Massage Professionals Article Archive

by Linda Fehrs, LMT

There is a story I would like to share that served as my inspiration for becoming a massage therapist. It is the story of Anna, a young woman who emigrated from Norway to the United States in 1923.

After paying for her transportation, Anna had just enough money to pay for one week’s lodging. Speaking no English, she found work as a cook at the Norwegian Seamen’s Home in New York City. Within two years she saved enough money to enroll in massage school and, in 1927, graduated from a grueling two-year program which included not only classes in massage, but all aspects of physiotherapy, including what Per Henrik Ling called Swedish Gymnastic techniques, and a year long hospital internship.

What the classes did not cover were instructions on marketing, how to find a job or setting up a private practice. Anna would learn this on her own. After graduation, she approached local physicians informing them of her skills and asking for patient referrals. Within a short time she was working for several doctors and making enough of an income with a private practice to rent an apartment in Manhattan.

In 1929 the stock market crashed. Anna was now married and pregnant. She and her husband William lost all their savings. What work William could find paid very little, 30 cents an hour at best. Anna’s practice, though, was doing fairly well, and at $2 to 3 per hour-long session, she was able to provide for the family. Between 1929 and 1934 her family grew to include not only her husband, but two children as well. The national economy was in crisis and there was little work to be found.

Anna knew she still had to make a living and never wavered from her work as a massage therapist. She never turned down a client, even after working a ten-hour day, for she never knew if or when there would be a time when there would be no more. A ground floor apartment provided her with an extra room to use as an office, which meant she was able to work from home. She offered special coupon books, paid for in advance, where clients paid the equivalent of nine sessions, but got ten coupons. At times she bartered her services for food and clothing, even furniture, knowing that clients relying on her had no money. Her family not only survived, yet in many ways prospered during the Great Depression, at a time when others were in dire straits.

Anna became a massage therapist because she wanted to help people. Her motivation was not to become rich, but simply to be of service to others. She knew if her intentions were good, honest and pure that she would in turn be given the means to provide for her family. She was not only determined, yet also assertive in seeking out and maintaining clients. Many of them remained with her for more than 20 years.

At the age of 75, after 50 years of working as a massage therapist, Anna finally retired. She still had several elderly clients that she worked on in their own homes and visited weekly.

Anna was my grandmother. At 75 she moved in with her daughter, my mother. Still holding true to her belief that massage was the answer to good health, and wanting to keep up her skills, she continued to give massages once a week to my mother for the next 25 years!

There are many messages for us in her story, messages about perseverance, determination and creativity.

Having a massage practice is not much different now and some of her ideas can be converted to a twenty-first century practice:

· Use down time to learn a new skill or technique. Have you been too busy in the past to take a course in hot stone massage? Now is the time to get in some CE Hours needed for re-certification.

· Get together with other massage therapists and contract for providing chair massage to local businesses. This may not only supplement your current income, but also provide you with potential future clients.

· Partner with local retail establishments to provide chair massage for busy holiday shoppers. Make sure to hand out business cards or fliers with special holiday offers for future massage sessions.

· Offer special pricing, such as buying a gift certificate for a massage at full price and getting another at a discount, or for the price of four massages the client gets five.

· Consider the feasibility of working out of your home, rather than a rented office. Do you have a room you could use as an office that would be convenient for clients and meets zoning requirements?

· Consider offering classes. You might provide instruction on infant massage to new mothers, classes in meditation, tai chi or stress reduction.

· Volunteer. Whether it is as a massage therapist, or serving meals at a homeless shelter, volunteering is a way to help others who are having an even harder time than you are. It also helps put things in perspective.

· Barter your services. Maybe there is a yoga class you would like to take but can’t afford. You can do this on a one-to-one basis with someone you know, or join a bartering club where services and goods are banked with a third party.

· For the winter holidays look into taking on a second part-time job. Retailers are often looking for temporary help. You’ll have opportunities to let more people know about your practice, earn extra income and perhaps get a substantial discount on items you need for your office or home.

Surviving a depressed economy is not easy. Instead of sitting at home or in an empty office worrying about what will happen next, use the time to approach your business in a new way, to expand your knowledge of the profession and to reflect on how you can reach out and be of service to others. What you give to them will come back to you in ways you could never imagine.

Recommended Study:
Chair Massage Fundamentals

References:

“Barter News.” 2008. Barter News. 4 Nov 2008 .

Roseberry, Monica. Marketing Massage: How to Build Your Dream Practice. Albany, New York: Milady Publishing, 2002.

Sohnen-Moe, Cherie. Business Mastery. 2nd. Tucson, Arizona: Sohnen-Moe Associates, 1991.

“How To Start and Operate Your Own Bartering Club.” 2008. World Information Center For Knowledge. 4 Nov 2008 .

by Nicole Cutler, L.Ac.

Because cupping gives massage therapists a break from deep tissue work while delivering a powerful therapeutic benefit, it is an ideal supplement to a massage therapy practice. While cupping is a relatively simple practice, there is a lot to learn about this method before mastering it. In addition to the flawless application and manipulation of cups, knowing what conditions it helps most and why cupping works, practicing therapists must know about cupping’s cautions and contraindications.

For background information on cupping, read TCM, Cupping and Massage: Part I and TCM, Cupping and Massage: Part II.

The therapeutic benefits to massage cupping are far-reaching. However, practitioners who include cupping in their repertoire must log in a significant amount of practice before performing it on clients. In order to assure its effectiveness and maintain cupping’s safety, massage therapists must be extra careful to prevent burns, apply the right level of suction and be familiar with all of the associated contraindications.

