As one of the more common chronic pain syndromes, massage therapists are likely to encounter and counsel clients with fibromyalgia. Find out more about the value exercise has for those with this debilitating condition as well as information you can share with clients who have turned to you for treatment.

by Nicole Cutler, L.Ac.

Seeking ways to reduce pain, increase energy and enhance quality of life are common goals of those living with fibromyalgia. Ideal complements to massage therapy, certain types of exercise are proven to reduce the pain associated with this condition. When working with fibromyalgia clients, incorporating exercise into your treatment plan (through teaching, suggesting or referring to an expert) will increase the effectiveness of all therapies being received.

About Fibromyalgia
Fibromyalgia is a medically recognized, chronic condition characterized by fatigue, widespread pain, stiffness, muscular aching and burning. Because there isn’t a specific diagnostic laboratory test for fibromyalgia, its diagnosis poses a challenge. Prior to receiving a diagnosis of fibromyalgia, many people endure several medical tests that are returned with normal results, such as blood tests and X-rays. Although these tests may rule out other conditions, such as rheumatoid arthritis, lupus and multiple sclerosis, they cannot confirm fibromyalgia.

The American College of Rheumatology has established general classification guidelines for fibromyalgia to help in the assessment of this condition. According to these guidelines, a diagnosis of fibromyalgia includes widespread aching pain for at least three months and a minimum of 11 out of 18 specified locations on the body that are abnormally tender under relatively mild, firm pressure.

Exercise
While the cause of fibromyalgia is hotly debated, researchers are making steady progress in uncovering its mysteries. One such discovery is that a regular exercise program is of tremendous therapeutic value to a person suffering with fibromyalgia. One of the many possible theories explaining fibromyalgia is a lack of oxygen in muscle tissue. Whether deficient oxygen is a cause or effect of fibromyalgia, exercise is an excellent way to increase circulation and supply oxygen to our body’s cells.

In the March 2005 edition of Current Opinion in Rheumatology, Swedish researchers reported:

“Previous studies indicate that aerobic exercise performed at adequate intensity for an individual can improve function, symptoms, and well-being. A recent study of aerobic exercise showed that training in sedentary women with fibromyalgia using short bouts of exercise produces improvements in health outcomes. A study of aerobic walking resulted in improvements in physical function, symptoms, and distress. Two studies of low-intensity pool exercise reported a positive impact on fibromyalgia symptoms and distress. Two studies of qigong movement therapy were reported, one indicating improvements in symptoms and the other in movement harmony.”

Clients suffering with fibromyalgia may be dubious about physical exercise. Understanding why a person whose muscles already hurt and is physically exhausted would be suspicious of the benefits of working out, will help you communicate compassionately with them. While exercise is probably the last thing a person with fibromyalgia feels like doing, it is crucial for muscular health and pain relief. By increasing oxygenation of muscle tissue, exercise improves flexibility, range of motion, strength, endurance and energy levels.

When clients complain that prior attempts at exercise have been disappointing, explain that this is likely due to the increased pain that can occur from unaccustomed muscle use. In those with fibromyalgia, the brain misinterprets signals from the muscles, causing your body to act protectively as if the muscles were injured. Instead of its well-meaning purpose, this misinterpreted signal feeds the cycle of fibromyalgia by perpetuating muscle weakness, pain and fatigue.

While helping your client begin or stick with an exercise program demonstrates invaluable support, make certain a physician has approved of their activities. Listed below are some helpful tips on exercising with fibromyalgia from industry experts:

1. Start slowly – Frustration for not being able to accomplish what used to be simple can easily result in giving up or doing too much. The rule for fibromyalgia is to start small, and only increase exercise gradually.

2. Progress sequentially – Always start the journey to fitness with a regular stretching program. Stretching will release some muscle tightness, decreasing the number of pain signals going to the brain. The next phase is muscle strengthening. After flexibility and strength are increased, aerobic and endurance activities can be added.

3. Minimize eccentric muscle loading – Simultaneous muscle contraction and lengthening is typically too demanding with fibromyalgia. When working with any muscle group, separate stretching the muscle from contracting the muscle into different exercises.

4. Focus on posture – Making sure to find one’s center of balance will correctly distribute the body’s weight and reduce how quickly the muscles fatigue. Proper posture can help reduce unnecessarily held muscle tension.

5. Limit muscle contraction time – Prolonged muscle contraction can perpetuate pain by fatiguing muscles too quickly. Make certain to take regular breaks from any activity. This can range from taking a break from swimming to do a two-minute stretch, or pausing for three seconds after every minute of vacuuming.

Working with fibromyalgia can be a terrifically rewarding niche for massage therapists. As one of the most encountered chronic pain syndromes in women, there is currently no medical cure for this mysterious condition. While massage therapy is one of the top-rated options for fibromyalgia, results are magnified when accompanied by a regular exercise program. The five tips listed above can help clients with fibromyalgia incorporate exercise into their health maintenance routine. By recruiting both massage and exercise into a treatment plan, fibromyalgia sufferers have a better chance of conquering this increasingly common syndrome.

Recommended Study:
Fibromyalgia and Massage

References:

Mannerkorpi, K, Exercise in Fibromyalgia, Current Opinion in Rheumatology, March 2005.

www.exercise.about.com, Exercising with Fibromyalgia, Paige Waehner, About, Inc., 2007.

www.fmaware.org, Starting an Exercise Program with Fibromyalgia, Lisa Lorden, National Fibromyalgia Association, 2007.

www.mayoclinic.com, Fibromyalgia, Mayo Foundation for Medical Education and Research, 2007.

www.myalgia.com, Everyday Flexibility Moves, Janice H. Hoffman, Fibromyalgia Information Foundation, 2007.

www.myalgia.com, A Fibromyalgia Patients Guide to Exercise, Sharon R. Clark, PhD, FNP, Fibromyalgia Information Foundation, 2007.

