Learn more about a Baker’s cyst and its symptoms, as well as how massage therapy can assist in the relief from this sometimes uncomfortable condition. Also, find out which massage techniques should be incorporated into a session when a client has a Baker’s cyst, and why it is important for bodyworkers to familiarize themselves with the signs, symptoms and risk factors associated with a deep vein thrombosis.

by Nicole Cutler, L.Ac.

In order to provide safe and effective bodywork, massage therapists have a responsibility to their clientele to be educated on a wide range of conditions. A growing number of consumers seek regular complementary healthcare treatments as a vehicle to remaining healthy. Many rationalize that these visits replace or at least supersede a visit to their allopathic medical doctor. This trend means that massage therapists are likely to be the first healthcare professional seeing a condition requiring a referral. Whether a client comes in with a diagnosed Baker’s cyst, or you recognize it as a possible explanation for a client’s lump, all bodyworkers should have a basic understanding of this condition.

What Is a Baker’s Cyst?
A Baker’s cyst, otherwise known as a popliteal cyst, is a swelling at the back of the knee. According to Ben Benjamin, Ph.D., a Baker’s cyst is actually not a cyst or an injury at the back of the knee, although it could be mistaken for either. Some people are born with a small pouch behind the knee formed by an extra piece of tissue. When a person with this extra flap of tissue sustains an injury, the body secretes excess synovial fluid into the joint, which accumulates and fills the pouch.

Excessive synovial fluid in the knee can be a result of many types of damage to the knee:

· Injury to the collateral or cruciate ligaments of the knee
· Torn meniscus
· Chondromalacia of the patella
· Osteoarthritis

Popliteal cysts occur most often in adults between the ages of 55 and 70 and in children between 4 and 7 years old. Up to one in five people with other knee problems may develop a Baker’s cyst.

Symptoms of a Baker’s Cyst
In some cases, a Baker’s cyst causes no pain and goes unnoticed. However, signs and symptoms that may be noticed include:

· Round to oval mass behind the knee, ranging from soft to hard – typically the size of a golf ball
· Knee pain and stiffness
· Tightness in the back of the knee and difficulty bending the joint.
· A sensation of pressure in the back of the joint, which can progress down into the calf muscle
· Knee aching and tenderness after exercise
· When all lights are turned out and a flashlight is directed through the lump, a red glow around the lump is seen. The red glow indicates that the lump is filled with fluid.

Allopathic Medical Treatment
In order to correct the problem, physicians treating a Baker’s cyst typically search for the underlying cause of the bulge. When severe enough to hamper daily activities, the allopathic medical community approaches Baker’s cysts with both surgical and non-surgical solutions. In general, the more conservative tact (non-surgical) is preferred. Only a person’s physician is qualified to determine if surgery is necessary or if the fluid can be successfully aspirated with a needle. Unfortunately, the more common treatment, needle aspiration, is only a temporary solution. Rest and elevation are crucial to any Baker’s cyst treatment plan.

With the understanding that their intervention merely provides temporary relief, many doctors have their patients work with a physical therapist using massage therapy, compression wraps and electrical stimulation to reduce knee swelling. Flexibility and strengthening exercises for the lower limb are often used to help improve muscle balance in the knee.

Massage Therapy
Massage therapy can help individuals harboring a Baker’s cyst. By focusing on the probable underlying knee problem, the swelling and discomfort of a Baker’s cyst can typically be relieved. Seeking the cause of an imbalance in the knee can be aided by performing some manual resistive testing to your assessment skills. For more information on these tests, read the article, Eight Tests for Anterior Knee Pain.

Interestingly, popliteal cysts are located in an area contraindicated for most massage techniques. Although it is important for bodyworkers to avoid deep, direct pressure on the cyst, it is still possible to have a significant therapeutic impact. Experts recommend treating the area above the cyst, primarily by addressing the hamstrings and adductors. Balancing the musculature supporting the knee joint compensates for pathological injury or torque contributing to knee dysfunction. Additionally, including lymphatic drainage massage techniques into a session will facilitate absorption of the excessive synovial fluid accumulation, leading to a quicker recovery.