Fire Cautions
Because it can provide a strong suction without causing tissue damage, the fire twinkling method is the traditionally preferred method of cupping by many practitioners. Nonetheless, when using the fire twinkling method, therapists must be attentive, quick and agile to prevent burning their clients. The following tips help prevent burns or fire hazards:

· Protect – Since the practitioners must place the flame into the cup in close proximity to their clients for quick adherence, the client’s skin, hair, clothing and anything flammable (hair product, oils, linens) must be protected from catching fire. Being alert is crucial to providing such protection.

· Plan – Logistical planning prior to cupping is essential to minimize any fire hazards. Once the flame is withdrawn from the cup, the cup is applied and the flame is blown-out, place the hot, alcohol-soaked cotton ball on a stable, non-flammable surface. Because the flame may not be 100 percent extinguished, practitioners must make sure it cannot re-ignite what it is resting on, or roll off onto something flammable. A wide porcelain bowl on a firm surface (not the massage table) is a good choice.

· Timing – Choosing the amount of time the flame is held inside the cup can be a fine line between too short and too long. If the lit cotton is in the cup for too short a time, it will not create sufficient negative pressure for suction. If the lit cotton is in the cup for too long, the lip of the cup will become very hot and could burn the client. Until mastery over cupping is achieved, practitioners should always err on the flame occupying the cup for a shorter period of time. If insufficient suction occurs, the process can always be repeated.

Suction Cautions and Contraindications
Whether you choose the fire twinkling or suction pump method to apply the cups, the therapist must avoid cupping’s contraindications and be careful with the degree of suction used.

· Bruising – While stationary cupping typically causes more bruising than massage cupping, either technique can leave large, unsightly bruises in the cups’ wake. (To review the difference between these cupping variations, read TCM, Cupping and Massage: Part I.) To prevent surprised and angry recipients, make sure to discuss this possibility with your client prior to using this modality.

· Degree of Suction – Getting strong enough suction is key to cupping’s effectiveness. Although, too strong of a suction could damage the tissue or even create a blister. Cupping’s intensity depends upon the following: the speed the cup is placed on the skin after the flame has been removed, the strength of the flame (certain alcohol burns hotter than others) and the size of the cup. Therefore, practicing the balance between these variables will help the therapist determine a safe cupping routine. Practitioners will find that it is very challenging to obtain suction over irregular angles, thin muscles or on areas with lots of body hair.

· Contraindications – Just like any modality that strongly invigorates the circulation, there are some situations where cupping should be avoided. Cupping should not be done on a client with a fever, convulsions or cramps, over allergic skin conditions, ulcerated sores or large blood vessels. In addition, cupping is contraindicated on the abdomen or lower back of pregnant women or on those with a bleeding disorder.

Cupping is a relatively simple application that, when done correctly, can relieve many types of congestion in the body. Despite its simplicity, there is a great deal to learn about cupping before it can be safely administered. By reducing fire hazards, preventing burns, practicing timing, informing your client about the potential for bruising, refining your degree of suction and memorizing cupping’s contraindications, therapists are better prepared to add this valuable technique to their massage practice.

References:

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.

http://www.naturalnews.com/z020253.html, Ancient Chinese technique of cupping offers pain relief without drugs or surgery, Alexis Black, Retrieved October 9, 2008, Natural News Network, August 2006.

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

Tierra, Lesley, L.Ac., The Herbs of Life, The Crossing Press, Freedom, CA, 1992, 148-149.

by Linda Fehrs, LMT

We are a society that works too much and exercises too little. We live longer than previous generations and tend to eat less nutritious food. As a result we have an aging population that increasingly experiences problems with our backs.

One of the most common causes of upper back pain is cervical stenosis, or a narrowing of the vertebral canal in the C4 – C7 region. This narrowing can be caused by any number of things such as trauma, degenerative disc disease or spondylosis (spinal osteoarthritis). It is a condition that can also be present at birth. As time goes on the spinal canal can continue to narrow until it begins to press on the spinal cord and/or the spinal nerves.

Anatomy of a Spine
The spinal column is made up of 24 individual vertebrae in the cervical, thoracic and lumbar regions, plus the fused sacral and coccygeal bones. The cervical vertebrae (C1 –C7) help to support the head and allow it to rotate, laterally flex and have anterior/ posterior flexion and extension. As with the lower spine, the structure of the cervical vertebrae form a kind of tunnel, or vertebral canal, which protects the spinal cord and nerves that exit through the vertebral foramina. In between each vertebra is an intervertebral disc that cushions the bones and helps make movement and flexibility possible. It is when the normal anatomy of the vertebrae is compromised that pain and other somatic problems can arise.

In cases of cervical stenosis the vertebrae in the neck may start to impinge on the spinal cord, which in turn can impede movement and affect various normal physical functions just about anywhere in the body.

Symptoms of Spinal Stenosis
Depending on the severity and rate of progression, symptoms can vary. If there is no spinal cord compression there may simply be neck pain and stiffness. If the spinal cord is affected, symptoms may range anywhere from tingling or numbness in the arms and hands, to an overall clumsiness or weakness. In some more severe and untreated cases, a person may also experience difficulty walking, an inability to complete complex motor tasks and even bladder and/or bowel problems. A thorough and comprehensive evaluation, including an x-ray or MRI, needs to be done to make an accurate diagnosis as there are many other diseases and syndromes which have similar symptoms, including fibromyalgia, chronic fatigue or even multiple sclerosis.

