Massage Professionals Article Archive

by Nicole Cutler, L.Ac.

One of the therapies employed by practitioners of Traditional Chinese Medicine (TCM), cupping is a powerful, manual technique for breaking up localized congestion. While it does require some additional training, cupping is within the scope of practice for most practicing massage therapists. Armed with expert guidance and a basic understanding of TCM theory, bodyworkers can deliver a deep, therapeutic cupping treatment while giving their hands a respite from the rigors of their profession.

What is Cupping?
Originally practiced to drain toxins from snakebites and skin lesions, cupping began by using hollowed out animal horns to suck poisons out of a recipient’s skin. As more was learned about human physiology, the therapeutic applications of cupping were applied to an increasing number of health conditions. Accompanying the progression of this therapy, the cups originally crafted from horns evolved to bamboo, then glass and sometimes plastic.

Records have proven that ancient cultures of China, Greece and Egypt regarded cupping as a medical practice as early as 28 A.D. Over the years, practitioners have relied on cupping’s strong suction to increase circulation for:

· Tightened or painful muscles
· Sprains or strains
· Pinched nerves
· Lung congestion
· Menstrual irregularities
· Inflamed breasts
· Lactation dysfunction
· Gastrointestinal disorders
· Cough
· Asthma

Cupping Variations
There are several cupping variations within a massage therapist’s scope of practice:

· Fire Twinkling Method – The practitioner clamps, then ignites a piece of alcohol-soaked cotton, places the flame into a glass cup, removes it quickly, and then inverts the cup onto the skin. Because the flame consumes the cup’s oxygen, a strong suction is created.

· Suction Pump Method – Usually composed of plastic, these cupping sets allow the practitioner to use a pump to remove oxygen from the cup, thus creating suction.

· Stationary Cupping – This is when a cup is applied to a specific, congested location and left there for up to 15 minutes.

· Running Cupping – This is when plenty of lubricant is applied to a broad area, a cup is adhered to the body, and then moved around without breaking the seal. Massage therapists can mimic several types of massage strokes by working with this technique.

Cupping Theory
Cupping is known for its ability to break up localized stagnation. Cupping is reputed to:

· Drain excess fluids and toxins
· Loosen adhesions
· Lift connective tissue
· Enhance circulation in stagnant musculature and fascia
· Stimulate the peripheral nervous system

In terms of TCM theory, the stagnation can be of just about any type: blood, toxins, qi or dampness. The suction created by cupping draws stagnant toxins, heat, energy or fluid out of where it has accumulated and brings it to the body’s surface. Once under the skin, the offending culprit can more easily be eliminated via the body’s waste removal systems.

Based on cupping’s most popular applications, the following conditions benefit from stagnation dispersal. For clarity, this is further broken down by stagnation type:

1. Blood Stagnation – Injuries, adhesions, menstrual irregularities

2. Stagnant Toxins – Gastrointestinal disorders, rigid muscles, breast inflammation

3. Qi Stagnation – Muscular pain, dysmenorrhea, pinched nerves

4. Fluid Stagnation – Lung congestion, asthma, lactation dysfunction

Once an adhesion or congestion is pulled away from its source, fresh blood, energy and fluids rush in to expedite healing. Besides sparing the practitioner’s hands from demanding physical labor, this dramatic increase in circulation makes cupping a valuable complement to bodywork. By learning about TCM stagnation theories and becoming practiced in the art of cupping, massage therapists have a unique and effective tool to bring their clients closer to their health goals.

For more information about cupping, look for the upcoming article, “Cupping for Massage Therapists: Part II.”

Recommended Study:
Shiatsu Anma Therapy

References:

http://www.massagecupping.com/, History of Cupping, Retrieved October 1, 2008, Massage Cupping Bodywork Therapy, 2008.

http://www.massagemag.com/spa/treatment/cupping.php, The Art of Massage Cupping, Anita J. Shannon, LBMT, Retrieved October 1, 2008, Massage Magazine Inc., 2008.

http://www.massagetoday.com/archives/2004/02/04.html, Massage Cupping Therapy for Health Care Professionals, Anita J. Shannon, LMBT, Retrieved October 1, 2008, Massage Today, February 2004.

