Massage Professionals Article Archive

by Nicole Cutler, L.Ac.

Because one quarter of all Americans have it, massage therapists should have a plan of action when encountering hypertension. Some practitioners automatically assume that the work they do will have an overall positive effect on cardiovascular health. However, this is not always the case. Because some techniques with a specific therapeutic application can cause blood pressure to temporarily rise, massage therapists must be cognizant to avoid these approaches on hypertensive clients.

About Hypertension
Otherwise known as high blood pressure, hypertension affects approximately 50 million Americans. Blood pressure is the force of the blood pushing against the walls of the arteries. A blood pressure reading is composed of two numbers:

· Systolic – Better known as the top number of a blood pressure reading, the systolic pressure describes the maximum pressure that occurs with each contraction of the heart.

· Diastolic – Also known as the bottom number of a blood pressure reading, the diastolic pressure describes the lowest pressure that occurs when the heart rests in between beats.

While there is some debate about the exact numbers that indicate hypertension, it is generally understood to be an average systolic blood pressure above 140 mm Hg, a diastolic blood pressure above 90 mm Hg, or both. While hypertension alone does not have many symptoms, it dramatically increases the risk of heart disease and stroke – the first and third most common causes of death among Americans.

Causes of Hypertension
There are many contributing causes of high blood pressure. There are two major types of hypertension: essential (primary) and secondary. Essential hypertension is by far the most common, accounting for more than 95 percent of all cases. While secondary hypertension is generally caused by an internal disease or substance abuse, essential hypertension is suspected to be due to a combination of the following:

· Genetics
· Low nitric oxide levels (a naturally occurring agent responsible for the dilation of blood vessels)
· Insulin resistance
· Obesity

Reducing Hypertension
Lifestyle modifications are a critical component to lowering blood pressure, and are always indicated regardless of the need for prescription medication. In addition to regular exercise, maintaining a desirable weight, reducing sodium intake, increasing fruit and vegetable consumption, stopping smoking and minimizing alcohol, massage therapy is a valuable tool for reducing high blood pressure.

Interestingly, researchers have found that some modalities are effective at reducing the pressure inside the artery’s walls, while others increase that pressure. The techniques regarded as good blood pressure reducers include:

1. Swedish Massage – Published in the January 2006 edition of The Journal of Alternative and Complementary Medicine, American researchers looked at the effects of different types of massage on blood pressure. They found that Swedish massage had the greatest effect on blood pressure reduction.

2. Cranial-Sacral Therapy – While not confirmed in a randomized study, advocates of cranial-sacral therapy tout its ability to lower blood pressure. According to the London-based integrated medical physician Dr. Andrew Logan, advanced cranial-sacral therapy can ease hypertension by relaxing the sub-clavian and femoral arteries.

3. Aromatherapy – A study published in a Korean medical journal in December 2006 evaluated the effects of an aromatherapy blend on blood pressure. The researchers found that inhaling blends of lavender, ylang ylang and bergamot once daily for four weeks reduced the blood pressure of those with hypertension.

Raising Blood Pressure
There are many ways to raise blood pressure – including being stressed out, drinking lots of caffeine, taking pseudoephedrine or steroids or receiving a painful type of bodywork. The January 2006 study that found Swedish massage to be most effective at lowering blood pressure also found that certain modalities increased blood pressure.

More specifically, the researchers determined trigger point therapy and sports massage both capable of increasing the systolic blood pressure. Recipients who received both types of massage within one session had both their systolic and diastolic blood pressure readings significantly increased. Since the conclusion was made that potentially painful massage techniques can result in a blood pressure increase, practitioners can assume that other aggressive therapies such as friction massage or Rolfing have the potential to exacerbate hypertension.

The goal in treating hypertension is to reduce the risk of serious complications, including heart disease and stroke. Although massage therapy is not a standalone treatment for high blood pressure, choosing the right bodywork modality can help reduce hypertension’s associated risks. For clients with high blood pressure, avoid techniques that could be painful. Instead, rely on Swedish massage, cranial-sacral therapy and aromatherapy to give your clients’ blood vessels a respite from the pathological pressure they routinely endure.

Editor’s Note: For more information about massage safety with hypertension, read Hypertension: Massage Indication or Contraindication?