Bodywork Precautions
The presence of a firm protrusion behind the knee should not be assumed by a massage therapist to be an innocuous Baker’s cyst. There is a possibility it could be a tumor or popliteal artery aneurysm, thus necessitating thorough evaluation by a medical doctor.

It is very important for massage therapists to avoid firm pressure directly on the cyst. A Baker’s cyst could become large enough to locally impinge nerves or blood flow, which in the worse case scenario could spawn an embolus. Familiarize yourself with the signs, symptoms and risk factors for a deep vein thrombosis to avoid this potentially devastating scenario. Rarely, a Baker’s cyst bursts and synovial fluid leaks into the calf region, causing sharp pain in the knee, swelling and sometimes redness of the calf. These signs and symptoms closely resemble those of a blood clot in the leg. If a client demonstrates these symptoms, prompt medical evaluation must be sought.

Bodyworkers are regularly presented with all types of pain and physical abnormalities. Some clients will announce they have a Baker’s cyst while others will just ask if you can help reduce the swelling behind their knee. Regardless of the presentation, massage therapists are best prepared to handle these situations when they are properly informed of the condition being presented, understand any danger lurking and are comfortable knowing what they can do to aid in the client’s recovery.

Recommended Study:
Advanced Anatomy and Pathology
Deep Vein Thrombosis
Lymphatic Drainage Massage

References:

Benjamin, Ben, PhD, Baker’s Cysts, Massage Today, July 2003.

www.thebodyworker.com, Baker’s Ganglion Cyst, thebodyworker.com, 2006.

www.mayoclinic.com, Baker’s Cyst, Mayo Foundation for Medical Education and Research, April 2006.

www.sportsinjuryclinic.net, Popliteal Cyst, Sports Injury Clinic, 2005.

Posted by Editors at 03:59 PM
© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org

Depending on what techniques are applied, massage therapy can either raise or lower blood pressure. In preparation for working with hypertensive clients, it’s crucial you know which modalities to choose.

by Nicole Cutler, L.Ac.

Because one quarter of all Americans have it, massage therapists should have a plan of action when encountering hypertension. Some practitioners automatically assume that the work they do will have an overall positive effect on cardiovascular health. However, this is not always the case. Because some techniques with a specific therapeutic application can cause blood pressure to temporarily rise, massage therapists must be cognizant to avoid these approaches on hypertensive clients.

About Hypertension
Otherwise known as high blood pressure, hypertension affects approximately 50 million Americans. Blood pressure is the force of the blood pushing against the walls of the arteries. A blood pressure reading is composed of two numbers:

· Systolic – Better known as the top number of a blood pressure reading, the systolic pressure describes the maximum pressure that occurs with each contraction of the heart.

· Diastolic – Also known as the bottom number of a blood pressure reading, the diastolic pressure describes the lowest pressure that occurs when the heart rests in between beats.

While there is some debate about the exact numbers that indicate hypertension, it is generally understood to be an average systolic blood pressure above 140 mm Hg, a diastolic blood pressure above 90 mm Hg, or both. While hypertension alone does not have many symptoms, it dramatically increases the risk of heart disease and stroke – the first and third most common causes of death among Americans.

Causes of Hypertension
There are many contributing causes of high blood pressure. There are two major types of hypertension: essential (primary) and secondary. Essential hypertension is by far the most common, accounting for more than 95 percent of all cases. While secondary hypertension is generally caused by an internal disease or substance abuse, essential hypertension is suspected to be due to a combination of the following:

· Genetics
· Low nitric oxide levels (a naturally occurring agent responsible for the dilation of blood vessels)
· Insulin resistance
· Obesity

Reducing Hypertension
Lifestyle modifications are a critical component to lowering blood pressure, and are always indicated regardless of the need for prescription medication. In addition to regular exercise, maintaining a desirable weight, reducing sodium intake, increasing fruit and vegetable consumption, stopping smoking and minimizing alcohol, massage therapy is a valuable tool for reducing high blood pressure.

