Massage Professionals Article Archive

by Linda Fehrs, LMT

Perhaps without knowing exactly why, primitive man instinctively used cold to relieve pain and heat to induce relaxation. And evidence shows that thousands of years ago nomadic tribes, whether Native Americans, Scandinavians or Central Asians, used the contrast of heat and cold to maintain their health and vigor. The most familiar to us might be the traditional Nordic sauna where one first steeps in herb-infused steam rising off heated rocks and then plunges into the icy nearby body of water. The icy plunge, though invigorating, is not appropriate for everyone. Many choose to just use the heat, invigorating themselves instead with branches of birch trees.

Physiological Effects
The effectiveness of heat and cold in therapeutic circumstances can be attributed to two basic physical rules. Heat expands, cold contracts. Physiologically this translates into the use of heat as a vasodilator – bringing nutrient rich blood to surface areas – and the use of cold acting as a vasoconstrictor – driving blood to the body’s core – nourishing and protecting the inner organs of the body. Used alone, heat can help to relax aching muscles, while cold reduces inflammation and inhibits pain. Pain reduction happens, in part, because the body’s pain receptors are particularly sensitive to changes in temperature. Cooler temperatures slow the velocity of nerve transmission, while heat tends to increase the velocity.

Variations in heat and cold also have a physiological effect on the body’s pain gate mechanism. In very simple terms, the brain is momentarily distracted away from sending or receiving pain messages through the use of contrasting temperatures.

Methods of Use
Heat and cold, as a therapeutic tool, can be used independently of each other or alternating every few minutes. Used in an alternating mode it is often referred to as contrast therapy, and can be used either locally using hot and cold packs or systemically using contrast baths or steam rooms and cold pools.

Heat and cold can be applied to the body in several ways. Perhaps most commonly is through the use of water or hydrotherapy. Steam baths, ice, wet compresses, immersion baths, hydrocollator heated pads and saunas are the most familiar tools of moist heat and cold. Heating pads and infrared lamps can provide dry heat, while vasocoolant topicals and sprays or sealed ice packs can provide dry cold. Warmed or cooled stones can provide wet or dry, heat or cold, depending on the method used to control the temperature.

Total Immersion vs. Local Use
There are two basic methods using contrast therapy.

1. Total immersion – would be where the person’s whole body is exposed alternately to heat and cold. A prime example of this would be in the use of a hot sauna, followed by a quick dip in to a cold pool of water. In a medical setting this might be done through the use of temperature controlled water-filled tubs and should only be used with proper training.

2. Used locally – contrast therapy has less of a systemic effect and can be useful in the easing of pain, reducing localized inflammation and increasing superficial circulation. With practice, and the understanding of the basic dilation and contraction action provided by the contrast in temperatures, the use of localized contrast therapy can be effective in assisting the body’s own pumping action, both in the superficial portion of the circulatory system and the lymph system.

How Hot, How Cold?
The human body has certain tolerance levels when it comes to temperature extremes. Applying direct heat above 115 degrees to the skin can be damaging, though steam vapors up to 140 degrees can usually be tolerated by a person in good health. A hot bath is considered anywhere from 100 – 115 degrees. A cold bath would be in the range of 40 – 65 degrees. Always make sure to check in with your client, as some people are much more sensitive than others with regard to temperature. Before using heat or cold applications, ask the client to inform you if there is any pain or discomfort associated with the treatment. If there is, the source of heat or cold should be removed immediately.

Precautions
Each person reacts differently to the application of heat and cold:

· A person with diabetic neuropathy, for example, has little or no feeling when it comes to pain and would not be able to give adequate feedback as to temperature.
· A person with heart disease or kidney infection would be adversely affected by the body’s attempt to accommodate the rapidly changing temperatures.
· Contrast therapy should never be used on open wounds or immediately following surgery, as it can cause bleeding or increase the chance of infection.
· Some people have hypersensitivity and/or allergic reactions to the application of cold. Any form of cryotherapy is to be avoided on clients with a history of frostbite or other cold related injury. The use of cold on such a person can result in prolonged burning sensations and extreme pain.
· Other pathologies adversely affected by the use of cold would be Raynaud’s disease, lupus, rheumatoid arthritis and Buerger’s disease.
· Any indication of peripheral vascular disease or compromised circulation is a basis for precaution.
· Heat and cold therapies should not be used in persons with any kind metal implants. Metal reacts differently than the human body when exposed to heat or cold. As a result, those changes, including heating to injurious temperatures and/or modifying the shape of the implant, can cause serious internal injuries.
· Never leave a client unattended when using heat or cold during a session.

Done correctly and with the understanding of precautions, the use of contrasting temperatures can greatly enhance the efficacy of a massage session and result in the ease of symptomatic pain and inflammation.

