Despite warnings to have moles examined by a dermatologist, only a small percentage of people actually follow this advice. As professionals in close contact with their client’s skin, a massage therapist may be the only person who sees someone’s skin irregularities. Learn how you can assist clients in examining their skin for potential areas of concern.

By Nicole Cutler, L.Ac.

As professionals in close contact with their client’s skin, a massage therapist may be the only person who sees someone’s skin irregularities. Many people look at easily visible parts of their body, but they may not regularly examine less accessible areas for skin concerns. Additionally, despite all of the existing warnings to map and track moles with a dermatologist, only a small percentage of people actually follow this advice.

Skin Cancer
Moles, brown spots and growths on the skin are usually harmless - but not always. According to the Skin Cancer Foundation, the following are some interesting facts about skin cancer:

• More than 1.3 million skin cancers are diagnosed annually in the United States.
• One in 5 Americans and one in 3 Caucasians will develop skin cancer in the course of a lifetime.
• Skin cancer is the most common of all cancers. It is also one of the most curable when detected early.
• More than 90 percent of all skin cancers are caused by sun exposure, yet fewer than 33 percent of adults, adolescents, and children routinely use sun protection.
• A person’s risk for skin cancer doubles if he or she has had five or more sunburns.

The three major types of skin cancer are basal cell and squamous cell carcinomas and the more serious malignant melanoma. More than one million cases of basal cell or squamous cell carcinomas are diagnosed annually in the United States. Typically occurring on exposed areas of the body – face, neck, arms and hands – most basal and squamous cell carcinomas are highly curable. On the other hand, malignant melanoma is usually only curable when caught early. About 62,000 cases of melanoma will be diagnosed this year, and more than 7,900 people will die of this cancer, which has been increasing in incidence annually by approximately 3 percent since 1980.

In the Institute’s Anatomy and Pathology course, the accompanying text discusses cancerous lesions in-depth and includes high-quality images of various irregularities of the skin.

Benign Moles or Melanoma
While cancer diagnosis is obviously beyond a bodyworker’s capability and scope of practice, suggesting a client have a mole examined falls within the bounds of being a responsible, caring health practitioner. Noticing a suspicious looking mole during your session and asserting your concern can increase your client’s awareness of skin cancer and can ultimately save their life. Known as the ABCDE’s of skin health, familiarize yourself with the five criteria to visual mole evaluation:

1. Asymmetry – An asymmetrical mole is a melanoma warning sign.
2. Border – The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched.
3. Color – Having a variety of colors is another warning signal. A number of different shades of brown, tan or black could appear. A melanoma may also become red, white or blue.
4. Diameter – Melanomas are usually larger in diameter than the size of a pencil eraser (1/4 inch or 6 mm), but they may sometimes be smaller when first detected.
5. Evolution – Any mole change (size, shape, color, elevation, or another trait), or any new symptom such as bleeding, itching or crusting, points to danger.

Sharing Your Concern
For your client’s sake, if you spot a suspicious looking mole, do not panic. Tact can go a long way in this area. Taking a responsible position on skin health is different than installing needless worry. Here are some suggestions for professionally communicating your concern:

• Ask your client if they perform regular skin checks, through self-evaluation or with a physician.
• Calmly mention that you see a mole worthy of further investigation, and inquire if they are aware of it.
• Tout the importance of yearly skin exams by a physician.

As is the case for all healthcare professions, don’t forget to document this communication in your client’s records. If you are particularly alarmed by the appearance of a mole and your client doesn’t seem to care, don’t be afraid to follow up with them about getting checked by a physician.

Second only to dermatologists, massage therapists probably see and touch the most skin of any profession. The nature of this work makes massage therapists ideally suited to learn about and educate their clients about skin health awareness. Embracing this concept does not tout anyone as an expert, but does raise the bar of massage therapy as a responsible and valuable health profession.

Editor’s Note: Handing a brochure with a body map and the warning signs of all major skin cancers to a client can give them time to digest your concern at home. For such a free brochure, send a stamped, self-addressed, business-size envelope to:

The Skin Cancer Foundation
245 Fifth Avenue
Suite 1403
New York, NY 10016

Recommended Study:
Advanced Anatomy and Pathology

References:

www.cdc.gov, Skin Cancer: Preventing America’s Most Common Cancer, Centers for Disease Control and Prevention, 2006.

www.newyorktimes.com, Do Your Skin a Favor: Protect it in the Summer, Jane E. Brody, June 6, 2006.

www.skincancer.org, Skin Cancer Facts, Skin Cancer Foundation, 2006.

www.skincancer.org, What to Look For, Skin Cancer Foundation, 2006.

Posted by Editors at 10:51 AM

© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org <http://www.integrative-healthcare.org/>

Name: Star Anise Essential Oil.

Botanical Name: Illicium verum.

Common Method of Extraction: Steam Distilled.

Color: Pale Yellow.

Consistency: Thin.

Perfumery Note: Middle.

Strength of Initial Aroma: Strong.

Aromatic Description: Sharp, anise and licorice-like aroma.

Possible Uses: Rheumatism, bronchitis, coughing, colic, indigestion/cramping, colds, flu. [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 61-66.].

Constituents: (E)-anethole, foeniculin, methyl vhavicol, limonene, linalool, nerolidol and cinnamyl acetate. [E. Joy Bowles, The Chemistry of Aromatherapeutic Oils (NSW, Australia: Allen & Unwin, 2003), 190.].

