How Often Should I Get a Massage – Frequency Guideline

Following my initial blog post on this subject How Often Should I Get a Massage, here is my treatment frequency guideline, for massage therapists and their clients.

Remember, this is just a very generic guide, and will have to be adapted for individual situations.

Here are my general guidelines for treatment frequency:

Relaxation – once a month for an hour, unless you want to come more often.

Acute injury – more frequent treatments of shorter duration should help – for example, 2 times a week for 30 – 45 minutes. This should help relieve pain and congestion in the area, then after a few weeks, switch to deeper, muscular work for longer periods of time. At this point your injury may have moved into a subacute or chronic stage of healing, depending on the severity of the injury, 1-2 times a week for an hour, over a period of 3-4 weeks should get you on the road to recovery.

Treatment for chronic conditions (i.e. headaches or back pain) – one hour twice a week for 4 treatments, then try once a week for 3 or 4 weeks, and try to decrease to 1x in 14 days for 2 treatments. You will then go into maintenance mode. Once again, very individual, and the longer the condition has been an issue for the client, the more treatments will usually be needed to make consistent gains.

Some more general guidelines:

Follow remedial exercise and homecare advice – passive treatments such as massage therapy can only take you so far, it is YOUR responsibility to be proactive in your own health care. This means follow exercise, stress management, nutrition and lifestyle advice. Record what you do and how you feel, try to make a correlation between various factors. If you have a team of health care providers who are willing to work together, use them!

Don’t go too long between treatments! Progress made during a treatment is building on the progress made in a prior treatment. This means that if I’ve treated a client for chronic back pain for a month and we’re seeing some results, if he stretches out the length of time between appointments to 8 weeks instead of my recommended 2 – 4 weeks, it may be like starting all over again. What a waste of money for the client!

Remember, though, that if you start to feel consistently better (and consistent is key), you have the right to say “I’d like to stretch out the time between treatments a few more days, can we try that?” Your therapist can only give you advice and guidance, you have to figure things out what works for your situation.

If the treatment is not helping – find another therapist! Sometimes people feel awkward about ditching their therapist, especially if you have a good relationship with him or her. BUT, it’s your time and money, and you should see results. Sometimes massage therapy is not the be-all-end-all of treatments, I personally find a combination of therapies to be the most effective.

Knowing your rights as a client will prevent you from getting expensive, unnecessary or ineffective treatments, and will enable you to receive treatment that suits your needs.

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

What Does Muscle Strain Mean?

Muscle strain is a very common injury treated effectively with massage therapy. What does muscle strain mean, and how does this type of injury happen?

Strain is a term used to describe an injury to the musculotendinous unit, or the muscle and the tendon which attaches it to bone.

Muscle and tendon is known as contractile tissue due to its ability to contract (shorten) and extend (lengthen). This contraction and extension of muscle causes movement, and because of this, muscle strain will be noticed when you attempt to use the muscle, either contracting or stretching it during movement.

There are basically 2 mechanisms of injury which cause muscle strain:  overloading the muscle (too much pressure or weight), or overstretching muscle (think of trying to catch a falling object that is really heavy – weight is suddenly applied to muscle that is stretched. It could also happen, for example, due to a sudden slip or fall.

Symptoms of Muscle Strain:

The symptoms of a muscle strain will depend on the severity of the condition. Muscle strains are classified as mild (1^st degree), moderate (2^nd degree) and severe (3^rd degree).

Mild muscle strains occur when there is some tearing of the muscle or tendon fibres.  While you may still be able to carry on activities at the time of the injury, there is obvious muscle stiffness the following day.  In spite of the discomfort (with or without palpation) and stiffness, there is no loss of function.

In addition to muscle stiffness and soreness, there may be some minor weakness, a decrease in normal range of motion, some minor swelling and spasm, and minor pain with either contraction or stretching of the affected muscle.

Moderate muscle strains may have considerably more (up to 75%) muscle tissue damaged.  At the time of injury, you will be unable to continue activity, and there will be considerable pain. Inflammation will be present at the injury site, with increased muscle spasm and possible bruising.

Severe muscle strains usually result in immediate and complete loss of function due to disruption of the tissue. There may be extreme pain, however, if there is a complete rupture of the muscle or tendon, there may be no pain due to the lack of muscle contraction.  There may be visible and palpable gapping of the muscle tissue.

You’ve just hurt yourself, what do you do now?

Whether you slipped and fell, or were being a hero rescuing Granny’s kitten from a tree, it doesn’t really matter at this point. Let’s just hope it’s a mild strain and nothing more serious.  If you are in a lot of pain, or the body part in question doesn’t look like it usually does, please see a physician or medical professional ASAP who can diagnose and treat the problem.