Interestingly, researchers have found that some modalities are effective at reducing the pressure inside the artery’s walls, while others increase that pressure. The techniques regarded as good blood pressure reducers include:

1. Swedish Massage – Published in the January 2006 edition of The Journal of Alternative and Complementary Medicine, American researchers looked at the effects of different types of massage on blood pressure. They found that Swedish massage had the greatest effect on blood pressure reduction.

2. Cranial-Sacral Therapy – While not confirmed in a randomized study, advocates of cranial-sacral therapy tout its ability to lower blood pressure. According to the London-based integrated medical physician Dr. Andrew Logan, advanced cranial-sacral therapy can ease hypertension by relaxing the sub-clavian and femoral arteries.

3. Aromatherapy – A study published in a Korean medical journal in December 2006 evaluated the effects of an aromatherapy blend on blood pressure. The researchers found that inhaling blends of lavender, ylang ylang and bergamot once daily for four weeks reduced the blood pressure of those with hypertension.

Raising Blood Pressure
There are many ways to raise blood pressure – including being stressed out, drinking lots of caffeine, taking pseudoephedrine or steroids or receiving a painful type of bodywork. The January 2006 study that found Swedish massage to be most effective at lowering blood pressure also found that certain modalities increased blood pressure.

More specifically, the researchers determined trigger point therapy and sports massage both capable of increasing the systolic blood pressure. Recipients who received both types of massage within one session had both their systolic and diastolic blood pressure readings significantly increased. Since the conclusion was made that potentially painful massage techniques can result in a blood pressure increase, practitioners can assume that other aggressive therapies such as friction massage or Rolfing have the potential to exacerbate hypertension.

The goal in treating hypertension is to reduce the risk of serious complications, including heart disease and stroke. Although massage therapy is not a standalone treatment for high blood pressure, choosing the right bodywork modality can help reduce hypertension’s associated risks. For clients with high blood pressure, avoid techniques that could be painful. Instead, rely on Swedish massage, cranial-sacral therapy and aromatherapy to give your clients’ blood vessels a respite from the pathological pressure they routinely endure.

Editor’s Note: For more information about massage safety with hypertension, read Hypertension: Massage Indication or Contraindication?

Recommended Study:
Advanced Anatomy and Pathology
Aromatherapy Essentials
Cranial-Sacral Fundamentals
Swedish Massage for Professionals

References:

http://www.integrative-healthcare.org/mt/archives/2007/01/hypertension_ma.html, Hypertension: Massage Indication or Contraindication?, Nicole Cutler, L.Ac., Retrieved December 7, 2008, Natural Wellness, January 2007.

http://www.liebertonline.com/doi/abs/10.1089/acm.2006.12.65, Changes in Blood Pressure After Various Forms of Therapeutic Massage: A Preliminary Study, Jerrilyn A. Cambron, et al, Retrieved December 7, 2008, The Journal of Alternative and Complementary Medicine, January 2006.

http://www.ncbi.nlm.nih.gov/pubmed/16267371?ordinalpos=7&itool=EntrezSystem2
.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum, The effect of therapeutic back massage in hypertensive persons: a preliminary study, Olney CM, Retrieved December 7, 2008, Biological Research for Nursing, October 2005.

http://www.ncbi.nlm.nih.gov/sites/entrez, The effects of the inhalation method using essential oils on blood pressure and stress responses of clients with essential hypertension, Hwang, JH, Retrieved December 7, 2008, Taehan Kanhoe Hakhoe Chi, December 2006.

http://www.umm.edu/altmed/articles/hypertension-000087.htm, Hypertension, Retrieved December 7, 2008, University of Maryland Medical Center, 2008.

Posted by Editors at 02:53 PM
© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org

Want to tighten your stomach muscles? Try out an abdominal exercise that best suits your fitness level. This article gives a brief idea about abdominal exercises. Read on…
Any activity that enhances physical fitness and helps in toning your body is known as physical exercises. There are two types of physical exercises – aerobic and anaerobic. These exercises help to strengthen the muscles and maintain the overall fitness of the body. Abdominal exercises help to tone the stomach muscles.

