Massage Professionals Article Archive

by Nicole Cutler, L.Ac.

As infectious pathogens become resistant to medications and evolve into harder-than-ever-to-treat illnesses, we remember that total immunity from all disease is an unattainable concept. The current swine flu pandemic is the latest reminder that our coveted health hangs in the balance between individual strength and the environment that surrounds us. As a healthcare professional, the bodyworker's environment can easily harbor any number of infectious organisms. Instead of living in fear of today's most prominent health threat, bodyworkers can take comfort in knowing that the transmission and contagion of swine flu is no different from the acquisition of any other bacterial or viral illnesses.

To prevent the virulent and lethal flu bug pandemic of 1918 where millions of people perished, public health departments are gearing up to stop the spread of swine flu. While these measures are put into place to protect our health, it also breeds fear in those who don't fully understand the problem. After recently working with a client who was "advising" people to ban all pork products in an effort to circumvent the swine flu, the fear surrounding this pandemic sunk in. Last year, the bird flu panic prompted a similar fear - where many people avoided eating chicken, although that had nothing to do with the virus' transmission.

To allay common fears and misconceptions about the swine flu, bodyworkers and their clients could benefit from some basic facts and suggestions about this influenza strain:

1. Flu viruses have a tendency to mutate and adapt, sometimes making the jump from pigs to humans (or from birds to humans).

2. Although it originated in pigs, the strain of swine flu (H1N1) currently going around is transmitted from human to human.

3. You cannot get swine flu from eating pork or pork products.

4. Just like other strains of the flu, influenza is primarily spread via uncovered coughing or sneezing of infected people.

5. Bodyworkers should reschedule clients who present cold- or flu-like symptoms, just as they would for any sick person.

6. Antiviral chemoprophylaxis can be considered for practitioners at high risk for influenza complications who are working in an area with confirmed swine flu influenza A (H1N1) cases.

7. The swine flu symptoms are similar to the symptoms of seasonal flu and may include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, fatigue, diarrhea and vomiting.

8. To prevent swine flu transmission, practice good hygiene just like you normally would during flu season. This includes washing your hands often with soap and water, using alcohol-based hand cleaners, avoiding touching your eyes, nose or mouth and covering a cough or sneeze with a tissue (and then washing your hands).

9. An often overlooked approach to flu protection is to keep the immune system in optimal shape. By paying attention to proper nutrition, getting adequate sleep, relieving pent-up stress and engaging in regular exercise, the immune system is better able to ward off a flu virus when it is encountered.

10. If you do get sick, stay home from work or school and limit contact with others to keep from infecting them. If you have a fever and other flu symptoms and may have had contact with someone with swine flu or severe respiratory illness in the past week, see your physician. In addition to testing for H1N1 for optimal tracking, your doctor may prescribe an antiviral drug helpful for swine influenza.

Although massage therapists work within close proximity to their clients, they needn't allow the threat of swine flu to create fear. Following universal precautions is part of every properly educated therapist's hygiene routine. As such, withholding sessions from clients who are sick, washing hands between each client, disinfecting counters and surfaces (including massage tables) and providing clean linens for each person is routine. Whether concerned with the H1N1 swine flu epidemic or preventing transmission of the common cold, bodyworkers can play a part in easing the fears circulating around the 2009 swine flu outbreak.

Recommended Study:
Infectious Disease: HIV/AIDS

References:

http://www.cdc.gov/h1n1flu/, H1N1 Flu (Swine Flu), Retrieved May 8, 2009, US Centers for Disease Control and Prevention, May 8, 2009.

http://www.emaxhealth.com/1024/90/30681/how-take-swine-flu-precautions.html, How to Take Swine Flu Precautions, Ramona Bates, MD, Retrieved May 8, 2009, EMaxHealth.com, 2009.

http://www.massagemag.com/News/massage-news.php?id=6500&catid=1&title=basic-hygiene-combats-swine-flu, Basic Hygiene Combats Swine Flu, Retrieved May 8, 2009, Massage Magazine, May 2009.

http://www.webmd.com/cold-and-flu/news/20090508/swine-flu-learning-from-past-pandemics, Swine Flu: Learning From Past Pandemics, Daniel J. DeNoon, Retrieved May 9, 2009, WebMD LLC, May 2009.

by Linda Fehrs, LMT

Commonly referred to as "staph," the bacteria Staphylococcus aureus (S.aureus, is found just about everywhere on the human body as well as on dry surfaces, such as doorknobs and countertops). Most of the time the human body's natural defenses easily fight off any potential infection. Sometimes though, the presence of S. aureus can lead to serious infection that resists treatment.