Safety Information: Lawless indicates that this oil is not a dermal irritant. Narcotic and slows circulation when used in large doses. [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 152.]. Tisserand cautions to avoid star anise in cases of alcoholism, liver disease, paracetamol use, breast-feeding, pregnancy, endometriosis, certain cancers, hyperplasia, damaged skin and with young children. [Robert Tisserand, Essential Oil Safety (United Kingdom: Churchill Livingstone, 1995), 171.].

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.

Do some of your clients try to extend their time with you by hanging around after their session ends? Find out how to limit the time clients spend in your office by asserting the boundaries of your working relationship, without the risk of losing their business.

by Nicole Cutler, L.Ac.

The intimacy of a massage could be the closest physical contact a client has with anyone in their life. All too often, this translates into a client’s desire to elongate a session by hanging around to chat post-treatment. After all, the massage therapist may be the only person who listens to them and provides both compassionate and physical interaction.

Assertive communication skills can effectively remove the awkwardness of having a client who simply won’t leave. While many massage therapists are compassionate givers with a genuine desire to help people, not all have successfully mastered the art of being assertive.

The three primary styles of communication are aggressive, passive and assertive.

Aggressive
Being aggressive is protecting one’s own rights at the expense of the rights of others. Aggressive communicators see their perspective as the only option, and may result to violence or verbal abuse.

Passive
When a person is passive, they allow their own rights to be violated by failing to express their honest feelings. Passive communicators typically defer to others’ opinions or desires to avoid conflict.

Assertive
Being assertive is stating and protecting one’s feelings, opinions and needs, while still being respectful of others. Assertive communication may feel risky in the moment, but it typically strengthens relationships in the long run.

Many people are concerned that if they assert themselves, others will think of their behavior as aggressive. However, there is a distinct difference between being assertive and aggressive. As opposed to being aggressive, assertiveness does not hurt, abuse or violate the person being addressed.

Assertiveness is an attitude and a way of relating to the outside world, supported by a set of skills for effective communication. To be truly assertive, you need to see yourself as being worthy of respect. At the same time, you value others equally, respecting their right to their opinion as well as to enjoy themselves. Being assertive allows you to engage respectfully with other people, while also valuing your own needs.

An important part of assertiveness is open, secure body language. The way that you present yourself has an impact on how you are perceived and treated by others. Passive body language includes hunched shoulders and avoidance of eye contact, while an aggressive stance is one with clenched fists, glaring eyes and intrusive body language. Assertive people generally stand upright but in a relaxed manner, looking people calmly in the eyes, with hands held open. A good first step to becoming more assertive is to consider your own body language through role play.

According to Dr. Linda Tillman, a licensed clinical psychologist, “Most of our personal styles are established when we are very young. If your parents were rigid and controlling, then you may have felt invalidated so much as a child that now you are afraid to speak up. If you were taught that it is good manners to be focused on the other person and not on yourself, then you may feel that it is not okay for you to ask for what you want.”

On a conceptual level, it’s easy to understand the need for assertiveness. However, mastering assertive social skills, and being able to use them can be challenging. Being assertive primarily involves three skills:

1. Clearly expressing yourself to others – Leaving any room for doubt or alternate interpretation can open the door to an undesired reaction.

2. Persisting with your goals in the face of opposition – This may require the massage therapist to imitate a broken record, but when done calmly and with logic to support your goal, your intentions are made crystal clear.

3. Appropriately standing up for yourself in the midst of conflict or criticism – Possessing enough self-confidence to demand respect means that you will not tolerate a dismissal of your request.

Many massage therapists encounter the client who refuses to leave. As you depart from the room after completing the massage, state they should take a few moments before getting up and you’ll meet them outside at the reception desk in a few minutes. If further suggestions to leave your office are ignored, assertive communication skills can accomplish your needs. Defining your boundaries with yourself and with clients clarifies an appropriate linger time length. Below are some suggestions for being direct, assertively defining your boundaries:

· It was good to see you. I need to prepare for my next client. See you next time.

· I really cannot socialize between sessions because I need to rejuvenate and prepare for my next client. Thank you for respecting this.

· Allow me to escort you out. I value you as a client and appreciate you respecting my schedule.

· (Insert name), our session has come to an end. I hope to see you again soon.

You have the right to set boundaries, even if it feels rude. Being direct is different from being rude. An additional tip towards being direct is to use “I” statements. When using an “I” statement, you own your needs, without passing judgment or attacking someone else.

Learning to become more assertive and clearly define your boundaries takes time and practice. Role play with colleagues or friends, to become comfortable with this newly found strength. Being assertive allows you to communicate better and command respect, ending the frustration of lingering clients, as well as strengthening your confidence as a healing professional.

References:

www.csusm.edu, Assertiveness Training, Cal State San Marcos, 2006.

www.hcd2.bupa.co.uk, Improving Assertiveness, The British United Provident Association Limited, 2006.

www.michigantech.com, Assertiveness Training, Michigan Technological University, 2002.

www.pioneerthinking.com, Speaking Up: How To Be More Assertive, Edel Jarboe, Pioneer Thinking Company, February, 2004.

Posted by Editors at 01:57 PM

© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org <http://www.integrative-healthcare.org/>

Regardless of the training received in massage school, the fainting of a client is a stressful situation for any bodywork professional. Review the causes and warning signs of fainting, preventive measures, as well as the necessary steps to safely and confidently handle this unpredictable occurrence like a pro.

by Nicole Cutler, L.Ac.

Realizing clients may faint during massage therapy does not mean you possess the confidence to handle the real, live situation. A formal massage education does not include an emergency room internship, where challenging experiences take place under the watch of a professional. Often, the first time a client faints during massage, the practitioner is on their own.