Conventional Treatment
Typically, once cervical stenosis has been diagnosed, early treatment may consist of a few days bed rest, the temporary use of a neck brace or moderate exercise to strengthen supportive muscles. Sometimes medications such as muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin, ibuprofen or naproxen, or narcotics are used to reduce the pain. Except for those experiencing some neurological deficit because of the compression, surgery is seldom required and noninvasive solutions are preferred.

Four Alternative Options
Along with the conventional treatments, several alternative therapies have shown promise in being effective in easing the symptoms of stenosis:

1. Acupuncture/Acupressure – Using Chinese medicine theory, acupuncture and acupressure have been shown to be successful in the reduction of pain. The Kidney and Bladder meridians are related to the deepest part of our anatomy: the bones and nerves. Many of the points are located parallel to the spine and, when used in treatment, are especially helpful in alleviating stenosis related symptoms.

2. Chiropractic – Depending on the severity of the stenosis, chiropractic manipulation may help to realign the spine and reduce the stress on the spinal column and nerves. Chiropractors may also use ultrasound stimulation, nutrition and exercise in their treatment regimen.

3. Cranial-Sacral Therapy – This gentle form of bodywork can be very effective in easing the pressure and pain on the cervical spine. It involves light touching that helps to balance the cranial-sacral system and is often used in alleviating back pain.

4. Swedish Massage – Traditional Swedish massage can be very effective in the reduction of pain caused by spinal stenosis. Depending on the severity of the stenosis, massage can range anywhere from light effleurage to deep cross friction techniques. Care must be taken to avoid joints that may be inflamed, because the surrounding muscles tend to splint against any painful movement and interference with this splinting could worsen the symptoms.

Before proceeding with any alternative treatment for spinal stenosis, an accurate diagnosis is essential and thorough knowledge of the condition is required to avoid any injury to the vertebrae or spinal cord, which in some case can be quite fragile. For massage therapists and other bodyworkers, being educated in the pathology of stenosis and its related complications such as spondylosis is important in both being able to alleviate the pain as well as avoiding any possible problems.

Recommended Study:
Cranial-Sacral Fundamentals
Shiatsu Anma Therapy
Swedish Massage For Professionals

References:

Alexander, Dale G.. "The Progression of Cervical Stenosis Toward Spondyllotic Myelopathy." Massage Today July 2008: 10-20.

"Cervical Stenosis and Myelopathy." Cervical Stenosis and Myelopathy/Neck and Arm Pain/Spine Problems. 2004. NYU Medical Center. 22 Jul 2008 .

Mummaneni, MD, Praveen V., Spinasanta, Susan. "Non-Surgical Treatment of Spondylosis (Spinal Artahritis)." 27 February 2008. spineuniverse. 22 Jul 2008 .

Regan, MD, John J.. "Spondylosis: or Spinal Arthritis." 15 February 2008. spineuniverse. 22 Jul 2008 .

Werner, Ruth. A Massage Therapist's Guide to Pathology. 2nd. Philadelphia: Lippincott, Williams & Wilkins, 2002.

by Nicole Cutler, L.Ac.

One of the most common injuries to the lower extremities, a hamstring pull is more than likely to be encountered in a massage therapist’s practice. Since today’s medical climate often makes it easier for most people to schedule an appointment with a massage therapist than with an orthopedist, there is an increased need for bodyworkers to have the skills for evaluating common injuries. When massage therapists can assess the origin of a client’s pain, they are better prepared to formulate an effective massage plan.

Anatomy
The group of muscles located on the posterior side of the upper thigh, the hamstring muscles consists of the:

1. Semimembranosus
2. Semitendinosus
3. Biceps femoris

While the hamstring muscles all originate from the ischial tuberosity of the pelvis, the biceps femoris has a second portion that originates from the lower outer portion of the femur bone itself. The hamstrings primary function is to extend the hip and flex the knee.

Pathology
Hamstring strain could result from any activity, but is caused most often by those involving sprinting, due to the high force loads on the hamstrings. The hamstrings are particularly susceptible to strain injury because of their structure and function.

Otherwise known as a hamstring strain, a pulled hamstring is a tear in one or more of the hamstring muscles. A common source of injury and chronic pain in athletes, injuries to the hamstring muscles primarily occur proximally and laterally – usually involving the biceps femoris. Symptoms of a pulled hamstring generally include:

· A sudden sharp pain at the back of the leg during exercise.
· Spasms of the hamstring muscles usually associated with pain on stretch and contraction.
· Swelling and bruising.
· If the rupture is severe, a gap in the muscle may be felt.
· Due to the tensile loads on the muscle-tendon unit, it is common for the person to report hearing a loud pop or snap when the injury occurred.

Severity
The severity of injury to the hamstring muscles is classified according to the following three grades:

· Grade 1 – is a mild strain with a few torn muscle fibers. This injury is likely accompanied by tightness in the posterior thigh, some discomfort and minimal swelling. Lying prone and trying to bend the knee against resistance likely will not illicit much pain.

· Grade 2 – is a moderate strain accompanied by a definite loss in strength. This more severe injury often disrupts the gait, is associated with sudden twinges of pain upon activity and is painful with applied pressure. Flexing the knee against resistance will cause pain and the client may not be able to fully straighten his/her knee.

· Grade 3 – is a complete tear of the hamstrings. This most severe of hamstring injuries will definitely affect a person’s ability to walk, causes immediate and noticeable swelling and is associated with severe pain – especially during knee flexion. Severe third-degree strains may involve an avulsion fracture, where the tendon is torn away from its attachment pulling a small chunk of bone with it. Regardless of the possibility of an avulsion fracture, a suspected third-degree sprain should be referred to a physician.

