Massage Professionals Article Archive

by Linda Fehrs, LMT

There are few things worse than having a business you love and being hit with a slowdown in the economy. It doesn't matter if that slowdown is affecting everyone at the same time or if it is simply a temporary seasonal downturn. Coming up with ways to attract new clients can be difficult, but it can also allow you to be more creative in your approach to marketing.

One way of reaching out to more people, as well as connecting with other professionals, is to offer at-home spa parties. The possibilities are endless, ranging from simply offering massage to various aesthetic services, a yoga class or even including entertainment such as tarot readings. Portable spa services can be done in private homes and at offices as a service to employees.

Here are some suggestions for starting what could turn out to be a very lucrative business:

· Decide what kind of services you would like to offer. Do you want to stay strictly with massage, or include aesthetic services such as facials and manicures? Do you want to make it more of a party atmosphere with tarot or palm readings? Or, do you want to get into product sales?

· Contact other professionals who may be willing to join with you. Get everyone together and brainstorm about putting together a cohesive business plan.

· Plan a menu of services. Think in terms of themes, whether they will be for a specific event such as a bridal shower or, more general, such as an afternoon of fitness. Provide as wide a range of services as you feel comfortable.

· You can offer package deals, with several services at a better price or ala carte items allowing the client to pick and choose services. Do you want to offer chair massage, table massage, reflexology, skin care treatments or makeup instruction?

· Put together an attractive brochure, listing the packages, services and prices. This needn't be expensive. Personal computers and specialized software make creating promotional material relatively easy.

· Take the brochures and post them in health food stores, gift shops, bridal shops and doctor's offices (such as ob/gyn), to name a few. Mail them to local businesses and colleges, and remember to follow-up with phone calls.

· Decide where you want to offer your services. How far do you want to travel? Do you want to go to private homes, businesses or hotel suites?

· The services you offer will most likely determine who your clients will be. Offering pre-natal massage or bridal shower pampering will bring women, while bringing massage services to a local insurance office will most likely bring a mix of men and women.

· When offering a package deal, be sure to provide the whole experience. Bring relaxing music, candles, scents - such as essential oils or flowers - and provide small favors - such as mini spa kits. You can even bring a selection of herbal teas, juices or bottled water. Spa robes and slippers are also a nice touch.

· When you determine your pricing, don't forget to include travel and setup time. Some businesses will even include a percentage for gratuities. You can include these as an additional cost or figure them into your overall package price.

· With package deals, determine a schedule for the various services. Have clients sign up when they arrive and offer enough so that everyone is kept busy.

· When the spa party is over, remember to take everything with you including any trash that may have accumulated. The only things you should leave behind are business cards and brochures!

Providing mobile spa services, especially during times when business is slow, cannot only bring you an additional source of income, yet it can also introduce you to potential new clients for individual massage. It can be a fun and creative way to enhance your business.

Recommended Study:
Chair Massage Fundamentals
Developing a Wellness Center

Resources:

"Mobile Spa Party and On-site Spa Event marketing." Spa Chick On The Go, Web. 22 Sep 2009. http://www.spachicksonthego.com.

"Tips for Hosting a Spa Party." How to Host a Spa Party. Spa Index, Web. 24 Sep 2009. http://www.spaindex.com/Articles/SpaParty.htm.

by Nicole Cutler, L.Ac.

For a majority of clients, a favorite part of bodywork is the back massage. There is something so nurturing, relaxing and healing about lying prone and having these large, stressed muscles of your body worked upon. Massage therapists with exposure to Traditional Chinese Medicine (TCM) know that there is a detailed system of reasoning behind back massage's influence on the entire body. Located on either side of the spinal column, TCM's back shu points give bodyworkers an accessible diagnostic and therapeutic map.

What Are the Back Shus?
The back shu points are like portals to our organs and associated meridians. The word "shu" literally means "to transport," indicating the back shu points' ability to move energy to and from our inner organs. Located on either side of the spine, each back shu point is level with a respective spinous process or sacral foramen. Positioned on the inner branch of the urinary bladder (UB) channel, the back shus stretch from lateral to the tip of the 3rd thoracic vertebrae down to lateral to the 2nd posterior sacral foramen.

Memorized by TCM practitioners, the following summary correlates each of the back shus with the 12 main organs and their channels:

1. Lung - UB 13 is located 1.5 thumb widths lateral to the lower border of spinous process of the 3rd thoracic vertebrae.