Why do Clients Faint?
Fainting, or syncope, is a sudden, brief loss of consciousness. Someone who faints may only pass out for several seconds or for as long as an hour. There are hundreds of possible causes of syncope, most of which are due to the vasovagal reflex, where blood vessels relax and dilate, causing a sudden drop in blood pressure.

Some of the most common reasons clients faint include:

· Low blood sugar (hypoglycemia), common in early pregnancy and diabetes
· Anemia
· Heat stroke or heat exhaustion
· Dehydration
· Eating disorders such as anorexia, bulimia
· A sudden change in body position like standing up too quickly (postural hypotension)
· Extreme pain
· Sudden emotional stress or fright
· Anxiety
· Taking some form of prescription medication. Examples include medicines that lower high blood pressure, tranquilizers, antidepressants, or excessive use of some over-the-counter medicines.
· Being in a hot, stuffy room or hot, humid surroundings
· Alcohol consumption

Fainting Prevention
The number one way to prevent client syncope is through being prepared and communication with clients.

· Be familiar with the medications clients are taking, including new medications and anything that may lower blood pressure.
· If your client has just come from physical activity and is overheated, allow them to cool down and re-hydrate.
· Know if your client has a history of orthostatic hypotension, fainting or dizzy spells.
· Be aware if your clients are diabetic and make certain they have checked their blood sugar or have sugar pills, juice or cookies available if necessary.
· If your client is hypoglycemic, or hasn’t eaten within the past five hours, provide them with a light snack or refuse treatment.

Foreshadowing
Even if you have no reason to suspect that a client may faint, there are a few signs that may precede a temporary loss of consciousness. If any of these signs appear, verbally check with your client to see if they are okay prior to continuing a session.

· The skin becomes hot and sweaty or cold and clammy.
· A client suddenly becomes fidgety.
· Complaints of dizziness or light-headedness.
· The person lifts their head out of the face cradle to yawn or take a breath. According to David Palmer, this is an involuntary reaction to not getting enough oxygen to the brain.

What to do
Although a client becoming fully unconsciousness is rare, it is best to be prepared. The following is the preferred order of steps to address syncope:

1. Be Calm - The number one thing to remember if a client loses consciousness is to remain calm.

2. Proper positioning - If the client is not lying down, assist them into a position where they can’t fall, their head is below their heart and the legs are elevated. This position promotes blood flow to the brain. If a victim who is about to faint can lie down right away, he or she may not lose consciousness. Call for assistance if you need help in accomplishing this, but do not leave the client’s side.

3. Check breath and pulse – If there are no sounds of breathing, make sure the airway is open and begin rescue breathing. If there is no pulse, begin CPR. Look for a medical identification bracelet, necklace or card that identifies a medical problem, such as epilepsy or diabetes. In either case, have someone call 911 for emergency help.

If the client has a pulse and is breathing, it is not necessary to call 911 unless the client does not regain consciousness in a few minutes or if the person is diabetic. A diabetic may be in insulin shock, requiring additional support.

4. Comfort measures – Make sure there is no tight-fitting clothing around the client’s neck, that there is adequate air circulation, and keep the client from getting chilled.

5. Acupressure – Only after the first four steps have been taken, consider this age-old technique for fainting. Oriental meridian theory suggests applying firm pressure to the following locations to revive someone from syncope:

· Governing Vessel 26 - Located in the philtrum, about 1/3 the distance from the bottom of the nose to the top of the lip.
· 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.

Additional Tips
Upon fainting, a common mistake is to try to give the person something to eat or drink, including water. This gesture must wait until the client is fully conscious. Additionally, don’t allow the person who’s fainted to get up until the sense of physical weakness passes. Then be watchful for a few minutes to be sure he or she doesn’t faint again. Once again, don’t leave your client’s side until they have fully recovered.

Other Reasons to call 911
If your client also has signs of a heart attack, call for emergency help. Such symptoms include:
· Chest pain or pressure.
· Pain that spreads to the arm, neck or jaw.
· Shortness of breath or difficulty breathing.
· Nausea and/or vomiting.
· Sweating.
· Rapid, slow or irregular heartbeat.

If your client also shows signs of a stroke, call for emergency help. Such symptoms include:
· Numbness or weakness in the face, arm or leg.
· Temporary loss of vision or speech, double vision.
· Sudden, severe headache.

Confidence
While episodes of syncope in the massage setting don’t occur every day, most massage therapists may encounter a few in their career. A thorough intake will provide the therapist with the information to prevent such an episode by alerting them to a fainting possibility, discovering if the client hasn’t had anything to eat or drink prior to a session, or by prompting modification of the session. Such modifications include avoiding strokes or techniques that further lower blood pressure or those drawing energy away from the head. Reviewing the causes of syncope, including these warnings and procedures, will build your confidence so if you do encounter syncope, you are both calm and prepared.

Massage professionals interested in enhancing their knowledge on this subject would benefit from the Institute’s Pharmacology for Massage distance learning program. This 13-credit course covers different medications that may render clients more susceptible to fainting and also suggests massage strokes to use to counter this tendency.

Editor’s Note: This information is for education purposes only, and is not intended to replace professional medical care. If not completely sure of your client’s well being, seek emergency medical help.

Recommended Study:

Pharmacology for Massage

References:

Palmer, David, Fainting and Chair Massage, Massage & Bodywork, June/July 2000.

Shanghai College of Traditional Medicine, Acupuncture: A Comprehensive Text, Eastland Press, 1995: 572-3.

www.healthy.net, First Aid for Fainting, American Institute for Preventive Medicine, 1996.

