Massage Professionals Article Archive

by Linda Fehrs, LMT

Despite the ever-growing pharmacy of pain killing drugs available, postoperative pain is something no one looks forward to. If the surgery is to be performed on the heart, perhaps the most vital of organs, one can add overwhelming anxiety to the experience as well. As massage therapists in training, we are told over and over again not to give a massage on someone who has recently undergone surgery, but more studies suggest that massage therapy given subsequent to surgery is beneficial in patient recovery and - perhaps most importantly - reduction in both pain and anxiety.

Massage Therapy Eases Post-Surgical Pain
A Mayo Clinic study conducted over a period of five months, showed so much of a reduction in post-surgical pain, they hired a full-time massage therapist to be available for patients after heart surgery. Approximately half of the 58 patients who participated in this original pilot study received massage. On a 10-point scale of pain, those who received massage had a mean pain score of less than one, while those who did not receive massage had an average score of three. In addition to the massage therapy, the Mayo Clinic has been looking into the advantages of other complementary therapies, including ambient music and guided imagery, both of which have shown to have a positive effect of patients recovering from surgery.

The Department of Veterans Affairs, VA Ann Arbor and Indianapolis Healthcare Systems conducted an even larger study involving 605 veterans, male and female, over a period of two years who had undergone major surgery (thoracic or abdominal). They were assigned to one of three groups. Approximately one third received routine care, as well as a daily 20-minute effleurage back massage each evening for up to five days. A second group got individualized attention, but no massage; and the remaining group got only standard routine care.

The purpose of the study was to see how massage and/or individualized support affected recovery after major surgery. Compared to the groups who received no massage, those who did receive massage experienced a faster rate of decreased pain intensity, pain unpleasantness and a reduction in anxiety in the first four days after surgery.

Music Reduces Pain and Anxiety
While music was not used in the above two studies, its use both pre and postoperatively has also shown to be helpful in the reduction of pain and anxiety surrounding surgery. Many studies have been conducted by the Touch Research Institute in Miami indicating that ambient music has been helpful in the reduction of cortisol levels. High cortisol levels are often present in a person with high levels of stress, anxiety and pain. At least one study consisting of 10 minutes of hand massage and music was effective in reducing agitation in a group of elderly participants.

The American Music Therapy Association's studies on pain management and anxiety have also been successful in showing how the use of music results in measurable physiological changes, including lower blood pressure, improved cardiac output, reduced heart rate and relaxed muscle tension both pre and postoperatively.

Even though prescription painkillers are available to patients after surgery, pain is often under treated. Some patients may fear dependency or are concerned about side effects. Some may simply be uncomfortable asking, not wanting to bother anyone. There may even be doctors or nurses who lack a certain responsiveness with regard to pain management. The use of massage and music therapies supplemental to prescribed medications may be one of the best adjuncts to alleviate pain, as well as addressing the individual needs of the patient.

Massage and music therapies may not eliminate the need for prescription pain medication entirely, but it may result in lower doses or medication used for a shorter duration of time. It would seem as though the partnership of massage and music therapies can have a significant effect on both the psychological and physiological conditions connected with surgery. Reduction of anxiety and postoperative pain is important, especially in the recovery of those who have undergone cardiac surgery.

Editor's Note: Precaution should still be taken if someone who recently had major surgery requests a massage through your private or group practice. Postoperative massage should have clearance from the person's physician and be performed under medical supervision in a hospital setting.

Recommended Study:
Stress Management Music

Resources:

"Cardiovascular Surgery Healing Enhancement Program - Treatment Options." 2008. Mayo Clinic. December 16,2008 http://www.mayoclinic.org/cv-surgery-healing-enhancement/.

"Massage May Help Ease Pain and Anxiety After Surgery." Science Daily. December 18, 2007. 16 Dec 2008 http://sciencedaily.com/releases/2007/12/071217162531.htm.

"Mayo Researchers: complementary therapies help patients recover after heart surgery." EurekAlert!. October 31, 2007. 16 Dec 2008 http:/www.eurekalert.org/pub_releases/2007-10/mc-mrc103107.php.

Mitchinson, Allison R. MPH, NCTMB, et al. "Acute Postoperative Pain Management Using Massage as an Adjuvant Therapy." Archives of Surgery 142:12 (2007): 1158-1167.

"Music Therapy Research Abstracts." 2008. Touch Research Institute. 16 Dec 2008 http:/www6.miami.edu/touch-research/Music.htm.

"Music Therapy in the Treatment and Management of Pain." 2008. American Music Therapy Association, Inc. 16 Dec 2008 http://www.musictherapy.org/factsheets/MT%20Pain%202006.pdf.

by Nicole Cutler, L.Ac.

