Massage Professionals Article Archive

by Linda Fehrs, LMT

There are a variety of physical and/or mental conditions that become apparent during childhood and cause certain limitations in ability. Among them are autism, cerebral palsy, epilepsy and mental retardation. Persons with developmental disorders may not learn very quickly or be able to express themselves clearly. They will often be unable to or have difficulty in taking care of themselves and have limited mobility.

The causes of the various limitations are many, and can occur before, during or after birth. They may be the result of genetic problems, poor prenatal care, exposure to toxic substances such as drugs or alcohol, lack of oxygen during the birth process or traumatic brain injury. Often the exact cause is unknown.

A History of Abuse and Neglect
Early in American history, those with developmental disabilities were generally grouped in a classification referred to as deviant. They were looked upon with suspicion and at times accused of witchcraft or of being possessed by the devil. If they survived at all, they were often housed together in correctional facilities along with prostitutes, beggars, paupers, convicted criminals and the criminally insane.

Until as recently as 30 - 40 years ago, many persons diagnosed with some form of developmental disability were treated and even officially classified as subhuman. Those who could not be cared for by a loving family were relegated to live in institutions, where they were routinely exposed to abuse and neglect. Personal needs or abilities were not recognized. Those who were institutionalized often shared clothing and were bathed en masse by being hosed down in a large shower room.

A Return to Dignity
Throughout history, while there has been mass abuse of this population, there have also been those who have fought hard for their rights as human beings, deserving of respect and entitled to decent housing, medical care, counseling and more.

Today there is far less abuse, and many who were formerly institutionalized now live in handicapped accessible group homes, where they share dining and general living areas, but have their own bedrooms. Care and supervision is personal and monitored throughout the day and a trained staff is present 24 hours a day. The residents of these homes have frequent interaction with physical therapists, occupational therapists, recreational therapists and social workers. They are treated to outings such as the occasional seasonal party or shopping days and have in-house activities such as music and art therapies.

As recently as September 2008, federal laws have been updated and expanded to improve the lives of those who may be unable to care for themselves.

How Can Massage Help?
Sometimes the benefits are obvious. A person with cerebral palsy might experience less tightness or spasming in his/her muscles after receiving massage. Someone who has restricted movement may experience greater flexibility through the application of massage and stretching. Often the benefits are subtle, yet profound for both the client and the therapist. A person with a history of being very docile or lethargic will, after a few massage therapy sessions, be more alert and reactive. Someone who has been, for the most part, non-verbal or non-communicative, will speak and interact with others.

Several forms of complementary therapies have been shown to be effective in treating the developmentally disabled. Among them are:

· Aromatherapy - The use of essential oils can be of great help when used with the developmentally disabled. Chamomile, jasmine, ylang ylang and rose are known for their calming properties, while marjoram, rose geranium and lavender are sometimes used to help those who have trouble sleeping. Precautions need to be observed, such as avoiding the use of scents that may be too stimulating. Many of the developmentally disabled take a lot of medications. It is vital that you know what they are taking if you use aromatherapy so as to avoid any unpleasant or possibly harmful reactions. For example, aniseed, dill, fennel, hyssop and sage should not be used if the person has epilepsy.

· Chair Massage - Knowing how to do chair massage can be of great help, as many of the developmentally disabled are wheelchair bound or simply unable to get onto a massage table. It is also generally not advised and often inappropriate to use their beds for a massage therapy session. While you may not be able to use a standard massage chair for the session, the skills you use for someone in a wheel chair can be easily transferred. A person who sits all day will benefit greatly from leg and foot massage, as well as massage on arms and hands that may ache from pushing the wheels.

· Lymphatic Drainage - Many of the developmentally disabled are in wheelchairs all day, or have limited physical activity because of impairment or physiological imbalance. The result can be lymphedema, or a buildup of fluids, especially in the legs and ankles. Lymphatic drainage massage uses very light pressure strokes to help eliminate this fluid and can reduce the discomfort cause by this condition

· Reflexology - Various physical or neurological disabilities may prevent the use of certain techniques, but reflexology can be used in some form on most persons. Used mostly on the feet, it can also be used on the hands, face or ears, depending on which system is used. These areas are rich in nerve endings, which correspond to reflex zones in the body. These, in turn, affect the various glands, organs and internal/external areas of the body.