You should, however, do something about it quickly. “Quickly” is the key word here, as a muscle strain injury (or any other type of injury) that is addressed immediately often is less complicated and takes less time to heal.

For an acute injury, remember R.I.C.E:

R is for Rest – don’t aggravate an injury and cause more damage by continuing on. Stop what you’re doing. Now. Ok, if it’s a mild injury, you may be able to get back to mild activity in a day or two which is good for the body (“mild” is the key) If it’s more serious, then I probably didn’t have to tell you to stop, because you (hopefully) would have anyway.

I is for Ice – great for controlling the degree of inflammation, ice is also great for controlling pain, as we all know. And here is why:

When tissue is injured, inflammation begins immediately in response to the injury. Inflammation is not necessarily a bad thing, as it can stabilize an unstable joint, and will clean away cellular debris and dead cells, increase circulation and cellular metabolism by delivering oxygen and nutrients via blood flow.  Due to this increase in fluid build up in the area, pain is caused because tissue is stretched and the pain receptors (nociceptors) in the tissue are irritated.

I have been made aware by colleagues who are physiotherapists that the “newer” approach is to place heat on an acute injury. Why? you might ask. (I asked the same question). Apparently (in theory) to increase the blood flow will increase the rate of healing. However, I will take this opportunity to respectfully disagree;   based on my experience, my clients who have had this type of treatment have been in absolute agony, as if the injury wasn’t enough.  The use of cold and ice isn’t long term, but in the acute stage, it is a great tool to control pain.

C is for compression – once again, compression will control the degree of edema (swelling) which occurs. It is imperative that it be done correctly; bandages that are too tight will completely cut off circulation, and uneven bandage pressure can also damage tissue. My suggestion is that if you can’t find a medical professional trained in wrapping to do it, than it might be better to forgo it altogether. Remember, too, that the bandage will have to be removed and reapplied at least once a day.

E is for elevation – elevation will help the blood and lymph flow away from the injury site, reducing the edema and relieving pain.

Disclaimer: This information is provided for educational purposes only, and is not meant to replace the advice of your primary health care provider. When in doubt, please consult a qualified medical professional in your area.

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

Can Massage Therapy Treat Fracture Injuries?

Massage therapy treatment can help maintain and improve tissue health in a fracture injury, enabling a person to regain his or her full function sooner.

Massage therapy is a treatment option which can reduce pain and discomfort in the soft tissue surrounding a fracture injury, and it can also assist in reducing edema and muscle tension of both the affected and compensating structures. When a massage therapy treatment plan is carried out correctly, once the cast is removed, a client can regain full function sooner as the health and mobility of compensating muscles has been addressed.

Initially, your massage therapist will only work above the cast, and will take care to not disturb the healing bone. Eventually, when the cast is removed, massage therapy will continue to restore the health of the tissue by increasing circulation, restoring function and strength, and reducing any scar tissue.

Considerations for treatment

It is highly recommended that your physician provide a written recommendation for massage, and your therapist probably won’t agree to treat you until your doctor has given the green light.

In all likelihood, you will also be seeing a physical (physio) therapist. It’s a good idea to provide written permission for your massage therapist to collaborate with your other health care professionals to ensure the best possible care and treatment outcome.

Before your massage therapist begins to treat you, he or she will want to verify the following information:

• your physician has approved massage therapy
• are you on any type of medication? (anti-inflammatory, analgesic, anti-coagulant, antibiotics).
• what is your general health – for example, consider age, fitness prior to injury, nutrition (your MT may refer you to a nutritionist, as proper nutrition impacts the healing process), lifestyle (i.e. do you smoke?)
• are there any open wounds which must be addressed? (i.e. with a compound fracture)
• Will treating the affected limb with massage therapy stress and disrupt the healing of bone, muscle, skin or nerve tissue?
• is there any neurological or vascular impairment in the area which prevents the use of certain massage techniques or modalities?
• do you have any plates, wires or pins? If so, hydrotherapy over the site will be contraindicated.
• the most important consideration is to avoid stressing and interfering with healing tissue. Any pressure or traction applied to the affected bone is contraindicated.
• have other types of injuries been sustained, such as sprains or contusions? (in all likelihood, there will be other injuries)
• muscle atrophy from disuse will be present when the cast is removed. Provided that the injury is not an avulsion fracture, the development of atrophy can be reduced by the use of isometric contractions at the appropriate time with cast on. If an avulsion fracture is present, avoid isometric contractions, as this may disrupt the healing bone.
• tissue under the cast will be fragile when the cast is removed, so extra care must be taken when massaging this tissue

As treatment progresses and the injury heals, issues such as tissue atrophy, altered biomechanics and altered proprioception must be taken into account. For this reason, there are different considerations for treatment with cast on and cast off.

