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Jul 01 2009

Chair Massage and Improved Ergonomics to Prevent RSI in the Workplace

21st June 2008Author: Brandon Thomas

If you are reading this article, it is safe to say that you spend a significant amount of time in front of the computer. What you might not be aware of is that spending several hours each day at a poorly designed workspace can be a contributing factor in developing Repetitive Stress Injury (RSI). RSI is a condition that is caused by repeated strain and overuse of a specific part of the body. RSI commonly affects the upper body and causes chronic pain and inflammation of the muscles and tendons of the neck, shoulders, back, forearms, wrists and hands.

Recently, a study conducted by Microsoft found that the reported cases of RSI increased by 30% in the past year and estimated that businesses lost $600 million in lost productivity. One of the major factors cited was the increasing number of ‘mobile workers’, or those who work from laptops or mobile devices for more than one hour per day. Poor posture and technique are common culprits and if left untreated, RSI can cause weakness, numbness and impaired motor control of the affected area, sometimes resulting in surgical correction. There are also less obvious factors that can contribute to developing this painful condition. It has been noted that using a computer for more than four hours per day without taking frequent breaks increased the likelihood of developing RSI. The effects of poor posture and incorrect typing techniques are compounded and this could explain why carpal tunnel syndrome is becoming more prevalent among office workers. Working in a high stress environment and not getting enough sleep are also issues to contend with. Stress combined with physical inactivity leads to muscle atrophy and weakened muscle fibers are more prone to injury.

Chances are, most professionals have more than one risk factor for developing a repetitive stress injury, and luckily, there is an economical tool that companies can use to aid in prevention and treatment of this increasingly prevalent condition. Massage therapy has been shown to effectively reduce pain and help to prevent injuries associated with RSI. Therapeutic massage stretches and elongates muscles and helps to heal torn and damaged fibers by breaking up scar tissue. Massage reduces compression and increases circulation, which allows for better nutrition and more effective removal of toxins held within the tissues. Traditional massage may not be an option for many busy professionals but there is a convenient alternative known as chair massage. Chair massage bestows the same benefits as traditional massage, but can be performed on-site and in a fraction of the time. Chair massage is ideal for workplace environments because the chair is easily set up and requires very little space. An empty corner or unused office or cubicle can be transformed into a retreat. The unique design of the massage chair opens the back muscles while providing complete support to the head and neck A session lasts as long as an average coffee break and since no oils are used, clients remain fully dressed. Companies that offer workplace massage report lower turnover, decreased absenteeism and increased staff productivity. Employees report feeling less pain, are more focused and have a more positive attitude. With workloads and time spent in the office on the rise, chair massage is a service that companies can offer to help reduce workplace injury and contribute to the overall health of their workforce.

Tags: culprits, posture, risk factor, muscle fibers, massage therapy, neck shoulders, numbness, office workers, forearms, tunnel syndrome, tendons, poor posture, physical inactivity
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Jun 11 2009

Bodywork Techniques for Plantar Fasciitis

There is more than one approach to help someone with plantar fasciitis. In this article, learn about this inflammation of the plantar fascia and find nine ways massage can be used to relieve this common type of foot pain.

Plantar fasciitis is a common painful inflammation of the plantar fascia, the fibrous band of tissue on the sole of the foot. This tissue is instrumental in helping to support the arch and in acting as one of the body’s shock absorbers. Plantar fasciitis occurs when this band of tissue is overloaded or overstretched. This tension produces small tears in the fibers of the fascia, especially where the fascia meets the anterior calcaneous.

Plantar fasciitis is common in many types of people. Those afflicted include, but are not limited to, obese people, pregnant women, diabetics, people who repeatedly walk or stand on a hard surface, athletes and weekend warriors. In a pronated (low arch) foot, the fascia is under a constant stretch. In a supinated (high arch) foot, the fascia is under constant tension. Both of these arch extremes can easily lead to plantar fasciitis. Worn or poorly constructed shoes can contribute to the problem if they do not provide enough arch support, heel cushion or sole flexibility. In athletes, plantar fasciitis may follow intense training, especially in runners who push themselves too quickly to run longer distances.