Posted by Editors at 11:28 AM

© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org

A neurological disorder affecting normal brain function, autism is a complex developmental disability that typically appears during the first three years of life. The safe and nurturing touch of therapeutic massage is being used more and more frequently as an accepted and innovative complementary treatment for children and adults with autism. Learn how you can help in treating this challenging disorder.

by Nicole Cutler, L.Ac.

Autism primarily impacts social interaction and communication skills. According to a 2004 report from the Centers for Disease Control Prevention, autism affects an estimated 1 in 166 births. Statistics from the U.S. Department of Education confirm that the number of children with autism is on the rise, with a growth rate of 10 to 17 percent more diagnosed cases each year.

Although there is no cure for autism, appropriate treatment and education can help many children with this disorder adequately learn and develop. Early detection is critical in order to reduce the developmental challenges autism poses. Treatment is tailored to the individual and typically includes a combination of behavioral modification, communication therapy, dietary modifications and medications. Proven effective in rigorous clinical trials, massage therapy has been shown to positively impact some of the more characteristic behaviors of autism.

Autism Traits
People with autism process and respond to information in several unique ways. Those with autism typically exhibit some of the following traits:

· Resistance to change, need for repetition
· Difficulty in expressing needs, use of gestures or pointing rather than words
· Repeating words or phrases in place of normal, responsive language
· Laughing/crying for no apparent reason
· Preference to being alone, aloof manner
· Tantrums
· Difficulty interacting with others
· Not wanting to cuddle or be cuddled
· Little or no eye contact
· Unresponsive to normal teaching methods
· Obsessive attachment to objects
· Seemingly over-sensitivity or under-sensitivity to pain
· No real fears of danger
· Noticeable physical over-activity or extreme under-activity
· Uneven gross/fine motor skills
· Non-responsive to verbal cues, acts as if deaf despite hearing tests in normal range

Sensory Integration
For most of us, the integration of all five senses helps us understand what we are experiencing. For example, our sense of touch, smell and taste work together in the experience of eating a ripe peach. The fuzz on the peach may be experienced by someone with autism as painful and the smell may make the child gag. Some children with autism are particularly sensitive to sound, finding even the most ordinary daily noises painful. A majority of professionals agree that some of the typical autistic behaviors, like the ones listed above, are actually a result of sensory integration difficulties.

Often described as a lack of attachment, failing to cuddle as an infant and disassociation from the environment, autism often involves a defensive reaction to touch. Withdrawing when touched, displaying aggressive behaviors or even refusing to eat certain foods due to their textures, all point to autism manifesting as a sensory integration dysfunction of the tactile system.

A properly functioning tactile system accurately transmits information from the skin’s receptors to the central nervous system. When the tactile system is immature and working improperly, neural signals sent to the brain’s cortex interfere with other brain processes. This interference causes over-stimulation of the brain, making it difficult to both organize behavior and concentrate and can cause a negative emotional response to touch.

Massage Therapy
Interestingly, the nervous system is formed from the same layer of embryonic tissue as skin. As such, excessive sensitivity to light touch is one of the most common symptoms of nervous system immaturity. The self-affliction of vigorous physical stimuli (such as striking one’s head against a wall) while avoiding tactile interactions with others (a light touch may cause the child to scream in pain) is typical of autism. Since light touch is over-stimulating to those with autism, deeper massage techniques and joint compression are better tolerated. Utilizing methods of sustained moderate pressure such as Swedish Massage and Neuromuscular Therapy, can help dampen the nervous system’s over-reactivity.

Michael Regina-Whiteley, LMT, who has been working with children and adults with special challenges for over 33 years, shares the following nine tips to enhance relaxation and reduce tactile defensiveness in autistic children:

1. Begin sessions with deep touch (as opposed to light strokes) for the client to accept nurturing touch.

2. Engage the child in music of their choice and a quiet atmosphere.

3. Place your hands on his/her upper back or back of the head for as long as they allow. If no resistance is met, proceed and do a back or head massage using deeper strokes. If there is resistance, remove your hand, wait a few seconds, and then return your hand to its original position.

4. Although some children will resist the touching of their hands, another approach for an apprehensive child is to use their own hand to do the massage on their arm or hand. Be sure to calmly explain to the child what you are going to do in a low voice.

5. Keep the sessions brief at first to acclimate your client to the touch.

6. While getting a client with autism to participate in a full-body massage is unlikely, work as much as the client will allow.

7. When the focus is to decrease distractibility or hyperactivity, your primary objective would be to provide the “relaxation effect.” If the client has a high enough cognitive level, you can incorporate some tense-relax-tense exercises into the routine to teach relaxation skills.

8. Breathing exercises may be used to facilitate the client’s participation in their treatment. Be sure to acknowledge the client’s active involvement with verbal praise.

9. Many children with autism also experience hypertonicity of foot and leg muscles. Deep kneading and petrissage are helpful on the gastrocnemius and soleus; however, don’t go too deep with the tibialis anterior and peroneus brevis. Be sure to spend time on the plantar muscle groups at all three layers.