These methods are safe, gentle and non-invasive, and can be used on children as well as adults. These and other forms of touch therapy help with proprioception and improvement in joint flexibility and mobility. Often there is some improvement in cognition and communication, which may be due in part to the one-to-one attention during the session.

While facing a challenging future, many with developmental disabilities can still lead full and active lives. Offering massage helps them integrate more fully into our society and receive a caring and compassionate hands-on therapy. Working with the developmentally disabled will not only improve their lives, but it will undoubtedly touch your heart and soul as well.

Recommended Study:
Aromatherapy Essentials
Chair Massage Fundamentals
Lymphatic Drainage Massage
Reflexology

Resources:

"Administration on Developmental Disabilities: ADD Fact Sheet." Administration for Children & Families. US Department of Health & Human Services. 18 Dec 2008 http://www.acf.hhs.gov/programs/add/Factsheet.html.

"Information and Technical Assistance on the ADA." Americans With Disabilities Act. US Dept. of Justice. 18 Dec 2008 http://www.ada.gov.

"NYS-OMRDD:FAQS." August 20, 2008. New York State Office of Mental Retardation & Developmental Disabilities. 18 Dec 2008 http://www.omr.state.ny.us/hp_faqs.jsp.

Wolfensberger, Wolf. "DHM: Library - The Origin and Nature of Our Institutional Models." (January 10, 1969) Disability History Museum. 18 Dec 2008 http://www.disabilitymuseum.org/lib/docs/1909.htm.

by Nicole Cutler, L.Ac.

Many people live with vague yet persistent symptoms that, even when evaluated by a physician, seem to have no rhyme or reason. The under-diagnosed conditions of celiac sprue and gluten sensitivity are increasingly common culprits of a wide range of non-specific health complaints. While close to unheard of a decade ago, evidence of the rising prevalence of acknowledged gluten intolerance is confirmed by the sprawling gluten-free sections in most major supermarkets. If familiar with the patterns that could indicate an intolerance to gluten, healthcare professionals can advise clients who may be affected to consider testing for this escalating problem.

About Gluten and Celiac
A protein contained in the grains of wheat, barley, rye and oats, gluten's unique molecular structure lends a doughy/elastic consistency to flours derived from these grains. Because of gluten's ability to stretch, gluten-containing grains are used extensively in breads and other baked goods to form a light, airy texture.

Also known as celiac sprue, celiac disease is a genetically inherited autoimmune disorder causing inflammation in the small intestine from the gluten protein. Scientific studies demonstrate that people are born with a genetic predisposition to celiac, and any trauma to the body such as surgery, stress, pregnancy or viral infections can ignite it. Approximately one in 100 people have celiac disease, most of which remain undiagnosed.

Gluten Intolerance
Gluten intolerance is a broad term, which includes all kinds of sensitivity to gluten. An estimated one in four have sensitivity to gluten without celiac disease. Constituting a growing number of healthcare visits, the correct term for these people is Non-Celiac Gluten Sensitive (NCGS).

Once in the digestive tract, gluten is broken down into its components, including an amino acid chain called gliadin. For those living with celiac or NCGS, the following problematic events are likely to occur:

· The absorption of gliadin in the small intestine triggers an inflammatory response that damages or completely disables the villi.

· The lack of functioning villi interferes with the absorption of all nutrients, and typically causes malabsorption and malnutrition.

· The damaged small intestine walls allows for large molecules to leak into the bloodstream.

· Detected as foreign invaders, these misplaced particles prompt the immune system to launch an attack.

Symptoms
Depending on the severity of the inflammation and the extent of damage to the intestinal villi, gluten sensitivity can cause a host of problems ranging from mild to severe. While often thrown into the category of irritable bowel or leaky gut syndrome, gluten sensitivity typically results in some (or all) of the following:

· Abdominal pain
· Gas and bloating
· Diarrhea and/or constipation
· Lots of oily, foul smelling stools
· Anemia
· Depression
· Fatigue
· Brain fog
· Joint aches and pains
· Muscle cramps
· Nerve pain
· Skin conditions like eczema
· Headaches
· Gastric reflux or heartburn
· Changes in weight
· Other food allergies

For Bodyworkers
Several companies are actively searching for a drug or supplement to help those with gluten sensitivity. However, there is currently only one effective solution for those affected. Although it requires education and commitment, eliminating all foods containing gluten from the diet effectively stops symptoms and allows areas damaged by gluten to recover. Because a gluten sensitive person's immune system sees this protein as a threat, many experts believe that skin products containing gluten must also be avoided. Of particular interest to the massage therapist, massage mediums containing wheat germ or hops have the potential to irritate the skin of someone with gluten sensitivity.