The physiology of plantar fasciitis is a debated topic. It is widely acknowledged that this condition is associated with small tears in the fascia. However, further analysis of the tissue’s integrity is unclear. While the term uses the suffix –itis, indicating an inflammatory condition, many believe otherwise. Whitney Lowe, in issue #105 of Massage Magazine, says “There is mounting evidence that many common tendonitis complaints are actually not inflammatory problems at all, but instead are caused by a degeneration of the collagen matrix within the tissue. It has been suggested that plantar fasciitis is similar to these tendon pathologies, and that the problem is collagen degeneration in the fascial tissue.”

Symptoms of plantar fasciitis extend beyond foot pain following activity. According to Janet G. Travell, MD, and David G. Simons, MD, symptoms of plantar fasciitis primarily revolve around pain in the region of the plantar aponeurosis and/or pain in the heel. A unique characteristic of plantar fasciitis is marked pain upon arising in the morning. The first 10-12 steps are severely painful until the plantar fascia and the muscles have been stretched. The pain worsens again in the evening and after weight bearing activities.

Bodywork is extremely effective in helping people overcome the pain and limitations of plantar fasciitis. According to Art Riggs, Certified Advanced Rolfer, CMT, in his Deep Tissue Massage book, “The pain [of plantar fasciitis] is caused by tight and inflexible plantar fascia and, also by tight calf muscles. Medication and rest may improve symptoms, but if the causes are not addressed, the likelihood of recurrence is increased.”

In helping your clients overcome this condition, a focus on the plantar surface of the foot must be combined with lower posterior leg work. The posterior leg muscles attach via the achilles tendon to the calcaneous. Tightness in these muscles, mostly the gastrocnemius and the soleus, will pull on the calcaneous and add tension to the plantar fascia. It is recommended to have training in the individual bodywork techniques discussed below before applying them to your clients.

Plantar Surface of the Foot

1. Glide on the plantar surface – Following some warm-up, glide your elbow, knuckles or thumbs from the foot pad to the heel. This will help the fascia migrate back up against the calcaneus. This can prevent heel spur development. Gliding on the lateral, medial and tranverse arches on the foot also contribute to relaxing of the plantar fascia.

2. Mobilize the calcaneous – This method is courtesy of Riggs’ video series Deep Tissue Massage and Myofascial Release. With the client supine, cup your bottom hand between the ankle and heel. Use your upper hand to hold the distal part of the foot, including the ball of the foot and toes. Use your lower hand to create movement in the heel by rocking it side to side (medial and lateral) and even up and down (superior and inferior). Because the plantar fascia attaches to the calcaneous, this mobilization can aid in freeing up restrictions of the plantar fascia.

3. Strip and stretch the plantar fascia – With the client supine, grasp the toes and ball of foot with one hand and dorsiflex the foot by stretching the plantar fascia. Use thumbs or knuckles to strip the plantar fascia from the ball of the foot to the heel. This may be very painful, but very helpful. Icing the foot afterward will speed the healing process.

4. Deep transverse friction – According to Lowe, “Deep transverse friction may be used directly on the plantar fascia to stimulate fibroblast activity and tissue healing from chronic overuse. However, caution should be used in applying friction massage near the attachment on the calcaneous because of the possibility of a bone spur.” This technique can be very painful. Use the maximum amount of pressure tolerable to your client. Icing the foot afterward will speed the healing process.

5. Wring the foot – The client is prone, with his/her knee at a 90-degree angle. Using a twisting motion, wring the foot as if you were wringing out a washcloth. This can be done for the entire foot, with one hand on the heel, and the other on the ball of the foot. This can also be done for the cuneiform joints, by having one hand on the ball of the foot, and the other on the center of the instep. As the muscles relax, you can increase the speed and intensity of the wringing to bring increased circulation and range of motion to the entire foot.

Posterior Lower Leg

1. Myofascial release of the lower posterior fascial line – This technique is described in the Institute for Integrative Healthcare Studies’ Myofascial Release manual. Position your client prone with the foot off the table to assess the leg’s fascia. Cross your arms and place one hand on the calf (proximal to the belly of the gastrocnemius muscle) and the other on the lower leg (just proximal to the ankle). Stretch and wait for a release. Allow the fascia to unwind in its own time.

