The history of massage
Massage has played into healing since early on in human history — some sort of healing through touch, or laying on of hands, has been part of all ancient cultures and continues into modern times. The ancient Greek and Roman physicians used massage as a principle means of removing pain. In the fifth century BC, Hippocrates, the ancient Greek physician and Father of Modern Medicine, wrote: “The physician must be experienced in many things, but assuredly in rubbing” (Lidell, Thomas, & Beresford Cooke, 2001, p.10). Most modern cultures include massage within their health care delivery system, most notably in China, where separate massage wards are found in the hospital setting. Many countries, including Germany, allow massage or other forms of touch therapy to be covered by medical insurance (Collinge & Duhl, 1997). In the immediate post-WWII era in the United States, as the practice of modern medicine became more focused on technologic and pharmaceutical interventions, massage as a medical modality was passed on from physicians’ hands to those of others — most notably physical therapists. Massage gradually lost its place as a primary medical intervention, with a few exceptions, such as in the osteopathic and chiropractic medical community. The 60s and 70s inspired a new paradigm of health and healing: revived interest in holistic measures, increased self-awareness and self-improvement, as well as optimal health, wellness, and prevention practices. As a result, massage and other forms of bodywork have received renewed attention.

Joni Kosakoski, BSN, RN, CARN ( admit@crossroadsantigua.org ) has practiced nursing for more than 25 years, the last 10 specializing in addictions. She is a member of the American Holistic Nurses Association and The International Nurses Society on Addictions.

References
Collinge,W. and Duhl, L.(1997). American Holistic Health Association Complete Guide to Alternative Medicine. New York: Warner Books.
Dossey, B., Keegan, L. & Guzzetta, C. (2000) Holistic Nursing: A handbook for practice, Third edition. New York: Aspen Publishers, Inc., p.618.
Field, T. (2002). Massage therapy. Medical Clinics of North America, 86, 163-171.
Lidell, L., Thomas, S., & Beresford-Cooke, C. (2001). The Book of Massage: The Complete Step-by-Step Guide to Eastern and Western Techniques. New York: Fireside.
Montagu, A. & Matson, F. (1979). The Human Connection. New York: McGraw-Hill Book Co., pp. 89-90.
Touch Research Institute. (2003). Massage therapy database. Available: www.miami.edu/touch-research/Massage
1.html
Various authors. (December/January 2003). Massage and Bodywork, 17, 6. Selected articles on addiction and reprints available: www.massageandbodywork.com

Massage is often labeled an alternative therapy in addiction treatment. Yet today’s evolving integrative health paradigm acknowledges massage, along with other body therapies, as a natural and logical instrument of human healing. The scientific study of massage is in its infancy, but recent research documents the effectiveness of massage and bears implications for the treatment of and recovery from addiction.

First, the meaning of touch
Even before human bodies become full bodies, touch is the first of the five senses to develop in the embryo and the most vital for survival (Dossey, B., Keegan, L. & Guzzetta, C., 2000). The skin is the largest sense organ of the body; a piece of skin the size of a quarter contains more than 3 million cells, 12 feet of nerves and approximately 900,000 sensory receptors (Dossey et al., 2000; Montagu & Matson, 1979). From this perspective, the skin is a giant communication system that, through touch, brings messages from a person’s external environment to his or her internal attention.

Given the potential powerful effects of touch, massage can play an important role in all aspects of recovery from addictions — from detoxification, when it is a valuable healing tool, through primary inpatient or outpatient treatment, when it increases awareness and promotes relaxation, to post-treatment, when it contributes to relapse prevention strategies, stress management, and the body’s innate healing power that leads to optimal health in recovery.

Joni Kosakoski, BSN, RN, CARN ( admit@crossroadsantigua.org ) has practiced nursing for more than 25 years, the last 10 specializing in addictions. She is a member of the American Holistic Nurses Association and The International Nurses Society on Addictions.

References
Collinge,W. and Duhl, L.(1997). American Holistic Health Association Complete Guide to Alternative Medicine. New York: Warner Books.
Dossey, B., Keegan, L. & Guzzetta, C. (2000) Holistic Nursing: A handbook for practice, Third edition. New York: Aspen Publishers, Inc., p.618.
Field, T. (2002). Massage therapy. Medical Clinics of North America, 86, 163-171.
Lidell, L., Thomas, S., & Beresford-Cooke, C. (2001). The Book of Massage: The Complete Step-by-Step Guide to Eastern and Western Techniques. New York: Fireside.
Montagu, A. & Matson, F. (1979). The Human Connection. New York: McGraw-Hill Book Co., pp. 89-90.
Touch Research Institute. (2003). Massage therapy database. Available: www.miami.edu/touch-research/Massage
1.html
Various authors. (December/January 2003). Massage and Bodywork, 17, 6. Selected articles on addiction and reprints available: www.massageandbodywork.com

Clients that breathe by lifting their shoulders to their ears need more than a massage to relax their neck and shoulder muscles. Learn how to help them strengthen their diaphragm to change breathing patterns and relax their body.