Bacterial staph infections are nothing new. They have been around since the beginning of time. The use of various natural substances - such as garlic, honey or certain mosses - to fight infection has been around for more than 3,000 years. But, the role bacteria plays in the spreading of infection has really only been understood by the medical profession for less than 300 years.

Whether it is from our own overuse of modern antibiotics, or the routine use of prophylactic antibiotics used in animal feed, many types of bacteria have evolved to become resistant to a large number of commonly prescribed antibiotics used to treat infections.

There are two forms of antibiotic resistant to staph bacteria:

1. HA-MRSA (Healthcare Associated - Methicillin Resistant Staphylococcus Aureus): HA-MRSA is rarely found outside the hospital setting, is highly resistant to most antibiotics and first appeared in the 1950s.

2. CA-MRSA (Community Associated - MRSA): It was recently discovered that another strain of MRSA was being found in non-hospital settings, such as nursing homes, prisons and athletic facilities. This form is differentiated by the designation CA-MRSA and is considered to be a highly communicable community-acquired infection that, though serious, more readily responds to treatment than HA-MRSA.

At Risk Populations
Certain populations are more susceptible than others to MRSA related infections, and it would not be unusual to see massage clients from these populations:

· Persons with weakened immune systems, such as those with HIV/AIDS, hepatitis and rheumatoid arthritis, as well as cancer patients
· Diabetics
· Young children
· The elderly
· Patients and staff staying or working in a healthcare facility for an extended time, such as nursing homes
· Persons confined or restricted in confined spaces, such as prisoners
· Athletes, particularly those involved in contact sports or weight training

Transmission
MRSA can be transmitted two ways:

1. through direct infection and
2. through toxins that the bacteria produce.

Direct infection is responsible for skin infections which may start when the bacteria enters through some sort of break in the skin. This could be a cut, an insect bite or rash. Toxins can be introduced through the ingestion of improperly prepared or stored food, especially diary based sauces, salad dressings and pastries.

The MRSA bacteria can live on inanimate objects for hours, days and even months depending on several factors: including the type of surface, the general environment and the amount of germs present. They can be spread from one person to another through contaminated linens, massage tabletops and other materials found in a massage practice, as well as from personal contact with an infected person.

Avoiding MRSA
Preventing MRSA is much easier than fighting it once an infection occurs. While MRSA is resistant to antibiotics, it is easily removed by using simple cleaning methods. You may also want to follow the basic rules of universal precautions, the same methods we learn in working with clients who may be immunocompromised by HIV/AIDS.

· One of the best ways to combat MRSA is by washing your hands with warm soap and water before and after each client as well as after changing massage linens.
· Wipe down the massage table before and after each client.
· Never use massage linens for more than one client. Remove and wash linens within 24 hours of each use.
· If you have a cut on your finger, make sure it is covered when working with a client. Use a finger cot in addition to a bandage to avoid contamination.
· Keep your office, treatment room and bathroom facilities clean. Have a cleaning regimen that includes the wiping down of any surfaces that may come in contact with skin, including tabletops, water coolers and sinks.
· Any open wound on a client is an area of precaution and should not be worked on directly or in the surrounding area. If working in an adjacent area, make sure the wound is covered and that you do not come into direct contact with it.

What Does MRSA Look Like?
Will you know if a client has CA-MRSA? Just looking at an infected sore will not tell you that the bacteria involved is antibiotic resistant. The only way to determine with accuracy is for the client to be seen by a doctor and have the site analyzed. It is imperative to get to medical facilities quickly as this particular type of infection can spread rapidly and, if left untreated, can cause a great deal of damage.

In the initial stages, an MRSA infection can look like a small pimple or insect bite. Within a short time it may take on the appearance of a larger boil, surrounded by reddened skin and may be accompanied by fever and/or a rash. Left unattended the infection can lead to systemic infection, toxic shock or even necrotizing faciitis. Any open wound that does not heal, appears inflamed and/or develops pus should be looked at by a physician as soon as possible.