Recommended study:
Stone Massage

References:

Aaland, Mikkel. “Seat Bathing and the Body.” Sauna & Health. Cyber-Bohemia. 3 Feb 2009 http://www.cyberbohemia.com/Pages/saunahealth.htm.

Beck, Mark F. Milady’s Theory and Practice of Therapeutic Massage. 3rd. Albany, New York: Delmar Publishers, 1999.

Dillard, James N., MD, DC, CAc. The Chronic Pain Solution: Your Personal Path to Pain Relief. New York: Bantam Dell, 2002

Fowlie, Laurel, RMT, BA, MEd.. An Introduction to Heat and Cold as Therapy. Toronto: Curties-Overzet Publications, 2006

Klein, Michael J., DO, MBA. “Superficial Heat and Cold.” emedicine. 28 January 2009. WebMD. 3 Feb 2009 http://emedicine.medscape.com/article/324974.

by Nicole Cutler, L.Ac.

Putting energetic touch therapies aside, most types of bodywork involve practitioners touching their clients. Although applying healing techniques with hand, elbow, forearm or even foot contact is expected, people’s reactions to a therapist’s touch can vary greatly. Since reactions to touch can be unpredictable, massage therapists who go out of their way to create a trusting physical bond with their clients are more likely to help those who need a healing experience.

One in Five
Some instantly melt under the hands of a skilled bodyworker, while other massage recipients tense in an automatic protective mode. While there may be many reasons a person is unable to relax and enjoy bodywork, previous emotional scars rank high as a cause.

Regardless of the practitioner’s or client’s awareness of an abusive history, a large proportion of bodywork recipients are likely to be survivors of some kind of touch violation. On average, one of every five clients a practitioner sees has a history of trauma or abuse. These statistics demand sensitivity to how trauma or abuse can impact bodywork clients. The facts also call for establishing a safe-centered touch routine to recruit a client’s trust. With these two approaches, massage therapists can circumvent ethical complications and help affected clients welcome their healing touch.

Intimacy and Sensitivity
Since providing or receiving bodywork is an intimate process, traumatizing events can re-surface. Even in the most professional of settings, intimacy can expose vulnerabilities leading to uncomfortable or awkward situations. In Ethics of Touch, psychologist Melissa Soalt explains a predicament common to survivors who receive bodywork:

“Being present in one’s body is a double-edged sword for survivors: On the one hand, working through the body can stimulate the trauma and evoke confusing or frightening feelings, on the other hand, it is this very ability to be present and in one’s body that ultimately allows one to feel more grounded and thus safer and more in control.”

Massage therapists risk crossing a professional boundary if they attempt to counsel such a client. However, understanding that this dynamic could exist enhances a practitioner’s sensitivity. A bodyworker’s compassion for someone’s emotional response to touch creates an atmosphere of security. In addition to a practice that prioritizes trust between recipient and caregiver, this safe feeling encourages clients to have any reaction that feels right.

There is the possibility that the impact of bodywork on an abused survivor goes beyond what can be handled solely by a massage therapist. Often decipherable by persistent and traumatic flashbacks, withdrawal from reality, personality regression or deepening depression, practitioners must be able to recognize when a mental health professional’s aid should be recruited.

Routine Considerations
Since predicting who may have trust issues around receiving touch is near impossible, it is in a bodyworker’s best interest to establish a routine that embraces a recipient’s feelings of safety. Because even regular clients can be surprised with a touch inspired fear, never get lazy and skip an element of your safe-centered touch routine. Some considerations to either include in every session or at least keep in your awareness are:

1. Ensure clients that their comfort is your priority by encouraging them to communicate with you from the session’s start.

2. Avoid any suspicions of your intentions by adhering to the highest level of professional draping standards.

3. Give clients the power of choosing what, if any, clothing they wear for a session.

4. Be clear about your professional boundaries prior to a session and during one (if necessary) to allay any apprehension.

5. As much as possible, maintain continual contact during a session so that your client knows where you are at all times.

6. If a client has an emotional release, stay grounded, present and supportive.

Clients who relax once you lay your hands on them should never be taken for granted. Because touch can illicit such a wide range of responses, massage therapists are more likely to be trusted by a trauma survivor with a routine emphasizing professional boundaries and client safety. Clients’ lives can be transformed by a practitioner with awareness of, and sensitivity to, their trust issues, as well as a willingness to enlist a counselor’s help when necessary. By combining these efforts, even the most wounded clients can reap the benefits of your healing touch.

Recommended Study:
Ethics: Therapeutic Relationships
The Educated Heart

References:

Benjamin, Ben, Cherie Sohnen-Moe, The Ethics of Touch, SMA Inc., Tucson, Ariz., 2003.

http://massage.largeheartedboy.com, Keeping Contact with the Client, Fingertips, largeheartedboy.com, May 2008.

www.buzzle.com, Don't Touch Me There! Avoiding Massage Mishaps and Misunderstandings, Terry McDermott, Buzzle.com, 2008.

www.ncbtmb.org, Code of Ethics, National Certification Board of Therapeutic Bodywork, 2008.

www.paulbrown.net, The Intention of Touch, Healing Hands – Paul Brown Massage Therapy, 2008.

by Nicole Cutler, L.Ac.

