Massage benefits are more than skin deep

Reprinted from the New York Times (www.nytimes.com). (link to original article at bottom of page)

By RONI CARYN RABIN
Published: September 20, 2010

Does a good massage do more than just relax your muscles? To find out, researchers at Cedars-Sinai Medical Center in Los Angeles recruited 53 healthy adults and randomly assigned 29 of them to a 45-minute session of deep-tissue Swedish massage and the other 24 to a session of light massage.

All of the subjects were fitted with intravenous catheters so blood samples could be taken immediately before the massage and up to an hour afterward.

To their surprise, the researchers, sponsored by the National Center for Complementary and Alternative Medicine , a division of the National Institutes of Health, found that a single session of massage caused biological changes.

Volunteers who received Swedish massage experienced significant decreases in levels of the stress hormone cortisol in blood and saliva, and in arginine vasopressin, a hormone that can lead to increases in cortisol. They also had increases in the number of lymphocytes, white blood cells that are part of the immune system.

Volunteers who had the light massage experienced greater increases in oxytocin, a hormone associated with contentment, than the Swedish massage group, and bigger decreases in adrenal corticotropin hormone, which stimulates the adrenal glands to release cortisol.

The study was published online in The Journal of Alternative and Complementary Medicine.
The lead author, Dr. Mark Hyman Rapaport, chairman of psychiatry and behavioral neurosciences at Cedars-Sinai, said the findings were “very, very intriguing and very, very exciting — and I’m a skeptic.”

A version of this article appeared in print on September 21, 2010, on page D6 of the New York edition.

Online edition link to article: http://www.nytimes.com/2010/09/21/health/research/21regimens.html?_r=1

Get the Most From Your Massage Treatment

Whether or not you are a newbie to the massage therapy world, or a veteran, learning how to get the most from your massage therapy treatments is sometimes a bit of a mystery. As a massage therapist at a busy sports & physiotherapy clinic, and a massage therapy patient myself, here are my tips for getting the most out of your treatment.

1. Depending on the reasons you are going for treatment, be discerning in your choice of facility. If you are going for a relaxation treatment it is going to be a bit easier to find a suitable therapist and facility than if you are going for an injury related treatment. Word of mouth is a great way to get started in your search.

2. When you’ve made your appointment, be sure to arrive early, especially if you have to fill out a health history form. This ensures that you are relaxed, and that you are ready at your appointment time. (this also demonstrates respect for your therapists time, something that we appreciate.)

3. Fill out your health history accurately. Whether or not you think something is relevant, your therapist needs to know in order to provide a safe and effective treatment. This includes past surgeries and accidents, and past or present diagnosis. He or she can’t ensure your safety if the information you’ve provided is inaccurate, incomplete or misrepresented. And, on a legal note, he or she can’t be held liable if you’ve withheld or misrepresented your health information.

4. Don’t eat a large meal within 1-2 hours before getting a treatment – your body is busy digesting, and honestly, it’s just plain uncomfortable to lie on a full stomach.

5. Empty your bladder before your treatment time. Think of it this way – have you ever tried to sit through a long movie when you really have to go? Exactly, except it feels 10x worse when you’re laying on a full bladder. (trust me!)

6. Communicate with your therapist. If you are nervous or want to ask a question, it’s your right to express how you’re feeling. The same goes for your comfort level during the treatment. Personally, I want to know if there might be potential issues so I can pre-empt any confusion and establish a therapeutic relationship of trust and respect.

7. Let your therapist know if you want to talk or not. I generally take a client’s lead – if he or she speaks to me, then I respond; if not, then I keep quiet except for asking about comfort levels. If you find that your therapist is chatty, but you want to “zone out”, tell them so.

8. Understand that if you are being treated for a specific condition, compliance is important with treatment plans, homecare and remedial exercise. Since massage therapy is a passive therapy, it is only about 20% of the recovery process from injury or conditions. Follow therapeutic recommendations and you will prolong the positive effects of treatment and improve much more quickly.

If for any reason you are not happy with treatment, or don’t feel you have a good relationship with your therapist, it’s OK to find someone else. Not everyone is a perfect fit for every massage therapist, and vice versa. You are investing your time and money to achieve a result, so it’s your right to find someone who can help you achieve the desired results.

For more information, please refer to Massage Therapy Client Rights and Massage Therapy Client Obligations and Responsibilities.

© Copyright 2010
www.whymassagetherapy.com
All Rights Reserved.

How Can Massage Treat Patellofemoral Syndrome Knee Pain?