Posted by Editors at 09:28 AM

© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org <http://www.integrative-healthcare.org/>

With its multi-faceted functions, the jaw’s temporomandibular joint is vulnerable to a variety of ailments. Learn what modalities best ease the pain and discomfort of TMJ as well as self-care suggestions to share with your clients.

By Nicole Cutler, L.Ac.

The jaw or temporomandibular joint (TMJ) is a major target for an array of joint disorders. Disorders of the jaw are typically referred to by the same name, TMJ. The temporomandibular joint connects the mandible to the skull’s temporal bone and contributes to the acts of biting, chewing, swallowing, speaking and making facial expressions. The National Institutes of Health (NIH) states over 10 million people in the United States suffer from TMJ problems.

Symptoms
Pain is the most common TMJ symptom. The pain is often described as a transient, dull ache in the jaw joint and nearby areas, including the ear. Instead of pain, some sufferers only have problems in the use of their jaws. Additional symptoms of TMJ can include:

· Inability to open the mouth comfortably
· Clicking, popping or grating sounds in the jaw joint
· Locking of the jaw when attempting to open the mouth
· Headaches
· A bite that feels uncomfortable or “off”
· Neck, shoulder and back pain
· Swelling on the side of the face
· Tinnitus or ear pain
· Dizziness

TMJ symptoms often improve without treatment in a matter of weeks to months. However, some individuals experience an increase in symptom severity, and may develop long-term chronic jaw pain.

Cause
TMJ can be caused by a number of factors, including:

· Local injury
· Dental work/oral surgery
· Whiplash
· Arthritis
· Widespread joint pain from another condition
· Sinus or ear infections
· Headaches
· Bruxism (teeth grinding and clenching)
· Stress

Although teeth grinding and stress are not the leading causes of TMJ, difficulty relaxing may be a common cause many sufferers are unaware of. Holding the body tout, including the jaw, is a common response to stress. Whether metaphorical for “keeping one’s mouth shut”, a result of the incredible strength and control we have over the mandible, or due to another reason, emotional tension can easily be reflected in the temporomandibular joint.

Treatment
Many types of healthcare professionals can be involved in TMJ treatment. This spectrum includes, but is not limited to, physicians, pain specialists, chiropractors, physical therapists, acupuncturists, dentists and bodyworkers. In certain cases, a splint or mouth guard is crafted specifically for the individual to prevent the TMJ from slipping out of place. Reconstructive jaw surgery is rarely employed for TMJ and is typically the very last resort. Some self-help suggestions to offer clients suffering with a painful jaw include:

· Maintain good posture while working at a computer, watching TV and reading. Pause frequently to change position, rest hands and arms, and relieve stressed muscles.

· Make a habit of relaxing the facial and jaw muscles throughout the day.

· Avoid chewing gum and eating hard foods.

· Apply moist heat to increase the circulation around tense jaw muscles.

· Use relaxation techniques to reduce overall stress and muscle tension in the entire body.

Bodywork is an ideal modality to relieve the pain of TMJ. According to medical massage proponent Boris Prilutsky, “Massage therapy should be focused toward the reduction of tension in the masticatory muscles, releasing tension in fascia, and elimination of trigger points. Post-isometric relaxation is an extremely important tool for the restoration of the range of motion.”

Training in the following five modalities is particularly valuable when treating jaw pain:

1. Neuromuscular Therapy - The application of ischemic pressure to trigger points in the jaw muscles (temporalis, masseter, lateral pterygoid, and medial pterygoid) can help relieve their spasms.

2. Cranial-Sacral Therapy - In addition to activating the classic stillpoint, adjustments to the mastoid, temporal, zygomatic and sphenoid bones can provide enormous TMJ relief.

3. Post-Isometric Relaxation – Using isometric contraction to actively stretch tensed muscle fibers, adding minimal resistance for a further stretch, followed by relaxation allows for enhanced relief of the targeted muscle. This technique can restore the range of motion that typically regresses with TMJ disorders.

4. Acupressure – Massaging the meridians, both distally and locally, that wind around the jaw can bring increased circulation and thus relief to TMJ. The primary meridians to the jaw are Gallbladder, Stomach, Large Intestine and Triple Warmer.

5. Swedish Massage – The relaxation that results from a full-body Swedish massage should not be underestimated. Since stress is a major contributor to TMJ disorders, initiation of the relaxation response can have a significant impact in reducing tension held in the jaw.

For bodyworkers, TMJ is no mystery. Many clients present jaw pain as their primary complaint, or as a secondary nuisance. Approaching TMJ pain by utilizing techniques from the described five modalities provides an inclusive, holistic and effective treatment.

Recommended Study:

Neuromuscular Therapy, Cranial-Sacral Therapy, Swedish Massage

References:

Lewit, K, DG Simons DG., Myofascial pain: relief by post-isometric relaxation, Arch Phys Med Rehabil., 1984 Aug;65(8):452-6.

Prilutsky, Boris, Medical Massage for Jaw-Joint (TMJ) Disorders, Massage Today, 12/04.

www.nlm.nih.gov/medlineplus, TMJ Disorders, A.S.A.M., Inc, 2005.

www.tmj.org, Basics, TMJ Association, Ltd., 10/31/05.

Posted by Editors at 09:14 AM
© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org <http://www.integrative-healthcare.org/>

Light intensity plays a significant role in creating a relaxing environment. Illuminate yourself on the principles of Feng Shui, the ancient art of design and learn what lighting works best for your massage space.

by Nicole Cutler, L.Ac.

