In addition to the health sustaining fiber, vitamins and antioxidants provided by produce, you are likely ingesting pesticides as well. Learn which popular fruits and veggies are relatively chemical-free, and which warrant splurging in your market’s organic section.

From a pesticide perspective, all conventionally grown produce is not created equal. This inequality stems from bugs’ own food preferences. Problems occur when bugs and humans have a penchant for the same fruit or vegetable. In order for crops to grow to maturity before being ravaged by pests, agribusiness uses a wide variety of pesticides.

While the health impact of ongoing pesticide ingestion is unclear, lab studies have demonstrated a connection between pesticides and birth defects, developmental delays, nerve damage and cancer. The effects relate to the toxicity of the individual pesticide as well as the amount consumed. Since it’s unrealistic to insulate yourself from exposure entirely, the ideal solution is to minimize pesticide consumption.

Organic produce is the saving grace of those wishing to consume mutually-desired (by bugs and humans), yet chemical-free food. The greatest caveat of filling our kitchens with organically grown fare is the considerable expense that accompanies this decision. Growers who don’t use pesticides yield smaller crops compared to their pesticide-using counterparts. It’s no wonder the increased cost of growing organic produce makes it dramatically more expensive.

The February 2006 edition of Consumer Reports helps those aware of the dangers of significant pesticide consumption to prioritize which fruits and veggies warrant paying the price for organic status. The U.S. Department of Agriculture has confirmed that even after washing, certain fruits and vegetables consistently carry varying levels of pesticide residue. As listed below, the Environmental Working Group (EWG), a research and advocacy organization, reports the 12 most contaminated foods:

Fruit/Veggie % of samples tested with detectable pesticide residues Average amount in parts per million of all pesticides found
1 Nectarines 97.3% 0.576
2 Celery 94.5% 0.330
3 Pears 94.4% 0.719
4 Peaches 93.7% 1.137
5 Cherries 91.4% 0.290
6 Strawberries 90.4% 1.138
7 Apples 90.9% 1.022
8 Imported Grapes 86.2% 0.280
9 Spinach 83.4% 1.182
10 Potatoes 79.3% 1.260
11 Bell Peppers 68.2% 0.171
12 Raspberries 58.9% 0.788

According to www.foodnews.org, an EWG website, washing a fruit or vegetable does not change the rank of the preceding 12 most contaminated foods. This is because the pesticide testing was performed after the produce was washed and prepared for consumption. While washing will help reduce residue, it does not eliminate pesticide presence. Unfortunately, pesticides are not only on the surface of the produce, but can also wind up inside the plant’s matrix, rendering it permanent.

To further help decision-making in your local grocery store’s produce aisle, EWG also reports on the 12 least contaminated items:

Fruit/Veggie % of samples tested with detectable pesticide residues Average amount in parts per million of all pesticides found
1 Sweet Corn* 0.2% 0.000
2 Avocado 2.4% 0.002
3 Onion 5.9% 0.289
4 Pineapple 6.7% 0.001
5 Mango 7.4% 0.008
6 Cauliflower 7.6% 0.033
7 Asparagus 10.1% 0.187
8 Papaya 21.7% 0.227
9 Kiwi 23.6% 0.133
10 Broccoli 26.6% 0.004
11 Sweet Pea 27.0% 0.009
12 Banana 53.1% 0.047

*Sweet Corn is not laden by pesticide residues because 75-90 percent of domestically grown corn has been genetically modified to resist pests.

Because fruit and veggies are crucial to a healthy diet, eliminating them based solely on finances is not an ideal solution. Instead, use the above rankings to help determine where your extra dough should go. If you can only afford to splurge on the organic variety of one fruit and one vegetable, choose organic strawberries and spinach. On the other hand, you can save your pennies by purchasing conventionally grown pineapples and sweet peas.

As with any health-related advice, moderation reigns. The health benefits of a varied diet rich in fruit and veggies, should overshadow pesticide concerns. Choosing the least pesticide-laden produce is even more important for those who are pregnant, have young children or liver health concerns (the liver processes all of the toxins we ingest). Regardless of your situation, consider these lists as a tool to help you make the best produce choices.

References:
Consumer Reports, February 2006; vol 71: pp 12-17.
www.foodnews.org, Report Card: Pesticides in Produce, Environmental Working Group, 2005.
www.kidsorganics.com, Organic Musts! 17 Most Important Foods to Eat Organic, Modified from: The Green Guide.

Posted by Nicole at 04:17 PM

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

The secret to fulfilling the New Year’s resolutions of your clients is providing them the oomph to follow through. Western and complementary medicines have united to create Lipid Replacement Therapy, a scientifically proven method of increasing energy.

Renewed desire for improved health surges with the start of a new year. While resolutions encompass all aspects of health, improved energy levels is a predominant wish. Healthcare practitioners frequently see clients complaining of fatigue. Unless there is a detectable pathological illness associated with the fatigue, most allopathic medical doctors have little to offer these individuals. Alternatively, bodywork professionals typically rely on energy invigoration techniques, however, their effects are temporary.

