Institute for Integrative Healthcare Studies

Oxytocin: The Hormone of Peace and Trust

We live in a stressful world. In our culture, high levels of stress tend to be the norm and even thought beneficial by some. In other parts of the world, inner peace and calm have been valued for centuries, and only recently have the practices of tai chi, yoga and meditation been explored in Western culture. As massage therapists, one of our objectives could be seen as the promotion of increasing calm and reducing stress in our clients. Read on to find out how massage, the hormone oxytocin and the reduction of stress are intertwined.

]]> by Linda Fehrs, LMT

When we learn about the hormone oxytocin in most anatomy and physiology classes, we are instructed with reference to its importance during and just after a mother giving birth. We are told it helps with uterine contractions during labor and that it facilitates the "letting-down" or expression of milk from the mammary glands. We are also told it is released in the baby's body to ease the stress of entering the birth canal during the delivery process. Beyond that, textbooks say little else.

In recent years, though, there are those who have been studying and uncovering more about oxytocin and its effects beyond childbirth. Long thought to have something to do with the bonding between mother and child during the first few weeks and months of life, this attachment was thought, at least in part, to be a natural outcome of the physical and psychological connections developed during breast-feeding and cuddling. Until fairly recently, little attention has been given to the chemical effects of the hormone itself.

What Is Oxytocin?
Initially discovered by English researcher Sir Henry Dale in 1906, oxitocin (named from the Greek words for "quick" and "childbirth labor") was found to speed up the birthing process and promoted the expulsion of breast-milk. More recently it has been found to influence areas of human behavior related to trust and empathy, as well as a reduction of anxiety and lessening of aggressiveness.

Oxytocin is a hormone produced by the hypothalamus and secreted by the dorsal (posterior) lobe of the pituitary gland in both sexes, but in women its effects are enhanced and expanded because of their higher estrogen levels. The presence of estrogen increases the number of oxytocin receptors and stimulates production of oxytocin. Oxytocin is also produced in the ovaries and testes as well as walls of blood vessels and in the heart. It is considered a neurotransmitter, much the same as serotonin or dopamine, but once released from into the bloodstream it cannot reenter the brain itself because of the blood-brain barrier. Instead, the neurological effects are thought to be caused by a release from certain neurons into the body, which in turn affect certain neurological responses. Oxytocin fuels a coordinating and modulating system that works through the bloodstream and nerve branches linking to important control centers of the brain.

Oxytocin has effects of its own, influencing the rest and digest mechanism in the nervous system. But it also works closely in combination with another hormone, vasopressin, which is important in the flight or fight mechanism. Together they form a kind of yin/yang balance and, when working properly, allow our bodies and minds to respond in healthy ways to what is presented by the world around us.

Massage and Oxytocin
According to Dr. Kerstin Uvnäs Moberg, author of The Oxytocin Factor, massage is one of the best ways to get oxytocin released into the body. She states that during a massage session, oxytocin is released not only in the person receiving the massage, but also in the giver. "Massage therapists show typical effects of high levels of oxytocin," writes Moberg, "such as lower levels of stress hormones and lower blood pressure."

Many studies have shown the effectiveness of massage in helping to reduce everyday stress, enhancing the immune system and generally making people feel more healthy and relaxed. And, massage has been shown to facilitate an increased release of natural oxitocin.

The Effects of Oxytocin
The release of oxitocin into the blood steam is thought to have important effects, both psychological and physiological. Some results from recent studies, include:

Autism - Children with autism have been found to have significantly lower levels of oxytocin, as well as hyperactivity in the amagdyla where most oxytocin receptors are located. Studies on individuals with autism have shown a reduction in repetitive behaviors when oxytocin was introduced intravenously.

Enhanced Digestion - Oxytocin has been found to regulate the process of digestion. It stimulates the release of various digestive hormones and gastric juices, which in turn lead to a more effective absorption of nutrients.

Facilitates Wound Healing - Oxytocin accelerates the body's healing process in part by helping to rejuvenate mucous membranes and encouraging the production of anti-inflammatory reactions.