Of all the types of arthritis, rheumatoid arthritis and psoriatic arthritis are among the most disabling. While many bodyworkers are familiar with rheumatoid arthritis, much fewer have an understanding of psoriatic arthritis. Because improperly applied massage therapy during a certain stage of psoriatic arthritis can exacerbate the pain, practitioners who know about this condition are best able to help affected clients.

About Psoriasis
Affecting approximately seven million Americans, psoriasis is a common, non-contagious skin condition. Unpredictable and irritating, psoriasis is characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin's surface and die, their sheer volume causes raised, red plaques covered with silver-white scales. Frequently appearing in cycles of flare and remission, psoriatic flare-ups often cause considerable itching.

Although the exact cause is not known, psoriasis commonly runs in families. Aside from the possibility of a genetic susceptibility, most doctors believe that psoriasis involves the immune system. This is because an increased number of white blood cells are present between the psoriasis skin layers and because this skin condition responds to immunosuppressant drugs. In addition, the following factors may contribute to psoriasis development, worsening or flare-ups:

· Cold, dry weather
· Skin injury
· Stress and anxiety
· Infection
· Certain medications

Psoriatic Arthritis
Although there are rarely any dangerous complications of this skin disorder, approximately 10 percent of people with psoriasis are at risk for a painful and possibly extreme form of arthritis, called psoriatic arthritis. General symptoms of psoriatic arthritis include:

· Pain in affected joints
· Swollen joints
· Joints that are warm to the touch

Just like psoriasis, psoriatic arthritis typically cycles between flare-ups and remission. Often, the skin and joint problems appear and disappear at the same time. There are five identified types of psoriatic arthritis:

1. Asymmetric - This is the mildest form of psoriatic arthritis, and it usually affects less than five joints on one side of the body; typical culprits are the hip, knee, ankle or wrist.

2. Symmetric - Usually affecting five or more joints on both sides of the body, symmetric psoriatic arthritis is more common in women and tends to be severe.

3. Fingers and Toes - Distal interphalangeal (DIP) joint predominant psoriatic arthritis is rare and occurs mostly in men. This type of arthritis affects the small, distal joints in the fingers and toes and often causes thickening, pitting and discoloration of the nails.

4. Spine - Called spondylitis, this form of psoriatic arthritis causes inflammation in the spine as well as stiffness and inflammation in the neck, lower back and sacroiliac joints.

5. Destructive - A small percentage of people with psoriatic arthritis have a severe, painful and disabling form called arthritis mutilans. Over time, arthritis mutilans destroys the small bones of the hands, especially the fingers, leading to permanent deformity and disability.

Because there is no cure for psoriatic arthritis, treatment is focused on controlling inflammation and preventing joint pain and disability. Often, a multidisciplinary approach is used to help both skin and joint symptoms.

Massage Therapy
Because the origins are not yet understood, healthcare providers can help their clients with psoriatic arthritis the most by looking at what precipitates a flare-up. Typically, symptoms bloom during periods of great stress or anxiety. While massage therapists can't do much about the client's medications, weather, preventing skin injury or infections, they can help their client achieve a relaxed state.

For massage therapists, psoriatic arthritis is treated the same as rheumatoid arthritis:

· Avoid areas that are hot and inflamed.
· Strive for joint mobility and pain reduction when there is no active inflammation.

When a client is having a psoriasis flare-up, the affected cells are hyperactive. Thus, increasing energy or circulation in that area could aggravate the condition. Therapists must remember that psoriasis can also be triggered by skin trauma. Accordingly, bodyworkers need to make sure their client immediately communicates if he or she feels any discomfort. After considering these two cautions, massage therapy can help alleviate the psoriatic arthritis trigger of stress. And just like for osteoarthritis, massage can reduce pain and stiffness in areas that are not currently inflamed.

Armed with the knowledge of what psoriatic arthritis is, when massage can benefit it and when to steer clear of painful joints, massage therapists will be better prepared to help clients affected by this potentially debilitating skin and joint disorder.

Recommended Study:
Advanced Anatomy and Pathology

References:

http://www.everydayhealth.com/psoriatic-arthritis/psoriatic-arthritis-physical-therapy.aspx, Psoriatic Arthritis and Physical Therapy, Retrieved March 13, 2009, Waterfront Media, Inc., 2009.

http://www.massagetoday.com/mpacms/mt/article.php?id=13477, Dealing with Psoriasis, Ruth Werner, LMP, NCTMB, Retrieved March 13, 2009, Massage Today, September 2006.

http://www.mayoclinic.com/health/psoriatic-arthritis/DS00476, Psoriatic Arthritis, Retrieved March 13, 2009, Mayo Foundation for Medical Education and Research, 2009.

http://www.medscape.com/viewarticle/571284, Comparative Effectiveness of Drug Therapy for Rheumatoid Arthritis and Psoriatic Arthritis in Adults: AHRQ Executive Summary, Retrieved March 15, 2009, Agency for Healthcare Assurance and Quality, March 2008.

http://www.webmd.com/skin-problems-and-treatments/psoriasis/understanding-psoriasis-basics, Psoriasis, Retrieved March 15, 2009, WebMD, LLC, 2009.

by Nicole Cutler, L.Ac.