An Integrated Solution
Integrative medicine borrows both from allopathic and complementary medical knowledge to offer state-of-the-art health solutions. When it comes to fatigue, integrative medicine successfully bridges the gap between healthcare systems. The approach to combating fatigue supplied by Lipid Replacement Therapy (LRT) is integrative medicine at its best. Components of LRT include:

• Western science chronicles the body’s energy manufacturing process on a cellular level.
• Breakdown of the energy production system is confirmed by contemporary research.
• Nutritional medicine provides a safe and proven method to repair the damaged structures responsible for energy production.

Lipid Replacement Therapy
Representing multiple medical perspectives, LRT is an effective, supplement-based, non-stimulant approach to naturally increase physical energy levels. LRT replaces phospholipids in cell membranes, resulting in improved function. Researchers Dr. Denham Harman and Dr. Bruce Ames have demonstrated that nutritional intervention can provide a healthier, more energetic life by supporting the health of energy-producing mitochondria. While many holistic healthcare practitioners have been schooled to examine how every system affects every other, looking at body dysfunction from a microscopic perspective is illuminating. Working backwards to understand energy’s abundance begins with the question, “What is energy and where does it come from?”

Basics of Energy Production
Although numerous factors can cause fatigue, solutions to increasing energy levels are restricted by the available metabolic energy supply. Remembering back to biology class, the human body’s principal energy molecule is adenosine triphosphate (ATP). ATP production occurs primarily in mitochondria, where an electrical chemical gradient is generated from the pumping of protons across its inner membrane (much like a battery). The charge builds, reaches a threshold and releases, providing the power to create ATP’s high-energy phosphate bond, the foundation of our body’s fuel.

The ability of the mitochondria to host the production of energy relies on the health of its membranes. The membrane’s lipid component allows it to remain fluid-like, ensuring an effective gradient for energy transfer. Oxidation by free radicals stiffens the membrane, making it less conductive, reducing energy levels. Spurred by age, disease, trauma and toxins, oxidative damage to the lipid membrane is considered to be the predominant cause of impaired mitochondrial function. Several clinical studies document the relationship between oxidation, membrane phospholipid loss, membrane damage and fatigue. Protecting cell membrane integrity is the key to enhancing cellular health, energy and metabolic efficiency.

Nutritional Medicine Protects and Heals the Membrane
Nutritional medicine is based on the premise that a healthy body requires the correct balance of foods, vitamins and nutrients. LRT is the actual replacement of damaged cellular lipids with healthy lipids. Essential for restoring membrane fluidity and function, LRT employs the following lipids to repair cell membranes:

• polyunsaturated phosphatidylcholine
• other polyunsaturated phosphatidyl lipids
• glycolipids

Clinical studies demonstrate a reversal of damage, restoration of cellular function and a return to normal energy levels when high concentrations of unoxidized, undamaged lipids are delivered to cells.

LRT requires several additional nutrients to be effective. Unfortunately, individuals whose weakened digestive systems pass nutrients quickly are unable to reap lipids’ benefits. In order to ensure lipids are utilized, nutritional medicine specifies the inclusion of essential fatty acids and probiotics (good bacteria) to nourish and balance the digestive tract, aiding nutrient absorption.

While lipids rebuild membranes, and fatty acids and probiotics ensure their delivery, antioxidants can stop the damage from occurring. The inclusion of antioxidants, found in amino acids, vitamins and minerals, adds another dimension of protection by preventing phospholipid oxidation and free radical production. LRT supplies nutritional supplementation with the appropriate balance of lipids, fatty acids, probiotics and antioxidants to support, protect and heal our microscopic, energy-supplying structures.

How You Can Help
In addition to the short-term benefits of invigorating massage techniques, bodyworkers can offer a proven long-term solution to fatigued clients by suggesting or selling a nutritional supplement based on LRT. Incorporating this approach to membrane health can make the difference between clients dragging through the day as opposed to being vibrant and energetic. Integrative medicine’s LRT combines the wisdom of nutritional therapy with a comprehension of biochemistry to end fatigue, making achievement of your clients’ 2006 health goals possible.

Editor’s Note: For information about Lipid Replacement Therapy products, e-mail editors@natural-wellness.com.

References:

Agadjanyan, M., V. Vasilevko, Ghochikyan, et al. Nutritional supplement (NT Factor®) restores mitochondrial function and reduces moderately severe fatigue in aged subjects. J Chronic Fatigue Syndr. 2003; 11(4): in press.

Beckman, K., B. Ames, The Free Radical Theory Of Aging Matures. Physiol Rev. 1998; (78): 548-81.

Goldberg, Burton, L. Trivieri, Jr., Chronic Fatigue, Fibromyalgia and Lyme Disease. Celestial Arts, 2004: 324-51.

Harman, D., The Biological Clock: The Mitochondria. J Am Ger Soc. 1972; (2): 145-47.

Nicolson G.L., Lipid Replacement Therapy as an Adjunct for Chronic Fatigue, Anti-Aging and Restoration of Mitochondrial Function. JANA. 2003; 6(3): 22-28.

Nicolson G.L., Chronic Fatigue, Aging, Mitochondrial Function and Nutritional Supplements. Townsend Letter For Doctors 2003; July/August.