Liangyue, Deng, et al, Chinese Acupuncture and Moxibustion, Foreign Languages Press, Beijing, 3rd printing, 1993: 346-347.

by Nicole Cutler, L.Ac.

Aside from those solely seeking relaxation, a significant percentage of massage therapy clients hope for pain relief. A 2005 USA Today/ABC News/Stanford University Medical Center poll indicated that more than half of Americans suffer from chronic or recurrent pain. To deal with many kinds of chronic pain, physicians commonly prescribe the non-steroidal anti-inflammatory drug (NSAID) Celebrex. Since most massage therapists are more than likely to have at least one client on Celebrex, it is important to understand how this drug works and its potential impact on massage therapy.

NSAIDS
Because they relieve pain, inflammation and stiffness, NSAIDs are widely used to help treat arthritis by blocking prostaglandins. Produced by the body’s cells, prostaglandins have several important functions. In addition to promoting inflammation, pain and fever, prostaglandins support the function of platelets required for blood clotting and they protect the stomach lining from the damaging effects of acid.

Prostaglandins are produced by the enzyme cyclooxygenase (Cox). While there are two Cox enzymes – Cox-1 and Cox-2 – only Cox-1 produces prostaglandins that supports platelets and protects the stomach. Since traditional NSAIDs block both Cox enzymes, they reduce the prostaglandins that protect the stomach and support blood platelets. Therefore, in addition to reducing ongoing inflammation, pain and fever, traditional NSAIDs have been known to cause stomach ulcers and encourage bleeding.

Cox-2 Inhibitors
With over one million prescriptions filled each month, Celebrex is a popular Cox-2 inhibitor. Cox-2 inhibitors are a distinct type of NSAID, which selectively inhibits Cox-2, while sparing Cox-1 to reduce gastrointestinal toxicity. Despite the apparent advantage of Cox-2 NSAIDs, they still have their share of risks.

At the end of 2004, the U.S. Food and Drug Administration issued a public health advisory concerning use of non-steroidal anti-inflammatory drug products (NSAIDS) including those known as Cox-2 selective agents. All prescription NSAIDs, including Celebrex, may be associated with an increased risk of serious cardiovascular events (heart attack and stroke) especially when they are used for long periods of time or in very high-risk settings (immediately after heart surgery). While several Cox-2 NSAIDS were removed from the market following this advisory, Celebrex remained for sale because its benefits outweighed the purported risk.

Concerns For the Bodyworker
Because clients on Celebrex are likely to have decreased pain and inflammation levels, extra caution in the depth and pressure of any massage stroke is required. The main side effects that are likely to affect a massage session are:

· Drowsiness
· Dizziness

In Pharmacology for Massage Therapy, Jean M. Wible advises countering these effects by using more rapid and stimulating strokes at the end of a session for clients taking Celebrex. In addition, Wible suggests special care be taken with elderly patients on Celebrex because they tend to have more problems with dizziness. During bodywork, older individuals are more prone to dizziness because of a slower nervous system response during positional changes.

If a client taking Celebrex mentions any of these more serious side effects, they should be referred to a physician:

· Abdominal pain
· Bleeding
· Anorexia
· Diarrhea
· Nausea
· Ulcers
· Jaundice
· Confusion
· Tinnitus or Vertigo
· Depression
· Bladder infection
· Blood in the urine

When prescribed judiciously, Celebrex helps many people reduce chronic pain. As a healthcare practitioner who helps people ease pain, you are likely to encounter clients taking this Cox-2 inhibitor. Being familiar with how it works, what the common and serious side effects are, and how to adjust your technique for this medication will directly benefit your clients who take Celebrex.