2. Work the plantar flexors – With the client prone, put the Achilles tendon in a stretch by placing the client’s foot against your belly. Then use your thumbs to friction the sides of the Achilles tendon. Release the foot from your belly and use one thumb to push the tendon aside. Working at the level of the malleoli, rotate your other hand in order to cross fiber the anterior part of the Achilles tendon with your index finger. Follow with a forearm glide and/or stripping up the posterior leg being careful not to put pressure on the posterior knee.

3. Treat trigger points – Use ischemic compression on trigger points of the soleus, gastrocnemius and flexor digitorum longus. James Mally, ND, in the Institute for Integrative Healthcare Studies’ Sports Massage manual, suggests having the client prone, pressing the trigger point, flexing the client’s knee and dorsiflexing the ankle. Then, Mally says to find the position where the client does not feel any pain in the trigger point (except if the point is in the soleus). Hold the point for 30-90 seconds or until a release is felt. Then bring the client back to a neutral position while continuing to hold the trigger point.

4. Posterior fascial line stretch – Have your client stretch this line by performing a forward lunge, keeping the back leg straight and the feet flat on the floor. Hold for 20 seconds without any bouncing. Release for several seconds and repeat the stretch. This stretch can also be achieved by standing on the edge of a step. The balls of the feet are on the step while the heels hang off the step. Slowly, allow the body weight to shift into the heels, so that they drop below the step. This provides a great posterior lower leg stretch.

In addition to the above massage suggestions, here are some additional tips to offer your clients with plantar fasciitis:

• Rest is recommended for the acute stage.
• A physical therapist and/or athletic trainer can offer ultrasound, a stretching protocol, strengthening exercises and adequate taping.
• Supportive shoes or heel cups are helpful to many people.
• A podiatrist can fit your client for orthotics and/or a nighttime brace.
• Ice decreases inflammation and reduces the pain. Roll the foot over a firm cold object, such as frozen golf balls or a can of frozen juice concentrate.
• Surgery is available, hopefully as a last resort.

Plantar fasciitis is an increasingly common condition. An understanding of the anatomy and physiology of the foot and lower leg is very important in rendering appropriate care. Communication and collaboration with other healthcare professionals will provide your clients with the most comprehensive and effective treatment plan. Because massage therapists have such powerful tools to relieve plantar fasciitis, more bodyworkers will focus on and team up with professionals who treat this condition. Mastering the techniques described here, and making them your own, will give you a leg up on the pain of plantar fasciitis.

Recommended Study
Myofascial Release, Sports Massage

Posted by Nicole at 12:26 PM
© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute.

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May 23 2009

The Far Reaching Benefits of Workplace Massage in New York City

16th September 2008Author: Brandon Thomas
Views: 20
New York is a fast growing, rapidly changing metropolis with a population of more than 8 million people. The city has long been an important center for shipping, finance, media and culture and the New York metropolitan area serves as the headquarters for many of the world’s largest corporations. The job opportunities are as varied as the population and all hope to attract the best and brightest professionals. There is stiff competition among companies to lure well-qualified candidates and retain them once they are hired.

Once hired, many employees find themselves over stressed and fatigued do to the competitive and fast paced nature of New York’s corporate culture. Increased levels of stress can have an adverse effect on job performance and health if left unaddressed. Excess stress has been shown to cause insomnia, chronic headaches, overeating, an inability to focus and can contribute to more serious problems such as high blood pressure, heart disease and stroke. Employers see an increase in absenteeism, lowered productivity and poor office morale, which translate into lost revenue.

A growing number of corporations are implementing employee wellness programs to keep their staff healthy and to reduce the frequency of sick days. Chair massage is an excellent addition to a corporate wellness program because of its convenience and lasting benefits. Therapeutic massage has been proven effective in calming anxiety, reducing stress and improving mental clarity. Physical benefits include relief from muscle aches, lowered blood pressure, improved circulation and improved immune system function.