Weighing in as one of the diseases women fear most, breast cancer is estimated to affect one in every eight women. Despite breast cancer being the second-leading cause of cancer deaths in American women, its early diagnosis and treatment has drastically improved this illness' survival rate. When included in a person's recovery from this illness, massage therapy has the capacity to improve the physical and emotional health of a breast cancer survivor.

With compassion, specific training and attention to documentation and legal issues, bodyworkers have the tools to help clients mend the parts of their life fragmented by traditional breast cancer treatment. As one of the leading treatments for breast cancer, the complete or partial surgical removal of breast tissue can make a significant impact on a person's life. In addition to the side effects from other therapies one may have received, the loss of one or both breasts may congest blood, lymph and energy circulation in the chest and upper extremities. Just as important to an individual's well-being, breast disfigurement or amputation can take a drastic psychological toll on survivors.

Types of Breast Cancer Surgeries
Since there are so many variations of type and severity of breast cancer, the treatment approach for this illness is highly individual. Involving a great deal of deliberation between patient and doctor, most women will have surgery and an additional therapy such as radiation, chemotherapy or hormone therapy. In general, breast removal surgeries fall into one of the following four categories:

1. Lumpectomy - A surgical excision of only the palpable tumor mass.

2. Partial Mastectomy - Removes less than the whole breast, such as a quarter of the breast where the tumor resides.

3. Modified Radical Mastectomy - Removes all breast tissue, including the skin, nipple, areola and most of the axillary lymph nodes on the same side while leaving the pectoral muscles intact. As the most common surgery for early stage breast cancer, this is also called a total mastectomy with axillary dissection.

4. Halsted Radical Mastectomy - Removes the breast, skin, both pectoral muscles and all axillary lymph nodes on the same side.

Massage Therapy Following Breast Surgery
Because of the unknown mechanism for spreading cancerous cells, most massage therapy schools teach that cancer is a contraindication for massage. However, modern research has repeatedly demonstrated that carefully executed bodywork offers measurable benefits to people currently living with or who have survived a bout of cancer. Regardless of the growing acceptance of massage therapy for cancer-related issues, approaching a client with a recent or distant history of breast cancer always mandates the practitioner proceed with caution.

· Permission - First and foremost, obtain the permission of your client's physician prior to administering massage.

· Consent - Make certain you have your client's written informed consent before proceeding with massage therapy.

· SOAP notes - Adhere to this conventional form of record keeping, which includes taking subjective, objective and assessment plan notes.

· Training - Only proceed with bodywork if you have successfully completed training specific to oncology massage.

Following breast cancer surgery, common physical problems may include local pain, swelling and restricted range of motion. If the pectoral muscles have remained intact, the physical effects are likely the result of impaired circulation from removed lymph nodes, scar tissue and adhesions from surgery. Including techniques such as therapeutic touch for acute surgical recovery, lymphatic drainage massage for lymphedema, scapular mobilization for a stiff shoulder, myofascial spreading for tight pectorals and cross-fiber friction to dissolve scar tissue, a therapist trained in oncology massage has many tools to help clients recover from breast cancer surgery.

Women who have experienced the trauma of breast cancer surgery can benefit emotionally from touch-centered therapy. When applied with healing intent and compassion, a massage therapist's touch can function as a bridge to help clients become reconnected to their body. For many breast cancer surgery recipients, the physical contact of massage eases the feeling of being a stranger in their own body, a transition that can help them find comfort in their new physical form.

Since a lumpectomy or mastectomy is indicated in a majority of cases, many breast cancer survivors must contend with the consequences of their surgery. Although not outfitted with a medical doctor degree, massage therapists can help clients with a history of breast cancer return to health. By seeking the proper training, taking acceptable notes, getting physician permission and obtaining client written consent, massage therapists can facilitate their clients' physical and emotional recovery from breast cancer surgery.

Earn continuing education credit for this article contained in our Cancer & Massage series. Click here to enroll.

Recommended Study:
Advanced Anatomy and Pathology
Ethical Case Management
Healing Energy and Touch
Lymphatic Drainage Massage
Myofascial Release

References:

Handley, W. C., Jr., LMT, Massage for Cancer Patients: Indicated or Contraindicated?, Massage Today, January 2007.

Manzulli, Sabino L., LMT, Bodywork & Visualization Therapy for People With Cancer, Massage & Bodywork, August/September 2001.