In 1997, researchers at the Touch Research Institute published results of its first study involving autistic children. Building on the success of previous studies demonstrating anxiety reduction and increased attention span using massage therapy for children, the Institute surmised touch therapy may be beneficial in reducing the autistic behaviors of inattentiveness, touch aversion and withdrawal. The researchers found that autistic children receiving touch therapy exhibited significant beneficial effects for orienting to irrelevant sounds and reducing stereotypic behaviors. Additionally, participants received improved scores on the Autism Behavior Checklist and Early Social Communication Scales. These beneficial effects of massage on autistic children may be credited to its active physical contact, relaxation effect and recruitment of the central nervous system.

The dysfunction of the nervous system’s sensory integration typically seen with autism can be minimized with touch therapy. Massage therapists showing interest in this condition can be a child’s bridge between autism’s seclusion and normal, developmental socialization.

Recommended Study:
Swedish Massage
Neuromuscular Therapy

References:

Regina-Whiteley, Michael, LMT, Autism and Treatment With Therapeutic Massage, Massage Today, February 2005.

Vanderbilt, Shirley, Massage Therapy for Autistic Children, Massage and Bodywork, February/March 2003.

www.autism-society.org, About Autism, Autism Society of America, 2006.

www.neurologychannel.org, Autism, Healthcommunities.com, Inc., 2006.

www.nimh.nih.gov, Autism Spectrum Disorders, National Institute of Mental Health, 2006.

www.thechildrenscenteraz.org, Tactile System, The Children’s Center for Neurodevelopmental Studies, 2006.

Posted by Editors at 02:33 PM
© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org

Name: Cardamom Essential Oil.

Botanical Name: Elettaria cardamomum.

Common Method of Extraction: Steam Distilled.

Color: Clear.

Consistency: Thin.

Perfumery Note: Middle.

Strength of Initial Aroma: Medium.

Aromatic Description: Spicy, woody, rich, sweet.

Possible Uses: Appetite (loss of), colic, fatigue, halitosis, stress. [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 63-67.].

Constituents: Terpinyl acetate, cineol, limonene, sabiene, linalool, linalyl acetate, pinene, zingiberene. [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 138.].

Safety Information: Essential Oil Safety by Robert Tisserand does not indicate any special precautions when using this oil. [Robert Tisserand, Essential Oil Safety (United Kingdom: Churchill Livingstone, 1995), 204.].

All Essential oils or highly concentrated, do not ingests or add directly to the skin. Always ask your trained massage aroma therapist on how to use any essential oils. These oils are used as a guide only.

Name: Carrot Seed Essential Oil.

Botanical Name: Daucus carota.

Common Method of Extraction: Steam Distilled.

Color: Golden Yellow.

Consistency: Thin - Medium.

Perfumery Note: Middle.

Strength of Initial Aroma: Medium – Strong, Lingering Aroma.

Aromatic Description: Earthy, woody, warm. It does not resemble the smell of carrots and is considered harsh or unpleasant by some.

Possible Uses: Eczema, gout, mature skin, toxin build-up, water retention. [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 57-60.].

Constituents: a-pinene, camphene, B-pinene, sabinene, myrcene, y-terpinene, limonene, B-bisabolene, geranyl acetate, Carotol. [B. Lawrence, "Carrot Seed Oil," Perfumer & Flavorist, August/September 1980, 29, cited in Salvatore Battaglia, The Complete Guide to Aromatherapy (Australia: The Perfect Potion, 1997), 149.].

Safety Information: Essential Oil Safety by Robert Tisserand does not indicate any special precautions when using this oil. [Robert Tisserand, Essential Oil Safety (United Kingdom: Churchill Livingstone, 1995), 204.].

All Essential oils or highly concentrated, do not ingests or add directly to the skin. Always ask your trained massage aroma therapist on how to use any essential oils. These oils are used as a guide only.

Name: Cassia Essential Oil.

Botanical Name: Cinnamomum cassia.

Common Method of Extraction: Steam Distilled.

Color: Golden Yellow/Brown.

Consistency: Medium.

Perfumery Note: Middle.

Strength of Initial Aroma: Sharp/Strong.

Aromatic Description: Resembling cinnamon oils in aroma, cassia is sometimes used as an economical substitute for fragrancing applications. Spicy, sweet, woodsy, earthy.

Possible Uses: Fragrancing, indigestion, gas, colic, diarrhea, rheumatism, cold/flu. [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 112.].

Constituents: Cinnamic aldehyde, methyl eugenol, salicylaldehyde, methylsalicylaldehyde. [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 112.].

Safety Information: Lawless indicates that this oil is a dermal irritant and mucous membrane irritant. [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 112.].

All Essential oils or highly concentrated, do not ingests or add directly to the skin. Always ask your trained massage aroma therapist on how to use any essential oils. These oils are used as a guide only.

When combined with grapefruit, the side effects of certain medications can intensify. Since these side effects may impact massage therapy, practitioners knowing about this potential are especially valuable to their clients.

by Nicole Cutler, L.Ac.

People on certain medications may or may not be aware of the potential danger evoked when they consume grapefruit or any of its derivatives. Because their work can have a dramatic effect on clients taking certain medications, the possibility of grapefruit interfering with a drug is even more complicated for massage therapists. Thus, bodyworkers taking extra precautions for clients who could have a drug and citrus interaction are better equipped to deliver a safe and therapeutic massage.

Grapefruit’s Good Side
Grapefruit and its juice are healthful, providing enough vitamin C, potassium, dietary fiber and other nutrients to earn the American Heart Association’s “heart-check” mark. Aside from the mixture of sweet and sour favored by so many, some of the documented health benefits of grapefruit include:

· Inhibition of tumor formation
· Supporting the body’s excretion of toxins
· Hindering Hepatitis C propagation
· Improvement in cholesterol levels
· Protection during cold and flu season

While this fruit’s obvious advantages explain its frequent recommendation by nutritionists, grapefruit can dangerously interact with over 50 medications.