Recommended Study:
Advanced Anatomy and Pathology
Aromatherapy Essentials
Cranial-Sacral Fundamentals
Swedish Massage for Professionals

References:

http://www.integrative-healthcare.org/mt/archives/2007/01/hypertension_ma.html, Hypertension: Massage Indication or Contraindication?, Nicole Cutler, L.Ac., Retrieved December 7, 2008, Natural Wellness, January 2007.

http://www.liebertonline.com/doi/abs/10.1089/acm.2006.12.65, Changes in Blood Pressure After Various Forms of Therapeutic Massage: A Preliminary Study, Jerrilyn A. Cambron, et al, Retrieved December 7, 2008, The Journal of Alternative and Complementary Medicine, January 2006.

http://www.ncbi.nlm.nih.gov/pubmed/16267371?ordinalpos=7&itool=EntrezSystem2
.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum, The effect of therapeutic back massage in hypertensive persons: a preliminary study, Olney CM, Retrieved December 7, 2008, Biological Research for Nursing, October 2005.

http://www.ncbi.nlm.nih.gov/sites/entrez, The effects of the inhalation method using essential oils on blood pressure and stress responses of clients with essential hypertension, Hwang, JH, Retrieved December 7, 2008, Taehan Kanhoe Hakhoe Chi, December 2006.

http://www.umm.edu/altmed/articles/hypertension-000087.htm, Hypertension, Retrieved December 7, 2008, University of Maryland Medical Center, 2008.

by Linda Fehrs, LMT

When we come into this world we are, for the most part, touched, held and coddled by family and friends. Everyone loves a baby and wants to be a part of this new life. At the end stages of life it is more likely that there are few eager to embrace a fragile body or address a weakening soul. Often the elderly and frail are all but shunned at a time when they should be most included in our lives. They are by some accounts the most “under touched” of our society.

As a massage therapist you are trained to provide what an elder or frail individual may need the most. While others may provide meals and other physical comforts, you can offer the essential gift of compassionate and healing touch.

The first of the baby boomers (those born between 1946 and 1964) are beginning to hit their 60s, an age when they will be officially classified as senior citizens. And it seems that for the most part they are a hale and hearty bunch. Brought up in a world of eclectic approaches to health, accepting as normal the practices of yoga, meditation, therapeutic massage and the consumption of organically grown foods, they benefit from advanced medical technology as well as many modern conveniences that make life easier. They are also the first generation to be brought up in a culture providing them with highly processed prepackaged foods, toxic air, water pollutants and the stress of high expectations.

8 Medical Issues and Massage Implications
Those born earlier, in the 1920s – 1950s, are living longer which, when combined with baby boomers, means the field of geriatric massage will only increase proportionately to this growing population. While serving this segment of the community might at times be challenging, it can be very rewarding. If you are focused on a geriatric population in your practice, you may have a large age range of clients, which means a need to be knowledgeable about a wide spectrum of medical issues.

There are some specific issues you may have to deal with in an aging client population. Here are eight examples of issues you may encounter along with ways you can make the massage session easier for both of you:

1. Hearing / Vision Loss – Allow more time for intake. A person with hearing or vision problems may take longer to fill out your forms. You may want to offer a large print format or suggest the intake be conducted in an interview style, which would lessen the chances of mistakes or misinterpretation of information.

2. Less Mobility / Agility – Make sure your office is handicapped accessible and, if needed, provide some sort of a sturdy step up to the massage table as well as a helping hand. If mobility is a major problem you can offer seated massage rather than one on your table.

3. Medications – Become familiar with common medications such as those used for high or low blood pressure, blood thinners, cancer treatments, heart problems and psychiatric problems. The absorption rates and side effects of many medications are affected by massage and, if not taken into consideration, can lead to dizziness, nausea, increased lethargy and/or bruising. Pain medications may make your clients less sensitive to touch or unable to give accurate feedback regarding appropriate pressure during a massage. Check with the primary physician if you are unsure about any medications your client may be taking.

4. Past Surgeries and Injuries – As one grows older they most likely have had some serious injuries or surgeries, such as joint replacement. Often, special bolstering or positioning is important for the client’s comfort and safety.

5. Common Diseases – During intake, make note of ailments like Crohn’s disease and diabetes, bronchial problems like asthma or chronic obstructive pulmonary disorder (COPD) and cancer. Be alert to these and other common conditions, as they will most likely affect how the massage is conducted.

6. Chronic Conditions – Gastrointestinal problems are common. As we get older our digestive tract often becomes less effective. The intestinal and abdominal musculature weakens and nutrients are absorbed less efficiently. Problems can vary from mal-absorption disorders, to diarrhea and constipation. Incontinence may be a concern because of kidney or urinary bladder deficiencies. Other organs slow down and become less productive. Still more problems may arise with the removal of dysfunctional organs like the gallbladder or spleen.