Maternal Behavior - In animal studies, mothers given oxytocin bonded with babies who were not their natural offspring. They tried to nurse them and protect them from intruders. Many of the mothers had never given birth. Normally, these unfamiliar babies would have been rejected or even attacked by them.

Increasing Trust - Human subjects given oxytocin via a nasal spray, displayed a higher level of trust - twice as often as the control group. In one study, small doses of inhaled oxytocin reduced the wariness of strangers in volunteers, while another appeared to make them more empathetic and generous with their money.

Reducing Anxiety - Clinical trials using oxytocin sprays have been shown to reduce anxiety and ease symptoms of shyness. It seems to reduce timidity and may help to increase confidence, leading to improved healthy social interaction.

Additionally, oxytocin counters the effects of cortisol, a stress hormone, which, if over long periods of time is produced in high levels in the body, can lead to high blood pressure, lowered immune function and even clinical depression. Sufferers of post-traumatic stress disorder (PTSD) have been found to have higher than normal levels of cortisol, and studies with regard to the effectiveness in massage and oxytocin production to reduce cortisol levels are being considered.

Massage for World Peace?
In 1995 Robert Noah Calvert, founder of Massage Magazine, wrote a novel titled, The Hundredth Monkey Conspiracy. In it he described how an organized group of massage therapists conspire to influence a global peace initiative through their work on world leaders, politicians and other influential people. If massage is an effective way to increase levels of oxitocin, and oxytocin is responsible for making people more prone to be less aggressive, more trusting and empathetic - then Mr. Calvert may have been on to something!

References:

Author Unknown, "The Miracle of Massage Continues Growing." 26 February 2007. World Massage Forum. 12 Aug 2008 http://www.worldmassageforum.com.

Barker, Susan E. . "Oxytocin: The Cuddle Hormone." 12 Aug 2008 http://www.oxytocin.org.

Brown, Irena. "Oxytocin." Skin Inc December 2004.

Calvert, Robert Noah. The Hundredth Monkey Conspiracy: A Global Network Works to Heal the Planet and Its People. Davis, CA: NOAH Publishing Company, 1995.

Cohen, Barbara Janson. Memmler's, The Human Body in Health and Disease. 10th. Baltimore: Lippincott, Williams & Wilkins, 2005.

"Oxytocin." 11August 2008. 12 Aug 2008 http://www.en.wikipedia.org/wiki/Oxytocin.

Sundberg, Tobias. "The Pursuit of Relaxation." 14 November 2006. World Massage Forum. 12 Aug 2008 http://www.worldmassageforum.com.

Uvnäs-Moberg, MD, PhD, Kerstin. The Oxytocin Factor: Tapping the Hormone of Calm, Love, and Healing. Cambridge, MA: Da Capo Press, 2004.

What Massage Therapists Should Know About the Q Angle

Although massage therapists typically don't measure the Q angle, it's important to understand its definition, normal range and potential implications.

]]> by Nicole Cutler, L.Ac.

The Q angle is an abbreviation for the angle of the quadriceps femoris muscle. A way to measure for lower body postural distortion, an exaggerated Q angle can easily lead to knee problems. Although massage therapists typically don't measure the Q angle, understanding its definition, normal range and potential implications improves a bodyworker's ability to communicate with clients' physicians. Additionally, bodyworkers can help relieve some of the problems resulting from an exaggerated Q angle.

What Is the Q Angle?
The degree of the Q angle is determined by measuring two lines superimposed on the lower extremity:

1. One line begins at the tibial tuberosity and continues in a superior direction through the midpoint of the patella.

2. The second line connects the anterior superior iliac spine (ASIS) with the midpoint of the patella.

The angle between these two lines is the Q angle. There are differing opinions about which quantities constitute an exaggerated Q angle. However, most sources concur that a normal angle in males is 13 degrees and 18 degrees in females.

Because there is some variability in how it is measured, evaluating the Q angle's role is challenging. However, repeated investigations have shown people with a larger Q angle have a greater likelihood of developing numerous knee complaints. Because women genetically have a larger pelvis than men, they are more likely to have an increased Q angle.