Posted by Nicole at 11:05 AM

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

ADHD or ADD is a neurological disorder that usually affects a person during their childhood, and persists into their adulthood. Here are some of the main ADHD symptoms.
You’ve probably come across them, the kids who simply cannot seem able to sit still, the ones that can’t seem to be able to pay attention, who can’t seem to stop themselves from blurting out inappropriate things at unsuitable times, who seem willfully not to follow instructions even though they have been explained clearly. Well, these are some of the classic ADHD symptoms that these children are displaying.

So, What Exactly is ADHD?

Well, ADHD, or Attention Deficit Hyperactivity Disorder, also referred to as just ADD, or Attention Deficit Disorder, is a chronic type of neurological disorder. The children and adults affected with this condition find it difficult to control their spontaneous responses, particularly those involving attentiveness, speech, and movement, which result in their inattentiveness, impulsive behavior, and hyperactivity. According to estimates, it is thought millions of children display the symptoms of Attention Deficit Disorder, and the condition usually continues into adulthood. Those affected with ADD symptoms usually also suffer from performance problems in school or at work, experience trouble with their personal relationships, and have low self-confidence and self esteem.

Exactly what treatment should be followed in order to control the symptoms of ADD is still under debate by the medical community. Presently, doctors are prescribing psychostimulant drugs in order to treat ADHD. However, even though many of the ADHD symptoms may be controlled by these drugs, they do not cure the condition. Plus, the side effects of these drugs can be a troubling factor. Special classroom modifications, support by the family as well as the community, and counseling are some of the supportive parts of the treatment.

Symptoms of ADD/ADHD

Most physicians are of the opinion that a child should not be diagnosed with ADHD unless the principal ADHD symptoms occur early in life and result in creating significant problems at school as well as at home in a continuous manner. Most children diagnosed with this condition display the signs of ADHD before they are seven years old, sometimes even earlier. The symptoms and signs of ADHD can be broadly categorized into two types: Inattentiveness; and Impulsive Behavior-Hyperactivity.

ADHD Symptom - Inattentiveness

Some of the symptoms of inattentiveness of ADHD are:
Careless mistakes made in schoolwork and the inability to pay attention closely to details
Difficulty in maintaining attention while doing tasks or even at play
Appears not to be listening even when directly spoken to
Finds it difficult to follow the instructions given and is not able to complete schoolwork, tasks, and chores
Usually has difficulty in organizing activities or tasks
Has the tendency to dislike or avoid any work that involves mental effort for a length of time, like when doing homework or schoolwork
Tends to be distracted easily
Frequently forgetful
Loses needful things like pencils, books, tools, or toys
ADHD Symptom - Impulsive Behavior-Hyperactivity

Some of the symptoms of the impulsive behavior-hyperactivity of ADHD are:
Has a tendency of squirming or fidgeting often
When it is expected for the child to remain seated, has the tendency of leaving his/her seat often
Excessive running or climbing when it is not appropriate, in adolescents it is displayed in constant restlessness
Excessive talkativeness
Has the tendency of blurting out answers before the questions have been asked fully
Has the tendency of intruding on or interrupting the games or conversation of others
Is too impatient to wait for his/her turn
Does not seem to have the ability to play quietly
Generally, children are diagnosed as having ADHD if they display six or more of the above symptoms in each of the categories, for a period of six months or so. Plus, these ADHD symptoms should affect at least two areas of the child’s life, namely at school and at home. This helps in ensuring that it is not because of a teacher or his/her parents that the child is displaying anomalous behavior. For example, children are not diagnosed as having ADHD if they seem to be having behavioral problems only at school while getting along quite well with their family at home or with their friends. Likewise with children who are inattentive or hyperactive at home, but are quite well adjusted at school and with their friends.

By Rita Putatunda
Published: 4/12/2008

Spring is fast approaching, meaning many sports enthusiasts will emerge from their winter den to begin physical activity. Shin splints can result from training too hard, too fast, sidelining any athlete. When performed appropriately, massage therapy can prevent anterior shin splints from recurring all season long.

Athletes and those who treat their injuries are all too familiar with the surge of strains, sprains and tears associated with the first few weeks of athletic training. Common among runners, anterior shin splints are one of the most prominent early season injuries. Anterior shin splints can develop gradually over a period of weeks to months, or may occur after a single, excessive bout of exercise.

Definition
Often occurring bilaterally, anterior shin splints typically involve inflammation and/or small tears in the tibialis anterior muscle where it is attached to the tibia. The pain is usually noticeable when exercise begins, then decreases as exercise continues. Often experienced as a burning sensation, the pain worsens after exercise or the following morning.

Due to the tearing of muscle fibers away from the periosteal attachment, anterior shin splints manifest as bumps and tender areas on the anterior leg. As these fibers heal, they become fibrotic, making it difficult for the muscle to lengthen normally. The fibrotic patches weaken the muscle by restricting movement, perpetuating the probability of future shin splints. Additionally, untreated shin splints place the individual at a greater risk for developing stress fractures.

