Massage Professionals Article Archive

by Nicole Cutler, L.Ac.

If you've ever experienced an uninvited episode of ringing in your ears, you likely understand the frustration of tinnitus. Most occurrences of ringing in the ear only last a short time, although some people must live with chronic tinnitus. An estimated 85 percent of chronic tinnitus cases are idiopathic (of an unknown cause) and are therefore difficult to treat. Although bodyworkers cannot offer a cure for those with ringing in their ears, they do possess several tools to reduce chronic tinnitus' frequency and intensity.

About Tinnitus
Affecting approximately one in every five people, tinnitus is actually a symptom of an underlying condition. The annoying sensation of hearing sound when no external sound is present, tinnitus can include the following types of noise:

· Ringing
· Buzzing
· Roaring
· Clicking
· Whistling
· Hissing

In more severe cases, tinnitus can be so loud it interferes with one's ability to concentrate or hear. Tinnitus may be present all of the time, or it may be intermittent.

Causes
Even though a number of health conditions can cause or worsen tinnitus, an exact cause may be hard to find. Typical tinnitus contributors include:

1. Inner Ear Damage - The tiny, delicate hairs in the inner ear move in relation to sound waves. This movement triggers a nerve impulse to the brain for sound interpretation. If these hairs are damaged, they could leak random electrical impulses to the brain, causing tinnitus. This can occur from age-related hearing loss and exposure to loud noise.

2. Earwax - While earwax generally protects the ear canal by trapping dirt and slowing the growth of bacteria, excessive amounts may cause tinnitus or hearing problems.

3. Otosclerosis - This genetic condition caused by abnormal bone growth can stiffen the bones in the middle ear and initiate tinnitus.

4. Meniere's Disease - Associated with ear ringing, dizziness and vertigo, this inner ear disorder is believed to be caused by abnormal inner ear fluid pressure or composition.

5. Stress and Depression - Although the relationship is unclear, physicians often cite this as a cause of tinnitus when no physical ailment can be identified.

6. Blood Vessel Disorders - Some of the blood vessel disorders that could result in tinnitus include atherosclerosis, high blood pressure, a kink in the carotid artery or capillary malformation.

7. Medications - Tinnitus is listed as a side effect for a variety of medications. Common culprits include antibiotics, cancer drugs, diuretics, quinine medications and aspirin.

Additional causes of tinnitus include allergies, dental work, head or neck injuries or a local tumor.

Treatment
Identifying the cause of tinnitus customarily dictates the treatment that would be most effective. For example, removing excessive earwax or changing medications can resolve tinnitus with corresponding etiology. For the cases unrelated to an identifiable condition, other strategies are employed by healthcare practitioners. These include:

· Masking the noise using a white noise machine, fan or other constant low level sound source

· Medications to reduce tinnitus' severity

· Avoiding tinnitus irritants such as loud noises, caffeine, nicotine and alcohol

· Managing stress

Bodyworkers can offer their clients with tinnitus several additional tactics for easing tinnitus. Three of the preferred approaches include:

1. Acupressure - Based on Traditional Chinese Medical theories, stimulating the acupressure points Triple Burner 3, Gallbladder 20, Gallbladder 34, Liver 3, Liver 2, Kidney 3 and Urinary Bladder 23 can help reduce tinnitus.

2. Aromatherapy - Whether stimulating local blood circulation, reducing congestion or calming the nervous system, applying essential oils posterior to the ear lobe and on the posterior neck on the affected side can bring rapid tinnitus relief. Some oils reportedly used for ear ringing include basil, lavender, juniper berry and cypress.

3. Cranial-Sacral Therapy - Because cranial-sacral therapy can release tension in the cranial bones that connect with the ear, removing these restrictions often stops idiopathic ear ringing.

Due to the range of possible tinnitus causes - some of them being severe medical conditions - any abnormal ear ringing should be evaluated by a physician. Once it is declared to be idiopathic, tinnitus can be helped with an array of approaches. Aside from the more traditional strategies of masking random ear sounds, medicating the patient, avoiding triggers and better managing stress, bodyworkers have a lot of value to add. For achieving more peace and quiet, acupressure, aromatherapy and cranial-sacral therapy can help to silence the buzz of chronic tinnitus.