2. Pericardium - UB 14 is located 1.5 thumb widths lateral to the lower border of the spinous process of the 4th thoracic vertebrae.

3. Heart - UB 15 is located 1.5 thumb widths lateral to the lower border of the spinous process of the 5th thoracic vertebrae.

4. Liver - UB 18 is located is located 1.5 thumb widths lateral to the lower border of the spinous process of the 9th thoracic vertebrae.

5. Gallbladder - UB 19 is located 1.5 thumb widths lateral to the lower border of the spinous process of the 10th thoracic vertebrae.

6. Spleen - UB 20 is located 1.5 thumb widths lateral to the lower border of the spinous process of the 11th thoracic vertebrae.

7. Stomach - UB 21 is located 1.5 thumb widths lateral to the lower border of the spinous process of the 12th thoracic vertebrae.

8. Triple Burner - UB 22 is located 1.5 thumb widths lateral to the lower border of the spinous process of the 1st lumbar vertebrae.

9. Kidneys - UB 23 is located 1.5 thumb widths lateral to the lower border of the spinous process of the 2nd lumbar vertebrae.

10. Large Intestine - UB 25 is located 1.5 thumb widths lateral to the lower border of the spinous process of the 4th lumbar vertebrae.

11. Small Intestine - UB 27 is located 1.5 thumb widths lateral to the 1st posterior sacral foramen.

12. Urinary Bladder - UB 28 is located 1.5 thumb widths lateral to the 2nd posterior sacral foramen.

Diagnostic Use
Simple observation or palpation of a back shu can reveal an imbalance in the corresponding organ system. When an organ is impaired, or the respective meridian is blocked or deficient, it is common for the back shu point to be tender. Also indicative of an imbalance in the corresponding organ or meridan, a pimple or other skin reaction may be apparent on a back shu point. For this reason, these points can give observant practitioners a great deal of diagnostic information.

Therapeutic Use
Upon studying the patterns of organ imbalance and their associations, the back shus can be chosen as a therapeutic tool. For example, a client with an imbalance in his or her digestive energy can extract great benefit from stimulation of the spleen and stomach back shus. These points are known to be adaptive, meaning they will tonify or sedate depending on the function needed. Thus, a practitioner can offer a therapeutic massage by simply stimulating the back shu associated with a client's condition - without the need for extensive TCM diagnostics.

A client without any specific complaints or reactive shu points will always benefit from stimulation of all back shus. Commonly practiced in TCM pediatric massage, working all of the shu points encourages healthful and balancing energy flow throughout the entire internal organ system.

Once familiar with where each back shu is located and what organ that point corresponds with, massage therapists can be more deliberate in their application of techniques. Stimulating the areas covered by this special category of points and observing any anomalies at their locations brings another dimension of healing to the assessment and treatment of the learned massage practitioner.

Recommended Study:
Shiatsu Anma Therapy

References:

Esher, Barbra, AOBTA CI. Dipl. ABT & Ac. (NCCAOM), Lac, The Soul of Your Shus, Massage Today, July 2001.

Liangyue, Deng, et al., Chinese Acupuncture and Moxibustion, Foreign Languages Press, Beijing, 1987.

Maciocia, Giovanni, CAc, The Foundations of Chinese Medicine, Churchill Livingstone, New York, 1989.

www.massagetoday.com, Clinical Pearls for the Massage Therapist: Learning and Using Acupuncture Back-Shu Points, Mark Anthony Kestner, DC, FIAMA, CCSP, CSCS, Massage Today, 2008.

by Nicole Cutler, L.Ac.

A variation on conventional Swedish massage, Esalen Institute has trained bodyworkers in their unique, psycho-spiritual massage approach for several decades. While many valuable aspects of Esalen massage have been studied and incorporated into bodywork practices across the nation, one native element remains controversial - nudity. Although the clothing optional custom at Esalen Institute is believed to enhance participating individuals' personal experiences, bringing this routine into the outside world of bodywork poses a great ethical challenge.

About Esalen Institute
Esalen is a non-profit organization that has been devoted to the exploration of human potential since the 1960s. Historical luminaries like Aldous Huxley, Joseph Campbell, Jack Kerouac, Allen Ginsberg, Joan Baez and countless others have gathered at Esalen to develop revolutionary ideas, transformative practices and innovative art forms.