Grapefruit’s Not So Good Side
Despite its reputation as one of nature’s perfect creations, grapefruit interferes with the absorption of certain medications. A compound in grapefruit binds to the enzyme CYP3A4 in the intestinal tract – the same enzyme that many drugs fasten to. Because this enzyme is occupied by the grapefruit, the medications that typically bind to it are blocked and pass from the digestive system to the bloodstream. This causes quantities of the drug to rise faster and higher than desired, sometimes dangerously too high.

Although the medications that interact with grapefruit juice always carry clear warnings, many consumers fail to fully read drug labels. Unfortunately, many people are unaware of their drug’s interaction with grapefruit. Since a single glass of grapefruit juice can reduce a drug’s intestinal absorption by nearly 50 percent, only a small amount is needed to dramatically boost blood levels of susceptible drugs.

An abbreviated list of commonly prescribed drugs that interact with grapefruit include:

· Anxiety: Xanax, Buspar, Versed, Halcion
· Depression: Luvox, Zoloft
· Allergies: Allegra
· Abnormal heart rhythm: Cordarone, Quinidine
· Heart disease/stroke/blood clots: Coumadin
· Epilepsy: Tegretol
· Cancer: Cyclophosphamide, Etoposide, Ifosfamide, Tamoxifen, Vinblastine, Vincristine
· Cough: Dextromethorphan
· HIV: Agenerase, Crixivan, Viracept, Norvir, Fortovase
· Prostate enlargement: Proscar
· Heart disease/High blood pressure: Coreg, Cardizem, Plendil, Cardene, Adalat, Procardia, Nimotop, Sular, Covera, Calan, Verelan
· Erectile dysfunction: Viagra, Cialis
· Asthma/Emphysema: Theophylline
· High cholesterol: Lipitor, Lescol, Mevacor, Zocor
· Pain: Alfenta, Duragesic, Actiq, Sufenta

Adding Massage Therapy to the Mix
Similar to any medical treatment capable of dramatic health improvements, massage therapy must be practiced with care. Included in careful bodywork administration is understanding that medications influence massage. Depending on the absorption, distribution and excretion of any particular drug, enhancing circulation through massage therapy can impact the function or side effects of that medication. Making for a larger potential impact, taking a drug that interacts with grapefruit while consuming grapefruit can exaggerate the side effects impacting massage therapy. Therefore, massage therapists can make the best decisions about giving a treatment when they know:

· which drugs carry a contraindication or side effect impacting massage
· and which drugs interact with grapefruit.

Below are three examples of drugs that fall into both categories and their corresponding massage implications:

1. Xanax – An anti-anxiety medication known to interact with grapefruit, this drug can cause fatigue, dizziness, drowsiness and hypotension. Thus, clients who are taking this drug and who have also recently consumed grapefruit are at much higher risk for getting dizzy or experiencing hypotension when changing positions or getting off the massage table.

2. Zoloft – This antidepressant medication also interacts with grapefruit. Its side effects that may impact massage include orthostatic hypotension, sleepiness, anxiety and insomnia. Thus, clients taking this drug who have recently consumed grapefruit are more likely to need stimulating strokes (such as tapotement) for orthostatic hypotension or sleepiness, or slow and rhythmic strokes (such as rocking) for anxiety or insomnia.

3. Duragesic – An externally applied patch used for pain, this narcotic also interacts with grapefruit. Side effects that can impact massage include dizziness, sedation, euphoria and decreased pain sensation. When working with clients on Duragesic, therapists must be extra careful with their depth and pressure due to decreased pain sensation – especially if the drug level in the blood is elevated from grapefruit consumption.

The problem of abnormally high blood levels of a drug caused by grapefruit consumption would not exist if everyone understood the warnings associated with their medication. However, massage therapists work in the real world, where some people are too hurried to comprehensively read and understand their drug’s labels.

Bodyworkers who recognize a client’s medication as one that interacts with grapefruit should always inquire about their fondness for this citrus fruit. By informing clients on these drugs of the danger of mixing it with grapefruit, advising them to discuss it with their physician and being careful with massage by assuming a possible exaggeration of side effects, massage therapists actively contribute to the safety of their clients and to the elevation of their profession.

Recommended Study:
Pharmacology for Massage

References:

Pharmacology Guide for Massage Therapy, Natural Wellness, 2008.

Werner, Ruth, You’re Taking What? Massage and Common Medications, Massage & Bodywork, April/May 2006.

www.globalrph.com, Drug-Grapefruit Interactions, D.McAuley, GlobalRPh Inc., 2008.

www.health.harvard.edu, Grapefruit and Medication: A Cautionary Note, President and Fellows of Harvard College, February 2006.

www.hepatitis-central.com/mt, Update: What You Need to Know About Grapefruit and Hepatitis C, Nicole Cutler, L.Ac., Natural Wellness, 2008.

www.webmd.com, Grapefruit May Improve Cholesterol, Miranda Hitti, WebMD, LLC, 2008.

Posted by Editors at 09:34 AM

“© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org ”

While people meditate in many different ways, guided imagery is a type of meditation massage therapists can successfully incorporate into their sessions. Learn how you can lead clients in a guided imagery meditation, helping to deepen their state of relaxation and increase the session’s therapeutic effectiveness.

by Nicole Cutler, L.Ac.

Even though many scenarios are appropriate for massage therapists guiding clients with imagery, therapists have a lot of leeway in personalizing each experience. While guided imagery is more than simply telling your client to relax, it doesn’t have to include a fully illustrated journey. The goal of combining the practices of meditation and massage is to bring the client’s mind into harmony with a relaxed and stress-free physical state.