Cause
Since the tibialis anterior muscle controls the lowering of the foot upon heel strike, stressing this movement can increase chances of injury. Activities leaving individuals susceptible to anterior shin splints include:

• Beginning a running program
• Excessive downhill running
• Sports requiring rapid starts and stops

Additional conditions which can increase the chances for shin splints are:

• Running on hard surfaces, or wearing shoes without adequate shock absorption
• Over-pronated (flat) feet, which increase stress on the lower leg muscles
• High arched feet due to their inability to absorb shock
• Excessive jumping, which places disproportionate stress on the toes

Prevention
According to James Mally, ND, instructor of the Institute for Integrative Healthcare Studies’ Sports Massage continuing education program, “The best ways to avoid shin splints are to warm-up well; stretch; run on soft surfaces as much as possible; avoid major changes in training, and ice at the first sign of discomfort. Orthotics may be necessary if there is inadequate arch support.”

Special considerations
Bodyworkers may note an imbalance between the weaker anterior leg muscle group and the larger and stronger posterior group. Tightness of the posterior muscle group can further aggravate anterior shin splints.

Prior to working with sharp anterior leg pain, the bodyworker should rule out a tibial stress fracture. A positive test for a stress fracture is eliciting pain at the fracture site when placing a vibrating tuning fork directly on the tibia. Refrain from local massage and refer to a physician if a stress fracture is suspected.

Another condition that may mask itself as shin splints is compartment syndrome of the lower leg. Also induced by exercise, compartment syndrome involves swelling, pain, parathesia, and can ultimately decrease leg motor function. Also requiring a referral, compartment syndrome demands medical evaluation.

Treatment
Orthopedic specialists agree that the most important treatment for shin splints is rest. If the activity aggravating the tibialis anterior continues prior to the tissue healing, damage to the muscle will ensue. Additionally, directly icing the shin after activity will minimize tissue damage.

Massage is a valuable tool when recuperating from anterior shin splints. Bodywork can drastically reduce the tightened and fibrotic muscle tissue typical of this injury.

In the Institute’s Sports Massage continuing education course, Dr. Mally teaches two methods to decrease shin splint pain:

1. In the supine position, slightly rotate the leg medially to provide better access to the tibialis anterior. Work your way up the tibialis anterior with the heel of your hand or with your proximal forearm.

2. In the prone position, increase the tension on the tibialis anterior by bending the client’s knee and grasping their toes to plantar flex the client’s ankle. In this position, the therapist can maximize the depth of work on the tibialis anterior muscle.

In the August/September 2000 edition of Massage and Bodywork, Zhenya Kurashova Wine imparts information on Russian sports massage for running injuries. Wine clarifies the reasoning for the upward stroke direction when addressing anterior shin splints, “To reiterate, it is very important not to apply any downward pressure since this will increase the chance of edema, hemorrhage and possibly more tissue damage.”

Additionally, Wine suggests a conservative approach for anterior shin splints, by beginning massage on the posterior leg before progressing to the anterior leg. By massaging the muscle antagonist first, the injured area is flooded with circulation to prepare for direct manipulation.

Acupressure practitioners work two important points near the tibia to increase circulation for enhanced tibialis anterior healing:

• Stomach 36: Located four finger breadths below the eye of the knee, one finger breadth lateral to the anterior crest of the tibia, in the tibialis anterior.
• Spleen 9: On the lower border of the medial condyle of the tibia, in the depression on the medial border of the tibia.

Rehabilitation
Once the tibialis anterior muscle has healed, another step is necessary before engaging in the original offending activity. No different than any other sports related injury, the anterior leg muscles must be progressively stretched and strengthened to prevent re-injury. The key to successful rehabilitation is a gradual increase in its intensity.

A certified athletic trainer and strength and conditioning specialist, Benny Vaughn, LMT, suggests resistance exercises using rubber tubing or bands. Performing resistance exercises consisting of ankle dorsiflexion, plantar flexion, eversion and inversion can lengthen and strengthen the lower leg muscles, providing added insurance against future shin splints.

Review
Anterior shin splints are a common injury, with every sports training facility seeing its fair share of painful tibialis anterior muscles. The massage techniques discussed here will maximize a bodyworker’s role in reducing anterior shin splint pain and damage.

The number one reason for recurring shin splints is an athlete’s impatience with the healing process and the premature return to activity. Educating these clients about the how, what and why of their anterior shin splints will facilitate prevention, healing and rehabilitation, paving the way for their full recovery.

Recommended Study:

Sports Massage

Resources:
Lowe, Whitney, LMT, NCTMB, Shin Splints or Compartment Syndrome?, Massage Today, December 5, 2005.

Mally, Dr. James. Sports Massage, Abundant Health Resources, 2002.

Wine, Zhenya Kurashova, Running Injuries, Massage and Bodywork, August/September 2000.

www.biotone.com, Vaughn, Benny, LMT, CAT, CSCS, Massage Therapy Makes the Difference in Sports and Exercise Benefits, 2006.

Posted by Nicole at 03:55 PM

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

Sports massage has evolved into a critical component of athletes’ training and recovery programs. This article clarifies the ‘when, what and why” of this specialized modality and how it can dramatically impact an athlete’s performance.