Q Angle Mechanics
An increased Q angle appears to be one factor responsible for reducing knee stability. Understanding the knee's anatomy helps us understand why an exaggerated Q angle would create problems. Because the quadriceps tendon fits in a groove under the patella, the patella's ability to track straight is determined by the quadriceps' angle of pull. With a greater Q angle, the quadriceps pulls the patella more laterally. When the patella is pulled laterally, there is increased stress on the soft tissues surrounding the knee. Conditions commonly resulting from an increased Q angle include:

· Chondromalacia of the patella - degeneration on the underside of the patella
· Patellar tracking disorders
· Patellar dislocation
· Anterior cruciate ligament (ACL) sprains - Women have considerably higher rates of ACL injuries than men.

Bodywork for the Q Angle
While there is little a massage therapist can do to influence a client's bony structure, his or her impact on the surrounding soft tissues can help relieve exaggerated Q angle stress. Some strategies for accomplishing this goal are listed below:

· As described by Whitney Lowe in the July 2008 edition of Massage Today, an overly tightened vastus lateralis muscle could aggravate a large Q angle's contribution to a patellar tracking disorder. Using sports massage techniques to soften the vastus lateralis can reduce the additional lateral tension this muscle might be placing on the patella.

· Myofascial release on the patella can assist in loosening a tight lateral patellar retinaculum. If previous scar tissue in this location aids in pulling the patella laterally, cross-friction massage may be useful. However, acute inflammation will make cross-friction massage painful.

· Relaxing and lengthening the muscles that cross the knee takes pressure off the joint and facilitates good patellar tracking. Because they are crucial to knee stability and cross the knee joint, the quadriceps and hamstring muscles are key targets. Proprioceptive Neuromuscular Facilitation (PNF) stretching on these two muscle groups can have a dramatic impact on easing additional forces on the knee.

Talking with a doctor about a client's Q angle, why it might be exaggerated and what problems it is causing can yield valuable information for an attending bodyworker. In addition, bodyworkers can help clients with knee problems resulting from an exaggerated Q angle by using myofascial release and sports massage techniques on the tissues surrounding the knee.

Recommended Study:
Anatomy Review for Professionals
Myofascial Release
Sports Massage

References:

http://findarticles.com/p/articles/mi_qa3987/is_200310/ai_n9305119/print?tag=artBody;col1, Women in sports, Q angle, and ACL injuries, William M Austin, Retrieved September 11, 2008, Dynamic Chiropractic, October 2003.

http://sportsmedicine.about.com/od/women/a/Q_angle.htm?p=1, The Q-Angle and Injuries In Women Athletes, Elizabeth Quinn, Retrieved September 11, 2008, About.com, 2008.

http://www.amtamassage.org/journal/fall05_journal/pdf/KneePain.pdf, Reduce Knee Pain Through Massage, Patricia J. Benjamin, Retrieved September 11, 2008, Massage Therapy Journal, Fall 2005.

http://www.massagetoday.com/mpacms/mt/article.php?id=13838, The Role of the Q Angle in Anterior Knee Pain, Whitney Lowe, LMT, NCTMB, Retrieved September 11, 2008, Massage Today, July 2008.

Karageanes, Steven J., Principles of Manual Sports Medicine, Lippincott Williams & Wilkins, 2005: 469.

A Refresher on Pernicious Anemia for Bodyworkers

People can live with anemia for years before being diagnosed and consequently receiving treatment. If bodyworkers can recognize a potential case of pernicious anemia, a swift referral can prompt an evaluation - and potentially get clients the help they need.

]]> by Nicole Cutler, L.Ac.

Despite its ominous sounding name, pernicious anemia simply describes a type of blood deficiency. A condition where a lack of vitamin B12 does not make enough healthy red blood cells, pernicious anemia is commonly found in those who have lost the ability to absorb vitamin B12 from their food. Unfortunately, many people suffer from pernicious anemia's consequences for a long time before the cause is identified. Although this condition must be diagnosed by a physician, recognizing a potential case and suggesting an appropriate referral could make a big difference in your client's quality of life.

Pernicious Anemia Basics
The pathological condition of having insufficient, healthy red blood cells to oxygenate the blood is called anemia. One of the many different types of anemia, pernicious anemia's lack of vitamin B12 results in blood cells that do not divide normally. Consequently, the blood cells are too large, prohibiting them from leaving the bone marrow to enter blood circulation.