Bodyworkers may choose a recording to guide clients into relaxation or use their own voice to lead the way. Two examples of useful journeys are described below:

· Imagine warm sunlight coming down from above. The warm, golden light beams down, touches the top of your head and relaxes the tension held in your scalp. The golden glow moves down your body slowly stopping to warm each muscle group, draining any tightness into the earth below you.

· As you feel your body relax and release tension it becomes lighter and lighter. As resistance is removed, your body becomes so light it begins to float. You lift off the earth and float like a cloud up to the sky. The warm sun envelops you and a gentle breeze carries you through the sky.

Imagery is an effective treatment for stress. Relaxation techniques can release neurochemicals that act as natural brain tranquilizers and lower blood pressure, heart rate and anxiety. Because imagery relaxes the body, doctors specializing in imagery often recommend it for stress-related conditions such as headaches, chronic neck and back pain, high blood pressure, spastic colon and cramping from premenstrual syndrome.

Several studies suggest that imagery boosts immunity. Danish researchers found increased natural killer cell activity among ten college students who imagined that their immune systems were becoming very effective. Natural killer cells are an important part of the immune system because they can recognize and destroy virus-infected cells, tumor cells and other invaders. In another small study, researchers at Pennsylvania State University and Case Western Reserve University School of Medicine found that seven people who suffered from recurrent canker sores in their mouths significantly reduced the frequency of their outbreaks after they began visualizing that the sores were bathed in a soothing coating of white blood cells.

Combining meditation with massage can elevate the recipient’s physical and spiritual well-being. As published in the October 2005 Journal of Palliative Medicine, Yale University researchers looked at the effect of meditation and massage on quality of life in people with AIDS. Study participants were allocated to either a massage group, a meditation group, a combined meditation and massage group or a standard care group. The researchers concluded the combination of meditation and massage demonstrated a significant favorable influence on overall and spiritual quality of life in late-stage disease relative to standard care, or either intervention component alone.

Leading your clients in a guided imagery meditation while you work requires practice. Below are five tips for getting started in guiding someone into a meditative state:

1. Listen to Guided Imagery – Make sure you are familiar with different ways of guiding a meditative state to help you develop your own style. Experiencing it yourself will help you recognize its benefits and choose what process suits you best to make you a better meditative leader. You can either listen to someone else’s guided imagery recording or be the recipient of a guided imagery session.

2. Practice on Friends First – Rehearse guided imagery with friends and family members and get their feedback before attempting to lead clients. It takes practice to guide a seamless opening, middle and closing meditation while simultaneously performing massage therapy.

3. Center Yourself – You can only lead a client into the relaxed state of meditation if you are grounded. Taking several deep, cleansing breaths, releasing accumulated tension and feeling connected to the earth below is one way to get centered.

4. Progress Slowly – When using imagery to guide someone towards relaxation, it is important to pause long enough for them to imagine each scenario you have set. Pace yourself so you don’t rush through the relaxation of a muscle group that may be carrying extra tension.

5. Voice Control – Maintain an even, calm voice tone throughout the meditation. Guided imagery works best when the practitioner’s voice is liquid, soothing and free of expression so the client doesn’t get distracted.

Incorporating guided imagery into your massage sessions may not be desirable for every situation. Clients who are not open to being led on a cognitive trip may find your guidance clashing with their attempts at relaxation. However, clients who are receptive to guided imagery have a unique opportunity to participate in their own healing process.

By working with the above five tips for beginning guiding meditations, you can learn to deliver a memorable physical and spiritual session. With research proving the advantages of combining meditation with massage, verbally guiding your clients into a deeply relaxed state will render your massage treatments even more effective than they were before.

Recommended Study:
Integrative Massage – Spirit

Recommended Recordings:
Ten Minutes to Relax
Your Present: A Half Hour of Peace

References:

Williams AL, Selwyn PA, Liberti L, Molde S, Njike VY, McCorkle R, Zelterman D, Katz DL, A randomized controlled trial of meditation and massage effects on quality of life in people with late-stage disease: a pilot study, Journal of Palliative Medicine, October 2005.

www.amcollege.edu, Guided Imagery, Dr. Richard Browne, Acupuncture Massage College, January 2007.

www.eupsychia.com, Guided Imagery, Eupsychia Institute, Inc., 2007.

www.holisticonline.com, Guided Imagery or Visualization, ICBS, Inc., 2007.

www.intelihealth.com, Guided Imagery, Natural Standard and Harvard Medical School, Aetna InteliHealth, Inc., 2007.

www.spas.about.com, Partnered Meditation and Massage, Margaret Doner, LMT, 2007.

Posted by Editors at 10:05 AM

© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org

While many people suffering with restless legs syndrome benefit from bodywork, this review offers specific guidance for the practitioner. By being aware of the cautions and utilizing the five bodywork tips for restless legs syndrome, therapists can make a dramatic impact on this condition.

by Nicole Cutler, L.Ac.

Restless legs syndrome (RLS) describes the condition where leg sensations cause an almost irresistible urge to move the lower limbs, usually right before sleep. According to the National Institutes of Health National Center for Sleep Disorder Research, RLS affects as many as 10 percent of Americans. For the projected millions of people struggling with restless legs, bodywork is one of the favored approaches to lessen this disruptive, potentially painful, sleep-depriving condition.