Recommended Study:
Advanced Anatomy and Physiology
Pharmacology for Massage Therapists

References:

Arthritis Therapy: You Decide, Consumer Reports on Health, July 2007.

http://arthritis.about.com, What are COX-2 Inhibitors?, Carol & Richard Eustice, About.com, 2008.

Wible, Jean M., Pharmacology for Massage Therapy, Lippincott, William & Wilkins, 2004.

www.cdc.gov, Arthritis Related Statistics, United States Department of Health and Human Services, 2008.

www.celebrex.com, About Celebrex, Pfizer, Inc., 2008.

www.fda.gov, Public Health Advisory Non-steroidal Anti-Inflammatory Drug Products, US Food and Drug Administration, 2008.

www.foxnews.com, Pain Poll: Many Americans Suffer Chronic Pain, Fox News Network LLC, May 2005.

www.medicinenet.com, Celecoxib-oral, MedicineNet Inc., 2008.

www.medicinenet.com, Nonsteroidal Antiinflammatory Drugs (NSAIDS), Omudhome Ogbru, Pharm. MedicineNet Inc., 2008.

www.usatoday.com, Chronic Pain: The Enemy Within, Steve Sternberg, USA Today, May 2005.

by Nicole Cutler, L.Ac.

Whether you are applying deep tissue, sports massage, Swedish techniques or another bodywork modality, some clients will bruise. Since massage therapy is often implicated in creating black and blues, practitioners should be aware of why bruising might occur, and when it is indicative of a more serious problem.

Getting a phone call from a client that their previous massage with you left several bruises is never easy to deal with. However, explaining this possibility beforehand can eliminate a lot of needless worry. On the other hand, severe or unwarranted bruising could be a sign of a condition requiring a physician’s referral.

Why Do Clients Bruise?
Also known as ecchymosis, bruises are a discoloration and tenderness of the skin or mucous membranes due to the leakage of blood from an injured blood vessel. Although typically resulting from an injury, capillaries may break and cause an ecchymosis from any kind of tissue contact. In a healthy individual, there are several reasons why a person might bruise after massage therapy:

· More common with deep tissue massage, great amounts of pressure can cause capillaries to break.

· Hypertonic tissue is more prone to bruising from massage because more force may be used to release tight musculature.

· Older people are more susceptible to bruising because of weakened capillary walls and thinner skin.

· Medications increase susceptibility to bruising.

Medications Increasing Bruise Risk
There are many reasons a massage therapist needs to know what medications their clients are taking and how those drugs might impact massage. A perfect example of why bodyworkers must learn how pharmacology relates with massage is the large number of drugs that increase the likelihood of bleeding. If a client is taking any of the following medications, they will be especially susceptibility to bruising and require a gentler touch:

1. Blood Thinners – Aspirin, ibuprofen (Advil), naproxen (Aleve), warfarin (Coumadin) and clopidogrel (Plavix) are examples of drugs that either thin the blood or reduce the blood’s ability to clot. These drugs could cause even the slightest capillary damage to bleed extensively.

2. Dietary Supplements – Fish oil, ginkgo, ginger, dang gui and garlic are supplements that also have blood-thinning properties. Although typically exerting a milder blood-thinning effect than the pharmaceuticals, a client who takes these supplements may be more prone to bruises.

3. Corticosteroids – Cortisone, hydrocortisone, methylprednisolone and prednisone are examples of corticosteroids typically administered to stop the inflammatory response. Because these drugs cause the skin to thin, it is much easier to cause bruising.

When To Be Concerned
While bruising can be a normal side effect from massage therapy, it may indicate a more severe problem. Practitioners should be aware that some types of bruising could indicate a blood-clotting disorder, a blood disease, domestic violence/abuse or another serious condition. By using the following assessments, massage therapists can decide whether to refer out and/or call for help. Be cautious if:

· Your client has unusually large or painful bruises – especially if the bruises seem to develop without reason. This could indicate abnormal platelet function and requires a physician referral.