People can develop low levels of this important vitamin in three main ways:

1. Intrinsic Factor - Some people lack intrinsic factor, a protein in the stomach that helps the body absorb vitamin B12. The parietal cells that make intrinsic factor can be destroyed by a damaged stomach lining, a destructive immune system or as a result of stomach surgery. Without these cells, intrinsic factor is not manufactured, so vitamin B12 cannot be absorbed. This is the most common cause of vitamin B12 deficiency.

2. Dietary Deficiency - Although not a common cause, those with insufficient vitamin B12 in their diet are prone to pernicious anemia. A shortage of this vitamin can be due to strict vegetarianism or malnutrition. The best sources of vitamin B12 are meat, poultry, fish, eggs or dairy products.

3. Gastrointestinal Disorders - There are certain intestinal disorders that can interfere with the absorption of vitamin B12, such as Crohn's disease, intestinal infections or peptic ulcers.

Before the cause was discovered as a lack of vitamin B12, pernicious anemia was often fatal - thus it's injurious name. It is especially common in older adults and can usually be treated with the administration of vitamin B12 pills or injections.

Signs and Symptoms
As is the case with most types of blood deficiencies, symptoms typically develop slowly over time and may involve just a few of the long list of potential problems. Although many factors contribute to symptom differentiation, the most common signs of pernicious anemia include:

· Fatigue
· Weakness
· Having a bright red, smooth tongue
· Tingling and numbness in the extremities
· Pale or yellowish skin
· Low-grade fever
· Orthostatic hypertension (dizziness upon standing up)

In addition to pernicious anemia's general symptoms, there are also complications that may involve the cardiovascular, nervous and digestive systems. While some of these complications are due to the anemia, others are the effect of a low vitamin B12 level on parts of the body. Not surprisingly, these complications are laden with their own set of symptoms, including:

· Cardiovascular System - Symptoms may include shortness of breath, chest pain, heart murmurs, rapid heart rate and heart failure.

· Nervous System - Hand and feet tingling/numbness, walking difficulty, unsteady movement, loss of balance, changes in vision, taste or smell, memory loss, confusion, depression and psychosis.

· Digestive System - Mouth sores, bleeding gums, enlarged liver, nausea, vomiting, bloating, gas, heartburn, bowel habit changes, loss of appetite or weight loss.

Massage Considerations
Aside from a referral for a suspected case of pernicious anemia, massage therapy is unlikely to have a direct effect on the condition. However, techniques to keep the digestive system functioning optimally may prevent further stomach-lining deterioration. In addition to being safe, bodywork approaches geared towards enhancing circulation in the stomach and intestines foster a healthy gastrointestinal environment. Such techniques are likely to include:

· Abdominal massage
· Stimulation of stomach and intestine reflexology points
· Shiatsu techniques to invigorate the stomach, large intestine and small intestine meridians

For those with established pernicious anemia, injections of vitamin B12 are a likely treatment, since they may be unable to absorb it orally. For massage therapists administering treatment to a client who receives these monthly injections, the injection site should be avoided for at least one hour following administration. Since vitamin B12 is considered to be replacement therapy, its action is not affected by the application of massage.

A growing number of Americans seek minor body discomfort relief from alternative healthcare providers, such as massage therapists. Thus, massage therapists may be one of the first educated professionals to recognize their client's need for an anemia evaluation. If a client presents with signs of a vitamin B12 deficiency, yet is unable to determine the source of their ailments, a physician referral to rule out pernicious anemia may be the best advice your client could ever receive.

Recommended Study:
Advanced Anatomy and Pathology
Pharmacology for Massage Therapy
Reflexology
Shiatsu Anma Therapy

References:

Wible, Jean M., Pharmacology for Massage Therapy, Lippincott, Williams and Wilkins, 2004.

www.nhlbi.nih.gov, What is Pernicious Anemia?, National Heart Lung and Blood Institute, National Institutes of Health, 2008.

www.medicinenet.com, Pernicious Anemia, MedicineNet, Inc., 2008.

