losing, you and your client.

It is not unusual that the effects of Tian Di therapy continue for days after the session. It is as if you have opened a portal and allowed the newness of the experience to enter and linger there.

Cupping and Gua Sha
Cupping and Gua Sha are techniques that work more at a physical level. They come as an aid to finish the work done with the Cho sticks. They suction and sweep away what has surfaced from the treatment.

Cupping involves placing suction cups on the skin with a vacuum-like device to deeply work along the meridians. The original cups were made of bamboo but today there are cups made of glass and plastic as well. The technique is very effective to relieve stagnation. Stagnation refers to congestion or accumulation of fluids, lymph, Qi or blood due to lack of movement of any kind.

Cupping is the opposite of massage. In massage, for the must part, we do compressions. With cupping, however, we suction and lift. As we glide slowly with the cups, the suction is able to penetrate far deeper than with any other tool we may have.

Cupping therapy can aid numerous conditions, ranging from chronic pain, stiff muscles or joints, fatigue, emotional and psychological states, and more.

Gua Sha dates back over 2,000 years. It uses round-edged instruments made of horn, bone or pieces of jade, to work along the surface of the skin to promote vitality and flow.

In Chinese, Gua (gwa) means to scrape or extract and Sha (shaw), means sand or toxins.

So we literally scrape or sand off toxins from the body as they surface from the bamboo and cupping treatment. This ancient method is used to promote Qi or bioelectric vital life energy, blood circulation and removal of toxic heat, stagnant blood and lymph fluid from the body.

These three techniques together – Bamboo massage, Cupping and Gua Sha – make a complete and powerful Tian Di session. The beauty of it is that you as the therapist can choose to use one, two or all three methods during the session depending on the needs of the client.