Recommended Study:
Aromatherapy Essentials
Cranial-Sacral Fundamentals
Shiatsu Anma Therapy

References:

http://holistic-online.com/Remedies/Ear/tin_alt_acupuncture-to-color.htm, Alternative Medicine for Tinnitus, Retrieved December 18, 2008, ICBS, Inc., 2008.

http://www.cst.eu.com/tinnitus.html, Tinnitus, Retrieved December 18, 2008, Julian Cowan Hill, RCST, 2008.

http://www.ctds.info/tinnitus.html, Tinnitus: Alternative Medicine Treatments for Ringing in the Ears, Retrieved December 18, 2008, Pine Canyon Media, LLC, 2008.

http://www.kgstiles.com/articleringingearrelief.htm, Ringing Ear (Tinnitus) Relief, KG Stiles, LMT, RBT, CBP, NCTMB, Retrieved December 18, 2008, KG Stiles Health Mastery Systems, 2008.

http://www.mayoclinic.com/health/tinnitus/DS00365, Tinnitus, Retrieved December 18, 2008, Mayo Foundation for Medical Education and Research, 2008.

http://www.ncbi.nlm.nih.gov/pubmed/18560742?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum, The role of the cervical spine and the craniomandibular system in the pathogenesis of tinnitus. Somatosensory tinnitus, Biesinger E, et al, Retrieved December 18, 2008, HNO., July 2008.

by Nicole Cutler, L.Ac.

Anchored in strong beliefs about the significance of their work, most professional massage therapists are familiar with some of the emotional and physical benefits of bodywork. Massage's ability to foster relaxation and relieve anxiety seems obvious. However, the universally accepted consequences of intentional touch have been underestimated for far too long. Based on facts compiled by academics at Harvard University, an ability to reduce anxiety translates to a capacity for improving some of our culture's most widespread physiological ailments.

While it makes perfect sense that massage's release of muscle tension would also reduce anxiety levels, our empirical society demands that scientific research prove any generally accepted notion. A pioneer in confirming the value of massage therapy, Tiffany Field, Ph.D., formally established The Touch Research Institute (TRI) at the University Of Miami School Of Medicine in 1992. The first center in the world devoted solely to the study of touch and its application in science and medicine, TRI has conducted countless trials on the physiological impact of bodywork. Based on over 100 studies and 350 articles in respected medical journals, Field is one of the most influential contributors to transforming massage therapy into an acknowledged arm of complementary medicine.

Anxiety Reduction
Under Field's guidance, TRI has published landmark studies on touch therapy's reduction of anxiety. Two of those include:

1. Published in 1992 in the Journal of the American Academy of Child and Adolescent Psychiatry, TRI researchers found that a 30-minute back massage given daily for five days reduced anxiety of hospitalized, depressed and adjustment disorder children and adolescents.

2. Published in 1996 in the Journal of Applied Behavioral Science, TRI researchers found that significant reductions in anxiety levels were found in employees receiving on-site chair massage.

These two studies represent a small sampling of the evidence equating massage therapy with anxiety relief. Used in Field's and others' research, chemical markers, anxiety questionnaires and other medical tests are used to measure these results, and bodywork's reduction of anxiety levels has been repeatedly demonstrated.

Anxiety and Physical Illness
Putting massage research on other conditions aside, the ability of bodywork to relieve anxiety is so important, because high anxiety levels are connected to many physical ailments. Although most bodyworkers recognize the strong connection between emotions and physical health, scientific research on the physiology of anxiety-related illness is just beginning.

According to Harvard University scholars, physical diseases are harder to treat in the estimated 57 million adults who suffer from an anxiety disorder. More specifically, heart disease, chronic respiratory disorders and gastrointestinal ailments are more severe when coupled with anxiety:

· Heart Disease - Published in a 2005 edition of Circulation, the Nurses' Health Study found that women with the highest levels of phobic anxiety were 59 percent more likely to have a heart attack and 31 percent more likely to die from one than women with the lowest anxiety levels. In addition, data from 3,300 postmenopausal women in the Women's Health Initiative showed that a history of full-blown panic attacks tripled the risk of a coronary event or stroke.

· Respiratory Disorders - In several studies involving people with chronic obstructive pulmonary disease, anxiety has been associated with more frequent hospitalization and with more severe distress at every level of lung function. Published in the May 2008 edition of the Annals of General Psychiatry, Greek researchers found that depression and anxiety were very prevalent in participants with pulmonary disease, especially chronic disease.

· Gastrointestinal Ailments - Published in the June 2008 edition of the Journal of Psychosomatic Research, German researchers found that gastrointestinal (GI) symptoms are associated significantly with depression and anxiety in primary care. More specifically, they found that the prevalence of severe levels of anxiety was nearly fourfold in patients with GI symptoms compared to patients without GI symptoms.

The scientific community is finally gathering the proof concluding that anxiety worsens many types of chronic, potentially fatal diseases. As more irrefutable evidence links anxiety disorders to heart, respiratory and digestive diseases, anxiety relief is becoming more important than ever. Massage therapy has repeatedly demonstrated an ability to reduce anxiety levels within the medical research model. Thus, bodywork is emerging as one of the most valuable therapies for addressing the concurrence of emotional and physical health.