Besides carefully choosing massage oil or lotion, therapists may encounter clients who have many symptoms of gluten intolerance - yet have not been evaluated for celiac sprue or NCGS. Thus, a supportive practitioner who suggests testing for gluten sensitivity could help direct his/her client towards finally finding the answer to all that ails them.

Recommended Study:
Advanced Anatomy and Physiology

References:

https://www.enterolab.com/StaticPages/Frame_Faq.htm#What_is, Frequently Asked Questions, Retrieved May 17, 2009, EnteroLab, 2009.

http://www.massagetoday.com/archives/2006/03/16.html, Celiac Disease, Part 1: What Is Going On Here?, Ruth Werner, LMP, NCTMB, Retrieved May 16, 2009, Massage Today, March 2006.

http://www.massagetoday.com/mpacms/mt/article.php?id=13424, Celiac Disease, Part 2: What Is Going on Here?, Ruth Werner, LMP, NCTMB, Retrieved May 16, 2009, Massage Today, May 2006.

http://www.prohealth.com/ME-CFS/library/showArticle.cfm?libid=14523&B1=EM050609C, The Gluten Syndrome: A neurological disease - Source: Medical Hypotheses, Rodney Philip Ford, Retrieved May 14, 2009, ProHealth, Inc., April 2009.

http://www.psychologytoday.com/articles/pto-19980301-000024.html, Gluten for Punishment, Richard Firshein, Retrieved May 17, 2009, Psychology Today, March/April 1998.

http://www.seattlewomanmagazine.com/articles/may08-4.htm, No Gluten, Please, Mary Jane Halligan, LMP, NTP, CT, Retrieved May 16, 2009, Caliope Publishing Company, May 2008.

by Linda Fehrs, LMT

In the late spring of 2008 I noticed a redness on my upper left shoulder. It looked more like an enlarged and slightly irritated mosquito bite more than anything else. But in three days it grew from the size of a nickel to a circular patch with a diameter of more than eight inches. On the fifth day I woke up to discover it covered close to one-quarter of the left side of my upper body, and large red splotches were appearing on my left leg as well. A trip to the doctor confirmed it was Lyme disease and three weeks of antibiotics ensued.

Despite my diligence, earlier this summer, I discovered that familiar bull's-eye circle on my left leg, behind my knee. I had removed a tick attached there about two weeks earlier, monitored it for about ten days and everything seemed fine. It was the Fourth of July weekend, and I waited until Monday to go to the ER - when once again I was diagnosed with Lyme disease.

I like to think that as a massage therapist with knowledge of pathology, a desire to maintain good health, as well as being a nature lover living in the woods, would mean I was up on the facts about preventing and recognizing Lyme disease. But it took this most recent bout to get me to read up on it and share the information with other massage therapists.

What Causes Lyme Disease?
Lyme disease is caused by a spiral shaped bacteria belonging to the genus Borrelia, which is carried by ticks belonging to the species of the genus Ixodes. The deer tick is responsible for Lyme in the Eastern United States, while the western black-legged tick is responsible for Lyme on the West Coast of the U.S. (Europe and China have other species of ticks that transmit diseases similar to Lyme.)

A tick itself is no larger than a poppy seed, which makes them very hard to detect. The bacteria transfers to humans via an infected tick, which is in either the nymph or female adult stage of development. The tick needs to be attached to the body for more than 24 hours to transmit Lyme.

Diagnosis
Diagnosing Lyme disease is tricky. Perhaps the most definitive diagnosis comes when you know you've been bit by a tick and then get the classic bull's-eye rash (erythema migrans). Most doctors won't even bother with a blood test if those two factors are evident. However, not everyone with Lyme knows he or she has been bit. And of those diagnosed with Lyme, only about 60% - 80% present the rash.

Even the typical blood tests given often show false positives, as well as false negatives. This means that Lyme could be either vastly over- or under-diagnosed. A person infected with Lyme may not show any symptoms for 30 days or more, or symptoms can manifest just a few days after the tick bite.

Some of the symptoms of Lyme disease, especially if there is no rash, can be confused with other pathologies including fibromyalgia and chronic fatigue syndrome, which are treated much differently than Lyme.