Esalen Institute, renowned for its healing natural hot springs, has long been recognized as a world leader in alternative and experiential education. Dramatically situated on Big Sur's cliffs overlooking the Pacific Ocean, Esalen Institute is a premiere incubator for mind-body-spirit techniques and has consistently remained at the forefront of new developments and discoveries in the fields of psychology and bodywork.

About Esalen Massage
Esalen Massage (EM) is known for its healing and nurturing touch; it combines long strokes, gentle rocking and stretching, sculpting of deep musculature and the precision of acupressure. However, EM goes beyond the physical result of bodywork by focusing on energy exchange and psychological well-being. Taught and trademarked by the Esalen Institute, EM aims to tune the mind and body together to create a sense of serenity and peace.

Ten key aspects of the Esalen technique for practitioners include:

1. Grounding yourself before giving a massage.
2. Waiting and listening to the client's breath before making initial contact.
3. Gentle rocking to help the body let go of rigidity.
4. Creating a unified and whole massage defined by long, lengthening strokes.
5. Making small circular movements around joints to encourage release.
6. Bringing the whole body weight into the movement.
7. A little unpredictability to ease away holding patterns.
8. Allowing time to pause.
9. Understanding that massage goes beyond the physical self.
10. Remembering that everybody loves and wants to be touched.

Esalen and Nudity
When visiting Esalen Institute, some guests may notice that there are clothing optional areas. Although Esalen's clothing optional policy has long been challenged, most guests go nude at the hot springs and ardently defend their right to do so.

According to playwright and Esalen regular Lynne Kaufman, "I've been at the baths naked for a period over 25 years. It was at Esalen, through the baths and through the massage, that I saw my body as natural. The amazing thing is that once people take off their clothes, there is more commonality. It was the clothing that made for differences. When released from that, they were just other organisms. What I saw was an acceptance of all kinds of body types, which was a very different experience: it was evolutionary. You see the youthful bodies, the old men and women. You see life."

Author of the essay Fig Leaf in the Wind, Sharon Thom describes Esalen's acceptance of nudity as an acknowledgment of personal freedom. In her essay she explains, "Our need to hide, all of the time, behind a variety of decorative devices and professional excuses and whatever status we've managed to fluff up around ourselves, our need to avoid one another at all costs, is what makes us less free. Taking our clothes off lies a few steps short of authentic liberation."

Nudity in EM
While clients have the option of shedding their clothing during an EM session at Esalen Institute, this decision is made by the client only if he or she is completely comfortable with nudity. Because massage recipients traditionally soak in the hot springs prior to their EM appointment, this setting supports nudity as a natural state.

During the course of the massage, the EM client is draped with a sheet or towel. When massage therapists are trained at Esalen, they are instructed to proceed very gently and introduce people to massage in the most non-threatening way possible. Outside of Esalen Institute's setting, this means giving clients an option of being fully clothed, wearing undergarments or going nude. Despite the level of covering or uncovering massage recipients choose, professional draping practices assures a non-threatening atmosphere.

In general, our society has very little acceptance of nudity. As a massage practitioner, respecting client privacy is crucial for professionalism and to prevent major psychological implications that could result from bearing all. Esalen Massage's unique approach to integrating the physical, emotional and spiritual selves has been appreciated by clients and practitioners for decades. Regardless of where the massage is performed, helping a client find serenity and peace is independent of Esalen Institute's optional clothing practice. Thus, if the idea of psycho-spiritual massage while being surrounded by nudes inspires freedom and healing in your soul, book yourself for a workshop or extended stay in California's Esalen Institute. For everyone else, you can benefit from the innate wisdom of Esalen's massage techniques and pass it along to your clients while maintaining the professionalism and ethics required in a legitimate massage therapy practice.

Recommended Study:
Esalen Massage DVD
Ethics: Therapeutic Relationships
Integrative Massage: Spirit

References:

http://atpeacemedia.com, Massage and Bodywork: Upclose Interviews, Peggy Horan and Emma Ingrisani, At Peace Media LLC, 2008.

www.esalen.org, What is Esalen Massage?, Brita Ostrom, Esalen Massage and Bodywork Association, 2008.

www.massage-classifieds.com, Esalen Massage, massage-classifieds.com, 2008.

www.positivehealth.com, Esalen Masage: Deep Connections, Lucia Appleby, Positive Health Publications, Ltd., 2008.

www.well.com, Fig Leaf in the Wind, Sharon Thom, well.com, 2008.

www.wisegeek.com, What is Esalen Massage?, S.E. Smith, Conjecture Corporation, 2008.

by Nicole Cutler, L.Ac.