To Bleach Or Not to Bleach
According to the Centers for Disease Control (CDC) it is not necessary to use hot water and bleach to kill MRSA on inanimate surfaces. The CDC claims that laundry washed in detergent and the warmest water recommended for that particular fabric is sufficient for removing possible contamination by MRSA. As a general disinfectant the CDC recommends using an EPA-registered product rather than bleach. If that is not available, chlorine bleach, which is a broad-spectrum disinfectant, can be a useful alternative. Do not use bleach full strength. Rather, use a solution equivalent to ¼ cup of bleach to one gallon of water, and never mix it with other cleaning agents.

There are many natural, environmentally friendly products on the market that have been shown to be effective as disinfectants. Vinegar is well known for its cleaning and disinfecting qualities (the smell does dissipate within a short time). There are also many essential oils that have antibacterial properties including tea tree oil and the oils of lemon, pine, chamomile, clove and thyme among others. Make sure you are familiar with the use of essential oils and their properties before creating any cleaning recipes on your own.

Maintaining a clean office in your practice is one of the best ways to assure that both you and your clients are safe from the spreading of germs or bacteria.

Recommended Study:
Advanced Anatomy and Pathology
Infectious Disease: Hepatitis
Infectious Disease: HIV/AIDS

Resources:

Boyce, John, MD ad Pittet, Didier, MD. "Guide For Hand Hygiene in Healthcare Settings." 25 October 2002. Department of Health and Human Services, Centers For Disease Control. 24 Mar 2009 http://www.cdc.gov/handhygiene/.

Cunningham, Chris. "What Massage Therapists Should Know About Staph Infections." Massage Magazine November 2008: 70-76.

Division of Healthcare Quality Promotion, "CA-MRSA: Environmental Management of Staph and MRSA in Community Settings." 3 July 2008. Department of Health and Human Services, Centers for Disease Control and Prevention. 24 Mar 2009
http://www.cdc.gov/ncidod/dhqp/ar_mrsa_Enviro_Manage.html.

"List of Essential Oils." Organic Facts. 2006. Rural Tech Services. 26 Mar 2009 http://www.organicfacts.net/organic-oils/natural-essential-oils/list-of-essential-oils.html.

Mayo Clinic Staff, "Staph Infections." 7 June 2007. Mayo Foundation for Medical Education and Research. 24 Mar 2009 http://www.mayoclinic.com/staph-infections/DS00973/DSECTION=causes.

Werner, Ruth, LMP, NCTMB. "Methicillin-Resistant Staphylococcus Aureus: A Moving Target." Massage Today July 2006, Vol 6, Issue 07.

by Nicole Cutler, L.Ac.

For most people, being touched by a bodywork practitioner is an incredibly relaxing experience. However, a significant number of men have an embarrassing, visible response to massage therapy. Although most practitioners understand the likelihood that some men may develop an erection during a session, that understanding could turn to anger if they encounter a client who has ejaculated. But for a number of men, such an unsolicited release could have been an involuntary, asexual physiological reaction to the massage. By learning more about this possibility, massage therapists with a client who accidentally ejaculates can maintain compassion while upholding their professional ethics and infection control standards.

Intentional or Accidental
If a client ejaculates during your session, the first thing a practitioner must do is figure out if his/her client has any sexually related motives. In the article, A Common Male Physiological Response to Massage, eight important steps are outlined to help massage therapists address inappropriate behavior and determine a client’s intent. Upon identifying a client seeking a sexual outlet, the therapist’s ethics and safety are his/her first priorities. When addressed professionally while maintaining firm ethical boundaries, affected men without sexual intentions are likely to be surprised and embarrassed by their body’s actions.

Many men are trying to understand why their body betrayed them while receiving bodywork. Unfortunately, there is little information available about why some ejaculate without purposeful genital stimulation or sexualized thoughts. Despite medicine’s dismissal of this situation as a rare anomaly, more men are emerging from their shame to try and find an explanation.

The Physiology of Ejaculation
Technically, ejaculation is the process of sperm transport from the epididymis to the urethral meatus, resulting in expulsion of semen. Ejaculation occurs in two phases:

1. Seminal emission, which is mediated by the sympathetic nervous system.

2. Propulsatile ejaculation, which is controlled by the parasympathetic nervous system.

Men who have experienced unexpected, unwanted ejaculation during a massage typically claim that it occurs when they are in the prone position with the therapist working on their low back, buttocks or upper thighs. Considering the location of the afferent and efferent nerves responsible for ejaculation, these locations are not surprising:

· Via the sympathetic nervous system, autonomic impulses responsible for seminal emission exit the spinal cord between the tenth thoracic vertebrae and the second lumbar vertebrae.