Patellofemoral syndrome is a term used to describe knee pain caused by improper movement, or tracking, of the kneecap over the femur. This condition often results from muscle imbalance in the quadriceps, or thighs. Massage therapy is useful in addressing this muscular imbalance, resulting in decreased pain and increased function of the patellofemoral (knee) joint.

The patellofemoral joint specifically refers to the articulation of the femur and the patella. The patella, or knee cap, is a sesamoid bone and is located within the quadriceps tendon. The patella glides over the boney prominences of the femur, or the femoral condyles, as the quadriceps contract or tighten during extension of the knee.

The quadriceps (aka, quads or thigh muscles) is really a group of four muscles, consisting of the rectus femoris, vastus lateralis, vastus intermedius and vastus medialis. The muscular imbalance which may be one cause of patellofemoral syndrome occurs when the vastus lateralis is stronger than the vastus medialis, and pulls the kneecap to the outside of the thigh during movement. This imbalance is often seen in athletes such as runners, though it is not limited to athletes, and may be caused by posture.

Pain occurs when the quadriceps tendon tightens during movement and pulls the kneecap “off track” – meaning that the underside of the kneecap articulates improperly with the femur. If left untreated, this misalignment can cause inflammation and degeneration of the bony surfaces, eventually leading to arthritic changes.

The treatment

Massage therapy is very useful in reducing the tone and myofascial trigger points of the quadriceps, specifically that of the vastus lateralis. Trigger points in this muscle, which refer pain to the lateral thigh along the iliotibial band area, as well as the lateral knee, may contribute to altered gait. During a massage therapy treatment, the therapist will address the involved and compensating muscle groups, as well as stretching and using hydrotherapy during treatment (heat) and post treatment (ice or cold). The application of cold post treatment will assist in the reduction of inflammation in the patellofemoral joint and surrounding muscle tissue.

Another important aspect of rehabilitation is the strengthening of the vastus medialis, specifically the lower, oblique fibres medial to the patella, known as the vastus medialis oblique (VMO). By strengthening this muscle, the normal position of the patella is regained and it will interact correctly with the femur.

The duration and frequency of the treatment will depend on the presentation of the condition, and how long it has been present.

© Copyright 2010
Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.

How often should I get a massage?

Without fail this is one of the most common questions I receive as a massage therapist. The truth is, though, how often you should get a massage treatment is very individual and doesn’t follow a set formula.

As a massage therapist, I am asked this question by every 9 clients out of 10.  There are several factors that I take into consideration, and these factors include, but aren’t limited to, the following:

1. Why are you coming for treatment?  For example, is this for a specific issue, or is it for relaxation?

-       treatments which focus on specific issues are usually more frequent, though I rarely have treated a client more than 2 times a week for more than 3 or 4 weeks.

-         for relaxation and general health purposes, more than once a month is not necessary unless you have the time and financial resources to get treated.

2. What is the tissue presentation?

-         if you have a chronic, long-standing issue, and the tissue is very “dense” or “hard”, then you may need several treatments over a few weeks to make progress. Once your tissue has loosened up a bit, you should start feeling better. After a few weeks, your therapist should see how you are progressing, and you should be given the option of reducing treatment frequency.

-         tissue that is inflamed from injury cannot be treated directly with massage therapy, however, surrounding and compensating structures can and should be addressed to prevent pain and muscle imbalance.

-         tissue that is inflamed from injury can be treated with Manual Lymph Drainage (also known as lymphatic drainage or mld). Frequent treatments of this nature are recommended as this therapy facilitates the removal of metabolic waste from the injury and relieves pain and congestion.

3. Keeping in mind that everyone is individual and responds differently to treatment, you may notice that the effects of the treatment last only a day or so after the first treatment, with longer periods of feeling better as you progress – this is when your therapist should reduce treatment frequency.  After all, how are you going to know that you’re feeling better if you are still getting treatments twice a week? Exactly …

4. After 3 treatments, how are you feeling?

-         Personally, even with chronic issues such as upper back pain and tension, I feel that a client should notice an improvement by the end of the 3^rd treatment. This is my guideline which tells me I am on the right track, and it keeps me focused on what the client needs. I’m not saying there should be a huge or remarkable improvement, but some progress should have been made.

-         And just a side note for clients – if you aren’t seeing some improvement such as decreased pain, increased mobility etc by the end of the 3^rd treatment, then your issues aren’t being addressed. At this point your therapist should go over the treatment plan again (sometimes we miss things), and perhaps revamp it a bit.