Serious athletes typically utilize sports massage therapy to recover from injuries and/or to maintain flexibility, strength and their performance edge.

Sports massage therapy, a recognized, valuable addition to other physical therapies and treatments, has become just as much a part of an athlete’s routine as diet and exercise. A sports massage therapist is the last person to touch many professional athletes prior to their competition. Athletes from all over the world, in every sport, have come to comprehend the advantage of a massage therapist with a thorough understanding of anatomy and kinesiology, the muscles used for a given sport and the wisdom to anticipate areas prone to injury.

Michael McGillicuddy, LMT, NCTMB, states in the May 2003 issue of Massage Today, “Sports massage is the specific application of massage techniques, hydrotherapy protocols, range of motion/flexibility protocol and strength-training principles utilized to achieve a specific goal when treating an athlete.” Keys to understanding these principles of sports massage, says McGillicuddy, are the “when, what and why” of sports massage; mainly timing, technique and intent.

Timing
Possibilities include:

• Pre-event massage
• Post-event massage
• Maintenance massage
• Rehabilitation massage

Technique
Technique refers to what applications will be used. Different techniques specific to sports massage include, but are not limited to, effleurage, friction, petrissage, vibration, shaking, compression, broadening, direct pressure, cross-fiber friction, range of motion, trigger point, counterstrain, reciprocal inhibition and proprioceptive neuromuscular facilitation (PNF) stretching.

Intent
The intention behind administering sports massage ranges from:

• Increasing blood flow
• Aiding recovery from exhaustion
• Increasing flexibility
• Improving strength and posture

Pre-event Massage
Pre-event massage typically occurs at the sports event, just prior to the athlete’s participation. Dr. James Mally, instructor of the Institute’s Sports Massage course, states that pre-event massage should take place prior to, but not replace a warm-up, approximately 20-30 minutes before the event. Pre-event massage focuses on the muscles that will be stressed most during competition. Depending on the sport, pre-event massage often uses friction to help warm the body, compression to increase blood flow to targeted muscles, and range of motion to prepare neural pathways and assist with joint mobility.

Pre-event massage routines and techniques depend upon the event the athlete is preparing to compete in. Examples include:

• Swimmers and runners require quick reaction time.
• Boxers need their muscles to remain loose.
• Gymnasts require flexibility.

Each competitor will require a unique combination of techniques designed to maximize his/her performance. Pre-event massages are typically vigorous with the intention of imparting speed, power and endurance.

Pre-event massage effects include:

• Dilating blood vessels, which results in improved cellular nutrition to the muscles.
• Improving circulation to tendons and ligaments.
• Relaxing muscle antagonists, which results in greater muscle efficiency.
• Releasing trigger points that could negatively affect athletic performance.
• Increasing flexibility – best for gymnasts and athletes who require flexibility.
• Preventing and treating muscle spasms.
• Preparing the body’s nervous system for strenuous activity.
• Increasing heart rate, respiratory rate and body temperature.

Post-event Massage
Post-event massage is performed at the event site after competition. This work requires a great degree of skill and knowledge to assist the athlete in recovery. Reducing muscle soreness and/or cramping while reestablishing range of motion and blood flow can facilitate a faster return to training after an event. Post-event massage is given for 10-15 minutes following a cool-down period of about 15-20 minutes. Cuts, bruises, blisters, mild strains, sprains or muscle cramps must be treated prior to massage. If muscle cramps are due to dehydration, medical attention should be sought immediately.

Post-event massage might consist of compressive effleurage for calming the nervous system and pushing fluid, petrissage for easing muscle tension, compression for spreading muscle fibers and restoring blood flow, broadening strokes to lengthen tight muscles, and compressive effleurage as a finishing stroke to soothe the athlete. Stretching can relieve muscle tension and restore range of motion while reciprocal inhibition can relieve muscle cramps not due to dehydration. Athletes usually look forward to a post-event massage because the benefits are experienced immediately.

Maintenance Massage
Sports maintenance massage is performed when an athlete is not competing in an event. An effective maintenance program focuses on an athlete’s strength, flexibility, coordination, biomechanics, posture, stress patterns, scar tissue and existing injuries. It is important to determine if an injury is acute or chronic, as this will dictate the appropriate technique to use and prevent exacerbation of the injury.

A sports massage maintenance program designed to meet a specific athlete’s needs can add a significant edge to his/her performance. McGillicuddy advises a sports massage therapist to design a maintenance program based on information gathered from discussing the athlete’s existing goals and watching the athlete’s workouts or competitions. In addition, recording current or previous injuries, evaluating prior treatments and setting specific performance goals with the athlete contributes to designing an ideal maintenance program.

Rehabilitation Massage
Even with preventive maintenance, athletes’ muscles cramp, tear, bruise and ache. While rehabilitative sports massage should only be performed in conjunction with proper medical care, it can significantly speed healing and reduce discomfort.