Referred to as handlebar palsy in the cycling community, Guyon's canal syndrome (GCS) is an irritation of the ulnar nerve within the palm of the hand. Because compression from outside of Guyon's canal is responsible for the offending symptoms, the practicing massage therapist must understand the involved anatomy and pathology in order to avoid exacerbating the client's discomfort.

The Ulnar Nerve
The ulnar nerve's primary role is to supply sensation to the little finger and lateral half of the ring finger. Additionally, it controls most of the little muscles in the hand that control fine movements as well as some of the forearm muscles responsible for creating a strong grip. Important for grasping objects, the adductor pollicis is often affected by ulnar nerve compression. Therefore, ulnar nerve problems not only cause little and ring finger tingling, but can also manifest as difficulty in holding objects in the hand, or clumsiness when performing precision activities such as writing.

Guyon's Canal
In the wrist, Guyon's canal is the tunnel formed by the pisiform and hamate bones and the flexor retinaculum ligament. Passing through this tunnel, the ulnar nerve is vulnerable to compressive forces on these structures. However, when evaluating symptoms of ulnar nerve compression, a practitioner must decipher the location of the suspected problem.

Causing similar types of symptoms, there are three primary areas where the ulnar nerve can be compressed:

1. The Wrist - which is likely due to compression in Guyon's canal

2. The Elbow - which is likely due to compression in the cubital tunnel

3. The Neck - which is likely due to thoracic outlet syndrome or cervical radiculopathy

Because the orientation of the ulnar nerve is unique in all three of these locations, massage approaches will differ for each area.

GCS Symptoms
Marked by numbness and tingling in the ring and small fingers, GCS typically begins with the feeling of pins and needles. If this irritation persists, it is often followed by decreased sensation in the lateral part of the hand. When the small muscles of the hand become affected, weakness and clumsiness eventually result.

GCS Causes
There are many causes of GCS, including trauma, fractures and small, benign tumors of the nerve or surrounding tissues of the tunnel. In addition to these structural problems, prolonged pressure on the wrist can cause this syndrome.

Guyon's canal syndrome may occur as either an acute or chronic compression neuropathy. Acute injuries to Guyon's canal occur most often when there is an abrupt force on the base of the hand while the wrist is in hyperextension. Falling on an outstretched hand is a good example. Chronic compression injuries occur from pressure maintained on the base of the hand for long periods. A common example is long-distance cycling, where the weight of the body is resting on the handlebars with the wrist in hyperextension.

GCS Distinguishing Pathology
Understanding the mechanics of nerve compression within Guyon's canal can help a healthcare practitioner administer the most beneficial treatment. Since many people assume they have carpal tunnel syndrome with neurological symptoms in their hand worsening with wrist pressure, isolating the sensory symptoms of ulnar nerve distribution is important for an accurate assessment of GCS.

Because there are no tendons in Guyon's canal to press on the nerve, pathological compression in GCS occurs from extrinsic factors. Extrinsic nerve compression happens when there is excessive force applied from outside the canal as opposed to pressure originating from inside the canal. In contrast, a condition like carpal tunnel syndrome involves intrinsic pressure because it comes from within the tunnel due to tendon swelling.

Massage for GCS
Once the appropriate tests reveal GCS, deliberately applied massage therapy offers sufferers an alternative to splinting and orthopedic surgery. Because GCS results from external forces causing compression on the ulnar nerve in the tunnel, massage strategies must focus on liberating the compressive force. While massage performed directly over the tunnel may worsen GCS symptoms and impair the healing process, techniques designed to decompress the nerve often provide much sought relief.

According to Doug Alexander, instructor of the Institute's Nerve Mobilization continuing education course, there are various ways to decompress the ulnar nerve in Guyon's canal. In this distance-learning course, Alexander gives specific instruction on some of these techniques, including:

· wrist pumping to reduce irritability of the ulnar nerve in the Guyon canal
· fascial release of the Guyon canal
· neural milking proximal to the Guyon canal
· ulnar nerve glides with respect to the Guyon canal
· ulnar nerve stretching in the Guyon Canal

While nerve decompression is extremely valuable to someone struggling with GCS, Alexander cautions practitioners, "You should not be creating any nerve compression symptoms during this process. If nerve symptoms are unavoidable, they should abate within a second or two of the completion of the manipulation. If they continue longer than that, you will need to explore less challenging manipulations until the nerve becomes less irritable."