A Few Abdominal Exercises

Abdominal exercises have three levels - beginners, intermediate and advance. The abdominal exercises would help to strengthen one’s lower, upper and oblique muscles. A person could choose the level that suits him best and work out the same twice or thrice a week to help strengthen and tone ones abdominal muscles. It is necessary to take small breaks between various abdominal exercises. You could increase the number of repeats for the chosen level of abdominal exercise by two and gradually raise the workout number to 20 repeats. One of the best ways to tone one’s abdominal muscles is to vary the exercises and workout routines. The abdominal exercises should be performed slowly to get best results. An abdominal exercise generally tones the muscles known as rectus abdominis.
Abs Crucnch
Use the following steps to perform the abdominal crunch exercise.

Lie on the ground with knees bent. Keep your feet flat on a leveled ground. Fold your hands under the head. Relax before you start the workout.

Keep the neck straight and the chest up. Slowly tighten the abdominal muscles.

Slowly crunch your body weight up and forward from the sternum. Raise it to the level of comfort. Now slowly lower the weight and stop just before the shoulders touch the floor. Repeat this exercise a couple of times in a week.

Always remember to keep your lower back flat on the floor. Never raise it.
Abs Reverse Crunch
Abs reversal crunch also helps in strengthening the muscles rectus abdominis. The following steps help in toning abdominal muscles.

To perform reverse abs crunch lie on the floor with legs straight. Put your hands under your buttocks for support.

Keep the lower back on the floor and tighten the abdominal muscles.

Slowly raise your legs perpendicular to the ground. Remember not to lock the knees. The lower back should remain flat on the floor when this workout is performed.

Gradually lower your legs and stop few inches above the floor. Repeat this exercise couple of times.
Bicycle Crunch Exercise
Bicycle crunch is an abdominal exercise that is rated among the top ten exercises. Read these steps to perform this abdominal exercise.

Relax before you do this exercise. Lie flat on the floor keeping the lower back pressed against the ground.

Keep the hands folded under the head and breath easy.

Raise your knees to 45-degree angle and move them in bicycle pedal motion.

Slowly, touch your left elbow to the right knee and vice versa.

Repeat this exercise around 5 times initially and later on increase the repeats.

Abdominal exercises help to flatten your stomach, and also tone and strengthen the abdominal muscles. The top ten abdominal workouts include captain’s chair, torso track, long arm crunch, reverse crunch, bicycle crunch, exercise ball crunch, full vertical crunch, ab rocker, plank on elbows and toes.

By Maya Pillai
Published: 7/21/2008

Stomach exercises help to achieve a flat stomach by toning the abdominal muscles. Here are a few stomach exercises.
Any kind of physical exercises would help you to unwind and de-stress after a long day in workplace. Exercises help to keep our body fit by reducing health problems such as blood pressure and blood sugar. It is a fact that by following a suitable exercise program, you can reduce your weight.

Stomach fat, visceral fat and potbelly are most often referred to as belly fat. Health practitioners are sounding alarm since belly fat is detrimental to health. Health problems such as diabetes, heart diseases, and high cholesterol are related to belly fat. There are many stomach exercise programs that help you to lose excess belly fat.

Tips to Achieve a Flat Stomach

Achieving a flat stomach is one of the dreams of many a people around the world. There are many exercises and exercise programs to achieve a flat tummy. Prior to choosing your exercise program you need to know these tips.

Eat right kind of food - Remember, gaining weight is easy but losing the acquired fat is a bit difficult. The right combination of diet and exercise is the first step to achieve a flat stomach. Eat right kind and quantity of food at regular intervals and drink lots of water. A combination of fresh and dried fruits, whole grains such as whole cereals, vegetables and lean protein would make a healthy meal.

Cardiovascular exercises - One of the ways to burn fat around your stomach is to practice cardio exercises at least thrice a week for a minimum of thirty minutes. If you perform cardiovascular exercises, slowly the belly fat will reduce.

Work the abs regularly - Working on abdominal exercises regularly would help to lose stomach fat. Some of the exercises that help are crunches such as bicycle crunches, exercise ball crunches and Roman chair leg-lifts.

Last but not the least, if you are not sure what kind of diet to follow or what exercises to practice do not hesitate to approach a trainer.