Chair massage is ideal for a workplace setting because it requires only a small amount of space and is performed in short but thorough sessions. Sessions normally last between 5 and 15 minutes, which is within the span of a typical coffee break. Chair massage therapists do not use oils or lotions, which allows professionals to maintain their appearance and remain completely dressed. Positive results can be felt immediately and are long lasting. Work related injuries, resulting from poor ergonomics or repetitive stress and strain are escalating among office workers. New York massage services can alleviate pain caused by muscle strain and reduce tenderness and swelling of areas affected by repetitive stress injuries such as carpal tunnel syndrome. The improved circulation that New York chair massage provides helps to rid tissues of excess fluids and toxins, while facilitating the flow of important nutrients to the area. Harried professionals often consume high levels of refined sugar and caffeine, which contributes to a nutrient-poor diet. A poor diet coupled with increased stress can take a toll on the immune system’s ability to ward off illness by hindering the production of white blood cells. A short New York City massage releases toxins and heightens the production and effectiveness of the body’s natural germ fighters.

Morale and job satisfaction are also major concerns for employers. A low office morale can greatly reduce productivity by fostering feelings of apathy and an individual’s inability to effect change. Workers within such environments report feeling burned out, unmotivated and overly anxious. The negative effects of stress are multiplied and can cause a marked increase in absenteeism and employee turnover. Companies that offer regular employee massage have found it to be a cost effective way to improve workplace morale, attract top performers and view it as an opportunity to show their commitment to their employees’ physical and emotional health.

Tags: high blood pressure, mental clarity, reducing stress, immune system function, therapeutic massage, coffee break, chronic headaches, levels of stress, chair massage, massage therapists
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May 23 2009

Chair Massage is an Effective Marketing Tool for Trade Shows in New York City

15th September 2008Author: Brandon Thomas
Views: 15
New York City is a top destination and hub for the world’s most prominent companies. It’s no surprise that New York’s metro area convention centers and large venues are booked with trade shows featuring the latest innovations and products for a wide variety of applications, spanning across numerous industries. Spaces at these events are often limited and exhibitor’s fees alone can cost thousands of dollars. Advertising, furnishing and operating a trade show booth is also costly, and the price for transportation and lodging of employees comes at a premium.

With all of the time, effort and money spent on promoting a company’s products at a trade show, it is imperative that the booth stands out among the crowd. Most corporate trade show booths offer brochures and promotional gifts to entice visitors to spend a few moments hearing about what they offer. However, these tactics are proving to be less effective as a means of attracting and retaining potential clients long enough to see a product demonstration or to hear the sales pitch. More often than not, visitors will give most corporate booths a passing glance and pick up a brochure or free pen, and then continue on their way. This makes it quite difficult for the sales team to assess whether or not they have made a lasting impression, or generated a quality lead. Spending meaningful face time with a potential client is the most effective way to produce valuable sales leads.

Offering a free chair massage at a corporate trade show booth is an enjoyable and cost effective marketing tool aimed at providing an exhibitor with increased visibility and face time with future clients. The massage chair is easily set up and is ideal for a trade show environment because a fully functional station can operate in a very compact space. Chair massage therapists do not use oils or lotions, which eliminates the need to undress. The massage is performed over clothing and sessions last for an average of five minutes. A New York chair massage is an excellent draw to a company’s booth because most trade show visitors have traveled a significant distance and are on their feet for extended periods of time. These factors can cause visitors to feel fatigued and lacking focus, which take away from the impact of the marketing message. A free massage is always attractive to weary trade show attendees, and many will wait in line just to receive one. A small crowd gathered at your corporate booth will attract more attention and the time that guests spend there will increase exponentially. Your sales team will have an extended opportunity to meet and speak with potential clients as they wait for their free chair massage, resulting in a positive effect on the number of quality leads they can generate while providing increased exposure for your company’s products.

Chair massage is also a great way to garner positive name recognition for your company and products. A short, thorough session soothes aches and calms anxiety. Recipients of New York massage services feel relaxed and invigorated with an enhanced sense of well being. These feelings are long lasting and correlate directly with the company that provided them with the enjoyable experience.