Differentiation
According to Ben Benjamin, Ph.D., a hamstring strain may be confused with a low back injury if pain is referred to the lower buttock. Benjamin advises orthopedic testing to differentiate between these two types of injuries. Since resisted flexion of the knee at 90 degrees places the greatest stress on the upper hamstring tendon, it will cause pain if that structure is injured.

Additionally, Benjamin suggests differentiating between these two injuries by palpating the hamstrings on both the right and left sides. If the hamstring on the painful side is more tender, you can conclude that muscle is contributing to the pain. If not, you know the pain is being referred from another location.

Since massage therapists are often recruited for pain relief prior to other medical professionals, the skills to evaluate this common injury are crucial. Therapists who can identify a hamstring strain and determine its severity can better administer massage that will deliver safe, targeted, pain relief.

Recommended Study:
Advanced Anatomy and Physiology
Anatomy Review for Professionals
Sports Massage

References:

Benjamin, Ben, PhD, Upper Hamstring Pain, Massage Today, April 2007.

Lowe, Whitney, Assess & Address: Hamstring Strain, Massage Today, May/June 2005.

www.emedicine.com, Hamstring Injury, Herman Brad Ruiz, MD, WebMD, 2008.

www.sportsinjuryclinic.net, Pulled Hamstring/Hamstring Strain, Sports Injury Clinic, 2008.

by Nicole Cutler, L.Ac.

Whether it is fueled by the media, America’s involvement in two overseas wars or some other reason, those with aggressive children have a lot to be concerned about. Memories of Columbine and news stories of adolescent violence encourage parents toward swift intervention if their kids display aggressive behavior. While it is not condoned as a replacement for psychotherapy or other medical assistance, massage therapy is gaining recognition for its value in helping reduce aggression in affected youths.

Two Violence Breeding Grounds
Although there is likely a combination of reasons explaining why some children have problems with aggression, two culprits have recently been confirmed in respected professional journals: violent video games and children of deployed military soldiers.

Trailing behind television, video gaming is the second largest segment of the entertainment industry. In today’s booming video game market, eighty percent of the most popular games feature aggressiveness or violence as their primary themes. According to AskDrSears.com, one in four American boys plays an extremely violent video game each day. Unfortunately, the sales of extremely violent games are climbing.

A study published in the November 2008 issue of Pediatrics revealed important information about the effect violent video games have on children. After assessing American and Japanese children’s video game habits and their level of physical aggression against each other, the researchers concluded that exposure to violent video games was a causal risk factor for aggression and violence in those children.

Also appearing in a November 2008 publication, another study investigating childhood aggression appeared in the Archives of Pediatrics & Adolescent Medicine. While it is known that deployment stresses a soldier’s family, further investigation revealed the impact on preschoolers of having a parent away at war. The researchers concluded that children between the ages of 3 and 5 with a deployed parent are more likely to show aggression than other young children in military families.

An Escalating Problem
Physical aggression in children is a major public health problem. In addition to the physical and mental effects on the aggressor’s victims, aggressive children are at higher risk of alcohol and drug abuse, accidents, violent crimes, depression, suicide attempts, spousal abuse and neglectful or abusive parenting.

Experts in the field believe that humans learn to regulate their use of physical aggression during the preschool years. Those who do not learn this regulation are at the highest risk of serious violent behavior during adolescence and adulthood. Thus, parents are advised to pursue therapeutic intervention for young children who are already demonstrating aggressive behavior or who are at high risk for aggressive behavior before physical aggression becomes a way of life.

Massage Therapy to Reduce Aggression
Depending on the cause, the degree of aggression, the person’s age, resources and healthcare coverage, there are many approaches for dealing with aggressive behavior. While it comes as no surprise to many learned bodyworkers, a convincing body of evidence is demonstrating that daily massage therapy sessions can reduce aggression in children:

· In the September 2008 edition of Acta Paediatrica, Swedish researchers found that five to ten minutes of massage each day is an easy and inexpensive way to decrease aggression among preschool children.

· In the May 2008 edition of The Australian and New Zealand Journal of Psychiatry, researchers observed that massage therapy could immediately reduce anxiety and, thus, is a useful tool to deescalate aggressive situations in a psychiatric setting.

· In the Fall 2002 edition of Adolescence, a study compared the effects of massage vs. relaxation in aggressive adolescents. While those in the relaxation group experienced few benefits, the adolescents receiving massage had markedly reduced anxiety and hostility and were perceived by their parents as being less aggressive after the five-week study.

The recently published study from Sweden proving that massage reduces aggression in preschoolers opened up a huge market for bodyworkers. Considering the popularity of violent video games and the thousands of American children with a parent away at war, there are more children than ever that could benefit from regularly applied massage therapy.

References:

http://www.ajc.com/metro/content/printedition/2008/11/04/milfamilies.html, Aggression shows in kids of deployed, Carla K. Johnson, Retrieved November 16, 2008, The Atlanta-Journal Constitution, November 2008.

http://www.askdrsears.com/html/10/T101200.asp, Video Violence is Coming to a Screen Near You, Retrieved November 16, 2008, AskDr.Sears.com, 2008.

http://www.ncbi.nlm.nih.gov/pubmed/12458696?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum, Aggressive adolescents benefit from massage therapy, Diego MA, et al, Retrieved November 14, 2008, Adolescence, Fall 2002.

http://www.ncbi.nlm.nih.gov/pubmed/12564826?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum, Violence and touch deprivation in adolescents, Field, T., Retrieved November 14, 2008, Adolescence, Winter 2002.

http://www.ncbi.nlm.nih.gov/pubmed/15231972?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed, Physical aggression during early childhood: trajectories and predictors, Tremblay RE, et al, Retrieved November 14, 2008, Pediatrics, July 2004.