Recommended Study:
Advanced Anatomy and Pathology
Advanced Anatomy and Physiology
Chair Massage Fundamentals
Integrative Massage: Spirit

References:

http://archinte.ama-assn.org/cgi/content/abstract/166/19/2109, Disability and Poor Quality of Life Associated With Comorbid Anxiety Disorders and Physical Conditions, Jitender Sareen, BSc, MD, FRCPC, et al, Retrieved August 5, 2008, Archives of Internal Medicine, October 2006.

http://clicks.health.harvard.edu/dm?id=9B1CEC9A0B81648357D04872ABF06696A554D9D0E5C06788, The Link Between Anxiety and Physical Illness, Retrieved August 5, 2008, Harvard University, HEALTHBeat, August 2008.

http://massagetherapy.suite101.com/article.cfm/anxiety_and_massage_therapy, Anxiety and Massage Therapy, Sylvia Carlson, Retrieved August 5, 2008, January 2007.

http://www.chinese-holistic-health-exercises.com/reflexology-for-anxiety.html, Acupressure and Reflexology for Anxiety, Retrieved August 5, 2008, Chinese Holistic Health Exercises, 2008.

http://www.circ.ahajournals.org/cgi/content/abstract/111/4/480, Phobic Anxiety and Risk of Coronary Heart Disease and Sudden Cardiac Death Among Women, Christine M. Albert, MD, MPH, et al, Retrieved August 7, 2008, Circulation, 2005;111:480-487.

http://www.massagemag.com/Magazine/2000/issue87/research87.php, Massage Reduces Cancer Patients' Pain, Anxiety, Retrieved August 5, 2008, Massage Magazine, September/October 2000.

http://www.massagemag.com/News/2006/January/125/Tiffany.php, Tiffany Field on Massage Research, Karen Menehan, Retrieved August 6, 2008, Massage Magazine, January 2006.

http://www.ncbi.nlm.nih.gov/pubmed/10660924, The effects of foot reflexology on anxiety and pain in patients with breast and lung cancer, Stephenson NL, et al, Retrieved August 5, 2008, Oncology Nursing Forum, January/February 2000.

http://www.ncbi.nlm.nih.gov/pubmed/18495038?ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum, A comparative study of anxiety and depression in patients with bronchial asthma, chronic obstructive pulmonary disease and tuberculosis in a general hospital of chest diseases, Moussas G, et al, Retrieved August 6, 2008, Annals of General Psychiatry, 2008 May 21;7:7.

http://www.ncbi.nlm.nih.gov/pubmed/18501261?ordinalpos=16&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum, Gastrointestinal symptoms in primary care: prevalence and association with depression and anxiety, Mussell M, et al, Retrieved August 6, 2008, Journal of Psychosomatic Research, 2008 Jun;64(6):605-12. Epub 2008 Apr 28.

http://www.ncbi.nlm.nih.gov/pubmed/18652682?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum, Complementary and alternative medicine use and cost in functional bowel disorders: a six month prospective study in a large HMO, van Tilburg MA, et al, Retrieved August 6, 2008, BMC Complementary and Alternative Medicine, 2008 Jul 24;8(1):46.

http://www.ncbi.nlm.nih.gov/pubmed/8884390, Massage therapy reduces anxiety and enhances EEG pattern of alertness and math computations, Field T, et al, Retrieved August 5, 2008, The International Journal of Neuroscience, September 1996.

http://www6.miami.edu/touch-research/about.htm, History of the Touch Research Institute, Retrieved August 6, 2008, Touch Research Institute, 2008.

http://www6.miami.edu/touch-research/Massage.htm, Massage Therapy Research Abstracts, Retrieved August 6, 2008, Touch Research Institute, 2008.

by Nicole Cutler, L.Ac.

Detecting and removing ticks may be far beyond what a massage therapist might have anticipated in his/her job description. However, bodyworkers may be the only person to see certain parts of their clients' bodies; and thus be the first to glimpse one of these blood-feeding parasites. Massage therapists who educate themselves on what to do in the presence of a tick are best prepared to help this arthropod's victim - whether it is a family member or one of their own clients.