While generalized massage strokes aiming at tissue compression can benefit many neurological symptoms, Guyon's canal syndrome is an exception. By combining detailed study of the wrist's anatomy and pathology with ulnar nerve decompression techniques, a massage therapist can feel confident in approaching compression within Guyon's canal.

Recommended Study:
Advanced Anatomy and Pathology
Nerve Mobilization

References:

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

http://orthoinfo.aaos.org, Ulnar Nerve Entrapment, American Academy of Orthopedic Surgeons, 2007.

http://orthopedics.about.com, "Guyon's Canal Syndrome, Jonathan Cluett, MD, About, Inc., 2008.

Lowe Whitney, LMT, NCTMB, Median Nerve Compression Pathologies, Massage Today, October 2004.

Lowe, Whitney, LMT, NCTMB, Ulnar Nerve Entrapment, Massage Magazine, April 2005.

www.handsurgeon.com, Guyon's Canal Syndrome, Hand Surgery Center of Brooklyn and Staten Island, 2008.

by Linda Fehrs, LMT

As of June 11, 2009 the World Health Organization (WHO) raised its worldwide pandemic alert regarding the H1N1 flu to Phase 6. This was due specifically to the widespread nature of the virus and not the severity of the symptoms, which tend to be similar or even milder than the seasonal flu. The United States continues to report the largest number of those diagnosed with the H1N1 virus. As of June 2009, all 50 states had reported cases of H1N1, though only about 41 states are currently reporting widespread infection, with New York appearing to be the hardest hit.

While the 1918 influenza outbreak was also classified as H1N1, as was an outbreak in 1977, the current strain is considered "novel" and much less potent than earlier strains. The 1918 outbreak was caused by an extremely virulent and deadly form of the virus and affected about one-third of the world's population, while the 1977 outbreak was isolated and affected only about 200 soldiers stationed at Fort Dix, New Jersey. Weekly updates on the current number of people affected can be obtained at the Centers for Disease Control and Prevention (CDC) website. Keep in mind that the numbers reflect those individuals who have sought medical care and received a definitive diagnosis. They do not include those who have treated themselves at home.

Warning Signs and Symptoms
Most who are infected with the flu will suffer the usual flu symptoms of body aches, congestion, fever, chills, cough, headache, fatigue, diarrhea and/or vomiting. Not all people will have all the symptoms and most of the time will get better by just staying home and taking it easy. There comes a time, though, when symptoms become more serious and a trip to the emergency room or family physician is necessary.

In children, the warning signs include:

· Trouble breathing, or unusually fast breathing
· Bluish skin color
· Not waking up or interacting
· Flu-like symptoms that get better, but then come back worse
· Fever with rash
· Extreme irritability

In adults, the warning signs include:

· Difficulty breathing
· Shortness of breath
· Sudden dizziness
· Confusion
· Severe, persistent vomiting

You needn't go the emergency room if you are just a little sick, but do go if the symptoms get worse or if you are in a high risk population. If your symptoms are mild, and you don't have the flu, going to an emergency room will only expose you to others who do have the flu and you could catch it from them.

The Most Vulnerable
It appears that the most vulnerable to getting the H1N1 virus, as well as having the most serious symptoms, are those under 24 years of age and pregnant women. This may be because those in the older population have had exposure to similar viruses in the past, which created immunity. Those who are most vulnerable among the general population, along with healthcare workers and those taking care of children younger than six years of age, are the highest priority for getting the vaccine as it becomes available.

Others who are more susceptible to getting the flu, or who may likely suffer more severe and even life-threatening symptoms, include those with preexisting illnesses such as:

· Cancer
· Blood disorders
· Chronic lung disease
· Diabetes
· Heart disease
· Kidney or liver disorders
· Neurological disorders
· Neuromuscular disorders such as muscular dystrophy or multiple sclerosis
· Weakened or compromised immune systems, including HIV/AIDS

The H1N1 specific vaccine started being shipped out to hospitals and clinics in mid-October. According to the CDC, shipments will continue and increase through December.