Vanderbilt, Shirley, Into the Looking Glass: Massage for Mastectomy Patients, Massage & Bodywork, August/September 2000.

www.amtamassage.org, Mastectomy Massage, Cheryl Chapman, Eileen Kennedy, American Massage Therapy Association, 2008.

www.breastcancer.org, About Breast Cancer: Statistics, Causes, Symptoms, Surgery Options, breastcancer.org, 2008.

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

www.suite101.com, Massage After Mastectomy, Chris E. Barrett, 2008.

by Nicole Cutler, L.Ac.

Massage therapy schools, certification programs and continuing education courses all place a great deal of emphasis on teaching bodywork contraindications. In keeping with the motive to do no harm, massage therapists are well versed in the conditions they must avoid. However, sometimes the conditions that are supposed to raise cautionary flags for massage therapy have not yet been identified by the client. Plantar warts present an example of this dilemma, because clients are not always aware that their feet harbor this skin condition that locally prohibits massage. In order to avoid spreading this potentially contagious infection, massage therapists must become an expert in detecting plantar warts even before their clients can.

About Plantar Warts
Known as a plantar wart, Verruca Plantaris is a common viral infection of the skin. Infecting the skin by direct contact, the Human Papilloma Virus (HPV) causes plantar warts. While antibodies can destroy HPV, some people are more susceptible to this virus than others. The virus more easily enters the body through an area of skin that is moist, peeling or cracked.

Growing on the bottom surface of the foot, plantar warts tend to be found in areas that endure pressure, such as the heel and ball of the foot. Plantar warts typically grow into the deeper layers of skin because of the forces they are under. Because of their weight bearing location, plantar warts often cause pain and may make walking difficult.

Plantar warts can be difficult to identify because their location typically involves internal growth, rather than externally protruding from the skin. Hence, they are often mistaken for corns or calluses. Five factors to help distinguish a plantar wart from a more innocuous skin anomaly include:

1. Small, fleshy, grainy bumps on the soles of your feet

2. Hard, flat growths with a rough surface and well-defined boundaries

3. Gray or brown lumps with one or more black pinpoints, which are actually small, clotted blood vessels

4. Bumps that interrupt the normal lines and ridges in the skin of the foot

5. Plantar warts grow anywhere on the bottom of the foot; corns and calluses grow in areas that receive the most wear-and-tear

Plantar Wart Infectivity
Although most experts insist that plantar warts are not highly contagious, they are caused by an infectious virus. Any skin that flakes off around a wart, or any blood that seeps from around an irritated wart, may carry HPV. By simply touching a plantar wart, it can proliferate on the same host or to another:

· The virus may spread to additional spots on the same foot

· Viral particles could slough off and land in a location where someone else could pick them up

To reduce the risk of plantar warts, experts advise the following:

· Avoid direct contact with warts, including your own warts

· Keep your feet clean and dry; change your shoes and socks daily

· Don’t go barefoot in public areas; wear shoes or sandals in public pools and locker rooms

· Don’t pick at warts as picking may spread the virus

If you do see what you believe to be a plantar wart, it is important to avoid any direct contact with it, including skipping local massage. However, it is inappropriate for bodyworkers to make a diagnosis. Instead, Ruth Werner, LMP, NCTMB, suggests advising your client to have the area checked by a dermatologist or podiatrist before trying to remove the rough spot with clippers or a pumice stone. Werner proposes that massage therapists take this opportunity to educate their clients about the potential for transforming a mildly annoying plantar wart into several large, painful and even crippling growths on the feet.

Since many massage therapists routinely touch people’s feet with their bare hands, their assumption that a bump or rough spot is a simple foot callous could cause harm. For this reason, massage therapists should know how to identify and visually examine their client’s feet for plantar warts.

Recommended Study:
Advanced Anatomy and Pathology

References:

Chaitow, Leon, et al, Clinical Application of Neuromuscular Techniques Volume 2: The Lower Body, Elsevier Health Sciences, Churchill Livingstone, 2000: 528.

http://skincare.lovetoknow.com/Plantar_Warts_Treatment, Plantar Warts Treatment, Retrieved November 4, 2008, LoveToKnow Corp., 2008.

http://www.dermatologychannel.net/viral_infection/warts.shtml, Viral Infections: Warts, Retrieved November 5, 2008, Healthcommunities.com, Inc., 2008.

http://www.emedicinehealth.com/plantar_warts/article_em.htm, Plantar Warts, Retrieved November 5, 2008, WebMD, Inc., 2008.

http://www.massagetoday.com/mpacms/mt/article.php?id=13147, Verruca Vulgaris: Warts!, Ruth Werner, LMP, NCTMB, Retrieved November 3, 2008, Massage Today, January 2005.

http://www.mayoclinic.com/health/plantar-warts/DS00509, Plantar Warts, Retrieved November 3, 2008, Mayo Foundation for Medical Education and Research, 2008.