The ancient Chinese art of design, Feng Shui, extends well beyond home decorating. Based on the premise that our environment can profoundly affect our physical, emotional and spiritual well being, many factors contribute to this style of design. First used to help farmers decide where to plant their rice fields and build their houses, Feng Shui’s principles today are used to design both interior and exterior spaces where people feel comfortable interacting with one another. Creating a space that makes you feel good includes its directional orientation, arrangement of items, spatial layout of furniture and placement of objects, as well as the source, intensity, location and direction of the room’s lighting.

Well-known to Feng Shui practitioners, lighting can dramatically transform any space. Dependant upon how it is lit, a room can be perceived as cool and sterile, small and cramped, or warm and cozy. “How a space feels,” says Feng Shui consultant and lecturer Linda Varone, RN, MA, CFS, “affects how people respond at a conscious and unconscious level. While some spaces just don’t feel right and people want to leave right away, other spaces invite people to relax and talk comfortably about personal concerns.”

Yin and Yang
Feng Shui is based on the principle of yin interplaying with yang. In Chinese philosophy, yin and yang represent the two cosmic, opposing forces of the universe. Yin is the receptive, passive, solid and cold force, while yang is the aggressive, energizing, moving and warm force. As such, light is perceived as a yang element. Using bright light within a space or shining it on an object increases the active energy of that location.

To encourage the restfulness and inactivity typically desired as part of a massage session, reducing the amount of light is favored. However, this concept does not encourage complete darkness, as achieving balance always remains the goal in Chinese-driven philosophies. The well-known yin-yang symbol represents such equilibrium, illustrating darkness following light, while each retains a small component of the other.

Effective Feng Shui occurs when yin and yang are harmoniously balanced. For example, a room with no windows, very little light and dark walls is exceedingly yin in nature, and needs a yang force to balance it. In this example, bringing in yang with appropriate lighting will stimulate the energy and transform this room into a pleasant space.

In the physical realm, light is radiant, electromagnetic energy. When light strikes the retina, it creates visual sensations, stimulating a neurological response in the brain. Revealing shape, size, texture, color, depth and location, light encourages brain activity. Desired during a massage session, a hiatus from conscious brain activity leads to increased relaxation. On the other hand, an overly darkened room can transmit feelings of depression and suffocation. Once again, finding a balance between light and dark is conducive to healing.

Flicker
Most institutionalized healthcare settings use florescent lights that function by flickering on and off up to 60 times per second. While this is too rapid for the eye to see, this flicker is noticed on a subliminal level and can cause fatigue. To counter this effect, lamps using incandescent bulbs or windows bringing in natural sunlight reduce the impact of a flicker. Although relaxation is desired in bodywork, causing fatigue from over-stimulation of the eye runs contrary to a healer’s purpose.

Hard and Soft
When choosing lighting for a massage space, it is important to consider the difference between hard and soft lighting.

Hard lighting equates to a brightly lit area, and is best suited for areas requiring attention or concentration. Hard lighting makes hallways, landings and porches safe and can help spaces seem wider. For vulnerable individuals, prolonged exposure to hard lighting creates feelings of stress. Hard lighting includes:

· Direct light (ex: spotlight)
· Fluorescent light
· High wattage bulbs

Soft lighting reduces brightness, encouraging relaxation. Also called ambient lighting, this illumination is ideal in the actual room where massage therapy is administered. Ambient lighting comes from an indirect light source that throws light against a wall or ceiling, creating soft illumination through reflection. Ambient lighting creates a relaxing, inviting atmosphere with:

· Indirect light (ex: sconces)
· Floor torchieres or uplights
· Lamp shades
· Yellow or pink lighting
· Dimmed lighting or low wattage bulbs

Diffuse, indirect, soft and low lighting are a bodyworker’s best bet in creating a relaxing, comforting and healing environment. By using the principles of Feng Shui in lighting up your massage space, you are adding another dimension to your services. Careful consideration of the type of illumination you use and how it will affect your clients is a relatively small detail that can make a big difference in your practice.

References:

www.altreligion.about.com, Yin Yang, Jennifer Emick, About Inc., 2006.

www.associatedcontent.com, Feng Shui Balancing Tools Including Color and Light, Kathy Browning, Associated Content, Inc., 2006.

www.fengshui.about.com, Feng Shui Cures, About, Inc., 2006.

www.fengshui.com,au, Lighting, Gayle Atherton, 2002.

www.feng-shui-tips.net, Fantastic Fixtures, Sally Fretwell, 2006.

www.healthliteracy.com, In Other Words…Using Feng Shui to Improve Healthcare Communication, Helen Osborne, MEd, OTR/L, Boston Globe’s On Call Magazine, May 2001.

www.qi-journal.com, Feng Shui: Light and Lighting, Sally Fretwell, Qi Journal 2006.

www.strang-inc.com, Integrated Lighting Design Boosts Performance, Strang, 2006.

Posted by Editors at 09:51 AM
© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org <http://www.integrative-healthcare.org/>

The physical demands we place on our bodies daily can easily disrupt the delicate balance our spine struggles to maintain. At any given moment, an estimated 40 million Americans are experiencing sciatica caused by a herniated disk. Learn why bodyworkers practicing neuromuscular therapy are ideally suited to assess and provide relief to client’s with a herniated disc.

by Nicole Cutler, L.Ac.

Ergonomically, the human form is a curious creation. We walk upright on two of our limbs, while a long curvaceous bony structure extends upwards to balance the head. By throwing gravity a couple of curves, the natural bends in the lumbar and cervical regions of the spine help maintain stability. Although this ingenuous structure characterizes our evolution and allows us to perform a vast range of functions, it also primes human beings for injury.