· Your client bruises easily AND has abnormal bleeding elsewhere, such as from the nose, gums or intestinal tract. This could indicate abnormal platelet function and requires a physician referral.

· Your client has no history of bruising but suddenly experiences bruises, especially if he/she recently started a new medication. This could indicate abnormal platelet function and requires a physician referral.

· Your client repeatedly presents with inexplicable bruises in unusual locations like the eye or face. This should prompt an inquiry into the possibility of abuse.

· Your client has bruising around the navel. This could indicate dangerous internal bleeding and requires an immediate physician referral.

· Your client has bruising behind the ear (also known as Battle’s sign). This could be due to a skull fracture and requires an immediate physician referral.

· Your client has raised bruises. This may indicate an autoimmune disease and requires a physician referral.

While most of the bruises resulting from massage pose no danger, there are times when a caregiver must be on alert. Even though pain and bruising is never wished upon anyone, the occasional ecchymosis resulting from a therapeutic massage is likely worth the benefits. However, bodyworkers can prevent angst by discussing the possibility of bruising prior to treatment and by using a lighter touch on those more likely to bruise. In addition, massage therapists who are aware of when bruising is abnormal can safely guide their clients towards the care they might need.

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

References:

http://arthritis.about.com/cs/steroids/a/corticosteroids.htm, The Facts of Corticosteroids, Retrieved July 30, 2008, About.com, 2008.

http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/bruises.jsp, Bruises, Retrieved July 29, 2008, HealthAtoZ.com, 2008.

http://www.mayoclinic.com/health/easy-bruising/HQ00355, Easy Bruising: Common as you Age, Retrieved July 29, 2008, Mayo Foundation for Medical Education and Research, 2008.

http://www.webmd.com/a-to-z-guides/bruises-and-blood-spots-under-the-skin-topic-overview, Bruises and Blood Spots Under the Skin, Retrieved July 29, 2008, WebMD LLC, 2008.

by Linda Fehrs, LMT

There are no clear boundaries when it comes to those who are victims of domestic violence and abuse. A person’s economic status, race, religion, ethnicity or age makes little or no difference. Gay or straight, elderly or disabled, illiterate or well-educated, living in a rundown shack or spacious mansion – no one is exempt from the statistics.

The annual medical expenses resulting from domestic violence in the United States are estimated to be anywhere from $3 to $5 billion. Lost wages, sick leave, absenteeism and non-productivity account for another $100 million in costs to businesses.

On average, one of every five clients a massage therapist sees is a victim of some kind of trauma or abuse. Many are victims, specifically, of domestic violence.

As a massage therapist, you are trained to be sensitive to the changes in the body’s energy and have the ability to perceive the subtle variances in muscle tone and physical tension. You can feel if a person constricts when you get to a certain area. Muscle tension within the body of a person who has been traumatized feels different than the tension created from over exercising. You can see the bruising and physical injuries others cannot. Because the act of massage therapy often encourages an intimate trust, it can unlock a person’s emotions and you may be witness to a verbal releasing of what has happened to them.

Signs
Perpetrators of domestic violence often produce injuries and bruises that are concealed under clothing, or otherwise easily hidden. Massage therapists are in a somewhat unique position, as they are able to see what lies beneath. They are educated in recognizing the differences between a normal bruise caused by a harmless bump into something, as compared to one caused by a belt buckle or other weapon.

Some other common signs include:

· wearing of heavy makeup to cover bruises
· new, unexplained bald spots
· frequent injuries, such as bruising, cuts or fractures
· cigarette burns
· bite marks
· rope burns

Bruising, cuts, chronic illness, nonspecific chronic pain, injuries that don’t seem to heal over time, or that don’t seem to ring true with the explanation of how it was received, are all possible signs of battering.