Typically characterized by creeping, crawling, burning, tingling or aching, a person living with this syndrome feels a need to move their legs to relieve these sensations. Considered a central nervous system disorder, RLS often interferes with resting or falling asleep. Partial or complete relief of the sensations occurs with leg motion, and the symptoms often return upon cessation of these movements. It is easy to see why many RLS sufferers fall into an unhealthful cycle of sleeplessness.

RLS Symptoms
Although the symptoms can be different for each person affected, most people with RLS experience the following:

· Irritation – Leg sensations are often irritating, typically described along the scale from painful to uncomfortable. Although sensations are often in the calf area, some experience them in the upper leg, feet, arms or even the hands.

· Need to Move – People with RLS often have an overwhelming urge to move. Typically, getting up and moving around can relieve the discomfort.

· Position and Time Variables – The discomfort of RLS tends to increase when a person is in a sitting or lying down position. The intensity usually escalates in the evening or at night.

· Visible Movement – When a person with RLS sits or lies down, the movement or jerking of their feet or toes may be witnessed by others.

RLS Causes
Although family history and high caffeine ingestion may cause RLS, the etiology is unknown in most cases. Restless legs syndrome can also be a secondary problem, brought on by other conditions. Examples include:

· Chronic Disease – An underlying medical problem, such as diabetes mellitus, kidney disease, Parkinson’s disease or rheumatoid arthritis could precipitate RLS.

· Pregnancy – Many women experience RLS in the last months of pregnancy. This may be related to an iron deficiency. Left untreated, the symptoms often go away after delivery.

· Iron Deficiency Anemia – A lack of iron in the blood may not allow a muscle to rest.

· Neurologic Lesions – People with spinal cord tumors, peripheral nerve lesions or spinal cord injury often report symptoms of RLS.

· Drug Side Effects – Medications including tricyclic antidepressants, anti-nausea and anti-seizure drugs, selective serotonin reuptake inhibitors (SSRIs), lithium, and some cold and allergy drugs may increase or trigger RLS symptoms. In addition, withdrawal from sedatives may trigger RLS.
Other conditions suspected of contributing to RLS include sleep apnea, narcolepsy, varicose veins, thyroid problems or problems with hand or feet nerves.

RLS Treatment
The medical community regards restless legs syndrome as a condition that can be managed, but not necessarily cured. In general, the therapeutic approach is dependent on improvement of the primary condition and the severity of the RLS.

For those with extreme pain and total sleep deprivation, medications are prescribed. The medications used for RLS are frequently “off-label” uses of the drugs, meaning they are not specifically intended for RLS, but have been found to help with symptoms. The following are the medications most prescribed for RLS and how they might impact bodywork:

· Benzodiazepines – These medications are depressants that artificially promote sleep. Unfortunately, the sensations of RLS are usually not suppressed with this class of drugs. Of concern to bodyworkers, hypotension (low blood pressure) is a typical side effect of benzodiazepines. Any client at increased risk of hypotension requires extra attention during a position change or when rising from a massage table.

· Dopaminergic Agents – Used to treat Parkinson’s disease, these drugs reduce motion by affecting the level of dopamine in the brain. Common examples include pramipexole (Mirapex), pergolide (Permax), ropinirole (Requip), and a combination of carbidopa and levodopa (Sinemet). Hypotension is also a typical side effect of dopaminergic agents. Again, any client at increased risk of hypotension requires extra attention during a position change or when rising from a massage table.

· Opioids – These narcotic drugs are used as painkillers to reduce severe RLS symptoms. Examples of these drugs include the combination of oxycodone and acetaminophen (Percocet, Roxicet) and the combination of hydrocodone and acetaminophen (Vicodin, Duocet). Because clients taking opiods are likely to have decreased pain sensation, bodyworkers must be extra careful with their depth and pressure.

If medications are not used, most healthcare providers advise one or more of the following approaches:

· Massage – Habitual leg massage has been reported to ease RLS.

· Hydrotherapy – Advising clients to take a warm bath often demonstrates favorable results. On the other hand, some people find relief with the application of cold packs.

· Moderate Exercise – While moderate exercise early in the day benefits leg circulation and therefore leg pain, strenuous exercise could potentially aggravate RLS.

· Avoid Alcohol, Caffeine and Nicotine – Refraining from these substances, especially in the evening, can help reduce RLS severity.

· Compression – Wrapping the legs in ace bandages, or wearing compression stockings or tight pantyhose can reduce RLS sensations.

Five Bodywork Tips for RLS
Massage therapy is one of the most well known approaches for helping RLS. While concentrating on bodywork for the lower half of the body is the general rule, below are five specific tips for the administering therapist:

1. When treating RLS, it is always advisable to first seek the client’s physician’s approval.

2. Releasing the piriformis muscle typically yields dramatic improvement in RLS symptoms.

3. Some favored modalities for preventing the energetic accumulation common with RLS are myofascial release, trigger point therapy, deep tissue massage and sports massage techniques.

4. Increasing circulation in the hamstrings can relieve uncomfortable sensations in the legs.

5. Bodyworkers should be aware that in some cases, deep relaxation may aggravate RLS.

Although there is no surefire way to get rid of RLS, bodywork is one of the most effective ways to deliver relief and reinstate a healthy sleep schedule. Being familiar with the symptoms, possible causes and treatment options for this condition will help bodyworkers deliver topnotch care to the many suffering from restless legs syndrome.

Recommended Study:

Deep Tissue Massage
Myofascial Release
Neuromuscular Therapy
Sports Massage

References:

http://sleepdisorders.about.com, Restless Legs Syndrome – the Basics, About.com, Inc., 2007.

Pharmacology Guide for Massage Therapy, Natural Wellness, 2007.