Prevention for Bodyworkers
There are many things that massage therapists and other bodyworkers can do to help prevent the spread of the H1N1 virus, or any other form of seasonal influenza:

· If a client comes in who is obviously ill with flu-like symptoms, reschedule the appointment to a later date. No one should be worked on who presents a fever, congestion, chills or other typical indications of influenza.

· If you work in a medical setting, such as a hospital, hospice or group home, consider getting vaccinated. Healthcare workers are classified as a priority when vaccines are administered.

· If you do get the flu vaccination, consider rescheduling appointments for at least a week. It takes up to two weeks for the vaccine to be effective and, until that time, you are vulnerable. There may also be mild side effects from the vaccine, such as low-grade fever, muscle aches or a runny nose, depending on which type of vaccine you get.

· If it seems like a lot of your clients are getting the flu, you may want to offer home-call sessions to your healthy clients. This means less exposure for them. The one problem with this is you do not have strict control over flu-prevention precautions at their home or office.

· Have handouts available for clients with updated information. The CDC has free downloadable brochures, flyers and posters in PDF format on their website, as well as free podcasts with current information.

· Look up local flu outbreak statistics. They are available and updated regularly on the CDC website. The online version of your local newspaper or health department may also have the information.

· Be vigilant when it comes to cleanliness, especially around your office. You may want to toss used sheets in a plastic bag or a cloth bag that can be washed, rather than a hamper. Remember to wash hands both before and after working on clients and wipe down the massage table and bolters before and after each use. There are many antiviral sprays and wipes on the market that are both effective and easy to use.

The best approach to staying healthy is not to panic. Stress only depresses the immune system and makes you more vulnerable to illness. By following basic universal precautions you can reduce the likelihood of catching most seasonal illnesses and remain available to your clients. If you do end up getting the flu, it will most likely be mild and respond to time, bed and plenty of fluids, including good ole grandma's chicken soup.

Recommended Study:
Advanced Anatomy & Pathology
Infectious Diseases: HIV/AIDS

Resources:

"2009 H1N1 Flu: Situation Update." CDC H1N1 Flu. 16 October 2009. Centers for Disease Control and Prevention, Web. 22 Oct 2009. http://www.cdc.gov/h1n1flu/update.htm.

Cutler, Nicole, L.Ac. "Ten Swine Flu Facts for Bodyworkers." Institute for Integrative Healthcare Studies. 22 May 2009. Web. 22 Oct 2009. http://www.integrative-healthcare.org/mt/archives/2009/05/ten_swine_flu_f.html.

Tamkins, Theresa. "Swine Flu To-Do (and Don't Do) List." Health.com. 08 October 2009. Time, Inc., Web. 22 Oct 2009. http://www.health.com/health/condition-article/0,,20311274,00.html.

by Nicole Cutler, L.Ac.

Without a photographic memory, remembering all of the skin conditions learned in anatomy and pathology class can be challenging. After all, that's what dermatologists are schooled in - and even this highly trained type of physician must rely on his or her references to ensure diagnostic accuracy. While massage therapists are not expected to be familiar with every type of skin disorder, cellulitis poses an exception. Unfortunately, clients are not always aware of the ailments they harbor or their severity. In these instances, bodyworkers must be able to recognize cellulitis and comprehend massage therapy's potential benefits and dangers when working with this dangerous condition.

About Cellulitis
Cellulitis is a spreading bacterial infection of the skin and tissues beneath the skin. Often starting with a small area of tenderness, swelling and redness, a person with cellulitis typically develops a fever and chills as the reddened area enlarges. Without treatment, the fever can get very high. In addition, lymph nodes near the affected area commonly swell. Cellulitis is often associated with "tracking," which is seen as streaks of red traveling away from the area of inflammation though lymphatic ducts towards the nearest group of lymph nodes.

Unlike a superficial skin infection, cellulitis refers to an infection also involving the skin's deeper layers: the dermis and subcutaneous tissue. Although several different bacteria can be involved in cellulitis, streptococcus or Staphylococcus aureus are the pathogens predominantly responsible. Cellulitis most often affects the legs, but it may also occur on the arms, face and scalp.

In general, cellulitis can be cured with antibiotics. However, the development of antibiotic-resistant bacteria and the complications that are associated without treatment can make cellulitis life-threatening. In 50 to 60 percent of cases, the person has had some kind of recent skin injury such as a cut, insect bite, trauma, burn, surgical incision, intravenous catheter or dermatitis. While cellulitis may appear after an injury, it's also been diagnosed in infants, adults and seniors who have recently recovered from strep throat.