During a massage therapy session, a client often begins talking and, at times, may reveal intimate things about relationships. Perhaps your client jokes about how jealous her partner is, or confesses how afraid she is of him and his temper.

It could be your client simply does not have the usual relaxation of the majority of clients. She remains hyper-alert, and even flinches or pulls back when you approach certain parts of her body. Some clients experiencing an emotional release may even start to cry while receiving a massage. Being alert to signs indicating possible abuse may help you to open a conversation later about various resources available in your community.

What You Can Do To Help
During a session, always be sure to maintain professional boundaries. Be aware of your draping as well as certain techniques or movements used that might appear threatening to a victim of domestic violence. Remain sensitive and alert to the possibility of emotional changes in the client as a reaction to the massage.

If a client has a strong or unusual reaction during the session, you may need to discuss it with him/her. You can ask if they wish to stop and take a break or would prefer to simply end the massage. While it is generally beyond the scope of practice for a massage therapist to offer counseling, you can listen if they are ready to talk about it. Offer them local or national hotline telephone numbers or, if appropriate, the names of local shelters or other places to go for help or advice.

If you have a private practice, keep informed as to what resources are available in your community and place brochures, fact sheets or other various handouts in your waiting room.

If you have created your own intake form, consider adding an optional question like ‘have you ever been a victim of domestic violence, or sexual abuse.’ This way, clients know that everyone is routinely asked, and you can explain, if questioned, that it helps to know if someone has suffered severe trauma as it might make a difference in massage technique.

Volunteer at a local women’s shelter. Many abused women do not seek out massage. This may be out of embarrassment, poor self-image, low self-esteem, cost or simply not being aware of the benefits of massage therapy. By offering your services you are helping battered and abused women to heal and move forward in their lives.

Provide regular classes or workshops at your office. If you don’t feel comfortable as the facilitator, invite an experienced speaker, such as a psychologist or counselor trained to discuss domestic violence issues. You could make it open to the general public, massage therapists and/or other healthcare professionals.

Keep yourself balanced. Dealing with many clients who are suffering from trauma can lead to burnout. Find other massage therapists and psychologists or other professionals who routinely work with battered women/spouses, and form a support group that meets regularly.

Every massage therapist should educate him/herself about domestic violence. Become familiar with the common signs of abuse. In some states, massage therapists are mandatory reporters, legally required to report their suspicions. The laws vary from state to state but, in all states, domestic violence and abuse are illegal.

It is not the responsibility of a massage therapist to ‘fix’ the relationship, or get your client out of it. But by educating yourself and making resources easily available to your clients, you can remain objective and still help those who need assistance.

Domestic violence is pervasive in our society. By becoming aware of the problem and learning what you can do to help, you are becoming a part of the solution and may even save someone’s life.

Recommended Study:
Anatomy Review for Professionals
Ethics: Therapeutic Relationships

Resources:

Benjamin, Ph.D, Ben E., and Cherie Sohnen-Moe. The Ethics of Touch. Tuscon, Arizona: Sohnen-Moe Associates, Inc., 2003.

"Domestic Violence is a Serious, Widespread Social Problem in America: The Facts." Family Violence Prevention Fund. 11 Sep 2008 .

"Fact Sheets." National Coalition Against Domestic Violence. 16 Sep 2008 .

Hixson, Audra Lynn. “Examining the Benefits of Massage Therapy For Survivors of Sexual and Domestic Violence.” 2006 Boca Raton, Florida: Dissertation.com

Mines, Ph.D, Stephanie. "Healing Triumphs Over Domestic Violence: How Massage Therapists and Bodyworkers Can Change the World." 11 Sep 2008 .

Razo, Rebecca J. "Understanding Domestic Violence: What Massage Therapists Should Know." Massage Today October 2004, Vol. 04, Issue 10:

"Violence Against Women in the United States." National Organization for Women. 16 Sep 2008 .

"Would You Recognize a Victim of Domestic Violence?" YWCA. 16 Sep 2008 .