Shock Absorption
Acting as shock absorbers, intervertebral discs lie between each spine segment to cushion our movements. Known as herniation, these discs can create an enormous amount of pain when they deteriorate, are compressed or get pushed to one side. Technically, a herniated disc describes the extrusion of the soft inner core of the intervertebral disc (nucleus pulposus) through the disc’s outer fibrous core (annulus). Symptoms appear when this extrusion places pressure on the corresponding nerve root.

In the lumbar area of the spine, the most common sites for a herniated disc are between lumbar vertebrae four and five (L4-5) and between lumbar vertebrae five and the top of the sacrum (L5-S1). Herniations in these areas typically result in sciatica, where back pain progresses to pain and/or numbness radiating down the posterior and lateral leg, occasionally traversing the knee to the lower leg.

Assessment and Differentiation
Since a massage therapist is not qualified to diagnose the condition, it is important to have a physician determine the etiology of a client’s back pain. Attempting to work with a client in pain without knowing its cause can be dangerous when cancer, cauda equina, osteoporosis, fracture or infection is at the pain’s root. However, being familiar with signs of a herniated disc are helpful if the cause of back pain is unknown.

A challenging aspect of evaluating clients with symptoms of a herniated disc is differentiating between a low back strain and a herniated disc. According to the American Academy of Family Physicians, there is a general rule of thumb applicable to assessing back pain. Typically, pain caused by a low back strain is exacerbated by putting the affected muscles under stress (standing and twisting motions) while pain caused by disc herniation is worse in positions increasing pressure on the disc (sitting and bending). Inquiring about whether the client’s pain worsened while driving to your session may be a revealing question to pose to a client during the interview process. For safety purposes, even the most astute palpation and interviewing skills must be supplemented by a doctor’s evaluation.

Signs and Symptoms
Typically originating from a herniated disc at L4-5 or L5-S1, sciatica can cause both sensory and muscular abnormalities in the legs and thighs. Common symptoms of sciatica include:

· Deep, severe pain starting low on one side of the back
· A cramping sensation of the thigh
· Shooting pains from the buttock, down the leg
· Tingling, or pins-and-needles sensations in the legs and thighs
· A burning sensation in the thigh
· Leg or foot numbness

Additionally, people with sciatica may notice a worsening of their symptoms during movements increasing the pressure around the sciatic nerve such as squatting, sneezing, side-bending, laughing or coughing.

Massage Therapy
Massage professionals offer one of the most effective treatments for relief of a herniated disc. Two large government-funded studies released in November 2006 concluded that back surgery for painful herniated disks provided no greater benefit than other, less-invasive forms of treatment. Due to the side effects and risks associated with surgical intervention, this research supports the use of safe complementary therapies, such as Neuromuscular therapy, for disc herniation pain.

Neuromuscular therapy (NMT) is a style of massage that restores homeostasis between the central nervous and musculoskeletal systems. Ideal for addressing disc herniation, NMT can desensitize the extremely painful symptoms associated with this condition. Characteristics unique to NMT offer therapeutic relief for sciatica sufferers:

· The NMT technique of milking the nerve’s myelin sheath gives fast pain relief and reduces nerve inflammation. Nerve inflammation and pain are hallmark symptoms of sciatica.

· NMT alleviates involuntary muscle contraction and tissue congestion resulting from nerve conditions. Involuntary muscle contractions are spasms that typically accompany sciatica.

· NMT’s techniques can change chronic structural deviations of the body responsible for causing and perpetuating mechanical stress injury. A herniated disc causing sciatica is a structural deviation that can be affected with NMT.

· NMT prevents further aggravation of referred nerve symptoms. Through using trigger point locations for treatment, NMT helps relieve the referred pain defining sciatica.

When it comes to herniated discs, there is a tremendous demand for effective and safe therapy. Because our spine’s shock absorbers are prone to occasional misalignment, the skills to assess this common occurrence and apply appropriate treatment can make an enormous contribution to healthcare. NMT’s balancing of the nervous system with the musculoskeletal system makes it the logical choice when addressing sciatica.

Recommended Study:
Neuromuscular Therapy

References:

Curnett, Michael, Mary L. Karlton, SciatiCare: Hands-On Technology for Healing Spinal Disc and Nerve-Impingement Conditions, Massage Magazine, January 2006.

www.aafp.org, Clinical Evaluation and Treatment Options for Herniated Lumbar Disc, S. Craig Humphreys, MD, and Jason C. Eck, MS, American Academy of Family Physicians, February 1999.

www.emedicinehealth.com, Sciatica, WebMD, 2006.

www.massagebyben.com, Neuromuscular Therapy, History and Uses, Peter Lane, CMT, CNMT, massagebyben.com, 2006.

www.mayoclinic.com, Herniated Disc Guide, Mayo Foundation for Medical Education and Research, September 2005.

www.news.yahoo.com, Studies: surgery no better for sciatica, Carla K. Johnson, The Associated Press, November 2006.

Posted by Editors at 10:36 AM

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

The onset of arthritis will become increasingly common as the “baby boomer” generation continues to age. Discover two methods for treating the pain, swelling and loss of movement associated with this condition.

by Nicole Cutler, L.Ac.

Statistics show that one out of every three U.S. adults will experience arthritis as they grow older. Researchers at Beth Israel Deaconess Medical Center (BIDMC), an affiliate of Harvard Medical School, have found that baby boomers have significantly higher rates of arthritis than their parents’ generation. “Baby boomers are just approaching the age when arthritis rates begin to rise dramatically. Many baby-boomers have lived with obesity for much of their lives. We can expect to see the health and functional consequences of this epidemic in the coming decades,” says Suzanne Leveille, PhD, senior author of this BIDMC study.