Massage therapists are well aware that helping to bring health and well-being to people is filled with infinite rewards. However, bodyworkers also must be cautious of the risks associated with tissue manipulation. Perhaps one of the greatest contraindications for massage therapy is someone who is at high risk for having a cerebrovascular accident - otherwise known as a stroke. Responsible practitioners typically memorize the list of conditions that are riskiest for this potentially devastating event and require a physician's consent for those affected. However, there is no guarantee that a seemingly healthy client won't fall victim to an unexpected stroke. Because every minute counts when seeking medical treatment for a cerebrovascular accident (CVA), therapists who can recognize early stroke signs are best equipped to prevent such a health crisis.

Cerebrovascular Accident
Stroke is the number one cause of adult disability and the third leading cause of death in the United States. Occurring when the blood flow to the brain is impaired by a blockage or rupture of an artery to the brain, the resulting lack of oxygen suddenly kills brain cells.

Sometimes referred to as a brain attack, a CVA impacts the brain in much the same way a heart attack impacts the heart. Every stroke is different and is largely dependent upon the area of the brain affected and the length of time that area was without oxygen. Strokes typically belong to one of two categories:

1. Transient Ischemic Attack (TIA) - A TIA is often referred to as a warning stroke, occurring when a blood clot blocks an artery for a short period of time. While the symptoms are much like a major stroke, they last for a shorter period of time.

2. Hemorrhagic Stroke - Also referred to as a major stroke, a hemorrhagic stroke occurs when a blood vessel ruptures and bleeds deep in the brain or on the surface of the brain.

CVA Risks
Although strokes can affect people of all ages, genders and races, there are some risk factors that make some more vulnerable than others. The more risk factors a person has, the greater their chances are of having a stroke. While some factors are beyond a person's control, others can be manipulated to lower a person's risk:

The major known stroke risks include:

· Increasing age - especially over age 55
· Male sex
· Race - specifically African American
· Family history of stroke
· Cigarette smoking
· Obesity
· High blood pressure
· Diabetes
· History of TIAs
· High cholesterol
· Heart Disease
· Peripheral Artery Disease
· Deep Vein Thrombosis

Stroke Recognition
Every 45 seconds, someone in the United States has a stroke. While awareness of the risks for a stroke can help you better identify massage contraindications, there is no way to predict who will fall victim to a CVA or when it will occur. Sometimes, those who you would least expect have a stroke. Thus, knowing all the warning signs of a stroke could help you save someone's life and/or well-being.

The faster you can recognize the symptoms of a CVA, the sooner medical help can be sought. Because there is only a three-hour window to administer clot-busting drugs for diminishing the effects of a stroke, prompt treatment is crucial. With quick medical treatment for a stroke, the brain can be shielded from extensive damage, which can spare death or serious disabilities such as paralysis, speech impairment and dementia.

The beginning of a cerebrovascular accident can be recognized by any of the following ten signs. Please note, the first three automatically indicate a stroke, while the subsequent seven signs could signal a CVA:

1. Crooked smile - One side of the mouth doesn't move well or appears to droop when smiling

2. Arm drift - With eyes closed and the client's arms held straight out in front for approximately 10 seconds, one arm does not move, or one arm drifts down more than the other

3. Slurred speech - When attempting to repeat a simple sentence, the words are slurred, incorrect or don't come at all

4. Sudden weakness - Sudden weakness in an arm, hand or leg

5. Numbness - The inability to feel one side of the face or body

6. Sudden blindness - The sudden inability to see out of one eye

7. Trouble walking - Sudden difficulty walking

8. Does not comprehend - The inability to understand what someone is saying

9. Vertigo - Feelings of dizziness or loss of balance

10. Headache - Having the worst headache ever

If you suspect a client is having a stroke, call 911 for immediate help! In addition, record the time when you started seeing symptoms to help establish where a person may be within the three-hour treatment window.

When it comes to caring for your client's health and well-being, recognizing the warning signs of a stroke - especially a crooked smile, arm drift and slurred speech - can yield an unparalleled level of gratitude for both the practitioner and the client. Massage therapists are not expected to be emergency medical technicians. However, being able to identify this kind of emergency could save your client's life - or at least preserve his or her livelihood.