Who Is At Risk?
If you live in or near a wooded area, especially in the Northeastern United States, you are at risk for getting Lyme disease if bitten by a tick. Though living elsewhere is not a guarantee of safety. According to the Center For Disease Control (CDC), about 93% of all cases of Lyme disease come from the Northeast states and Minnesota though every state, as well as the District of Columbia, has reported cases. Depending on where you live, ticks can be active anywhere from mid-May to November and tend to thrive in moist, grassy areas.

Treatment
Lyme disease is typically treated with antibiotics with different ones used to treat children and adults. Doxycycline is generally prescribed for adults, amoxicillin for children and erythromycin for pregnant women.

In the past it was thought that only long-term use of antibiotics could totally rid the body of the Lyme causing bacteria. There is still some controversy over the use of long-term antibiotic treatment, though most doctors advise against it and the typical treatment now lasts three weeks. Long-term antibiotic use comes with a high price - including a depressed immune system and the development of drug resistant infections.

Stages
There are three stages of Lyme disease.

First Stage: The initial phase (7 - 10 days after the bite) may include the hot, itchy circular rash and typical flu-like symptoms such as high fever, swollen lymph nodes, headache, night sweats and fatigue. There may be overall achiness and stiffness as well. If there is no bull's-eye rash, this phase may be misdiagnosed as the flu, mononucleosis or even meningitis and so may be treated incorrectly.

Second Stage: If left untreated, the disease may progress to a second stage and result in cardiovascular problems including irregular heartbeat and dizziness, neurological problems such as Bell's Palsy, numbness, tingling, poor coordination and even forgetfulness. There can be a general malaise and debilitating fatigue as well.

Third Stage: The third stage is associated with inflammation of one or more large joints, most notably the knees. If left untreated it can cause permanent damage.

The second and third phase can occur weeks, months or even years after infection with Lyme causing bacteria. In later stages, if left untreated, the bacteria disseminate throughout the body and can cross the blood-brain barrier making the Lyme much more difficult to treat.

Can Massage Help?
Massage can't cure or treat Lyme, but it can help with the symptoms such as the aches and pains, and also help to boost the immune system. In the initial stages of Lyme, a person may be too uncomfortable to even want a massage - (I know I was) - and it often is not advisable to administer massage to a person on antibiotics. Massage can reduce the discomfort of later symptoms that may continue long after the completion of antibiotic use.

Deep tissue massage is not recommended in acute stages of the disease, but gentler modalities, such as lymphatic drainage, polarity therapy, reflexology can be helpful. Light Swedish massage and Shiatsu can also be effective as long as the massage therapist recognizes the client's tolerance level.

Complementary Treatments
In addition to massage there are some other natural remedies that can complement allopathic treatment.

· Probiotic supplements, such as Lactobacillus acidophilus, can help maintain gastrointestinal health by replacing good bacteria and offsetting some of the effects of the antibiotics, such as diarrhea and yeast infections. Look for live, active probiotics in foods like yogurt and kefir, or get them in supplement form at your local health food store.

· Herb teas, or dried extracts in the form of capsules, powders or tinctures can help because of their antioxidant, anti-inflammatory and immune support qualities. Try decaffeinated green tea, ginkgo biloba, cat's claw, reishi mushroom, olive leaf or garlic. Inform your doctor if you take any of these to avoid any possible interactions with prescribed drugs.

· Homeopathic remedies, prescribed by a professional homeopath, can reduce the effects of Lyme. They may include ledum, thuja or lac canimum among others, depending on the homeopath's evaluation.

· Acupuncture can help to relieve pain, increase mobility and reduce fatigue. As they are also schooled in Chinese herbal medicine they can also offer remedies that may help with other symptoms and side effects of Lyme.

· Essential oils can help to alleviate some of the symptoms. For example cinnamon, clove or ginger can reduce fatigue and keep you alert; chamomile, lavender or myrrh can help reduce inflammation; and bay laurel, clove bud or garlic are powerful antibacterial agents.

If You Think You Have Lyme
If you have found a tick attached to your body, or if you find a bull's-eye rash (particularly prone areas are back of the knee, inside of elbows, armpits, groin, under the breasts and on the back), go to a doctor for evaluation and treatment as soon as possible.

To get up-to-date information on Lyme disease, tick removal and tick identification contact your local department of health. 1-800-866-LYME (5963) is a 24-hour hotline provided by the Lyme Disease Foundation.