-         If no progress has been made by treatment #5, ask to be referred to another therapist.  Beware the therapist who insists that you continue to book, and don’t be shy to say that you’re not feeling any different, after all, massage therapy is your investment in health.

If you are unable to come for the recommended frequency due to financial concerns, talk to your therapist. If he or she is aware of your financial limitations, she might be able to adjust the treatment plan so that you can maximum benefit for your restricted budget, or recommend things you can try at home to enhance and prolong the effect of the treatment.

For more information on Massage Therapy Treatment Frequency Guideline …

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

Massage Therapy – is the customer always right? (Part 2)

As a follow up to my post a few days ago – “Massage Therapy – Health Profession or Customer Service? “, I’m pretty sure that you know where I’m going with this.

At the forefront of my thoughts when talking about massage therapists and customer service (as in “is the customer always right?”) is that ultimately because the health and well-being of our clients is our responsibility during treatment, it supersedes the customer service aspect of the profession.

That being said, for the most part therapists will very seldom encounter situations where they have to pull out their “health professional first” hat and decline a customer request. Ultimately, if what you do as a massage therapist during treatment presents a risk of harm to the client, then you need to stick to your decision if you decide to refuse or alter a treatment. Cases where this might happen:

1) Your client refuses to fill out a health history form.

This is pretty basic – I won’t treat a client if I don’t know what is going on with his or her health. End of story. The client may say “my health is fine”, but really, what does fine mean? “Fine” is different between members of the general public and health professionals, and most people, as previously discussed, don’t have the knowledge to have any kind of discernment when it comes to therapeutic techniques. Can you imagine getting a severe diabetic client who wants scar tissue work done, or a client with a history of TIA (transient ischemic attack) or stroke who wants to “work the kinks out” of his or her neck. These are two conditions which require precaution when treating, and for which certain techniques are contraindicated.

How to approach this? Tell your client that there are often conditions which require a treatment to be modified, or that treatment may even be unsuitable. You as a therapist are unable to plan and deliver the best treatment possible without this health information. You can also remind them that the health history is fully confidential and their information will not be disclosed. If they are really sticky, you can quite simply say that you are not willing to be liable for any injury caused because you weren’t informed, and that you will not treat them. (

*Any time you have this type of conversation with a client, you need to keep an incident report of it, even if you didn’t end up treating them. This will cover all of your bases in the event that the client feels like accusing you of being unprofessional. (Personally, I haven’t ever heard of this, but it’s better to be safe than sorry))

2) Your (new) client is adamant about getting “really deep pressure”.

This is actually quite common, and I have had to finesse my way around this several times. John (or Jane) Doe may say “My therapist uses really deep pressure, it’s the only thing that works for me.” and you start treating and suddenly your client finds your moderate pressure too much. Why is this? It’s because everything is relative and subjective – what is deep to one person is too light for another, or too much. What feels good to one client may be excruciatingly painful to another. Your colleague’s pressure might be considered deep, but relative to whom? This is a situation where being creative and flexible really comes in handy.

The fact of the matter is that it is always better to use the first appointment as a trial run, so to speak. I’m not saying to just put oil or gel on your client and spread it around so that he or she gets no benefit – that would just be annoying and I can pretty much guarantee they wouldn’t rebook. What I’m suggesting is that you use moderate pressure (I love that word) and check in frequently – and don’t forget to advise your client that he or she may feel a bit sore the next day (informed verbal consent should have done even before getting them on the table anyway).

How to approach this? You can say to your client “Since I haven’t seen you before, I’m not sure how you are going to react to the treatment, or my pressure. What I usually do is use moderate but firm pressure during the first appointment, and then if you react well to the treatment, I’ll use more pressure next time. This is to prevent you from getting really sore in case I use too much pressure – you might not realize this until it’s too late, and you could be sore for days.” This is usually sufficient, but if the client argues further, I will say that I rarely have complaints about my pressure being too light, or my clients being too sore (but this my experience, you’ll have to figure out your own explanation )

3) Your client shows up with a bad cough, fever or chills

Many clients will show up when they are getting ill with acute bronchitis or flu-like symptoms because “everything hurts” and they think that a massage will make them feel better. At this point you should ask them if you can call a cab for them and rebook when they are feeling better. Don’t take “no” for an answer. Seriously.