If cellulitis is not treated on time, there can be several undesirable consequences. Although rare, complications of cellulitis can be serious and/or fatal, including abscesses, gangrene leading to limb loss, thrombophlebitis and sepsis.

Those with some of the following conditions are at higher risk for developing cellulitis:

· Diabetes
· Chickenpox and shingles
· Lymphedema
· Fungal infections of the feet
· Peripheral vascular disease
· Contaminated wounds
· A weakened immune system
· Widespread infection

Cellulitis Treatment and Prevention
Because the infection can rapidly spread throughout the body, receiving conventional medical treatment as soon as possible is necessary for containing and eliminating cellulitis. The standard treatment for cellulitis revolves around antibiotics. In addition to antibiotic therapy, Western medicine advises elevating the affected area, minimizing movement and applying cool, wet, sterile bandages for comfort relief. If these steps are insufficient, hospitalization and intravenous antibiotics are inevitable. Sometimes, surgery is required to drain an underlying abscess.

Most complementary medical interventions, including massage therapy, are dangerous until all signs of a cellulitis infection have dissipated. Even though massage is usually only contraindicated locally for most skin infections, this does not apply to cellulitis. As a systemic infection, the bacteria may have gained access to the lymph nodes and bloodstream in cellulitis. Therefore, attempts at circulation enhancement can easily spread this dangerous infection.

On the other hand, massage therapy may act as a preventative for developing cellulitis. Especially beneficial to those at high risk for this kind of infection, or for someone who has had a previous experience with cellulitis, the regular application of bodywork can help protect people from developing this kind of skin infection. Since those with a history of circulation problems - whether caused by diabetes, lymphedema, peripheral vascular disease or a similar condition - are particularly vulnerable to developing cellulitis, these individuals can benefit most from prevention approaches. The following two tactics will help protect even the most susceptible people from developing cellulitis:

1. Lymphatic Drainage Massage - By draining existing congestion and preventing fluid from accumulating in the lymphatic system, manual lymphatic drainage keeps the nodes clear to better remove potential cellulitis-causing pathogens.

2. Acupressure - Although many types of massage can improve immunity, stimulating the acupressure points Stomach 36, Spleen 6, Large Intestine 11 and Triple Warmer 5 help strengthen the immune system to better remove bacterial threats.

Since this bacterial infection can invade both the lymphatic and circulatory systems, massage therapy is contraindicated until all signs of infection have passed. Hopefully, clients who have cellulitis will know the importance of canceling a massage appointment. If on antibiotics for this kind of infection or if the therapist suspects cellulitis, clients should either be at home resting, visiting their physician or in a hospital bed. Then again, for clients who are at risk for, but without signs of a cellulitis infection, bodywork and exercise give them an advantage over future bouts of this rapidly spreading, perilous, systemic infection.

Recommended Study:
Advanced Anatomy and Pathology
Lymphatic Drainage Massage
Shiatsu Anma Therapy

References:

Puszko, Sharon, PhD, CMT, Jane Keegan, LPN, Working with Challenging Skin, Massage & Bodywork, August/September 2003

Werner, Ruth, LMP, A Massage Therapist's Guide to Pathology, Lippincott, Williams and Wilkins, 2005.

www.medicinenet.com, Cellulitis, Melissa Conrad Stoppler, MD, MedicineNet, Inc., 2008.

www.umm.edu, Cellulitis, University of Maryland Medical Center, 2008.

by Nicole Cutler, L.Ac.

Its potential as a social lubricant has put alcoholic beverages in the starring role for many gatherings and parties. Unless hosted by non-drinkers, the holidays stretching from Thanksgiving to New Year's are heavily dominated by alcohol-filled celebrations. Of course, a majority of these partiers pay for their night of imbibing spirits the following day with a hangover. Thus, massage therapists are more likely to have clients in a hung-over state during the holidays compared to any other time of the year.

About Hangovers
Referring to the unpleasant feeling following the consumption of alcohol, a hangover typically begins within several hours after the last alcoholic drink.
Some of the major symptoms of a hangover include:

· A severe, pounding headache
· Vomiting and nausea
· Fatigue
· Diminished ability to concentrate
· Blurry vision
· Unsteady gait
· Loss of appetite
· Dry mouth
· Upset stomach

Three of the reasons alcohol causes hangovers are:

1. Alcohol is a diuretic, so drinking too much causes dehydration. Dehydration causes intense headaches, dry mouth and fatigue.