Recommended Study:
Advanced Anatomy & Pathology

Resources:

Cutler, Nicole, L.Ac. "Is a Tick Burying Itself In Your Client's Skin?." Integrative Healthcare. 16 Jul 2009 http://www.integrative-healthcare.org/mt/archives/2009/06is_a_tick_buryi.html.

Ehrlich, Steven D., NMD. "Lyme Disease." 15 June 2008. University of Maryland Medical Center. 14 Jul 2009 http://www.umm.edu/altmed.articles/lyme-disease-000102.htm.

"Lyme Disease." Lyme Disease Foundation, Inc., 14 Jul 2009 http://www.lyme.org/otherdis/ld.html.

"Lyme Disease - Fact Sheet." September 2008. New York State Department of Health. 16 Jul 2009 http://health.state.ny.us/diseases/communicable/lyme/lyme/fact_sheet.htm.

"Lyme Disease - Medications." 03 September 2008. WebMD. 14 Jul 2009 http://arthritis.webmd/tc/lyme-disease-medcations.

"Lyme Disease - Treatment Overview." 03 September 2008. WebMD. 14 Jul 2009 http://arthritis.webmd/tc/lyme-disease-treatment-overview.

"Lyme Disease." Wikipedia. 14 July 2009. Wikimedia Foundation, Inc., 14 Jul 2009 http://en.wikipedia.org/wiki/Lyme_disease.

Smith, Jenna. "Lyme Disease Resource - Essential Oils." 2006. Lyme Disease Resource. 16 Jul 2009 http://lymediseaseresource.com/Essential_Oils.html.

Werner, Ruth, LMPA Massage Therapist's Guide to Pathology [133-137]. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2008.

by Nicole Cutler, L.Ac.

Considered by many healthcare practitioners to be one of the most challenging health conditions to work with, different forms of cancer are increasingly affecting the world's population. Although Western medicine has made great strides in treating cancer, many believe that alternative therapies play an important role in their healing process. Because of the caution that some treatments may encourage the spread of cancer cells, various alternative health practitioners have taken a hands-off approach to cancer in favor of safety. However, therapists trained in aromatherapy offer a predominantly safe method to help a person battling cancer.

Over the years, a bodyworker's role in working on people with cancer has shifted from a distinct prohibition to an emerging specialty. While no respectful practice should suggest that their healing method supersedes a physician's advice, pairing certain complementary health approaches with medical treatment can have tremendous positive benefits to the patient. As one of the more researched modalities, experts believe the ancient art of aromatherapy can be highly effective in helping manage the restlessness, anxiety and stress associated with conventional cancer treatment. However, as with anything of strong therapeutic value, there are some unique potential interactions between the use of essential oils and traditional cancer treatment.

When it comes to essential oils, Cherie Perez, a supervising research nurse in M. D. Anderson's Department of Genitourinary Medical Oncology who teaches aromatherapy to cancer patients, says they have been shown to have tremendous soothing and stress-relieving capabilities. According to Perez, "The most common complaint I have from [cancer] patients is with anxiety or sleeplessness." Perez has discovered that when patients are relaxed they sleep more comfortably, further enabling their bodies to heal.

Besides surgery, enduring either of the two prominent treatments for cancer - radiation or chemotherapy - is always a challenge. In fact, it is common for people receiving radiation and/or chemotherapy to have severe side effects and even long lasting health implications from these treatments. Although aromatherapy can be a soothing complement to cancer treatment, assuring it is safely applied must always be a practitioner's priority.

Chemotherapy
Aromatherapists Jane Buckle, Ann Percival and Pam Conrad are registered nurses who have studied the impact different essential oils have on those undergoing cancer treatment. These experts concluded that, because essential oils can compete with cell receptor sites utilized in chemotherapy, aromatherapy application should adhere to the following guidelines to ensure safety:

· Essential oils can be applied in massage up to two days before a chemotherapy treatment.

· Essential oils should be avoided for nine to ten days after chemotherapy administration.

· During a chemotherapy regimen, keep the dose of essential oils low by using only two drops per ounce of carrier oil or lotion.

· While inhalation to counteract nausea accompanying chemotherapy is acceptable, there are provisions for peppermint and ginger.

· Peppermint can be inhaled unless the client has cardiac problems or is on the chemotherapy drug 5FU, since peppermint enhances its absorption fourfold.