7. Skin Ulcers (commonly known as bedsores) – Skin ulcers are common among those who are forced to remain immobile for long periods of time. This can be easily avoided by moving the client to new positions regularly and by massage.

8. Psychiatric Problems – Various forms or dementia, such as Alzheimer’s disease can make giving a massage challenging. Depending on the severity and stage of the illness, clients may not comprehend what is happening and patience is needed to help them understand. Other clients may suffer from depression or anxiety, in which case a massage may help them to relax and feel more in control of their lives.

Offering Comfort and Influencing Health
The older one gets, the more things start to break down. The skin becomes thin and fragile, muscle tone and mass decrease and bones become more brittle. These are things to take into consideration when dealing with the elders in a massage setting. Whether it is providing them with a soft fleece pad to lie on while receiving a massage, an extra blanket for warmth or simply comforting them with friendly conversation, massage therapists can offer a welcoming and healthy atmosphere.

If a person is frail or ill, other than being poked and probed for medical care, they are often deprived of the very essential basic touch. Other family members are on the go, busy with their everyday lives. Their spouse may have died or be incapacitated. Children and grandchildren have moved away and old friends may be too ill to visit. There is often no one close to have warm, intimate or friendly physical contact with. Whether remaining at home or living in a facility, seniors can become socially isolated, depressed and lonely.

Some may be healthy and strong at 90, others may be frail and sickly at 50 and seem more “senior” than their elders. Active seniors may be healthy enough to come to your office for a massage, but in many cases you will find you must visit their home, hospital, assisted living facility or even hospice. No matter what the location, you may find that you need to provide some special accommodations to assure comfort and safety.

This emergent senior population will have a huge impact on our healthcare system, and massage therapists can have an equally large impact on influencing their health.

Recommended Study:
Advanced Anatomy and Pathology
Pharmacology for Massage

References:

Nelson, MFA, CMT, Dawn. Compassionate Touch: Hands-On Caregiving for the Elderly, the Ill and the Dying. Barrytown, New York: Station Hill Press, Inc., 1994.

Nelson, Dawn. From the Heart Through the Hands: The Power of Touch in Caregiving. Forres, Scotland: Findhorn Press, 2001.

Rose, Mary Kathleen. “Comfort Touch: Nurturing Acupressure Massage for the Elderly and Ill.” December/January 2004. Associated Bodywork and Massage Professionals. 14 Oct 2008 www.massagetherapy.com.

Wible, RN, BSN, Jean. Pharmacology for Massage Therapists. Baltimore, Maryland: Lippincott Williams & Wilkins, 2005.

by Nicole Cutler, L.Ac.

One of the unfortunate consequences of winter is sacrificing the quality of the air we regularly breathe. In order to be comfortable during the winter, we use energy to warm the air inside our walls and enforce barriers to keep the cold air out. Despite our good intention to conserve energy and stay warm, winterizing contributes to a stuffy indoor environment.

In order to provide bodywork clients with the best experience possible, therapists can keep their healing space warm while simultaneously improving indoor air quality. Even with all of the windows, doors and cracks sealed to keep out fresh, cold air, there are eleven simple ways to improve your indoor air. After bodyworkers take these extra steps, clients will appreciate their ability to breathe fresh, unpolluted air during their massage session.

Indoor Air
The Environmental Protection Agency (EPA) estimates indoor air pollutant levels to be two to five times higher than pollution levels outdoors. Despite this issue, winter weather prompts home and business owners to tightly seal any cracks that could allow cold drafts to penetrate inside. Unfortunately, insulating a building stops fresh air from entering and raises the concentrations of both allergens and pollutants inside. In wintertime, there are typically more contaminants breathed during a massage session than during months where open windows and doors facilitate a fresh air exchange.

Massage therapy encourages toxins to be released from the body. Breathing toxicity in while the body is expelling poisons almost nullifies the healing effort being made. However, when the air filling a client’s lungs is clean and low in pollutants, their healing potential from a session is increased.

Improving Air Quality
The EPA recommends three basic strategies to improve indoor air quality: source control, ventilation improvements and air purification. By making a concerted effort toward each of these three strategies, you could find yourself and your clients breathing clean, fresh air – even during the winter.

Source Control – Identifying and then minimizing the source of pollution can make a tremendous difference in air quality. Some sources and subsequent solutions include:

1. Dust and dirt – Vacuum, scrub and dust frequently during the winter. Pay extra attention to wet areas where mold might accumulate.

2. Emissions from a heater – Adjust controls to lower emissions and regularly maintain all heating sources.

3. Cleaning agents – Use only non-toxic cleaning agents.

4. Building materials and furnishings – Don’t choose winter as the season to make office improvements with chemical-containing materials. Insulation, carpeting, cabinetry or furniture made of pressed wood and paint all release small amounts of chemicals into the air for a surprisingly long amount of time.