Tags: marketing tool, time effort, latest innovations, massage chair, trade show booths, lasting impression, cost effective marketing, chair massage, massage therapists, undress, trade show booth, promotional gifts, metro area, face time
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May 18 2009

Eight Tests for Anterior Knee Pain

Anterior knee pain is a common complaint presented to bodyworkers. Learn how to perform eight orthopedic knee tests to determine when a referral to another healthcare professional is warranted.

As recognition of massage therapy’s importance within health care increases, so does the demand for educated and skilled practitioners. The widespread acceptance of therapeutic massage as a viable pain-relieving option leads many sufferers to see a massage therapist before visiting their physician. Since some orthopedic conditions can be aggravated by therapeutic massage, identification of and referral for these conditions is a testament to a therapist’s competency.

Anterior knee pain presents an ideal opportunity for employing condition differentiation skills. The body’s initial weight-bearing joint is stabilized most by ligaments, making the knee highly susceptible to injury. Using client history, observatory, palpatory and manual resistive testing skills, a therapist can confidently isolate injuries conflicting with massage and avoid manipulating a knee requiring medical attention.

Adding some simple orthopedic tests to a massage therapist’s evaluation can greatly enhance their assessment skills. The descriptions of specialized manual resistive tests for anterior knee pain is not intended to teach diagnosis, but rather, to help a therapist identify possible conditions requiring a referral to another healthcare professional; such as a physician, orthopedist, chiropractor or physical therapist.

A massage therapist increases his/her value exponentially, by knowing when to refer out. According to Benny Vaughn’s video, Functional Assessment Skills for Massage Therapists, “Knowing when NOT TO is just as important as knowing when TO.” Following a knee injury, a foot blue in color and cool to the touch is indicative of a dislocation. Signifying a serious injury to the foot’s blood vessels, this condition should be considered an emergency and professional help must be sought immediately.

When addressing anterior knee pain, the following injured structures mandate additional professional evaluation:

• Cruciate Ligaments -The cruciate ligaments stabilize the knee by crossing over each other in an X formation, from the upper to lower leg. Located in the center of the knee joint, the anterior cruciate ligament (ACL) is the major stabilizing ligament of the knee, connecting the femur to the tibia. The ACL prevents anterior displacement of the tibia, which would cause a knee to buckle. Of the four major ligaments of the knee, the ACL injury is the most common knee ligament injury.

The posterior cruciate ligament (PCL) also connects the femur to the tibia. The PCL prevents posterior displacement of the tibia. While this ligament is stronger than the ACL, and less frequently injured, it is still important to test for when faced with mysterious knee pain.

• Collateral Ligaments – The collateral ligaments are the ligaments on either side of the knee joint. On the outer aspect of the knee is the lateral collateral ligament (LCL), and on the inner aspect is the medial collateral ligament (MCL). The LCL stretches from a tubercle on the femur’s lateral condyle to the lateral surface of the head of the fibula, while the MCL connects the femur’s medial epicondyle to the medial tibial condyle. At its midpoint, the fibers of the MCL are firmly attached to the medial meniscus. Damage to the collateral ligaments typically involves significant force, such as a blow to the side of the knee during contact sports or a bad fall.

• Meniscus – There are two C-shaped pieces of cartilage in the knee joint, the lateral meniscus and the medial meniscus. Knee stabilization, joint lubrication and shock absorption are the three primary functions of the menisci.

• Chondromalacia patella – Patello-femoral syndrome indicates pain between the femur and patella. The patella is designed to glide smoothly over the femur, however, poor alignment causes inflammation and pain, indicating chondromalacia patella. Chondromalacia patella is the most common source of chronic knee pain, causing pathological changes and possibly leading to deterioration of the articular surface of the patella.

Manual resistive tests can give the massage therapist a substantial amount of information regarding the functioning of these knee components. A painful response from a client indicates a serious injury, necessitating a referral, as does a positive indication for any of the following tests described by Vaughn:

1. Lachman Test – The Lachman Test stresses the ACL to detect anterior tibial displacement. Performed with the client supine, the therapist grasps the distal portion of the thigh and the proximal portion of the lower leg to create anterior-posterior shifting. This shifting at the knee joint is from pulling the proximal tibia anteriorly, then pushing it posteriorly. Make certain there is a slight bit of flexion in the knee to create some hamstring slack, as hamstring tension can interfere with this test. A positive test is assumed when the movement feels “mushy” (soft endpoint), has a gapping sensation, or when excessive glide is noted. A positive test suggests ACL damage and requires a referral.