http://www.ncbi.nlm.nih.gov/pubmed/18478478?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum, Pilot study evaluating the effect of massage therapy on stress, anxiety and aggression in a young adult psychiatric inpatient unit, Garner B, et al, Retrieved November 14, 2008, The Australian and New Zealand Journal of Psychiatry, May 2008.

http://www.ncbi.nlm.nih.gov/pubmed/18782279, Massage decreases aggression in preschool children: a long-term study, von Knorring AL, et al, Retrieved November 14, 2008, Acta Paediatrica, September 2008.

http://www.sciencedaily.com/releases/2008/11/081103180252.htm, Violent Video Game Feed Aggression In Kids In Japan And U.S., Retrieved November 16, 2008, ScienceDaily LLC, November 2008.

by Nicole Cutler, L.Ac.

Whether years of easy credit, a highly inflated real estate market, faulty economic policies or banking institutions devoid of capital are to blame, our current financial crisis affects everyone. Even if you don't depend on investments, lines of credit or banks for sustenance, the domino effect of what has been likened to the greatest economic recession since the Great Depression will eventually impact all healthcare professionals, including massage therapists. Recognizing how this dramatic change in our economy will affect consumers and businesses will get you thinking about plans for safeguarding your career.

Published in the November 2008 edition of Massage Today, Ralph Stevens, B.S., LMT, NCTMB gives us some insight into the big financial picture in his article Economic Crisis: Be Aware: Get Prepared. As Stevens describes, "Many businesses and industries have run aground because they had the wrong perception of their place and purpose in the market, especially during times of economic change and crisis. For example, at one time railroad companies thought they were in the railroad business. They didn't realize until it was almost too late that they were really in the transportation business. Once they adapted to that larger paradigm, the ones that survived did much better.

In the example Stevens lays out, the way to outsmart a seemingly dismal trend is to figure out what the consumer is looking for. When it comes to the railroad business, people were not particular about riding a train - they just wanted the best deal for getting where they wanted to go. By transposing this perspective on the massage therapy profession, it appears that people will not be particular about receiving massage - as long as they get the best deal for their desired wellness objective.

For all but the wealthiest families, finding the least expensive option for health and wellness will become increasingly common. In times of financial stress, a preferred modality for health maintenance or prevention emerges as less critical than its effect. Thus, choosing massage therapy, acupuncture, chiropractic, reiki or nutritional support for achieving a goal will depend on the bottom line - which therapy delivers results for the least amount of money. Hence, the most cost-effective therapies will dominate complementary and alternative healthcare.

If you can demonstrate that massage's expense will save your clients money in the long run, your position in a consumer's budget moves from luxury to prudent buy. Prior to the explosion of massage therapy studies proving the therapeutic applicability of bodywork, massage was often considered a luxury. Unfortunately, those who have not kept up with recently published research may not be aware of massage's medical value. Because luxuries are first to be axed out of a strained budget, relaxation-based massage sessions may be considered an excessive expenditure of cash for those who don't know about its potential influence on their health. However, massage therapists who educate people on the value of their work and promote the cost-effectiveness of their treatments will benefit most from today's financial crunching.

Sparing those covered by a few honorable insurance companies, most American consumers bear the entire cost of complementary therapies out-of-pocket. Even though massage therapy makes an ideal candidate for cost savings due to its avoidance of high technology and reliance on the body's natural ability to heal itself, there is little conclusive evidence demonstrating its cost-effectiveness over traditional medical approaches. However, there are a couple of exceptions.

1. Post-surgery - Published in the May/June 2007 edition of Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, a study of cardiac surgery patients found that massage therapy improved client's mobility post-surgery by:

· decreasing pain
· reducing stress
· increasing overall sense of well-being

The authors concluded that massage therapy was cost-effective due to the consequences of increased mobility - namely by enhancing the patient's motivation to get well, which sped up the patient's safe dismissal from the hospital. Although the application of this study first appears narrow, it can open up many opportunities for promoting massage therapy's cost-effectiveness by reducing reliance on expensive Western medical treatments or facilities.

2. Back pain - Published in the June 2003 edition of the Annals of Internal Medicine, researchers evaluated the effectiveness, safety and costs of the most popular complementary and alternative medical therapies used to treat back pain. Although categorized as just a preliminary conclusion, the investigating team found that massage therapy, but not acupuncture or spinal manipulation, was able to reduce the cost of care after only one therapeutic session. This information is extremely valuable to those suffering with back pain. Since one or several massages could help back pain just as much or more than a full, costly series of a different modality, consumers are likely to recognize massage therapy as the more affordable choice.

With so much uncertainty and fear about the economy, it's easy to panic that your regulars might become less regular and that new clients will be harder to find. However, by understanding why your services would become even more attractive during this global financial hardship, you can begin your campaign to educate consumers and businesses. Once people understand that massage therapy will reduce their overall health expenditures, your services are sure to be a priority in an increasing number of household and corporate budgets.

Earn continuing education credit for this article contained in our Marketing Massage and the Economy series. Click here to enroll.