Ventilation Improvements – Enhancing ventilation is an easy and effective way to control poor air quality by funneling polluted air out while bringing fresh air into circulation. Some suggestions for improving ventilation include:

5. Open up – Open windows and doors whenever the weather permits.

6. Circulate – Use a fan to move stagnant air.

7. Vent outside – Make sure your heating sources are adequately vented.

Air Purification – Removing air contaminants is a surefire way to improve air quality. Some approaches for purifying the air include:

8. Diffuse purifying essential oils – Using a diffuser, infuse indoor air with an essential oil containing antibacterial or purification properties. Examples include lemon, grapefruit or tea tree.

9. Air purifier – Air purifiers equipped with HEPA filters do an excellent job of filtering contaminants from the air. Most air purifiers capture particulate matter but do not remove gas and other chemicals. Activated carbon filters are needed to remove gas and chemicals.

10. Replace filters frequently – Whether maintaining your heating source or air purifier, replace or clean the filter often to prevent pollutants from being reissued into the air.

11. Plants – Many plants are known as nature’s air purifiers because they can absorb toxins from the air. Be aware that mold often grows around plants that are watered often, so routinely check for and clean any subsequent mold growth.

We generally take the air we breathe for granted. However, ignoring the quality of our indoor air could impede healing. We are dependent on air and our bodies respond to how clean it is. Especially because massage recipients are encouraged to breathe deeply to accelerate the body’s release of toxicity, bodyworkers must make every effort to reduce indoor air pollution. By minimizing air contaminants, increasing ventilation and purifying the air, therapists can welcome their clients with a clean environment. In addition, these efforts will help clients realize the full potential of their massage – even in the dead of winter.

Recommended Study:
Aromatherapy Essentials

References:

http://ambafrance-do.org/alternative/28674.php, Aromatherapy at Home: Beating the Cold Bug, Francoise Rapp, Retrieved December 4, 2008, ambafrance-do.org, 2008.

http://www.achooallergy.com/indoor-air-quality.asp, Indoor Air Quality in the Winter, Retrieved December 5, 2008, achoo! Allergy & Air Products, Inc., 2008.

http://www.articlealley.com/article_27686_17.html, Winter Air Quality and Your Home, Christopher King, Retrieved December 5, 2008, Article Alley, February 2006.

http://www.auracacia.com/auracacia/aclearn/art_winterar.html, Winter Aromatherapy, Retrieved December 4, 2008, Frontier Natural Products Co-op, 2008.

http://www.auracacia.com/auracacia/aclearn/art_winteroils.html, Winter Oils, Evergreen Blend, Citrus Blend, Meditation, Retrieved December 4, 2008, Frontier Natural Products Co-op, 2008.

http://www.holistic-centre.com/articles/52-Articles/159-quick-tips-on-the-top-10-essential-oils-in-aromatherapy, Quick Tips On The Top 10 Essential Oils In Aromatherapy, Nancy Wellington, Retrieved December 4, 2008, Holistic Centre, 2008.

by Linda Fehrs, LMT

Exercise, fresh air and sunshine – a simple, old-fashioned prescription for good health, and yet we are often too busy to take advantage of this readily available resource which helps to provide us with strong bones and a healthy cardiovascular system.

One of the vital benefits this therapy provides is a sufficient amount of one of the most essential nutrients our body needs – vitamin D. The sun is not the actual source of the vitamin itself, but a necessary means of triggering body mechanisms to generate and synthesize it.

During the winter months you may find that some clients are suffering from higher levels of pain or perhaps they are more tired than usual. Clients, who are normally active and upbeat, seem less so with no obvious cause. Recent studies have shown that increasing levels of vitamin D through increased sun exposure, eating fortified foods or taking supplements can reduce the aches, pains and fatigue people feel this time of year. Asking your clients a few simple questions about their outdoor activity or vitamin supplementation may help in finding a solution – and increase the effectiveness of your massage.

Why Is Vitamin D Important?
In the body, vitamin D regulates calcium and phosphorus levels in the blood by promoting their absorption in the intestines and ultimately the kidneys. This enables normal mineralization of the skeletal system. Vitamin D also has a positive effect on the immune system in part by promoting phagocytosis, anti-tumor activity and immunomodulatory functions. Vitamin D has shown to be of benefit in treating various inflammatory diseases such as rheumatoid arthritis, osteoporosis, some forms of cancer and autoimmune diseases including type I diabetes.