Exercise Ball Crunches

Exercise ball crunches help to reduce your stomach fat. Before performing these exercises you need to ensure that the ball is fully inflated. To get best results, you need to hyperextend your lumbar region of the spine in the bottom position. The instructions for this exercise are given below.

Sit on the inflated exercise ball and make yourself comfortable before starting the exercise. Then slowly roll it forward so your lower back rests on the ball. To provide stability keep your feet 1-2 feet wide and bend your knees perpendicular to the floor.

Rest your shoulders on the ball at a level lower than the abdomen to arch your lower back.

Place your hands behind the head with elbows pointed out to the sides.

Inhale deeply and hold the breath. Raise your shoulders and head till they are above your hips. Tighten your stomach muscles. Keep the lower part of your body stationary while performing this exercise.

Exhale as you return to the original position. Repeat the above steps at a slow to moderate rate of speed. Perform this exercise for at least 5 to 10 times.

Bicycle Crunches

One of the exercises to tone your stomach is bicycle crunch. You need to perform this exercise regularly for at least for ten minutes. Take a look at the steps for bicycle crunches.

You begin by lying down on your back. Put your hands behind your head, but do not clasp them together.

Raise the left knee perpendicular to the floor while the other leg is stretched out.

Slowly lift your upper body and bring the right elbow to touch your left knee.

Alternate this procedure by bringing the left elbow to the right knee.

Repeat this procedure for minimum twenty times in a pedaling motion.

Roman Chair Leg-lifts

Roman Chair is an exercise equipment that is used to tone the lower and upper abdominal muscles.

Rest your forearms on the arms of the roman chair.

Slowly stretch your legs until they are parallel to the ground. Tighten the abdominal muscles while raising your legs above the floor. Exhale while raising your legs above the ground. Inhale while bringing your legs to the original position.

Repeat this procedure at least 10 times for better results.

Reverse Abdominal Crunch

This exercise tones the muscle rectus abdominis. Here are the steps to do this exercise.

Lie flat on your back with legs stretched and hands underneath the buttocks.

Tighten your abdominal muscles. Raise your legs and back perpendicular to the floor slowly without locking your knees.

The lower back should remain flat on the floor. Slowly, lower your legs and stop before the feet touch the floor.

Repeat this procedure ten times.

Women who are in the early stages of pregnancy or have just delivered a baby should do the stomach or abdominal exercises only after consulting the gynecologist.

By Maya Pillai
Published: 12/16/2008

Tired of staring at the flab that accumulates on the stomach despite endless workouts? Here are some useful lower abdominal exercise tips to get rid of excess fat.
What’s the secret of a well-toned body? Well, no crash diets but loads of exercise! Everybody dreams about perfection but to reach that specific stage takes more than just a balanced diet. A flat and sexy abdomen is on the wish list of many. The lower abdomen is one such area that requires a fixed exercise routine to tone down and strengthen the muscles. Lower abdominal exercises need to be incorporated in the daily exercise program to have flat, washboard abs.

The dream to have flat abs need not remain only as a dream. Contrary to popular belief, lower abdominal exercises are not as complicated as they may sound. These can be merged with regular exercises to get rid of belly fat. Losing weight and having flat abs can be possible even with simple home exercise routines. These lower abdominal exercises given below will help you to achieve your goal.

Steps for Lower Abdominal Exercises

Exercise 1
Crunches are one of the most important exercise programs that should be included in your routine. Using a towel with the basic crunches helps to correct postures. Before doing the exercise, fold a medium-sized towel in half. Then roll it into a tube. Lie flat on the floor and bend your knees. Feet should also be flat on the floor. Now, place the rolled towel underneath where a gap forms naturally between the back (curve of the spine) and the floor. This towel roll acts as a support while doing the crunches. Hold hands tightly behind the head without applying pressure. Gently lift the shoulders off the floor and pause. Exhale while lifting the shoulders. Now, inhale while going back to the starting position. Begin with a set of 8 counts for the initial period. Increase the number of sets gradually.