Recommended Study:
Developing a Wellness Center

References:

http://www.annals.org/cgi/content/abstract/138/11/898, A Review of the Evidence for the Effectiveness, Safety, and Cost of Acupuncture, Massage Therapy, and Spinal Manipulation for Back Pain, Daniel C. Cherkin, PhD, et al, Retrieved October 29, 2008, Annals of Internal Medicine, June 2003.

http://www.massagetoday.com/mpacms/mt/article.php?id=13886, Economic Crisis: Be Aware, Get Prepared, Ralph Stephens, BS, LMT, NCTMB, Retrieved October 29, 2008, Massage Today, November 2008.

http://www.nursingcenter.com/prodev/ce_article.asp?tid=719639, Massage Therapy: A Comfort Intervention for Cardiac Surgery Patients, Patrica G. Anderson, MS, RN, et al, Retrieved October 29, 2008, Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, May/June 2007.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1182346, Is complementary and alternative medicine (CAM) cost-effective? a systematic review, Patricia M Herman, et al, Retrieved October 29, 2008, BMC Complementary and Alternative Medicine, June 2005.

by Nicole Cutler, L.Ac.

Every fall, the flu’s appearance seems to coincide perfectly with the decline in air temperature. As professionals who are in close contact with their clients, this change in season should prompt massage therapists to be especially concerned about influenza protection. By thinking about the flu’s transmission from various angles, massage therapists can play a role in diminishing the damage from this highly contagious and potentially dangerous virus.

About the Flu
Commonly referred to as the flu, influenza is a viral infection of the respiratory tract. With type A flu being the most aggressive virus carrying the highest risk of significant complications or death, influenza is classified as type A, B or C. Although the flu is not considered to be a significant health issue in the U.S., this illness can cause life-threatening infections for certain populations. Each year, an estimated 5 to 20 percent of Americans get the flu, while about 200,000 people are hospitalized and 36,000 people die from influenza complications. Those at the most risk for flu complications include:

· Infants and young children
· Seniors
· Those with underlying lung or immune diseases

Usually transmitted via airborne particles or by hand from contaminated surfaces, the flu is considered to be very infectious. Upon gaining entrance into a new host, the virus targets mucus-producing cells that line the respiratory tract. Once infection has been established, the immune system is responsible for most of the flu’s symptoms such as:

· Respiratory irritation
· Runny nose
· Dry cough
· Headache
· Chills
· High fever
· Body aches
· Joint pain

While flu symptoms usually appear one to three days after exposure to the virus and can persist for up to two weeks, the danger of influenza lies in opportunistic secondary infections. The most common culprits include the development of otitis media, sinus infection, bronchitis or bacterial pneumonia – with the latter being a potentially serious or even life threatening complication.

Tips on How to Reduce the Flu’s Impact
Depending on where you stand, there are several different ways healthcare practitioners can diminish the flu’s impact. Five suggestions include:

1. Vaccine – Once the virus comes your way, the flu shot may increase your immunity against it. There is great controversy around influenza vaccinations, with some claiming it enables them to stay healthy while others insisting that it encourages viral resistance to create more harmful strains. Each year, scientists base the flu vaccine on international surveillance and estimations about which types and strains of viruses will circulate that season. Unfortunately, this vaccination can give someone the flu and it might not target the strain that appears in your area. While receiving the flu shot is a personal decision, the Centers for Disease Control include healthcare workers in their list of who should receive this vaccination.

2. Isolate – If you do come down with the flu, make sure you don’t pass it along. Due to its high level of infectivity, massage therapists should not attempt to work while they are experiencing any influenza symptoms. The best way to prevent transmitting the flu to others is to stay home during your illness.

3. Deny – Don’t work on clients who have flu symptoms. Because the movement created from massage can spread viral particles that had been contained by the immune system, bodywork can give the freed viral particles another chance to find new target cells. Thus, those with the flu who receive circulatory massage are likely to emerge with a more serious infectious than they otherwise have. Additionally, a person recovering from the flu still might be shedding the virus, which increases the likelihood of transmitting their illness to you (the bodyworker) or subsequent clients.

4. Hygiene – Prioritizing your practice’s hygiene protocol can reduce the transmission of all kinds of viruses. Since influenza spreads via airborne droplets, through hand contact with infected secretions and on the surfaces of objects, continual cleaning can reduce the virus’ ability to be passed on. While you can’t cover others mouths when they cough or sneeze, having tissues easily accessible in your office and signage encouraging their use may help. In addition, cleaning door handles several times a day during flu season and washing your hands before and after each client, and after using the restroom is crucial for infection control. For detailed information on hand washing, read Pristine Hygiene for Your Practice.

5. Stay Strong – Reducing stress levels, eating a varied and nutritious diet, sleeping well and exercising regularly all contribute to keeping your immune system strong. The stronger your immune system is, the less likely you are to be a conduit for catching and passing along the flu. For more tips on keeping you and your practice healthy, read Protection from Autumn’s Viruses.

Whether getting the flu shot, calling in sick from work, denying treatments to sick clients, practicing astute infection control or focusing on keeping your immune system strong, massage therapists can participate in preventing the latest influenza virus from affecting themselves and their clients.

Recommended Study:
Advanced Anatomy and Pathology
Infectious Disease: Hepatitis

References:

http://www.cdc.gov/flu/protect/keyfacts.htm, Key Facts About Seasonal Flu Vaccine, Retrieved October 15, 2008, US Centers for Disease Control and Prevention, 2008.

http://www.healthcentral.com/chronic-pain/c/5949/43567/flu-shot/, Should You Get a Flu Shot?, Karen Lee Richards, Retrieved October 13, 2008, The HealthCentral Network, Inc., October 5, 2008.

http://www.massagetherapypractice.com/Text/1194100764312-5093/pC/1164930017769-4776/, Influenza Knowledge and Preparedness for Massage Therapists, Doug Alexander, BSc, RMT, Retrieved October 13, 2008, massagetherapypractice.com, 2008.

http://www.massagetoday.com/mpacms/mt/article.php?id=13322, Avian Flu: How Threatening Is It?, Ruth Werner, LMP, NCTMB, Retrieved October 13, 2008, Massage Today, November 2005.

by Nicole Cutler, L.Ac.