· Although ginger is another good essential oil choice for relieving nausea, it can reduce clotting time.

Radiation
Even though several clinical studies have failed to report any improvements by using aromatherapy during radiation therapy, there are still a substantial number of people who believe otherwise. Despite this discrepancy, several wellness centers across the U.S. employ the benefits of essential oils for those undergoing cancer treatments.

Since one of the prominent concerns about radiation therapy is excessive burning and skin problems, applying anything to the skin should be carefully evaluated. As is the case with aromatherapy, topical application of phototoxic oils can be detrimental to those doing radiation therapy or those with skin cancer.

Stedman's Medical Dictionary defines photosensitization as, "sensitization of the skin to light, usually due to the action of certain drugs, plants, or other substances." Phototoxic oils cause light-related irritation or darkening of the skin when exposed to certain types of light. For a person about to be exposed to the intense rays of radiation therapy, it is important to avoid phototoxic oils so that you do not worsen skin sensitivity. The more commonly known phototoxic oils include:

· Lemon
· Bergamot
· Angelica
· Lime
· Grapefruit
· Orange
· Mandarin
· Tagete
· Verbena

It may be possible to safely use citrus oils with a person undergoing radiation therapy. By choosing a steam-distilled oil, the phototoxic elements can be avoided. If unsure, check with the essential oil manufacturer about your chosen oil's phototoxicity.

In addition, certain essential oils can irritate or sensitize the skin regardless of light exposure. Commonly known sensitizing oils include:

· Cinnamon bark
· Fig leaf
· Verbena
· Caraway
· Dill seed
· Peppermint
· Ylang ylang

In addition to considering the phototoxicity and sensitivity to the previously listed oils, a good rule of thumb to follow for those receiving radiation therapy is as follows:

Keep the concentration of essential oils low by using only two drops per ounce of carrier oil or lotion.

The more we learn about aromatherapy, the more we realize how strong essential oils can be. Bodyworkers incorporating aromatherapy into their practice can offer people undergoing cancer treatment a better experience and may even improve their ability to defeat their cancer. While this prospect excites those destined to heal, make certain you are being safe with those undergoing chemotherapy or radiation therapy. Even though aromatherapy poses little risk to spreading cancer, it is a potent application - and safety should always be a practitioner's first therapeutic consideration.

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

Recommended Study:
Aromatherapy Essentials

References:

Enteen, Shellie, BA, LMT, Aromatherapy for Clients With Special Needs, Massage Today, January 2007.

Osborn, Carrie, Essential Oils Simply Complex, Massage and Bodywork, December/January 2006.

www.associatedcontent.com, Aromatherapy and Phototoxic Essential Oils, Associated Content Inc., 2008.

www.cancerwise.org, Aromatherapy Soothes Cancer Patients, The University of Texas M.D. Anderson Cancer Center, 2008.

www.cancerwise.org, Exercise Safety When Using Aromatherapy, The University of Texas M.D. Anderson Cancer Center, 2008.

by Nicole Cutler, L.Ac.

One of the more enigmatic muscle groups in the human body, contracted scalenes are commonly found to be at the root of several pathologies. Due to their slightly hidden, highly innervated and vascularized locations, performing bodywork on these muscles requires extra care. Upon identifying contracted scalenes as problematic, carefully and thoroughly performing a sequence of massage techniques on these muscles can bring your client significant and seemingly miraculous relief.

Scalene Function and Dysfunction
Consisting of the scalenes anterior, scalenes medius and scalenes posterior, the scalene muscles originate from the transverse processes of cervical vertebrae two to seven and insert into the first and second ribs. Located on the lateral side of the neck, the scalenes serve two primary functions:

1. Neck movement by laterally flexing the head. In addition, the scalenes assist in rotating the head to the opposite side and flexing the cervical spine on the thoracic spine in an oblique direction.

2. Assist in respiration by raising the ribs. The scalenes are considered to be auxiliary respiratory muscles, becoming activated when more thoracic cavity space is required - usually occurring during exercise when a greater volume of air is needed to meet increased demands for oxygen.

Those who recruit neck muscles for everyday breathing are likely to develop trigger points in the scalenes. To learn more about the problems associated with apical breathing and how to correct it, read the article Diaphragm Strengthening for Neck and Shoulder Pain.