Because rehabilitative sports massage techniques can temporarily increase pain and inflammation, massage on acute injuries is traditionally followed by cryotherapy. When assisting the proper formation of scar tissue, McGillicuddy suggests using effleurage, compression and cross-fiber friction, followed by ice treatment and movement. Additional techniques employed for rehabilitation include lymphatic and trigger point massage. In the acute stage of injury, lymphatic drainage massage can decrease swelling and accelerate the healing process. Trigger point or neuromuscular therapy can reduce spasms and pain in both the injured muscles, and those compensating for the injury.

An accomplished sports massage therapist applies the correct sports massage technique in every situation. Dr. Mally suggests beginning with the gentlest methods, then progressing toward those that are more active. Trial and error typically helps delineate what is most beneficial for the athlete. Learning about common sports injuries, mastering the principles of each technique and fully comprehending musculoskeletal anatomy and kinesiology all play a part in becoming a successful sports massage practitioner.

Recommended Study
Sports Massage

References:

Mally, Dr. James. Sports Massage, Abundant Health Resources, 2002.

McGillicuddy, Michael. Three Key Principles of Sports Massage, Massage Today, May, 2003.

McGillicuddy, Michael. The Art and Science of Pre-Event Massage, Massage Today, July, 2003.

McGillicuddy, Michael. The Art and Science of Post-Event Massage, Massage Today, September, 2003.

McGillicuddy, Michael. The Art and Science of Sports Maintenance Massage, Massage Today, December, 2003.

Posted by Nicole at 10:53 AM

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

All healthcare professionals encounter clients who challenge their professional and ethical boundaries. Analyzing examples of such encounters fosters practitioner preparedness and reduces the likelihood of being caught by surprise and without a plan of action.

Professional codes of ethics dictate appropriate behavior in the professional and therapeutic relationships of massage therapists. Actions and behaviors have a tremendous impact on therapists’ clientele. Beyond the limitations of the client/practitioner relationship, actions and behaviors have the potential to affect clients’ families, colleagues, employers and the community at large. In all of these relationships, a therapist must continually ask whose interests are being served, and whose may be harmed by one’s own thoughts and responses.

While a code of ethics offers guidance in navigating each relationship, the safety and well-being of the client remains the primary focus. Trust and open communication must form the basis of every therapeutic relationship. Establishing and maintaining respectful boundaries between practitioner and client promotes the trust necessary for a safe and viable partnership.

When it comes to the ethics of touch, physical boundaries between a client and practitioner are delicate issues. Whether conversing with a coworker or on line at the bank, people test physical boundaries each day based upon their levels of comfort and safety. As professionals whose work requires close physical contact, bodyworkers are generally more comfortable initiating physical contact and more relaxed about maintaining personal space. Those unfamiliar with massage come from a variety of backgrounds and experiences, and may require some time to adapt to massage’s high level of physical contact.

In addition to physical interaction, comfort and safety concerns can arise from emotional and sexual boundaries. Our touch can both communicate a message and elicit a response in either of these areas. Ralph Napolitano, author of the Institute for Integrative Healthcare Studies’ Ethics: Therapeutic Relationships course states, “In fact, what we communicate through touch is what the client will receive, regardless of the words we say.” For example, unresolved negative, judgmental or sexual feelings toward a client may be communicated through touch. This is where both the intention behind touch and clear communication of boundaries become crucial.

Before boundary issues arise, it is best to be prepared by considering possible scenarios and thoughtfully developing a plan of action. The following scenarios provide the opportunity to think about each situation and how you might best respond.

Scenario One
A female massage therapist has been regularly seeing a male client for four months. Over this time, he has become increasingly demanding and directive during the massage. After working his tight hamstrings and then moving up to work his lower back, during the course of a massage the client rises up from the headrest and states in a loud, demanding voice, “I need more work on those hamstrings!” In response, the therapist quietly obliges the client and returns to working on the hamstrings. During the following massage, the therapist feels timid and unsure of herself throughout the session, following every directive the client gave.

After reflecting on this situation, the therapist realized that this client reminded her of her perfectionist father, who was a demanding and authoritative figure throughout her childhood.

“As healthcare practitioners,” Napolitano states, “we must be conscious and avoid bringing our own personal and emotional baggage into the massage relationship.”

In relationships where a power differential is present, as between a healthcare practitioner and client, there exists a potential for transference and countertransference to surface. Transference occurs when a client unconsciously projects unresolved feelings, needs and issues onto a practitioner. In countertransference, the therapist unconsciously assigns unresolved feelings, thoughts, and perceptions about someone from their personal history onto the client. As a result, the therapist may lose objectivity and misinterpret a client’s actions, responses and needs. These misperceptions can lead to misunderstandings, poor judgment and even negative feelings toward a client.

Negative feelings often arise when a client displays similarities to a person in the therapist’s life toward whom ill will is harbored. On the other hand, displaced positive feelings can arise when a client reminds the therapist of someone they feel favorably toward. Recognizing the signs of countertransference can prevent an awkward ethical dilemma up to and including litigation. The following behaviors are indicative of countertransference:

• Unusually strong positive or negative feelings directed toward a client.
• Predominance of impatience or anger when a client is not progressing.
• Being argumentative with a client.
• Experiencing an overemotional reaction to or involvement in solving the client’s problems.
• Making exceptions for a client’s inappropriate behavior.
• Giving a client extra time and attention before and after a session.
• Bending our professional and personal boundaries to accommodate a client.