Caused by the deterioration of joint cartilage, osteoarthritis is the most common type of arthritis resulting in pain, swelling, and decreased range of motion. Repetitive stress injuries and excess body weight are considered two of the most avoidable causes of osteoarthritis. Also known as degenerative joint disease, osteoarthritis causes the cartilage cushioning the surfaces of bones to wear out, causing crepitation, or the grinding of bones against each other. As a result of using our hands for nearly every daily task, osteoarthritis of the hands is among the most prevalent sources of discomfort for baby boomers.

While medications such as Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) have been the primary choice in treating osteoarthritis, their accompanying side effects and limited benefit often makes these medications less than desirable. According to the Arthritis Foundation, an increasing number of doctors are recommending massage to their arthritis patients for pain and stiffness relief. In addition to bodywork, heat-based therapies and detoxification protocols are exhibiting exciting results in reducing arthritic complaints.

One Heat-Based Therapy
For many years, paraffin wax has been used as a health treatment due to its effectiveness in transferring heat to the skin and joints. Warmed paraffin wax dips expand blood vessels which serves the following therapeutic functions:

· Increases circulation
· Draws nutrients to the skin’s surface
· Flushes toxins out of the skin

Paraffin wax’s very high heat capacity is a unique characteristic enabling absorption and retention of a great amount of heat. When used on the hands, the heat required to melt the wax is released after it solidifies into a custom-fitted, warm glove. This glove transfers the heat deep into the hand.

A 2006 Cochrane review reported positive results for paraffin wax baths for arthritic hands. When comparing various heat therapies, researchers concluded that paraffin wax treatment was especially helpful for arthritic hands on objective measures of range of motion, pinch function, grip strength, pain on non-resisted motion and stiffness compared to control (no treatment) after four consecutive weeks of treatment.

One Detoxification Solution
Elimination of toxins is an important avenue for realigning arthritic clients with their health. Toxins can accumulate and crystallize throughout the body in various tissues including:

· Blood
· Nerves
· Fascia
· Muscles
· Joints

This accumulation creates toxic congestion, lending the body susceptible to arthritis. As the body’s primary vehicle for waste elimination is the digestive tract, taking a detoxification supplement can have a profound effect on preventing and reversing toxic waste stagnation. Liv.52 is an ideal example of a supplement designed for body detoxification, and can be a valuable addition to an arthritic client’s repertoire.

While pharmaceuticals have real, but limited ability to help the millions of arthritis sufferers in the world, alternative therapies are showing increasing promise. Without the side effects associated with NSAIDS or other medications, treatments such as massage therapy, paraffin wax dips and detoxification supplementation are forging ahead of conventional treatment in bringing baby boomers the relief they need for painful, arthritic hands.

Editor’s Note: This information is for educational purposes only. As laws differ between occupations and locations, therapists are advised to operate solely within their scope of practice.

References:

Osborn, Karrie, Seeking Alternatives for Arthritis Sufferers, Massage & Bodywork, June/July 2005.

Robinson VA, Brosseau L, Casimiro L, Judd MG, Shea BJ, Tugwell P, Wells G, Thermotherapy for treating rheumatoid arthritis, The Cochrane Database of Systematic Reviews, Issue 3, 2006.

www.healthbanks.com, Paraffin Wax for Osteoarthritis, HealthBanks, Inc., 2006.

www.pacificcollege.edu, Massage Therapy for Arthritis, Jeff Denny, Pacific College of Oriental Medicine, 2005.

www.seniorliving.about.com, Arthritis Increasing in Baby Boomers, Sharon O’Brien, About, Inc., 2006.

Posted by Editors at 10:25 AM

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

How does taking Lipitor impact a client’s massage? This new book, by Jean Wible, provides massage therapists with essential information about adapting massage based on a client’s medication list.

Text: Pharmacology for Massage Therapy by Jean Wible, RN, BSN, NCTMB, CHTP, Lippincott Williams and Wilkins, 2005, 298 pages.

Pharmacology for Massage Therapy provides answers to the typical massage therapist question, “How does my client’s medication list impact a massage?”

Wible connects the often overwhelming subject of pharmacology to the application of touch-based therapy. The common ground both medications and massage share is that each has a physiological effect on the body. Wible, with qualifications as both a registered nurse and a massage therapist, is a pioneer in integrating allopathic and complementary medical modalities into a single perspective.

This text accomplishes the goal of teaching linear reasoning skills to someone without the technical vocabulary of a pharmacist. Organized by body system and/or symptom, Pharmacology for Massage Therapy outlines drug categories and the affect drugs have on the systems of the body (such as the nervous system, respiratory system, gastrointestinal system, endocrine system and cardiovascular system). Additionally, there are specialized chapters covering drugs for pain control, infections, inflammation and allergies, fluid and electrolyte balance, psychiatric conditions, cancer and a variety of over-the-counter supplements.

The first step in grasping the connection between pharmacology and massage is to understand what drugs do and how they work. Each chapter addresses key concepts such as pharmacokinetics (how the drug is absorbed, distributed and excreted from the body), pharmacodynamics (how the drug produces its effects in the body) and pharmacotherapeutics (how the drug is used to treat diseases or symptoms).

The strength of this book is the section discussing massage implications for each drug category. This gives the massage therapist the tools necessary to answer the question: “What does this drug mean for my client within the massage setting?” Using this deductive reasoning model, the massage therapist can logically determine cautions, contraindications, effects on massage and the best massage strokes to use based on the medications his/her client is taking.