Medicine for the Heart: Massage and Music

February is American Heart Month. After finding out one has to have surgery, anxiety about postoperative pain ranks high among the stressors. Indeed, the anxiety itself is believed to increase pain levels and may be a contributor to postoperative distress. Heart surgery ranks high in patient apprehension, but massage and music therapies have been shown to lessen anxiety and reduce the need for pain medication.

]]> 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.

Using Massage Therapy to Help Psoriatic Arthritis

Before a client with psoriatic arthritis comes to you seeking relief, make sure you know about this condition and understand when massage might aggravate it.

]]> 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.

Would You Know If Your Client Is About to Stroke?

Since there are no guarantees that a client won't have a stroke while in your care, make sure you can quickly identify the earliest stages of a stroke.

]]> 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.

Scholarly Chair Massage Opportunity

Find out the many reasons for a massage therapist to consider those striving for a collegiate degree to be their potential clientele.

]]> 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.

At-Home Spa Parties Can Increase Winter Business

Winter can be a slow time for massage therapists. Find out how offering at-home spa parties can liven up your business.

]]> 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.

Back Shu Points Can Escalate a Back Massage

By learning about Traditional Chinese Medicine's back shu points, massage therapists can enhance their diagnostic and therapeutic capacity.

]]> 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.

Nudity and Esalen Massage

Pioneered at Esalen Institute in California, Esalen massage is a well-respected integration of bodywork and psychology. While nudity is often associated with Esalen, its purpose and requirements are often misunderstood.

]]> 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.

Relieving Ulnar Nerve Tension in Guyon's Canal

Due to the prevalence of carpal tunnel syndrome, it may be mistakenly implicated in cases of neurological hand symptoms that worsen with wrist pressure. If Guyon's canal syndrome is responsible, this structure's unique anatomy requires a drastically different massage approach than that employed for problems of the carpal tunnel.

]]> 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.

H1N1 Flu Facts: When to Be Concerned

The H1N1 flu (formerly Swine flu) is on the minds of many. Even with the myriad of information available, there are those who still have questions - and the data coming out of the Centers for Disease Control and Prevention (CDC) changes almost daily.

]]> 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.

Is Massage Helpful or Detrimental to Clients With Cellulitis?

Even though it has an innocuous name, cellulitis is a skin infection that should be taken very seriously. Avoid any confusion by knowing if and when massage therapy is safe to administer to a client with cellulitis.

]]> 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.

When the Holiday Season Delivers Hung-Over Clients

Because many people overindulge in alcohol during the holidays, massage therapists are best prepared when they know how to handle clients who show up with a hangover.

]]> 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.

Hand Sanitizers in a Massage Practice

Hand sanitizer dispensers can be found everywhere, from elementary school cafeterias to cruise ships. Despite its dominance of many infection control programs, massage therapists are still advised to clean their hands the old-fashioned way.

]]> by Nicole Cutler, L.Ac.

Similar to the hygienic ritual required of surgeons, massage therapists find themselves washing their hands repeatedly throughout the day. With the rising popularity of hand sanitizers, some therapists are opting to rub an alcohol-based gel between their hands in lieu of scrubbing with soap and water. While hand sanitizers have revolutionized how we practice infection control, it may not always be the best choice for massage therapists.

Bodyworkers' hands function as their primary tools. Because their tools are reused on each and every client, keeping their hands free of pathogens is a prerequisite to being a responsible therapist. Bodyworkers must wash their hands:

· Before and after eating
· Before and after using the restroom
· Before and after each interaction with a client

That adds up to a significant amount of time at the sink as well as consumption of a lot of soap and water. In an attempt to minimize the cost and time of frequent hand washing, some therapists are choosing a quick spritz of hand sanitizer instead. Before choosing one method of hand cleansing over the other, make sure you know why washing with soap and water remains the standard procedure.

Hand Sanitizer Pros and Cons
Alcohol kills most pathogens. Thus, hand sanitizer's high alcohol content will eliminate many types of bacteria and viruses. Alcohol has even proven effective against some dangerous forms of bacteria, like methicillin-resistant staphylococcus aureus (MRSA), which can cause the deadly and frightening flesh-eating bacteria.