· Propulsatile ejaculation is caused by somatic input of the parasympathetic nervous system between the second and fourth sacral foramen.

In addition to its sympathetic and parasympathetic involvement, the pathways for ejaculation are also cerebrally mediated. As evidenced by nocturnal emissions, the ejaculatory reflex may be solely initiated by central nervous system input. While sexualized thoughts often occupy the mind prior to ejaculation, some sexual health experts believe that the brain’s role in ejaculation is more associated with a mental “letting go.”

At first glance, ejaculation appears to be out of line with bodywork. However, the level of relaxation that can be induced by massage therapy is a quintessential example of someone mentally letting go of his tension. From a physiological perspective, ejaculation could be initiated by combining deep relaxation with massage therapy’s activation of both the sympathetic and parasympathetic nervous systems.

Suggestions
For clients prone to involuntary ejaculation, the following five suggestions may be helpful:

1. Strict draping practices and rolled-up towels to create an additional boundary near the genitals will ease any anticipatory excitement.

2. Change massage location and/or technique when muscles tighten, breathing becomes more rapid or the client suddenly fidgets when working on the lower back, gluteus maximus and upper hamstrings.

3. When client is prone, limit torso rocking techniques to prevent unintentional genital stimulation.

4. Use additional barriers to quarantine or absorb accidental ejaculate.

5. Remember to treat anything that has been ejaculated on as infectious, including removal of sheets and towels with gloves, table and linen sterilization and thorough hand washing after cleanup.

If a client ejaculates, the situation can be awkward and possibly upsetting for the massage therapist. However, it could be completely humiliating for the massage recipient and prevent him from ever seeking massage therapy again.

After determining that an unsolicited release was not sexual, addressing this issue promptly can put the therapist and his/her clients at ease. Since a man’s physiology could cause involuntary ejaculation during bodywork, a practitioner who explains this to his/her client thus maintains ethical boundaries, exhibits compassion, takes steps to prevent its reoccurrence and follows infection control practices – and enforces his/her own professionalism. Additionally, tackling this topic facilitates the client’s recognition that there is nothing wrong with him and helps him let go of any shame surrounding his body’s unsolicited release.

Recommended Study:
Advanced Anatomy and Physiology
Ethics: Therapeutic Relationships
Infectious Disease: Hepatitis

References:

http://www.hawaii.edu/hivandaids/Clinical%20Physiology%20and%20Pathophysiology%20of%20Ejaculation%20and%20Orgasm.pdf, Clinical physiology and pathophysiology of ejaculation and orgasm, Stacy Elliott, MD, Retrieved October 21, 2008, The University of Hawai’i, March 2001.

http://www.integrative-healthcare.org/mt/archives/2005/12/a_common_male_p.html, A Common Male Physiological Response to Massage, Nicole Cutler, L.Ac., Retrieved October 22, 2008, Natural Wellness, 2008.

http://www.ncbi.nlm.nih.gov/pubmed/16198717?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed, Descending pathways modulating the spinal circuitry for ejaculation: effects of chronic spinal cord injury, Johnson, RD, Progress in Brain Research, 2006.

by Linda Fehrs, LMT

Candles have been around for thousands of years. The ancient Egyptians used reeds soaked in molten tallow made from animal suet for torches, while the Romans developed the wick candle, which made lighting safer and more portable and easier to use for travel at night, in homes and in places of worship.

In the Middle Ages, beeswax was used for candles. Beeswax did not produce the acrid odor or smoke like tallow, instead it burned clean and pure. But, beeswax candles were expensive and few people could afford them.

In the 18th century the most popular form of candle wax was derived from the sperm whale. The whale oil was crystallized into wax. It was harder than beeswax or tallow and did not soften or bend in hot weather.

In the mid 19th century it was discovered that paraffin could be made as a byproduct of the residues of refined petroleum products. It would burn clean and odorless. It was found that stearic acid, made from either animal or vegetable sources, could be added to counter paraffin's low melting point and thus made it the popular and inexpensive candle we know today.

Comparison of Wax Choices
While paraffin is the most widely used material in the manufacturing of candles, it is not the only, nor necessarily the best choice. Each of the following waxes has their pros and cons.

Paraffin - Paraffin burns cleanly and scent free. While many would deride its relationship to the petroleum industry, paraffin, as it is used in candles, is considered to be biodegradable. Opponents claim that burning paraffin gives off toxic fumes similar to auto exhaust. Though paraffin candles are the least expensive, they also burn faster than other types of candles and need to be restocked more frequently.