A Bit About Ticks
Because ticks are so common, people who spend any time in the outdoors will eventually encounter one. After attaching themselves to their host, a tick feeds on its host's blood. Unfortunately, ticks can acquire diseases form one host and pass it to another through their saliva. With more than 800 species throughout the world, ticks are the leading carriers of diseases to humans in the United States, second only to mosquitoes worldwide. They are responsible for carrying such diseases as:

· Rocky Mountain spotted fever
· Lyme disease
· Babesiosis (Texas fever)
· Ehrlichiosis
· Tularemia
· Colorado tick fever
· Powassan (a form of encephalitis)

Research conducted at Ohio State University indicates that transmission of disease begins approximately 24 hours after a tick begins feeding. However, most infected ticks usually don't spread the disease until they've been attached for at least 36 hours. Experts on disease transmission agree that the longer a tick feeds the greater potential for it to transmit an infection. Thus, anyone participating in outdoor activities, or who interacts with an outdoor pet, is advised to regularly survey his/her body for ticks.

Tick Removal
Since the longer a tick stays attached to someone the more likely they are to become infected with a disease, their prompt removal is imperative. Folkloric descriptions for the best way to remove a tick have circulated for years, creating confusion for those spying one of these bloodsuckers. Although some tick removal methods involve using soap, petroleum jelly, nail polish or a match, experts warn that these approaches can increase the amount of saliva the tick transfers to its host. Experts suggest the following protocol for tick removal:

1. Tweezers - Use fine point tweezers to grasp the tick at the place of attachment, as close to the skin as possible.

2. Pull - Gently pull the tick straight out. Avoid crushing the tick's body and do not be alarmed if the tick's mouthparts remain in the skin. Once the mouthparts are removed from the rest of the tick, it can no longer transmit bacteria. If the tick is accidentally crushed, clean the skin with soap and warm water or alcohol.

3. Save - Place the tick in a small vial or sealable bag with a damp paper towel to prevent it from dehydrating. If warranted by the victim's physician, protecting the tick from dehydration aids in its identification.

4. Clean - Wash your hands, disinfect the tweezers and cleanse the bite site.

Ethics of Tick Removal for Bodyworkers
A person receiving a massage may be unaware of a tick feeding on him/her. Especially if a client has recently been in a wooded area and the tick is hidden from his/her line of vision, a massage therapist's routine could be interrupted upon spotting one of these arthropods.

Since a client's well being should be a bodyworker's top priority, attached ticks cannot be ignored. However, tick removal is not defined within a massage therapist's scope of practice. Despite this omission, longer lengths of time increases the likelihood a feeding tick will transmit illness. Therefore, bodyworkers must take appropriate steps to help remove the tick from clients.

The following six steps are intended to guide a bodyworker who finds a tick on his/her client:

1. Remain Calm - Getting freaked out does not benefit you or your client.

2. Disclose the Problem - Calmly inform your client that you see a tick.

3. Ask Permission - Ask your client for his/her permission to remove the tick. If s/he seems hesitant, inform him/her of the importance of timeliness.

4. Remove Tick - Follow the tick removal instructions described above.

5. Avoid Area - After cleaning the bite site, avoid massage therapy in that affected area.

6. Advise - After your session, give the tick to your client and suggest s/he discuss future steps (tick identification and/or prophylactic medication) with his/her physician.

Even if the thought of seeing or removing a tick from your client makes you uneasy, all health professionals must be equipped for this possibility. Swift removal of a tick may prevent your client from becoming infected with a potentially serious disease. If you do find yourself in this situation and must remove a tick during a massage session, you will have provided a tremendous service to your client - and s/he will be forever thankful.

Recommended Study:
Advanced Anatomy and Pathology
Ethics: Therapeutic Relationships

References:

http://healingmagichands.wordpress.com/2007/06/13/ethical-dilemmas/, Ethical Dilemmas, Retrieved August 22, 2008, healingmagichands, June 2007.

http://mdc.mo.gov/nathis/arthopo/ticks/, Ticks!!, Dennis E. Figg, Retrieved August 22, 2008, Missouri Department of Conservation, 2008.

http://www.cdc.gov/ncidod/dvbid/Lyme/ld_tickremoval.htm, Tick Removal, Centers for Disease Control, Retrieved August 21, 2008, Centers for Disease Control Division of Vector-Borne Infectious Disease, 2008.

http://www.emedicinehealth.com/ticks/article_em.htm, Ticks, Retrieved August 22, 2008, WebMD Inc., 2008.

http://www.lyme.org/ticks/removal.html, Tick Removal, Retrieved August 21, 2008, Lyme Disease Foundation, Inc., 2008.

http://www.ncbtmb.org/pdf/CandidateHandbook.pdf, National Certification Exam Candidate Handbook, Retrieved August 22, 2008, National Certification Board for Therapeutic Massage & Bodywork, 2008.

http://www.tickinfo.com/, Home Page, Retrieved August 22, 2008, SCS Limited, 2008.