Strengthening muscles that normally receive little attention can make a monumental impact on your client’s health. For example, it is common to encounter an athlete with a chronic ankle problem. Every time that athlete injures an ankle, he/she goes through the process of healing and usually follows with a series of stretches to lengthen the injured tissue. Heat and massage are beneficial components of this recovery because they are key contributors to relaxation and circulation of and around the injured ankle. However, if this athlete does not continue his or her care with an ankle strengthening program, then he/she is sure to re-injure that same ankle. Strengthening is not something that applies only to athletes, it applies to everyone. Muscle development and strengthening are key to ensuring the integrity and longevity of our lymph and circulatory systems, our internal organ functions, our axial skeleton and our overall health.

One of our forgotten, yet essential, muscles is the diaphragm. The diaphragm is the large muscle just posterior to the rib cage that is used for respiration, and it is often disregarded as an involuntary muscle. Doug Alexander reminds us about the connection between diaphragmatic breathing and our health in the article “Coaching Your Clients,” published in the Summer 2005 edition of The Massage Therapy Journal.

Mr. Alexander explains a typical pattern called “apical” breathing. This is a tense pattern of breathing in which the diaphragm muscle is used less, while the neck and shoulder muscles are primarily relied on for respiration. Apical breathing recruits the upper trapezius, levator scapula, scalenes and sternocleidomastoid muscles for every breath taken. Repercussions of this type of breathing can be decreased oxygen intake and tightened, and thus shortened, neck and shoulder muscles. As many massage therapists are aware, these tightened muscles can lead to temple headaches, upper back, neck and shoulder pain, and the emotional state of carrying the world’s stresses upon one’s shoulders.

Learning to use the diaphragm for respiration can add a great deal of benefit to the health of your apical breathing clients. “Diaphragmatic breathing is inherently relaxing. It slows the body’s metabolism down, and draws the nervous system into a rest and relaxation mode,” says Mr. Alexander. “Good times to practice diaphragmatic breathing are at the beginning and end of the day; it can help us start the day with a feeling of relaxation and ease. At the end of the day, diaphragmatic breathing releases tension and helps set the state for deeper, more restorative sleep. Without this diaphragmatic practice at bedtime, apical breathers will go to bed with tense neck muscles, and then spend all night using their neck muscles to breathe, rather than relax and recover from the stresses and strains of the day.”

Restoration of normal abdominal (diaphragmatic) breathing can be accomplished by coaching your clients to engage their diaphragm. Have your client in a supine position while he/she places one hand on his/her belly (below the umbilicus), and one hand on his/her chest. Upon inhalation, have your client focus on belly expansion by being aware of the belly hand rising. Inhalation continues until he/she feels movement of the other hand on his/her chest. During the exhale, have your client focus on belly deflation, with that hand sinking towards the spine. This exercise can help strengthen diaphragmatic breathing. However, it may not be enough to break the cycle of apical breathing. Many apical breathers have difficulty learning to use their diaphragm (and thus strengthen it), or they forget about breathing into their belly when under stress.

Donna Fahri found that strengthening the actual diaphragm muscle can effectively break the apical breathing habit. In Fahri’s book, The Breathing Book, she suggests a diaphragm awareness and strengthening technique called sandbag breathing. Sandbag breathing uses a soft weight such as a sandbag, bag of rice or soft ankle weight on the belly, just below the umbilicus. According to Mr. Alexander, this weight “…increases the pressure inside the belly and places a gentle stretch on the diaphragm, causing it to dome upward slightly further into the thorax.” With your client supine, instruct him/her to gently push the sandbag up towards the ceiling with each inhalation. After a series of 10 sandbag belly breaths, Mr. Alexander advises his clients to allow the bag to slide off their belly. At this point they usually notice that they are unconsciously using their diaphragm more with each breath they take.

This diaphragmatic strengthening exercise can be slowly increased to include more repetitions, and can even include more weight. Adding more weight to the sandbag must be done slowly and gradually, as the diaphragm can become sore and fatigued from this exercise. Mr. Alexander says that when his clients do this daily for a few weeks, they naturally use their diaphragm more consistently when breathing. The more belly (or diaphragmatic) breathing a client does, the more rigidity is unloaded from his/her neck and shoulder muscles. Rigidity is reduced because the neck and shoulder muscles contract less, and thus, relax more.

While most people may not think of strengthening the diaphragm as an important component of health, Mr. Alexander helps us see that it is. Regular belly breathing can originate with the practice of strengthening the diaphragm muscle, and its rewards are multi-faceted. The benefits of increasing lung capacity with the expanded breath of belly breathing and the non-recruitment and thus relaxation of the trapezius, levator scapula, scalenes and sternocleidomastoid muscles can positively benefit any client’s health – especially those that have neck and shoulder tension.

Posted by Nicole at 10:51 AM
© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org