The scalenes are notorious for generating pain, both locally and distally. In addition to causing widespread pain in the neck, scalene trigger points can cause pain to refer to the:

· Chest
· Medial border of the scapula
· Shoulder
· Posterior and lateral sides of the arm to the thumb and index finger

The brachial plexus and the subclavian artery pass between the anterior and medial scalenes and the subclavian vein passes anterior to the anterior scalene. Thus, a shortening of these muscles from trigger point development can compress or irritate these nearby blood vessels. Therefore, it is not uncommon for clients with tight scalenes to complain of paresthesia, anesthesia, coldness, claudication and lymphedema in the involved extremity.

In general, a tight scalene group will pull the head to the same side. This can be tested by laterally flexing the neck and noticing where the motion is restricted. If flexion is restricted to the right, the scalenes on the left are tight. When working on the scalenes, massage therapists must be aware of the sensitive nerves and arteries nearby. The scalenes can impinge on the brachial plexus, causing nerve pain or numbness down the arm, otherwise known as thoracic outlet syndrome.

Scalene Release
When it comes to the increasingly common diagnosis of thoracic outlet syndrome, massage therapists are equipped to provide one of the most effective treatments. According to Doug Alexander, instructor of Natural Wellness' home study continuing education course Nerve Mobilization, "When the scalenes are released the first rib can be shifted downwards and the clavicle mobilized to create more space and ease for the plexus (brachial) to pass between these bones." In this course, Alexander teaches an effective sequence for releasing the scalenes, including the following techniques:

· Scalene length assessment and stretch
· Bowing the scalenes
· Scalene post-isometric relaxation
· Stripping of the scalenes

Due to the neighboring anatomical structures, Alexander consistently advises therapists to be careful of causing clients discomfort - and suggests ways of adjusting their technique if this occurs.

Since scalene constriction can cause pain in so many areas of the upper body, a comprehensive understanding of the neck musculature and underlying structures is essential for massage therapists. This anatomical familiarity will help therapists with accurate client assessment and safe, therapeutic applications to release the scalene muscles. With subsequently relaxed scalene muscles, clients are often amazed at the dramatic pain relief they experience.

Recommended Study:
Anatomy Review for Professionals
Clinical Massage Therapy
Nerve Mobilization

References:

Alexander, Doug, Nerve Mobilization Workbook, Natural Wellness, 2008.

http://en.wikipedia.org, Scalene Muscles, Wikimedia Foundation, Inc., 2008.

http://saveyourself.ca, Singing, Breath and Scalenes, Paul Ingraham, RMT, SaveYourself.ca, 2008.

Murphy, Donald R., DC, Scalene Trigger Points: The Great Imitators, Dynamic Chiropractic, November 1991.

www.realbodywork.com, Scalenes: Scalene Medius, Anterior and Posterior Muscles, Real Bodywork, 2008.

by Nicole Cutler, L.Ac.

As healthcare professionals who regularly make skin contact with their clients, massage therapists must be able to recognize and assess an array of dermatological conditions. Although folliculitis is commonly encountered in the general public, it is also one of the least understood skin anomalies. Despite folliculitis simply being an infection of the hair follicle, it could have half a dozen or more different causes. While one type of folliculitis poses little threat to the client or massage therapist, others may create a formidable transmission risk.

Symptoms of Folliculitis
The signs and symptoms of folliculitis vary, depending on the type of infection. Typically associated with the part of the hair follicle that is infected, there are mild and severe forms of folliculitis. Superficial folliculitis occurs when just the upper part of the follicle is infected, and deep folliculitis affects the entire hair follicle. In general, symptoms include:

· Groups of small red bumps around hair follicles
· Blisters filled with pus that break open and crust over
· Pain, itchiness or tenderness
· Large, swollen bump (in cases of deep folliculitis)
· Scarring after the infection heals (in cases of deep folliculitis)

Types of Folliculitis
Whether you suspect your client has folliculitis or the person tells you that he/she has already been diagnosed with it, there are many variations of this common skin disorder. Resulting from curly hair or bacterial, viral or fungal infections, a general summary of folliculitis forms include:

Curls
· Pseudofolliculitis - Although not technically an infection, this is an inflammation of the hair follicles usually affecting people with wavy or curly hair. When curly hair is shaved, its re-growth can curl back into the skin leading to inflammation and scarring. Also known as razor bumps, pseudofolliculitis is not contagious.