More massage therapists than ever are embracing additional complementary approaches for healing. Likely a result of the increasing popularity of massage therapy and, thus, the greater demand for highly trained practitioners, cupping has sparked interest in many massage therapy practices. While there isn’t an abundance of scientific evidence proving cupping’s effectiveness, its ability to promote circulation is well-known to practitioners of Traditional Chinese Medicine (TCM). Bodyworkers wanting to learn more about the tradition of cupping can experiment with the massage cupping techniques described below.

For a basic understanding of what cupping is, its general variations and the theories supporting its use, read TCM Cupping and Massage: Part I.

Cupping Massage Techniques
Being familiar with several massage cupping techniques can help a bodyworker confidently include cupping in his/her range of services. Below are ten suggestions for effective massage cupping:

1. The level of suction for running cupping should be gentler than that used for stationary cupping.

2. Prior to applying cups for running cupping, administer plenty of oil to the area being cupped to facilitate smooth cup movement.

3. When moving the cups, the movement should be smooth without the practitioner applying downward pressure, because that would inhibit the suction effect.

4. The broad area of the back is one of the best surfaces for running cupping. The back can generally accommodate the larger cups.

5. Imitating a long stroke with the cups can help drain fluid accumulation.

6. Circular movements with a cup over a specific area can help release stubborn knots, adhesions and other types of rigid tissue.

7. Applying a diluted essential oil to the skin immediately following running cupping will facilitate its absorption into the tissue.

8. Long strokes along the ribs can improve ribcage expansion and benefit deep breathing.

9. Vigorous circling with the cups on the gluteus maximus can help ease certain types of sciatica.

10. Strong stationary cupping on the Lung Back Shu points can help relieve chest congestion, coughing and asthma.

Evidence
Although the clinical support endorsing massage cupping is sparse, centuries of successful case studies have perpetuated its use. Since cupping falls under the umbrella of Traditional Chinese Medicine, most of the research on this modality has been conducted within a TCM setting.

The variation known as wet-cupping has dominated a majority of cupping’s research, and wet-cupping does not fall under a massage therapist’s scope of practice. Wet-cupping is when the skin is pricked with a lancet, then covered with a cup to draw out the stagnant blood. Bypassing the research on wet-cupping, a couple of clinical trials evaluated massage or stationary cupping in isolation:

1. Chronic Fatigue Syndrome – Chinese researchers observed the therapeutic effect of multiple, stationary cupping at the back-shu points on participants with chronic fatigue syndrome. By comparing their clinical symptoms before and after treatment with either cupping or acupuncture, the researchers found that cupping’s ability to reduce chronic fatigue symptoms far surpassed acupuncture’s effectiveness.

2. Senile Dementia – Researchers evaluated the effect of running cupping (massage cupping) on participants with senile dementia. Running cupping was performed over the spine (the Governing Vessel channel) and along the sides of the spine (the Urinary Bladder channel). The investigators determined that running cupping improved dementia’s symptoms as evidenced by increased measures of bodily strength, memories, feelings and movement.

While these two studies represent just a small percentage of a bodyworker’s clientele, the empirical evidence supporting massage cupping has preserved its practice for centuries.

Using cups to massage the body can be incorporated into most bodywork sessions. By learning about this modality and practicing different running cupping techniques, practitioners can add another layer of therapeutic effectiveness to their treatments.

For information about cupping’s cautions and contraindications, look for the upcoming article, TCM Cupping and Massage: Part III.

Recommended Study:
Aromatherapy Essentials
Shiatsu Anma Therapy

References:
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.

http://www.ncbi.nlm.nih.gov/pubmed/18306448?ordinalpos=31&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum, The efficacy of wet-cupping in the treatment of tension and migraine headache, Ahmadi A, et al, Retrieved October 1, 2008, American Journal of Chinese Medicine, 2008;36(1):37-44.

http://www.ncbi.nlm.nih.gov/pubmed/18630535?ordinalpos=10&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum, Observation on therapeutic effect of multiple cupping at back-shu points on chronic fatigue syndrome, Chen GL, et al, Retrieved October 1, 2008, Zhongguo Zhen Jiu (Chinese Acupuncture and Moxibustion), June 2008.

http://www.siom.edu/resources/class05/brown/sdrc.html, Treatment of Senile Dementia with Running Cupping Along Back Shu Points: 18 Cases, Translated by Jennifer Lynn Brown, Retrieved October 1, 2008, New Journal of Traditional Chinese Medicine, December 1996.

by Linda Fehrs, LMT

As massage therapists, we touch the body to help restore harmony and stay fit. Our clients place their welfare, literally, in our hands. Most come to us relatively healthy, asking us to treat specific aches or help reduce stress, but there are those arriving with untreated and, often unseen, wounds – wounds perhaps inflicted upon them by others, either physical or psychological in nature.

With the military being so much in today’s news, we are becoming more aware of the high incidence of Post Traumatic Stress Disorder (PTSD) in soldiers returning from combat. Distressed by what they see and experience, they may have difficulty readjusting to normal life.

Recent reports indicate that military troops diagnosed with PTSD jumped by approximately 50 percent in 2007. In 2006, 14,000 troops were diagnosed with this disorder, whereas only 1632 were diagnosed in 2003. Within four years the number has now jumped to 40,000 troops. With early treatment, chances for recovery are better, but PTSD symptoms may stay with them for the remainder of their lives.