2. The Drawer Tests – The Anterior Drawer Test stresses the ACL and will detect its weakness. Performed with the client supine, the knee is flexed at a 45-degree angle with the foot flat on the table. By sitting on or just past the foot, the therapist stabilizes the leg to prevent its movement. The therapist grasps the proximal portion of the tibia with both hands and yanks towards him/herself.

The Posterior Drawer Test is performed immediately following the Anterior Drawer Test’s forward tibia yank. The Posterior Drawer Test stresses the PCL, and is done by pushing the tibia back towards the client’s thigh. Positive Drawer Tests occur when the movement feels mushy (soft endpoint), has a gapping sensation or when excessive movement (anteriorly or posteriorly) is noted. A positive test suggests ACL or PCL damage and requires a referral.

3. Valgus Stress Test – The Valgus Stress Test puts pressure on the medial collateral ligament. The client lays supine with extended legs. While supporting the thigh and stabilizing the leg with a firm distal leg grasp, the therapist applies pressure to the lateral aspect of the knee by pushing medially. The knee is slightly flexed to avoid tightened hamstring muscles, which are capable of interfering with the accuracy of this test. The creation of pain or a widened joint space indicates a positive test and requires referral for further evaluation.

4. Varus Stress Test – The Varus Stress Test puts pressure on the lateral collateral ligament. Positioning is identical to the Valgus Stress Test except pressure is applied to the medial aspect of the knee by pushing laterally. The creation of pain or a widened joint space indicates a positive test and requires referral for further evaluation.

5. Apley Compression Test – The Apley Compression Test puts pressure on the meniscal cartilage. The client lies prone with the leg at a 90-degree angle to the thigh. The therapist grasps the plantar side of the foot and pushes down into the table. If there is no response, this test can be exaggerated by adding internal and external rotation of the tibia to the downward compression. Because compression traps the meniscus, pain indicates possible meniscal cartilage involvement. When rotation is added to the compression, pain can indicate injury to the meniscus, knee ligaments or both.

6. Apley Distraction Test – The Apley Distraction Test puts traction on the tibia, decompressing any pressure on the meniscus. The client lies prone with the leg at a 90-degree angle to the thigh. The therapist stabilizes the thigh by using the weight of their leg to prevent movement. Hold the ankle with both hands and pull straight up towards the ceiling, relieving any pressure on the meniscus.

If the Apley Compression Test elicits pain, and the Apley Distraction Test provides pain relief, then the likelihood of meniscal injury is high. If the reverse is true, where pain exists on distraction but not compression, then the collateral ligaments may be injured. In either case, a positive finding suggesting meniscal injury or collateral ligament injury necessitates a referral.

7. Patellofemoral Compression Test – The Patellofemoral Compression Test puts pressure on the patella. The client sits on the table with the lower legs hanging over the side. The therapist compresses the patella while the client flexes and extends his/her leg within a 35-degree range. The flexion and extension can be done actively (by the client), or passively (by the therapist). A positive test elicits pain or discomfort, indicating patello-femoral syndrome and a subsequent referral.

8. Clarke’s Sign – Clarke’s Sign is a test designed to identify the presence of chondromalacia patella and can only be done once. A positive test will cause a significant amount of discomfort or pain, and most clients will not allow for its repeat. The patient lies prone. With the web of the hand the therapist presses the patella down towards the feet in an inferior direction. The client is then asked to contract the quadriceps muscle as the therapist continues applying force. The test is positive if the patient cannot complete the contraction without pain, or has a great deal of apprehension about tightening their quads. A positive Clarke’s sign requires a referral; however, quadriceps, hamstring and adductor massage may reduce the pain in the meantime.