Hand sanitizer is especially convenient due to its ease-of-use, portability and non-reliance on water. However, many are not aware of its limitations:

· Hand sanitizer must have a minimum of 60 percent alcohol concentration to be effective. Some discount sanitizers and do-it-yourself preparations contain a lower concentration of alcohol. According to Scott Reynolds, a specialist in infection control at the James H. Quillen Veterans Affairs Medical Center in Mountain Home, TN, hand sanitizer with an insufficient concentration of alcohol appears to mobilize bacteria, spreading them around the hand instead of killing them.

· At least a dime-sized dollop should be scrubbed all over the hands for 30 seconds. If the sanitizer dries in less time, one likely did not use enough and should repeat the process.

· Any breaks in the skin (including hangnails) can be aggravated by alcohol-based hand sanitizer with burning, itching or rash development.

· While non-alcohol sanitizers are available, claims of their effectiveness are not as reliable as the alcohol-based gels.

· Hand sanitizers do not effectively clean the hands when they are exposed to bodily fluids, especially blood or fecal matter.

· Some individuals are sensitive to alcohol and will develop contact dermatitis from hand sanitizers.

Soap and Water
An integral element to any massage therapist's routine, washing with soap and water remains the best way to cleanse hands of dirt, germs and other harmful substances. Just like hand sanitizers, hand washing also has demonstrated the ability to prevent the spread of MRSA. However, the following steps must be adhered to for optimal hand washing effectiveness:

· Use warm water - not cold.

· Use soap and work it into a thick lather. Research shows that both regular and anti-bacterial soaps are equally effective.

· Rub hands with lather for at least 30 seconds covering every surface, including fingertips, beneath the nails and the base of the wrists.

· Rinse hands thoroughly.

· Dry hands with a towel.

Soap is an emulsifying agent, which means it is capable of dispersing oil in water. When people wash their hands, dirt and germs trapped in the natural oils of the skin are lifted and suspended in water. Body fluids or a massage lubricant could easily trap pathogens on a therapist's hands. Thus, the old fashioned approach of hand washing is preferred by most health professionals because it physically removes such substances.

When it comes to efficiency, there is actually very little time difference between properly cleansing the hands with hand sanitizers vs. soap and water washing. Since half a minute is required for either cleansing method, only hand washing's requirement of water (for lathering and rinsing) and a towel (for drying) make hand sanitizers more "convenient." On the other hand, soap and water is better at removing bodily fluids from the hands than hand sanitizer.

At first thought, bodyworkers may think that hand sanitizers save them time during their requisite hand cleansing. However, further investigation shows that this assumption is not accurate. In addition, hand sanitizers may kill most types of bacteria and viruses but they are not sufficient for removing body fluids from the hands. Thus, the old-fashioned approach using water, soap and a towel remains the preferred way for massage therapists to achieve clean, hygienic hands.

References:

http://biology.about.com/od/microbiology/a/handsanitizers.htm, Hand Sanitizers vs. Soap and Water, Regina Bailey, Retrieved November 21, 2009, about.com, 2009.

http://public-healthcare-issues.suite101.com/article.cfm/soap_vs_hand_sanitizer_which_kills_germs_best, Soap vs. Hand Sanitizer: Which Kills Germs Best, Tammie Burak, Retrieved November 21, 2009, Suite101.net, November 2009.

http://safety.lovetoknow.com/Hand_Sanitizer_Dangers, Hand Sanitizer Dangers, Retrieved November 21, 2009, LoveToKnow Corp., 2009.
http://www.massagemag.com/News/massage-news.php?id=6133, Handwashing Combats MRSA, Retrieved November 22, 2009, Massage Magazine, 2009.

http://www.nytimes.com/2006/03/21/health/21cons.html, Hand Sanitizers, Good or Bad? , Deborah Franklin, Retrieved November 21, 2009, The New York Times Company, March 2006.

http://www.wisegeek.com/how-does-hand-sanitizer-work.htm, How Does Hand Sanitizer Work?, Tricia Ellis-Christensen, Retrieved November 22, Conjecture Corporation, 2009.