2. In addition to alcohol in and of itself being toxic, the byproduct it is broken down into (namely acetaldehyde) is between 10 and 30 times more toxic than alcohol itself.

3. When alcohol is metabolized, vitamin B is consumed. Thus, some aftereffects of drinking alcohol are caused by a deficiency of this crucial vitamin. Vitamin B deficiency commonly causes fatigue and grogginess.

Judgment Calls
Upon discovering that their client is recovering from excessive alcohol intake, massage therapists must make several decisions:

1. To commence with massage? - Most massage therapy legislation clearly states that being under the influence of alcohol is a contraindication for receiving (or giving) massage therapy. However, being under the influence of alcohol is typically translated to being drunk - not being hung-over. In such a situation, therapists must make a judgment call deciphering if their client is still intoxicated or if his or her body is simply working on detoxification.

2. Is massage beneficial or harmful for a hangover? - Another decision that must be made is if the client's condition could be helped or harmed by a massage session. Different sources vary on their opinion on this matter, with some insisting that massage therapy can aid in the body's elimination of toxins, while others believe that massage can intensify a hangover by exacerbating symptoms. Again, this comes down to a judgment call of how severe the person's hangover is and if they are of sound enough mind and body to be a massage recipient.

3. What type of massage is best? - If you choose to work with an affected client, most sources agree that vigorous, extensive circulatory massage can exacerbate hangover symptoms. However, the best way to proceed is to communicate with your client during your session. Gentle and relaxing massage strokes, cranial-sacral therapy, foot reflexology with an emphasis on liver and stomach regions and shiatsu focusing on liver, pericardium and stomach meridians are all good options. However, always encourage a hung-over client to drink plenty of water before and after your session - especially after!

4. Suggesting other hangover cures? - Once again, doling out hangover suggestions to a client must be weighed carefully; are you enabling him or her to continue with harmful behavior or will your tips be used sparingly? If you choose to offer up your knowledge to relieve your client's suffering, the following are known to help reduce hangover symptoms:

a. Vitamin B Complex - Since vitamin B is depleted during alcohol consumption, supplementing with a B complex can help reduce fatigue and feeling shaky.

b. Ginger Tea - Ginger's anti-spasmodic effects can help calm nausea and stomach queasiness typical of a hangover.

c. N-Acetyl-Cysteine (NAC) - An amino acid, NAC contributes to the production of glutathione, which helps flush the body of toxins to alleviate a hangover.

d. Drink Water - Since a majority of hangover symptoms are caused by dehydration, drinking water is a necessity to feeling better.

Working with hung-over clients is not the reason most massage therapists entered into the healing profession. However, many bodyworkers encounter some variation of a hangover - especially during the holidays. By thinking about the issues surrounding a hung-over client ahead of time, massage therapists will be more prepared to make the judgment calls necessary for a professional and safe encounter.

References:

http://en.wikipedia.org/wiki/Hangover, Hangover, Retrieved November 13, 2009, Wikimedia Foundation, Inc., 2009.

http://www.aromatherapies.net/blog/aromatherapy-oils-to-cure-hangover.html, Aromatherapy Oils to Cure Hangover, Retrieved November 13, 2009, Aromatherapy Massage, 2009.

http://www.massagetherapy.com/articles/index.php/article_id/341/Holiday-Stress, Holiday Stress, Retrieved November 13, 2009, Massage & Bodywork, November/December 2000.

http://www.massagetherapy.com/articles/index.php/article_id/406/Ease-Holiday-Hangovers, Ease Holiday Hangovers, Lara Evans Bracciante, Retrieved November 13, 2009, Massagetherapy.com, 2009.

http://www.mayoclinic.com/health/hangovers/DS00649, Hangovers, Retrieved November 13, 2009, Mayo Foundation for Medical Education and Research, 2009.

http://www.ncbi.nlm.nih.gov/pubmed/15865498, Massage therapy improves the management of alcohol withdrawal syndrome, Reader M, et al, Retrieved November 13, 2009, Journal of Alternative and Complementary Medicine, April 2005.

http://www.wisegeek.com/what-is-a-hangover.htm, What is a Hangover?, Retrieved November 13, 2009, wisegeek, 2009.