Russell, Meg, LMBT, Massage Therapy and Restless Legs Syndrome, Journal of Bodywork and Movement Therapies, April 2007.

www.dentinstitute.com, Restless Legs Syndrome, American Academy of Sleep Medicine, 2007.

www.helpguide.org, Restless Legs Syndrome, helpguide.org, 2007.

www.thebodyworker.com, Pathology for Massage Therapists, Julie Onofrio, LMP, thebodyworker.com, 2007.

Posted by Editors at 12:49 PM

© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org

Polarity therapy has established itself as an effective system of alternative healthcare. Founded on similar physical concepts, adding chromotherapy to polarity-based bodywork is likely to enhance client results. What is chromotherapy?

by Nicole Cutler, L.Ac.

For centuries, a select group of alternative healthcare practitioners have known that colors can dramatically affect health, inner harmony and emotions. Although those trained within the conventional medical model may doubt the efficacy of color therapy, or chromotherapy, a surprising number of success stories have surfaced touting the ability of color to impact human health. As the science behind chromotherapy is uncovered, it is easy to recognize it’s parallel with polarity therapy. Since polarity therapy and chromotherapy are both deeply routed in the basic laws of vibrational physics, these two modalities make a logical union.

Chromotherapy
Based on the premise that different bands of the light spectrum produce different effects in the human body, chromotherapy is known as a vibrational healing modality. When color and light strike an individual, they influence that same vibration present in the body.

The set of frequencies related to musical notes demonstrates how the vibration of color can influence the human body. If two properly tuned guitars are in the same room and the G string is plucked on one guitar, the G string on the second guitar will also ring. This phenomenon occurs because the sound frequency of the G note travels across the room causing the resonant frequency of the G string on the second guitar to sound. Likewise, the body’s organs have their own resonant frequencies associated with each chakra and meridian. Well known to physicists, the electrically charged molecules composing living tissue is always vibrating. Thus, chromotherapy practitioners can tune their clients for optimal wellness by exposing chakras and meridians to the color needed.

Some of the properties of color that render it a potential healing tool include:

· A property of light, color is electromagnetic energy.

· Different colors of light have different wavelengths.

· The shorter the wavelength, like violet, the faster it vibrates; the longer the wavelength, like red, the slower it vibrates.

Creating resonance between the body’s vibrating electromagnetic particles and the desired color’s vibration helps chromotherapy recipients achieve a more healthful state.

Chromotherapy in Practice
Applying the principles of chromotherapy, a therapist can utilize light and color in various forms. Some of its more common applications include projecting colored light onto certain areas of the body, suggesting colored visualizations and incorporating various colored materials into a session. Each basic color used in chromotherapy is associated with a different chakra and relates to different physical and emotional issues:

· Red – Red stimulates brain wave activity, increases heart rate, respiration and blood pressure and excites the sexual glands. It energizes the first chakra located at the coccyx. Warming and energizing, red is appropriate for someone who is tired, cold and has poor circulation.

· Orange – The color of joy and wisdom, orange energizes the second chakra located at the sacrum. Regarded to stimulate the appetite, orange is beneficial for illnesses of the colon and digestion.

· Yellow – Related to the solar plexus chakra, yellow energizes, lifts the mood, improves memory and can improve digestion.

· Green – Affecting the heart chakra, green is calming to the central nervous system. A good color for cardiac conditions, high blood pressure and ulcers, green also benefits those suffering from depression and anxiety.

· Blue – The color of the throat chakra, blue is a good color choice to influence respiratory or throat difficulties. Calming and cooling, blue may help counteract hypertension.

· Indigo – Related to the brow chakra, indigo can improve problems with the sinuses and face. It has also been used to help heal burns and reduce pain.

· Violet – Associated with the crown chakra, violet is cleansing, strengthening and peaceful. Affecting the skeletal system, it is often used therapeutically to improve immunity, arthritis and relieve headaches.

Polarity Therapy
Polarity therapy is a natural health care system that is also based on the human energy field. Relying on the constant motion of molecules, polarity therapy is aimed at balancing the constant pulsation of energy between positive and negative poles. These poles create fields and energetic lines of force throughout the body. Dr. Randolph Stone, the founder of polarity therapy, explains that a disturbance in this energetic system causes a departure from good health.

By incorporating energy mapping of the five natural elements (Ether, Air, Fire, Water and Earth) and the seven primary energy centers or chakras, polarity therapy encourages each energetic field to achieve unrestricted, optimal vibration levels. A polarity practitioner adds their own energy to a disordered field, to create vibration in unison. Known in physics as a Bose-Einstein Condensate, creating vibratory unison allows a dysfunctional organ to work more effectively. Similar to understanding entropy in quantum physics, proponents of polarity therapy acknowledge that healing occurs as energetic order is restored to systems that had previously been disordered.

Polarity in Practice
Mostly using very gentle types of bipolar contact, polarity bodywork involves many techniques. Characteristic of polarity, bipolar contact is when a practitioner uses the fingers of both hands to energetically and functionally link related areas of the body for energy movement. Methods used include cranial holds, rocking movements, techniques similar to reflexology and some osteopathic and chiropractic influenced moves. However, polarity therapy always emphasizes energetic work over manipulation. Since forceful manipulations are not part of polarity therapy, it is suitable for elderly and frail clients.

Whether practicing polarity therapy or chromotherapy, bodyworkers have the opportunity to put their physics knowledge to good use. For a Western science trained, analytical mind, both modalities are logical ways to influence well-being. If proficient in both chromotherapy and polarity, practitioners can combine the two to increase the therapeutic effectiveness of their sessions.