Exercise 2
Lie flat on the floor. Use the towel beneath your back as mentioned in the previous exercise. Slowly bring your feet up into the air. Now, extend the right arm. Use the lower abdominal area to lift the shoulders off the floor. Try to touch the left toes with the right hand. Slowly lower yourself back to the starting position. Repeat the procedure but with reverse sides. Always remember that knees should remain straight and the chin should not be lowered towards the chest area. Maintaining a correct posture is very important in this case. Begin with a set of 8 counts and gradually increase with every session.

Exercise 3
Lie straight on the floor and place hands on the side. Flex your knees slightly and ensure your feet just brush the floor. Keep the feet together and bend the knees. As you bend, slowly raise legs off the floor. Bring the knees upwards towards the middle area of the body. Then, slowly lower the legs and come back to the starting position. Repeat 8 times. Increase count with every session.

Exercise 4
Stand straight and bend knees slightly. The back should be slightly arched. Inhale deeply as much as possible. Then exhale as deeply as possible. While exhaling, pull the belly button towards the inside. Bring the chin to the chest. Once you have completely exhaled, hold the position for a little while. And as you do so, inhale through lips. Lips should be slightly pressed against each other. Inhale and exhale for around 5-10 seconds. Repeat 8 times when you begin with the exercise routine. The counts can be increased once you are comfortable with the entire workout program.

Use these lower abdominal exercises along with your regular exercise program to see the difference. Consistency in the routine will help you to achieve your goal sooner than expected!

By Kashmira Lad
Published: 1/16/2009

The branched-chain amino acids (BCAAs) are leucine, isoleucine, and valine. BCAAs are considered essential amino acids because human beings cannot survive unless these amino acids are present in the diet.
What do they do?
BCAAs are needed for the maintenance of muscle tissue and appear to preserve muscle stores of glycogen (a storage form of carbohydrate that can be converted into energy). BCAAs also help prevent muscle protein breakdown during exercise.

Some research has shown that BCAA supplementation (typically 10-20 grams per day) does not result in meaningful changes in body composition, nor does it improve exercise performance or enhance the effects of physical training. However, BCAA supplementation may be useful in special situations, such as preventing muscle loss at high altitudes and prolonging endurance performance in the heat. Studies by one group of researchers suggest that BCAA supplementation may also improve exercise-induced declines in some aspects of mental functioning.

BCAA Benefits
BCAAs can active glutamate dehydrogenase—an enzyme that is deficient in amyotrophic lateral sclerosis (ALS), also called Lou Gehrig’s disease. In one double-blind trial, 26 grams per day of BCAA supplements helped those with ALS maintain muscle strength. However, a larger study was ended early when people using BCAAs not only failed to improve, but experienced higher death rates than the placebo group. Other studies have shown no benefit of BCAA supplementation for ALS or other neuromuscular diseases, though a small group of people suffering from diseases of the nervous system collectively called spinocerebellar degeneration did improve when given BCAAs in a preliminary study.

One study investigating the advantages of BCAA supplementation for people with diabetes undergoing an intense exercise program found no additional benefit of BCAAs on reducing abdominal fat or improving glucose metabolism.

Patients with liver diseases that lead to coma—called hepatic encephalopathy—have low concentrations of BCAAs and excess levels of certain other amino acids. Preliminary research suggested that people with this condition might be helped by BCAAs. Double-blind studies have produced somewhat inconsistent results, but a reanalysis of these studies found an overall benefit for the symptoms of encephalopathy. Therapeutic effects of BCAAs have also been shown in children with liver failureand adults with cirrhosis of the liver. Any treatment of people with liver failure requires the direction of a physician.

People with chronic kidney failure may also benefit from BCAA supplementation. A preliminary study found improved breathing and sleep quality in people given intravenous BCAAs during kidney dialysis.

Phenylketonuria (PKU) is a genetic disease that causes abnormally high amounts of phenylalanine and its end products to accumulate in the blood, causing damage to the nervous system. A controlled trial demonstrated that regular use of BCAAs by adolescents and young adults with PKU, improved performance on some tests of mental functioning.

This outcome makes sense because BCAAs may compete with phenylalanine, reducing its toxic effects.

By Prerna Salla
Published: 2/12/2005