By becoming more self-aware and overcoming prejudices, preferences, judgments and personal issues, health professionals establish clearer boundaries in the therapeutic relationship. When personal feelings are recognized, addressed and put aside, they do not interfere with the commitment to high quality healthcare. Awareness of countertransference marks the therapist’s return to professionalism. Moving beyond this barrier, the therapist in Scenario One can educate her client on the anatomical connection and therapeutic value of working the lower back to release the hamstrings.

Scenario Two
A therapist has been giving treatments to a home-bound client receiving workmen’s compensation, twice a week for 6 months. During the last month, the client begins every visit with a warm hug and a small, inexpensive gift (i.e., a candle, incense) for the therapist. During the session, the client plays music she knows the therapist likes. Further, following the massage, the client invites the therapist to stay and talk while having tea.

The therapist is noticing the boundaries of this therapeutic relationship are being breached.

Transference is the displacement or transfer of feelings, thoughts and behaviors related to a significant person onto someone else, such as the therapist. Individuals seeking help with unresolved needs, feelings and childhood issues are often attracted to a compassionate, helpful and knowledgeable caregiver, and can unconsciously transfer expectations of resolution onto that caregiver. Since vulnerability can stimulate transference, it is the responsibility of the therapist to be aware of this possibility, how it affects the client, and how the therapist’s behavior may affect transference.

A massage session can magnify transference because:

• There is a striking similarity between the practitioner/client relationship and a parent/child relationship.
• The client is in an altered state of consciousness.
• Bodywork involves a high level of intimacy.

As transference is mostly an unconscious behavior, it is up to practitioners to recognize its signs and maintain professional boundaries. It is important to remain firm within established boundaries such as starting and ending sessions on time, proper draping and minimizing dual relationships. These steps reduce the likelihood transference has to destroy the therapeutic relationship.

Transference can be recognized in a client who:

• Frequently asks about the therapist’s personal life.
• Calls the practitioner at home when explicitly stated otherwise.
• Brings a gift to every session.
• Solicits help in solving personal problems.
• Has difficulty maintaining physical boundaries (i.e., wants to hug or touch during every interaction).
• Asks for more time before and at the end of a session, and is disappointed when not appeased.
• Asks the therapist out on a date.

It is also possible to misinterpret a client’s behavior and subsequently, react negatively due to preconceived notions or fears. Often small gifts from clients are a personal sign of appreciation, as may be the case for clients who cannot afford to tip. Weighing the client’s intention for giving gifts, hugs or invitations to stay after the massage will dictate a practitioner’s ethical plan of action. Whatever the decision, the goal is to create clear and comfortable boundaries between the therapist and his/her clients. As Napolitano asks, “Will the action I choose enhance the therapeutic relationship, or hinder it?”

Scenario Three
A massage therapist attends group therapy for personal development. An opening in the group is unexpectedly filled by one of the therapist’s clients. Although a member of the group for years, now the therapist feels uncomfortable about disclosing personal information with the group in the presence of the client.

A dual relationship is one where multiple roles exist or overlap between a therapist and a client. Consisting of both professional and social roles, examples of dual relationships are when a client is also a student, friend, family member, employee, business associate, teacher or healthcare provider to the therapist. In the healthcare field, it is the practitioner’s responsibility to be informed and accountable for dual relationship repercussions. The power differential that exists within a therapeutic relationship demands practitioners gauge the nature of dual relationships in order to establish and maintain clear relationship boundaries.

Seeing a client at a monthly association meeting or at the gym may initiate a minimal level of intimacy. However, a client who joins a therapist’s gym, church or association to be closer to the therapist may be seeking a deeper level of intimacy. As the massage profession’s nature initiates a certain level of intimacy, each role within dual relationships and levels of intimacy determine a course of action.

Switching roles in the therapeutic relationship can lead to confusion and the possibility of transference or countertransference. Although not a massage therapist during group therapy, the client may transfer their pre-existing respect onto your personal opinions shared in the group. Self-disclosure to a client outside of the professional relationship will impact the atmosphere when bodywork sessions resume. Both parties are often tempted to treat sessions as a time to continue developing a personal relationship rather than maintaining a professional atmosphere. Under these circumstances, boundaries crumble, session length considerations decrease and focus on the client during the session diminishes.

A therapist must ask why they would self-disclose in the presence of a client. If it may benefit the client in some way, such disclosure may be valuable. Timing, method of delivery and the amount of information revealed, will aid in preventing dual relationship dilemmas.

If a massage therapist is lonely and in need of social interaction, it may be tempting to reciprocate the adoration and respect received from clients. Since massage therapists are not precluded from social contact after treatment sessions by their code of ethics, this is a personal decision based on self-assessment and the retention of clear boundaries.

It is up to the therapist to evaluate the potential risks involved in fostering a dual relationship. When evaluating the risks, consider the following:

• What is the level of intimacy?
• What is the potential impact of the power differential?
• Who is accountable for what in the relationship?
• What is the relative maturity level?
• What are the consequences of non-participation?