Recommended Study:
Polarity Therapy

References:

http://healing.about.com, Color Therapy – Chromotherapy, Phylameana lila Desy, About.com, Inc., 2008.

Rowen, Robert Jay, MD, 9 Alternative Health Scams, Second Opinion Publishing Inc., Atlanta, Georgia, 2002.

www.biopulse.org, Color Therapy, Association Alternative Medicine, 2008.

www.polaritytherapy.org, Polarity Therapy: An Introduction, Will Wilson, American Polarity Therapy Association, 2008.

Posted by Editors at 12:36 PM

© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org

The fundamental mechanism of how our bodies maintain posture and produce movement is based simply on the balance of continually contracting and relaxing opposing muscles. Discover how using this principle, reciprocal inhibition, helps reduce spasms as well as strengthens and improves flexibility in your clients.

by Nicole Cutler, L.Ac.

Originally used by osteopaths, athletic trainers, physical therapists, kinesiologists and physiotherapists, reciprocal inhibition is a simply learned stretching principle capable of amplifying the benefits of massage therapy treatment. Defined as a muscle’s automatic relaxation response to accommodate the contraction of its opposing muscle, reciprocal inhibition provides for optimum joint function and longevity. Commonly used in sports massage, reciprocal inhibition is the application of resisted tension to the opposing muscle group.

The symbolism of yin yang is akin to human muscular anatomy, where a healthy functioning unit is comprised of two contrasting forces. Just as there could be no concept of dark without light, flexor muscles need their opposing extensors to function properly. Our muscles primarily operate in pairs; when one contracts (the agonist) its partner (the antagonist) relaxes. The body naturally and brilliantly orchestrates this mechanism during activities like running, where muscles opposing each other are engaged and disengaged sequentially to produce coordinated movement. This alternation of contraction facilitates movement ease and safeguards against injury. Classic examples of opposing muscle group partnerships include the biceps and triceps, as well as the hamstrings and quadriceps.

If a muscle becomes engaged for a prolonged period, such as a cramp, spasm or chronic tension, the opposite muscle becomes correspondingly inhibited. This response to dysfunction inhibits normal joint performance, which can result in deterioration of muscle, tendon and joint tissues. In the case of affected upper arm musculature, spasms in the biceps will likely lead to a discovery of weakened triceps. Whenever the agonist is much stronger than the antagonist, the agonist can overpower and injure the antagonist. This relationship is why most strength training programs revolve around balanced muscle pair exercises. While not exhaustive, the following list comprises nine common agonist-antagonist muscle pairs that can assist a practitioner when using reciprocal inhibition techniques:

1. Biceps – Triceps
2. Deltoids – Latissimus Dorsi
3. Pectoralis Major – Trapezius/Rhomboids
4. Iliopsoas – Gluteus Maximus
5. Quadriceps – Hamstrings
6. Hip Adductor – Gluteus Medius
7. Tibialis Anterior – Gastrocnemius
8. Anterior Deltiod – Levator Scapula
9. Forearm Flexors – Forearm Extensors

Inhibition of the antagonistic muscles is not required for every muscular contraction. In fact, co-contraction can sometimes occur. This can be observed during a sit-up, where one might assume that the stomach muscles inhibit the contraction of the muscles in the lumbar region of the back. However, sit-ups engage contraction of both the spinal erectors as well as the abdominal muscles. This reciprocal inhibition exception is one reason why sit-ups are good for strengthening both the back and stomach muscles. Thus, careful evaluation of the musculature involved is a precursor to choosing reciprocal inhibition stretching techniques.

Activation of an opposing muscle group with resisted tension forces the contracted muscle to relax. For example, a cramp in the posterior, lower leg can be relieved by applying resisted tension to the anterior, lower leg muscles. When stretching, it is easier to stretch a muscle that is relaxed than to stretch a contracted muscle. By inducing the antagonists to relax during a stretch due to contraction of the agonist, massage therapists can take advantage of reciprocal inhibition by getting a more effective stretch.

An additional key to maximizing stretching is to have the client consciously relax any muscles used as synergists by the muscle attempting to be stretched. For example, a gastrocnemius stretch can be accomplished by contracting the tibialis anterior through foot flexion. However, since the hamstrings use the gastrocnemius as a synergist, have the client also relax the hamstrings with quadriceps contraction by keeping their leg straight.

The principle behind reciprocal inhibition stretching is that the muscle not contracting is inhibited because the stretch suppresses contractibility. Prior to working with a muscle, initiating the reciprocal inhibition response will enhance the results of any stretching regimen. Applying reciprocal inhibition to the appropriate muscle groups can stop a muscle spasm, build strength and flexibility in opposing muscle pairs, prevent re-injury to a vulnerable area and dramatically increase your client’s flexibility. Learning to perform this specific type of stretching allows massage therapists to utilize their knowledge of anatomy and physiology for maximizing their therapeutic effectiveness.

Recommended Study:
Anatomy Review for Professionals
Sports Massage

References:
www.appliedmotorcontrol.com, Inhibition and False Positives, Applied Motor Control, 2007.

www.cmcrossroads.com, Physiology of Stretching, Brad Appleton, 2007.

www.ifafitness.com, Anatomy, International Fitness Association, 2007.

www.leanandhungryfitness.com, Using Reciprocal Inhibition in Stretching, Jim Biancolo, 2007.

www.pponline.co.uk, Flexibility: A physiotherapist explains the science behind the importance of keeping flexible, Chris Mallac, Peak Performance, 2007.

www.sportfit.com, Glossary, Sport Specific Fitness Corporation, 2007.

Posted by Editors at 03:31 PM

© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org