Pharmacology for Massage Therapy contains bonus features such as; sidebars detailing adverse reactions and side effects of each drug group, quizzes throughout the text to integrate the information, case studies to understand the application of the material and a drug index at the end of the book for easy reference.

This text underlines the value of massage therapy within a medical setting. Wible’s demonstration of the impact different massage strokes have on people taking various medications highlights a relationship with which every massage therapist should be familiar. This is also an extremely valuable reference tool for bodyworkers and can be used as part of the movement toward fully integrating massage therapy into traditional healthcare.

Recommended Study
Pharmacology for Massage

Posted by Nicole at 09:41 AM

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

Combining therapeutic approaches is the cornerstone of integrative medicine. Learn how to combine two popular massage techniques to improve client sessions, and help stand out from others in your field.

by Nicole Cutler, L.Ac.

Two leading massage modalities cover an even broader range of applicability when fused together. At its very essence, integrative medicine consists of combining therapeutic approaches to yield a more effective outcome. Integrating hot stone massage with the meridian principles of Traditional Chinese Medicine (TCM) exemplifies how the sum can be greater than its parts.

Massage therapists are becoming increasingly adept at fusing different bodywork styles. Using different techniques from various schools is how therapists can create a signature massage. While there seems to be no end to the combinations, some provide more benefits than others. Even while working simultaneously with stones and meridians, massage professionals can imprint their own unique flair. However, a comprehensive grasp of both modalities is required before uniting stone massage with meridian work.

Hot Stone Massage
Hot stone massage is a form of thermal hydro-therapy. Using smooth, warmed, heat-retaining stones as extensions of the hands, clients receiving a well-administered hot stone massage will seek it again and again. For some, stone therapy brings unrivaled deep tissue release and alignment. For others, the heat of the stones gently softens muscular tension and melts away emotional stress. On a spiritual plane, the stones are from the earth and have an extremely grounding quality adored by many. Grounding can be very helpful to individuals struggling with issues related to sleep, headaches, dizziness, anxiety or feeling overwhelmed or scattered.

The heat of the stones, combined with the soothing gliding massage movements, warms and relaxes the muscles to a much greater extent than what can be achieved by massage alone. Proponents claim the following benefits of warmed stone bodywork:

· Increased circulation, lymph and vitality
· Release of excessive toxins
· Relief from tight muscles
· The weight and material of the stones function to ground the body
· Reduced ticklishness for many vulnerable clients
· Relaxed central nervous system (when stones are laid upon the spinal column)
· Added energetic quality to massage when incorporated with vibration (clicking or tapping of stones)

From active placement to active stone massage, there are many different ways to manipulate the stones on a person’s body. Using the heated stones to apply pressure to acupressure points, trace or rub meridians is one way to amplify the therapeutic efficacy of a treatment.

Meridian Bodywork
A part of TCM, massage along the body’s energy-containing meridians can have many therapeutic uses. According to the 3,000 year-old practice of TCM, energy that is deficient, excessive or stagnant within the body’s meridians results in imbalance and eventually, disease. By breaking up blockages and promoting energy’s free and easy flow, acupuncture and acupressure are common modalities used to influence the health of energy flow throughout these meridians. Because meridians connect every part of the body to every other part, bodyworkers are able to address all types of pain and illness at easily accessible body locations. Once the affected meridian is properly assessed, bodywork on that meridian can have seemingly miraculous results – including restoring vitality, stopping pain and restoring blood sugar levels.

TCM understands the human body as a microcosm of its surrounding environment. As such, factors affecting the environment also affect the body. Forces such as heat, cold, dryness, dampness and wind have specific implications to a person’s health. A host of common TCM pathologies evolve when excessive amounts of cold influence the urinary bladder, lung and kidney meridians. These are the meridians most easily affected by cold temperatures. A practitioner can recognize whether cold is cause of an imbalance when the following symptomatic patterns emerge:

· a preference for warm beverages
· frequent sensations of cold or being chilled
· a worsening of painful symptoms in cold conditions
· pale facial complexion
· profuse and watery urination

Once it is understood that cold is a culprit, using heat becomes a logical therapeutic choice. A common TCM technique, moxibustion is the burning of an herb over an acupressure point or meridian to impart warmth. While admittedly beyond the scope of practice of most massage therapists, there are other methods of warming a chilled meridian. Using hot stone massage is an alternate technique to warm and invigorate the energy within a meridian.

The Union
Continued education fuels creativity. Knowing how to give a skilled hot stone massage and combining it with meridian massage will enhance your sessions. Once you are aware that a client could use some energetic warming, the treatment you can capably provide will rival any of the most respected therapies available.

Recommended Study:
Stone Massage
Shiatsu Anma Therapy

References:

Alexandra, Sonia, LMT, Stone Massage Therapy: A Catalyst for Health, Massage Today, November 2003.

Baltz, Bruce, Deep Tissue Healing: The Art of Stone Massage, Massage Today, January 2005.

www.ezinearticles.com, Hot Stone Massage Guide eBook, Kareen Fellows, Ezinearticles.com, 2006.

www.hb.syl.com, A Stone Massage Description - Useful Knowledge for Self-Maintenance, www.syl.com, March 2006.

www.neholistic.com, The Breath in the Stone, Karyn Chabot, D.Ay., LMT, The North East Directory of Holistic Resources, 2006.

www.nhi.edu, Hot Stone Massage: An Ancient Tradition That Still Rocks! Upasana Titterington, National Holistic Institute, 2006.

Posted by Editors at 11:24 AM

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