Bacterial
· Staphylococcal folliculitis - When hair follicles become infected with Staphylococcus aureus, itchy, white, pus-filled bumps can occur anywhere on the body. When located under the facial hair of men, this dermatological problem is called barber's itch. Commonly occurring from shaving or a skin injury, it can turn into a boil or carbuncle if the entire hair follicle is affected. Unfortunately, a substantial number of cases of methicillin resistant staphylococcus aureus (MRSA) began as folliculitis. This virulent strain of bacteria is highly resistant to multiple types of antibiotics.

· Pseudomonas folliculitis - Also known as hot tub folliculitis, the pseudomonas bacteria thrive in a wide range of environments and can cause a rash of red, round, itchy bumps that will eventually develop into small, pus-filled blisters.

· Gram-negative folliculitis - Affecting the entire hair follicle, this type of folliculitis often develops in those on long-term antibiotic treatment for acne due to an overgrowth of gram-negative bacteria. Gram-negative folliculitis can cause severe acne lesions.

Fungal
· Tinea barbae - Also developing beneath the facial hair of men, this fungal infection causes tiny, white itchy bumps with surrounding red skin. Untreated, this rash can escalate to pus-filled nodules that eventually form a crust, which may be accompanied by swollen lymph nodes and fever.

· Pityrosporum folliculitis - Evidenced by chronic, red, itchy pustules on the back, chest, neck, shoulders, upper arms and face, this yeast-like fungus commonly affects young and middle-aged adults.

· Eosinophilic folliculitis - Although experts are unsure of its cause, this type of folliculitis is mostly prevalent in those with HIV. Characterized by recurring, spreading patches of itchy, inflamed, pus-filled sores, primarily on the face and sometimes on the back or upper arms, eosinophilic folliculitis is suspected to involve a yeast-like fungus.

Viral
· Herpetic folliculitis - When a herpes simplex viral cold sore is shaved through, it can spread the herpes infection to nearby hair follicles.

For the Massage Therapist
Unless curly hair is the culprit, most of the types of folliculitis are contagious. Unfortunately, many with folliculitis regard it as a minor annoyance and don't consider it important enough to discuss with their bodyworker. In addition, many cases of folliculitis are mistaken for a simple pimple or acne breakout.

A massage practitioner who makes contact with the affected area could spread the infection to neighboring hair follicles. Besides exacerbating the client's condition, the therapist and subsequent clients are at an increased risk of exposure to the folliculitis' causative pathogen. Due to these risks, there are several imperative steps bodyworkers must take to maintain safety:

1. Avoid the area - Never work on an area with folliculitis, whether it is a suspected or confirmed case. If possible, use gloves and a bandage to cover the problem area and request the client do so prior to future sessions.

2. Launder carefully - Make certain that any linen in contact with a client harboring folliculitis is separated from other linens and is properly laundered with hot, soapy water and bleach.

3. Protect your hands - If you do not use gloves, keep liquid bandage on hand to make sure any cuts or nicks on your hands are completely sealed. In addition, take extra care when washing your hands before and after clients.

When it comes to breaches in the skin's integrity, bodyworkers must be prepared to protect their client, themselves and subsequent visitors. By realizing that what could be mistaken for a pimple could actually be a bacterial, viral or fungal infection, massage therapists will increase their attentiveness to the presence of folliculitis. As long as bodyworkers avoid the affected area, are careful with dirty linens and protect their hands, they needn't worry endlessly about the pathogens lurking in their client's hair follicles.

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

References:

http://sportsinjuries.suite101.com/article.cfm/mrsa_infection_in_athletes, MRSA Infection in Athletes, Steven M. Cohen, Retrieved August 12, 2008, suite101.com, August 2008.

http://www.massagetherapy.com/articles/index.php/article_id/921, Break Free from Acne Breakouts, Cathy Ulrich, Retrieved August 12, 2008, Associated Bodywork & Massage Professionals, 2008.

http://www.mayoclinic.com/health/folliculitis/DS00512/DSECTION=treatments-and-drugs, Folliculitis, Retrieved August 12, 2008, Mayo Foundation for Medical Education and Research, 2008.

http://www.orlandoskindoc.com/pseudofolliculitis.htm, Pseudofolliculitis, Retrieved August 14, 2008, John L. Meisenheimer, MD, 2008.

http://www.webmd.com/a-to-z-guides/folliculitis-topic-overview, Folliculitis, Retrieved August 13, 2008, WebMD, LLC, 2008.