Types of fractures

There are several basic types of fractures:

1. Simple – there is no broken skin, and the break is clean. Also known as a “closed” fracture.
2. Compound – the broken bone damages surrounding tissue and skin by piercing it. There is a greater risk of infection in this type of break due to breaking of the skin and protrusion of the injured bone.
3. Comminuted – a fracture that is in several pieces – common among a population with more brittle bones (i.e. elderly)
4. Compression – a fracture where the bone is crushed
5. Depression – a fracture where the bone is crushed and pressed inward
6. Impacted – bony surfaces are forced into each other (impacted)
7. Spiral – an break with ragged edges that result from twisting
8. Greenstick – an incomplete break that is common in children, as bones are more flexible
9. Stress fracture – a.k.a. hairline fracture, is a tiny crack in the bone and may not be visible with an x-ray
10. Avulsion – this occurs when a ligament or tendon pulls away a chunk of bone to which it is attached.

Fractures and breaks are repaired by “reduction” – when the bony ends are placed back together. A closed reduction is done manually by a physician, whereas an open reduction involves surgery, and possibly the placement of pins or wires to hold the bony surfaces together.

Finding the best massage therapist for you

It goes without saying that an injury as serious as a fracture or break will require treatment from a therapist who really knows his or her stuff and understands the healing process. Personally, I would ask my physical therapist if he or she could refer me to a qualified and experienced massage therapist, and then ensure that I give them both permission to communicate with each other so that my treatment plan would address all of my needs and concerns.

© Copyright 2009

www.whymassagetherapy.com

All Rights Reserved.

Massage Therapy, Fitness and Optimal Performance

Massage therapy is often used as an adjunct to a fitness routine to assist in achieving peak athletic performance. There are a variety of ways in which massage therapy is used to promote optimal fitness – massage therapy is not all just about spas and “fluff”. Massage can be used to increase the suppleness of muscle, aid in recovery after exertion, assist in fluid removal in the presence of injury or inflammation (from non-infectious origins) or control pain through the release of endorphins.

Massage therapy affects muscles in 2 ways: mechanically and chemically. Mechanically, it is the kneading, stretching and compression of the tissue which stimulates the smooth muscle of the blood vessels and increases blood flow to and from the area. (due to an increase in histamine – see below). Manual manipulation of the tissue will also literally break adhesions and scar tissue, regardless of whether techniques are applied with or against the muscle fibre. This decrease in inelastic scar tissue will allow muscles to contract and elongate as they should, and will increase muscle performance.

At a chemical level, massage therapy can cause the release of “endorphins”, neurotransmitters that reduce the perception of pain, and increase a feeling of wellbeing. Increased permeability of the blood vessels is caused by release of histamine in response to mechanical stimulation – this increase in blood flow leads to “hyperemia”, redness which is often visible after a massage.

The application of therapeutic massage plays a role in event preparation as well as recovery and maintenance, though the goals and application will be different depending on the timing of the treatment in relation to the activity.

Pre-event, the purpose of massage is to “wake-up” and warm-up the muscles, ensuring that they are ready for physical demands to be placed on them. During a pre-event treatment, the movements of the therapist are quick, stimulating the nerves in the area and increasing the ability of a muscle to react to stimuli. Circulation to the muscle is also increased and with it oxygen delivery to the muscle cells, causing a subsequent increase in cellular metabolism and improved functionality. Increased blood flow also warms up the muscle, allowing for greater pre-event stretching, imperative to optimizing performance and reducing injury due to muscle strain.

Post-event massage is much slower, encouraging the body to relax after exertion. Massage therapy at this stage is utilized to assist the body in removing metabolic waste, relaxing and stretching the fatigued muscle. This is done by increasing the circulation and pliability of the muscle tissue. The increased removal of metabolic waste such as lactic acid will decrease recovery time and soreness in the days following an event.

Massage therapy used as a maintenance tool will assist an athlete in maintaining optimal muscle health. During maintenance treatments, the therapist will assess the condition of tissue and establish a treatment plan in conjunction with the goals and condition of the client. It is during these treatments that muscle imbalances are often identified; adhesions and scar tissue are broken down (thus increasing muscle functionality) via manipulation, stretching and breaking down of tissue. Circulation is increased, assisting in oxygen delivery and metabolic waste removal.

Regardless of fitness level, massage therapy can help a fitness enthusiast or athlete achieve his or her performance goals by promoting and maintaining muscle health.

© Copyright 2008-2009
Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.