Soy - Soy wax is made from hydrogenated soybean oil, leftover from the processing of soy meal and soy products for human consumption (like tofu or soy milk). Soy may be mixed with other waxes for a smoother consistency. One drawback for some is the fact that most soybeans grown in the U.S. are genetically modified. If you want a soy candle that meets vegan standards, contains no Genetically Modified Organisms and does not rely on the petroleum industry, look for candles made of 100% organic soy.

Beeswax - Proponents of beeswax claim it burns brighter, longer and cleaner than any other candle wax. They also claim that beeswax is the only candle fuel to produce negative ions, which have been found to improve air quality air, enhance relaxation and even lessen the severity of asthma attacks. Beeswax candles also have a natural scent influenced by the nectar of the flowers the bees feed on. Opponents of beeswax feel that commercially raised bees are often treated badly and forced to overproduce beyond their natural proclivity causing a lot of stress within the hives.

All sources of candle fuel may be scented either with artificial fragrances, essential oils or a combination. Essential oils should be used in therapeutic settings to lessen the chances of allergic reactions in your clients.

Whatever type of candle you choose, perhaps one of the best places to purchase them is at a small, privately owned candle shop, where the candles are handmade and the owners are knowledgeable about the products they sell. It comes down to knowing and having confidence in your sources.

Candle Safety
If you choose to have traditional candles in your office or treatment room, here are a few safety precautions:

1. Never leave a burning candle unattended and keep it within sight at all times.

2. Burning candles should be kept away from any kind of air current such drafts, vents and fans.

3. Never put a lighted candle near anything that can catch fire, such as drapes, bedding, carpets, books, papers or wall hangings.

4. Always use a container or holder meant for use with candles. A candleholder should be heat resistant, sturdy and large enough to contain any drips.

5. Make sure the candle and holder are placed on a stable, heat resistant surface. A candle placed on a table that jiggles every time a truck goes by is not very safe.

6. Use a candlesnuffer to put out the flame. Blowing on the candle or using water to put it out may make the hot, melted wax splatter.

7. Trim wicks to approximately ¼ inch before lighting. A long wick can cause uneven burning and a sooty flame,

8. Make sure your room is well ventilated. Like any flame, a lit candle consumes oxygen, and while one candle in a large room may not pose a problem, many lit candles in a small room can.

Alternatives To Candles
It can get expensive to constantly replace candles. However, there are now many alternatives that can provide soft lighting, therapeutic scents or both.

Flameless Candles - These are usually made out of the same materials as traditional candles, some sort of wax with a wick. The difference is that buried somewhere within or at the base of the candle is a hollowed out space where a battery-operated light is placed. They come in all varieties of shapes and sizes. Some have added fragrances, some are on timers and some come with a remote control. They offer the same ambiance without the dangers.

Scent Diffusers - If you are using scent either therapeutically or as an air freshener, there are several ways to go. Scent diffusers come in many forms. There are light bulb rings in which you can place several drops of fragrance oil. There are steam diffusers and ceramic burners. One of the most popular items used is the reed diffuser, where several absorbent reads or sticks are placed in a small bottle of scented liquid. You can even simply place a few drops of essential oil in a bowl of water. As the water evaporates it will carry the scent with it.

The Final Decision
You may choose to offer soft lighting with candles or low wattage electric lighting. Or, you may choose to create a pleasant, even therapeutic scent in your office with candles or some other scent diffuser. Whatever you decide, always keep the comfort and safety of your clients in mind.

Recommended Study:
Aromatherapy Essentials

Resources:

"Beeswax: The Miracle Fuel." Green Home Environmental Products. 31 Mar 2009 http://www.greenhome.com/info/articles/Beeswax:_The_Miracle_Fuel/142/.

"Beeswax vs Paraffin." Beeswax Co. LLC. 31 Mar 2009 http://www.beeswaxco.com/beeswaxVsParaffin.htm.

"Candle Safety Rules." National Candle Association. 31 Mar 2009 www.candles.org/safety_rules.html.

"Elements of a Candle." National Candle Association. 31 Mar 2009 http://www.candles.org/elements_wicks.html.

"History of Candles." Candle Comfort. 31 Mar 2009 http://www.candlecomfort.com/historyofcandles.html.

"How is Soy Wax Processed?" Green Scents. 31 Mar 2009 http://greenscents.com.au/pages/soyprocessing.php.