It’s not just that treating someone with an acute or systemic infection will be really bad for them (after all, they body is already trying to fight off a virus or bacteria – increasing circulation won’t help them at this point) – you are also putting yourself, other clients and your clinic at risk of infection. Remember the SARS epidemic (Sudden Acute Respiratory Syndrome) in Ontario, Canada in 2003? It was absolute chaos for a while, and massage therapists all over Ontario received guidelines from the CMTO concerning protocol in preventing the spread of infection. The last thing you need is to be remembered as the therapist or clinic that was an incubator for infection – even if it wasn’t your fault.

What I would suggest that you say to a client in these or similar events is something like this “Since you are not feeling well, I believe that it is in your best interest to go home and rest until you get better, the massage won’t help you and may make you worse. Let your body deal with the infection, and then call me in a week or so to rebook.

The bottom line is this, a client will 99% of the time appreciate that you are making his or her health as a priority. If a client cannot see reason in your commitment to her health or well-being, then you may risk losing her business. But, in my experience, I would rather have 20 clients who respected my knowledge and professional judgement than 40 who did not.

For more information on building and maintaining a practice, check out a fantastic, tried and true resource – Business Mastery: A Guide for Creating a Fulfilling, Thriving Business and Keeping it Successful

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

My first massage therapy treatment – is it normal to be sore?

A frequent question that I hear from new clients is “My (Aunt Betty) had a massage, and she was so sore she could hardly move the next day. Will I be sore, too?”

We have all heard horror stories about the therapist who had bone-crushing pressure and didn’t listen when asked to back off. I’ve heard another client of mine tell me that when she asked her (previous) therapist to lighten up, the response was “I’m not using a lot of pressure, and it has to hurt to work.”

I’m hear to tell you that this is NOT the case – and that massage can be very effective when applied with moderate pressure. It takes intuition, experience and time to learn just how much pressure the tissue (and a client) can take, and this amount of time varies from therapist to therapist. I’d also like to add that your massage therapist should never brush off indications of pain – as a massage therapist myself I wouldn’t go to someone else who seemed to have no regard for my pain tolerance.

Does Massage Therapy “have” to hurt?

Let me put it this way – it is normal, especially if you’ve never had a therapeutic massage before, for muscles to feel a little stiff or sore after a treatment. I think of it much the same as working out, after all, muscle tissue is being manipulated and worked, so a little discomfort is not unusual. If a person has never been to the gym before, it is not a good idea to ask him or her to leg press 100lbs, any more than it is wise for a massage therapist to put all of his or her weight behind their elbow as they perform muscle stripping on the back of a new client. Either way you look at it, if you’ve never had a treatment before, you have NO idea how your body will react or how much pressure is “enough”, and the therapist really has NO idea what “deep” means to a client. Depth of pressure is very subjective, and pain is a subjective response – what hurts to client A might feel great to client B – there is just no way to tell.

It didn’t take me long to learn that the size of the client has absolutely no bearing on how much pressure he or she can take. I have been able to use deep pressure effectively and painlessly with some very small women, and much less pressure with some very muscular and burly men. My approach is now this – when I first start treating a new client, I use broad, firm pressure, and resist the urge to “go deeper” even at their request. What I tell them before they get on the table is that the first treatment I will be very moderate because I’m not sure of how they will react – they may feel great in the days following the treatment, in which case next time I will go deeper. (here’s a question to consider – does the saying “the customer is always right” apply in this scenario?) If my client feels not so great in the days following a treatment, then I know I need to do something different and will adapt subsequent treatments to suit my client.

In a nutshell, what I would tell a client is that while some discomfort is normal, your request to a therapist to lessen the pressure should never be ignored or brushed off. You are paying for a treatment, and you always have the right to stop or modify what is happening (an FYI in case your therapist doesn’t tell you this.) If you are a therapist, especially a new one, take the time to listen to your client and his or her muscle tissue – not everyone is created the same, and it does take time to learn how much is “enough”. Also, be sure to advise your client of any possible side effects or risks associated with the treatment (informed verbal consent), and let him or her decide what is right for their body.

Massage Anatomy review – Divisions of the spine, connection of Vertebrae

Question of April 15/09
How many divisions are there of the spine? (33 bones)
- There are 5 divisions of the spine: cervical, thoracic, lumbar, sacrum, coccyx
- Cervical spine has 7 vertebrae, thoracic 12, lumbar 5, sacrum 5, coccyx 3 – 5 (fused)

Today’s Question
How are the movable vertebrae of the spine connected (cervical, thoracic, lumbar)? In addition to movement, what other significant role do they play?