Recommended Study:
Advanced Anatomy and Pathology
Deep Vein Thrombosis
Medical Errors

References:

http://clicks.health.harvard.edu/dm?id=9B1CEC9A0B816483BB3C771B05E43922B824F9DD798A7CB7, 3 Warning Signs of Stroke, Retrieved September 25, 2008, Harvard University, 2008.

http://www.americanstroke.org/content/view/17/46/, Stroke Risk Factors and Stroke Information, Retrieved September 25, 2008, American Stroke Foundation, 2008.

http://www.massagemag.com/News/massage-news.php?id=3513&catid=%27Healthy%27%20individuals%20may%20be%20at%20risk%20for%20heart%20disease&title=, 'Healthy' individuals may be at risk for heart disease, Retrieved September 25, 2008, Massage Magazine, September 2008.

http://www.medterms.com/script/main/art.asp?articlekey=2676, Definition of Cerebrovascular accident, Retrieved September 26, 2008, MedicineNet, Inc., 2008.

by Nicole Cutler, L.Ac.

Today's harsh economical climate puts pressure on many Americans to find additional ways to earn money. For those with a marketable service, it is just a matter of being innovative to generate extra work. Falling squarely into this category, massage therapists have a valuable skill they can capitalize on. Opportunities for part-time gigs are especially plentiful for those trained in chair massage, in possession of a portable massage chair and driven to think outside the box. For an environment perfectly suited for chair massage, bodyworkers need look no further than a nearby university.

A college student's needs are a good match for chair massage, because:

· Students Need Stress Relief - How a student fares on mid-terms and final exams could extend (or end) a merit-based scholarship. In addition, these monumental tests may have a direct impact on their future education or career direction. All of this pressure puts enormous amounts of stress on the serious scholar. Because even a short chair massage can lower stress levels, bodyworkers can offer monumental support during exam times.

· Students Need to Focus - In order to do well in their classes, students typically appreciate any resources they can find to help improve their scholastic abilities. Because balancing the central nervous system is one of massage therapy's unique benefits, massage is ideal for helping students focus and stay alert.

A 1996 study published in the International Journal of Neuroscience confirmed that chair massage is useful for reducing anxiety and strengthening cognition. Upon comparing the effects of a 15-minute chair massage with 15 minutes of relaxation, researchers concluded the following:

· Suggesting enhanced alertness, chair massage decreased frontal alpha and beta power.

· Compared to the relaxation group, the massage group showed increased speed and accuracy on math computations.

· Anxiety levels were lower only following chair massage, not after the control sessions.

· A physiological measure of stress, salivary cortisol levels were lower following chair massage.

From a therapist's perspective, the university population consists of ideal massage clients. A 2007 National Center for Complementary and Alternative Medicine survey of over 75,000 Americans investigated the use of complementary and alternative medicine (CAM). Since massage therapy is one of the more popular CAM therapies, conclusions from the surveyors about CAM are also applicable to massage therapy. Of particular interest is the evaluation of who uses CAM therapies the most. While the investigators found that people of all backgrounds use CAM, the proportion is much greater in those with higher levels of education. As such, those pursuing a college degree are more likely to receive chair massage than those with less formal education.

When it comes to logistics of chair massage in a university setting, there are two important considerations:

1. Location - In order to make signing up for a chair massage convenient, choose a central location where students often meet to socialize or study, like a student union or library.

2. Payment - While charging $1 a minute is a common practice, the university setting offers some additional options. Some colleges run all of their finances through a student credit card. If your services are negotiated with the bursar's office, students may be able to finance chair massage via these cards. In addition, most colleges require students pay an activity fee. If a therapist goes through the appropriate channels, the university's student activity council may put chair massage during exams into their budget. As such, a block of time could be paid for by this student council, thus allowing chair massages to be free for eligible students.

For massage therapists in close proximity to a university, opportunity might be knocking. There are many reasons to include a local college in your business plan. For starters, chair massage is convenient, helps relieve stress and improves alertness and cognitive ability. In addition, pursuers of higher education are more likely to seek bodywork than the general population. And lastly, college students are among the few who have access to creative funding. Thus, massage therapists may find it is worth their time to check out this ideal demographic.

Recommended Study:
Chair Massage Fundamentals

References:

http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm#most, The Use of Complementary and Alternative Medicine in the United States, Retrieved June 5, 2009, National Center for Complementary and Alternative Medicine, 2009.

http://www.ncbi.nlm.nih.gov/pubmed/8884390?ordinalpos=17&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum, Massage therapy reduces anxiety and enhances EEG pattern of alertness and math computations, Field T., et al, Retrieved June 5, 2009, International Journal of Neuroscience, September 1996.

http://www.student-affairs.buffalo.edu/shs/wes/chairmassage.php, Weekly Chair Massages, Retrieved June 5, 2009, Wellness Education Services University at Buffalo, 2009.

http://www.today.colostate.edu/story.aspx?id=201, Chair Massages at the Wellness Zone, Retrieved June 5, 2009, Colorado State University, 2009.