Not only in the military, PTSD is also seen in victims of child abuse, domestic violence, national disasters and other traumatic events. Some individuals heal from these events and lead a normal life, but there are those who carry the burden of the trauma with them forever. The event is imprinted in their body, hidden and locked away.

Researchers believe that, at least in part, imprinted memories of these traumatic events remain as distant echoes of the experience. PTSD symptoms may surface later when something, even unrelated to the event, triggers a release of the traumatic experience.

What is PTSD?
According to the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association (APA) considers PTSD an anxiety disorder developed after being exposed to, either by direct experience or witnessing, an extreme or overwhelming traumatic event where they felt intense fear, helplessness or horror.

In our anatomy and physiology classes we learn that our nervous systems usually react to threatening situations with a “flight or fight reaction.” But researchers studying PTSD found some people react with a kind of “freeze” reaction instead, feeling helpless and hopeless during the trauma. Unable to either defend themselves or run away they, in effect, play dead, becoming numb to the experience. Though the memories of these experiences fade from everyday thoughts, they remain hidden in the nervous system and muscles where they become deeply imbedded.

Sometime after the initial experience, either almost immediately or in some cases much later, the person shows signs of PTSD, including hyper-vigilance, avoidant behavior and intrusive thoughts. These affect their everyday lives and those of their families, friends and co-workers. They may become depressed for prolonged periods, abuse drugs or alcohol, have obsessive/compulsive behaviors, anxiety attacks, flashbacks or simply withdraw from normal activities.

Bodywork and PTSD
People want massage for a variety of reasons, but you will not usually hear “I want massage for PTSD.” They may not even be aware of it and instead come for a variety of other reasons such as stress, anxiety, having chronic pain or simply someone gave them a gift certificate.

You then proceed with a full-body Swedish massage, only to find they don’t relax into it, but remain tense and alert, or completely dissociate from the experience. They may cry or have some other unexpected reaction. Even a thorough intake may not alert you that this person experienced a traumatic event that wounded not only their mind and spirit, but their body as well.

Even if the event doesn’t directly involve the body, it remembers, on a visceral level, what the mind experienced. In working with the body, we can help heal those wounds. Working in conjunction with physicians and psychiatric professionals specializing in PTSD, massage therapists can help them be comfortable in their body, to learn to relax and be in the present moment.

A Treatment Plan
If PTSD has been diagnosed, you can develop a plan of treatment that slowly introduces non-intrusive bodywork and leaves them feeling less vulnerable

Chair massage is an easy way to establish trust between the massage therapist and the PTSD client with the person clothed, and sitting, not lying down. A chair massage can be as complete and relaxing a massage as one on the massage table. Initial sessions might be 15 minutes and over a period of time increase to 30 or 45 minutes.

Later you might introduce Shiatsu, bringing the bodywork from a sitting position, to one of lying on the floor, still fully clothed. Encourage the client to wear something loose and comfortable, such as a sweat suit or yoga attire to allow for stretches during the session.

Your sessions may never go beyond this phase, or might graduate into work done on the massage table such as cranial sacral work or polarity therapy, both of which can be done while the client is clothed. These techniques are non-intrusive and help re-harmonize the energies and rhythms of the person’s body. They may also help reinforce work done with other medical professionals.

Lifelong Recovery
Massage therapy doesn’t cure PTSD. Nothing cures it completely; sufferers merely learn how to live with it. But studies show that massage does improve associated symptoms such as chronic pain, immune system deficiencies and stress. PTSD sufferers have also been found to have elevated levels of cortisol, which leads to cognitive impairment, poor glucose management and lowered immune response, as well as interruption of homeostasis. Massage helps reduce cortisol blood levels, according to studies by the Touch Research Institute, and so lessens the damaging effects.

PTSD is not new, only newly defined and reexamined. It has been around, using different terms, for a very long time. It is a disorder with no hard and fast rules. For many it is a lifelong problem. Compassion, understanding and patience are a massage therapist’s most valuable tools in helping to assist the healing of their internal wounds.

Recommended Study:
Advanced Anatomy and Physiology
Chair Massage
Cranial Sacral Fundamentals
Ethical Case Management
Polarity Therapy
Shiatsu Anma Therapy

Resources:

Cutler, Nicole, L.Ac., The Therapeutic Relationship in Post Traumatic Stress Disorder, Institute for Integrative Healthcare, July 21, 2005.

Dryden, Trish, M.ED., RMT, and Fitch, Pamela, B.A., RMT, Recovering Body and Soul from PTSD, Massage Therapy Journal, Issue W107, American Massage Therapy Association, www.amtamassage.org.

Jelinek, Pauline, Number of Troops With PTSD Up 50 Percent, Associated Press, Washington, D.C., May 28, 2008, www.ap.org.

Levine, Peter A., Ph.D. Waking the Tiger: Healing Trauma, North Atlantic Books, 1997, www.northatlanticbooks.com.

Matsatsakis, Aphrodite, Ph.D., I Can’t Get Over It: A Handbook for Trauma Survivors, 2nd ed., New Harbinger Publications, Inc, 1996, www.newharbinger.com.

Scaer, Robert, M.D. The Trauma Spectrum: Hidden Wounds and Human Resiliency, W.W. Norton, 2005, www.wwnorton.com.

Touch Research Institute, Movement and Massage Therapy Reduce Fibromyalgic Pain, Journal of Bodywork and Movement Therapies, Vol. 7, Issue 1, Jan. 2003, pgs 49-52

Fact Sheet - What is PTSD?, U.S. Department of Veterans Affairs,2008, www.va.gov.

Working With Trauma Survivors: What Workers Need to Know, National Center for PTSD Research, 2008, www.ncptsd.org.