In all practitioner/client relationships, the power differential favors the practitioner, who must use that power to best serve their client’s needs. For example, a massage therapist has a car in need of repair and an auto mechanic as a client. This may appear to be a mutually beneficial dual relationship at first. However, before initiating this dual relationship, consider possible scenarios where the power differential may reverse:

• What if the mechanic does a poor job?
• What if the mechanic never shows up on time and causes the therapist to miss appointments?
• How might this situation spill over into the treatment room?
• After the car was supposedly fixed, would it be tempting to give a below standard treatment if your automobile problem resurfaced?

Professional ethics require accountability, guide us to do no harm and dictates we help our clients to the best of our ability. Nina McIntosh, author of The Educated Heart, suggests asking yourself the following questions to determine if any action taken is ethical:

• Does the action keep the focus on safety and well-being of the client?
• Are you being respectful of the power imbalance and/or the transference effect? Or are you using this power imbalance to your own benefit?
• Does the action create a dual relationship and make the therapeutic boundaries less clear?
• Does the action remain within the original contract with our client – or are we exceeding either our area of expertise or the client’s informed consent?
• Does the action create a safer environment for the client or detract from it?
• Could the action lead to future problems in the therapeutic relationship?

Massage and bodywork professionals have a license to touch. The type of touch used either establishes a sense of safety and reassurance, or it can make clients feel uneasy, apprehensive and uncomfortable. Establishing appropriate boundaries in regard to the nature and type of touch used and communicating these to clients early in the relationship can avoid potential misunderstandings.

Recommended Study
Ethics: Therapeutic Relationships

Posted by Nicole at 09:44 AM

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

Name: Sandalwood Essential Oil.

Botanical Name: Santalum album.

Common Method of Extraction: Steam Distilled.

Color: Clear with a Yellow Tinge.

Consistency: Medium - Thick.

Perfumery Note: Base.

Strength of Initial Aroma: Medium.

Aromatic Description: Rich, sweet, fragrant yet delicate, woody, floral.

Possible Uses: Bronchitis, chapped skin, depression, dry skin, laryngitis, leucorrhea, oily skin, scars, sensitive skin, stress, stretch marks. [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 56-67.].

Constituents: Santalols, santyl acetate, santalenes. [J. Chana, "Sandalwood Production," International Journal of Aromatherapy, Winter 1994, 11-3, cited in Salvatore Battaglia, The Complete Guide to Aromatherapy (Australia: The Perfect Potion, 1997), 200.].

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), 210.].

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: Saro Essential Oil. Also known as Mandravasarotra Essential Oil.

Botanical Name: Cinnamosma fragrans.

Common Method of Extraction: Steam Distilled.

Color: Clear.

Consistency: Thin.

Perfumery Note: Top.

Strength of Initial Aroma: Medium - Strong.

Aromatic Description: Camphorous yet uplifting and lemony/fruity.

Possible Uses: Limited reliable information exists on Saro Essential Oil. Its camphorous/expectorant quality makes this an oil likely to be helpful with respiratory issues including easing coughs, asthma and bronchitis. Emotionally, this oil is uplifting and may be helpful in diffuser blends for depression and anxiety.

Constituents: Awaiting verification.

Safety Information: Limited reliable information exists. It is recommended that Saro Essential Oil is not used with children or in pregnancy, epilepsy, with those having heart conditions or in other situations where fragile health exists. Avoid use on the skin.

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: Scotch Pine Essential Oil.

Botanical Name: Pinus sylvestris.

Common Method of Extraction: Steam Distilled.

Color: Clear.

Consistency: Medium and Slightly Oily.

Perfumery Note: Middle.

Strength of Initial Aroma: Medium - Strong.

Aromatic Description: Fresh, woody, earthy, balsamic.

Possible Uses: Colds, coughing, flu, rheumatism, sinusitis. [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 61-66.].

Constituents: Pinene, Limonene, Borneol, Bornyl Acetate, Cineole, Camphene, Myrcene, Phellandrene [Shirley Price, The Aromatherapy Workbook (Hammersmith, London: Thorsons, 1993), 54-5.].

Safety Information: Sensitization can occur. [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 200.]. 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), 210.]

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: Spanish Sage Essential Oil.

Botanical Name: Salvia lavandulaefolia.

Common Method of Extraction: Steam Distilled.

Color: Clear.

Consistency: Thin.

Perfumery Note: Middle.

Strength of Initial Aroma: Medium/Strong.

Aromatic Description: Herbaceous, camphorous, reminiscent in aroma to rosemary.

Possible Uses: Acne, cuts, dandruff, dermatitis, eczema, sweating, hair loss, arthritis, muscular aches and pains, poor circulation, rheumatism, asthma, coughs, laryngitis, colds, flu, headaches, anxiety, fragrancing. [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 213.].

Constituents: Camphor, cineol, limonene, pamphene, pinene. [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 213.].

Safety Information: Tiserand and Lawless indicates that this oil is generally not toxic or irritating. They advise to avoid during pregnancy (Tisserand lists it as an abortifacient). [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 211.] [Robert Tisserand, Essential Oil Safety (United Kingdom: Churchill Livingstone, 1995), 210.].

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.