In children, lack of vitamin D can result in rachitis, more commonly known as rickets. Known to cause skeletal malformations, which commonly manifest in the child having bowed legs or spinal deformities, a deficiency in vitamin D can also be responsible for overall muscle weakness, uncontrollable muscle spasms and costochondral swelling.

Adults over 50 are also at greater risk for vitamin D deficiency. According to government standards, most adults require a minimum of 200 IU (International Units) per day. After age 50 that requirement rises to 400 IU, and after 70 increases to 600 IU. Lack of adequate vitamin D in older adults has been linked to osteoporosis, depression, some cancers (including those of the breast, colon, rectum, ovary, kidney, lung and uterus), multiple sclerosis, type I diabetes and, most recently, heart disease. Recent studies have shown that low levels of vitamin D double the chances of someone having a heart attack or stroke. An inadequate supply of vitamin D has also been shown to be responsible as a cause of generalized muscle pain and weakness.

How Can Your Clients Get Enough Vitamin D?
How much vitamin D, or sunshine exposure, a person needs varies depending on several factors. For example those with light skin need less than those with darker skin. People who live further north require more exposure to sunlight than those who live near the equator. Older adults need more than young people, and heavier people need more than those who are thin. It also depends on the season, how much sun block is used and what time of day one goes out into the sunlight. If you are ill, your body may require more vitamin D to help strengthen the immune system.

The best and easiest way to get vitamin D is to go outside and expose yourself to sunlight for at least 15 minutes per day, preferable early in the day before the sun’s rays are too strong. This also means exposure without sunscreen. A sunscreen with a protection factor of 8 will block more than 90% of the UVB rays needed for the body to produce vitamin D. UVB rays do not penetrate glass, so sitting inside, behind a window will not promote vitamin D production either. Clouds, shade and pollution also reduce the amount of UVB rays that reach your skin.

Few foods contain vitamin D. The best natural food source is fish. A tablespoon of cod-liver oil contains more than 300% of the daily requirement, while cooked salmon or mackerel contain about 90%. Egg yolk, liver and some cheeses contain very small amounts, less than 5% of what is recommended. Some processed foods are now fortified with vitamin D, including many dairy products such as milk, cheese and yogurt. Breakfast cereals and fruit juices may also contain added vitamin D.

On the other hand, some people may choose to take vitamin D supplements. For optimal absorption and efficacy it is best to take Vitamin D together with calcium and magnesium.

Precautions
There are certain precautions that need to be observed with regard to taking vitamin D supplements. Vitamin D may interact with or affect absorption of certain medications including corticosteroids such as Prednisone, medications for ulcers, blood thinners, cholesterol lowering drugs, anti-seizure medications and certain antibiotics. Liver and kidney disease may impair the assimilation of vitamin D, as can a number of hereditary disorders.

Too much sun exposure has been shown to be responsible for an increase in malignant melanoma, a potential fatal form of skin cancer. So caution needs to be taken in not staying out in the sun long enough to do damage to the skin. Anywhere from 5 to 30 minutes of sun exposure at least twice a week to the face, arms, legs or back is enough to produce sufficient vitamin D synthesis.

Some people exhibit a hypersensitivity to vitamin D in large doses. With quantities higher than 2000 IU, a person with this sensitivity may exhibit symptoms such as nausea, vomiting, constipation, weakness or weight loss. Exposure to the sun will not cause vitamin D toxicity because the body is able to self-regulate the vitamin’s production.

Help Your Clients Stay Healthy This Winter
As a massage therapist you cannot diagnose illness, nor can you prescribe medications, but you can advise clients on ways to optimize their health.

In our Western culture we often stay inside during the winter. Doing so not only keeps us from staying in harmony with the rhythms of nature, yet can also adversely affect our health. Help your clients stay healthy this winter and suggest they take a walk in the morning before heading off to work, or go outside during their lunch break and sit in the sun. The fresh air will do them good, and they can be assured of getting the ever-vital vitamin D.

References:
Cutler, Nicole, L.Ac. “Caution: Hepatitis C and Vitamin D Deficiency.” Hepatitis Central. October 27,2008. 11 Dec 2008 .

“Dietary Supplement Fact Sheet: Vitamin D.” October 21, 2008. National Institutes of Health – Office of Dietary Supplements. 11 Dec 2008 .

“Mayo Clinic - Vitamin D - Builds Bones and More.” July 14, 2008. Mayo Clinic. 11 Dec 2008 .

Roberts-Grey, Gina. “Winter Rx: More Sunshine.” Heart-Healthy Living. Winter 2008: 28-32.