Incorporating these manual resistive tests into a massage therapist’s skill set requires practice. It is highly recommended to rehearse new maneuvers on uninjured volunteers before using them in a therapeutic setting. While the descriptions provided act as a guide, live training or repeated video viewing (such as Vaughn’s video) provides complimentary visual support. As a therapist’s comfort level for performing the preceding tests rises, so will his/her confidence in safely working with anterior knee pain.


Functional Assessment Skills for Massage Therapists. Writ. Benny Vaughn. Benny Vaughn Associates. 1997.

Posted by Nicole at 11:07 AM

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

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Apr 25 2009

Sports Massage Adds a Performance Edge

Sports massage has evolved into a critical component of athletes’ training and recovery programs. This article clarifies the ‘when, what and why” of this specialized modality and how it can dramatically impact an athlete’s performance.

Serious athletes typically utilize sports massage therapy to recover from injuries and/or to maintain flexibility, strength and their performance edge.

Sports massage therapy, a recognized, valuable addition to other physical therapies and treatments, has become just as much a part of an athlete’s routine as diet and exercise. A sports massage therapist is the last person to touch many professional athletes prior to their competition. Athletes from all over the world, in every sport, have come to comprehend the advantage of a massage therapist with a thorough understanding of anatomy and kinesiology, the muscles used for a given sport and the wisdom to anticipate areas prone to injury.

Michael McGillicuddy, LMT, NCTMB, states in the May 2003 issue of Massage Today, “Sports massage is the specific application of massage techniques, hydrotherapy protocols, range of motion/flexibility protocol and strength-training principles utilized to achieve a specific goal when treating an athlete.” Keys to understanding these principles of sports massage, says McGillicuddy, are the “when, what and why” of sports massage; mainly timing, technique and intent.

Possibilities include:

• Pre-event massage
• Post-event massage
• Maintenance massage
• Rehabilitation massage

Technique refers to what applications will be used. Different techniques specific to sports massage include, but are not limited to, effleurage, friction, petrissage, vibration, shaking, compression, broadening, direct pressure, cross-fiber friction, range of motion, trigger point, counterstrain, reciprocal inhibition and proprioceptive neuromuscular facilitation (PNF) stretching.

The intention behind administering sports massage ranges from:

• Increasing blood flow
• Aiding recovery from exhaustion
• Increasing flexibility
• Improving strength and posture

Pre-event Massage
Pre-event massage typically occurs at the sports event, just prior to the athlete’s participation. Dr. James Mally, instructor of the Institute’s Sports Massage course, states that pre-event massage should take place prior to, but not replace a warm-up, approximately 20-30 minutes before the event. Pre-event massage focuses on the muscles that will be stressed most during competition. Depending on the sport, pre-event massage often uses friction to help warm the body, compression to increase blood flow to targeted muscles, and range of motion to prepare neural pathways and assist with joint mobility.

Pre-event massage routines and techniques depend upon the event the athlete is preparing to compete in. Examples include:

• Swimmers and runners require quick reaction time.
• Boxers need their muscles to remain loose.
• Gymnasts require flexibility.

Each competitor will require a unique combination of techniques designed to maximize his/her performance. Pre-event massages are typically vigorous with the intention of imparting speed, power and endurance.

Pre-event massage effects include:

• Dilating blood vessels, which results in improved cellular nutrition to the muscles.
• Improving circulation to tendons and ligaments.
• Relaxing muscle antagonists, which results in greater muscle efficiency.
• Releasing trigger points that could negatively affect athletic performance.
• Increasing flexibility – best for gymnasts and athletes who require flexibility.
• Preventing and treating muscle spasms.
• Preparing the body’s nervous system for strenuous activity.
• Increasing heart rate, respiratory rate and body temperature.

Post-event Massage
Post-event massage is performed at the event site after competition. This work requires a great degree of skill and knowledge to assist the athlete in recovery. Reducing muscle soreness and/or cramping while reestablishing range of motion and blood flow can facilitate a faster return to training after an event. Post-event massage is given for 10-15 minutes following a cool-down period of about 15-20 minutes. Cuts, bruises, blisters, mild strains, sprains or muscle cramps must be treated prior to massage. If muscle cramps are due to dehydration, medical attention should be sought immediately.

Post-event massage might consist of compressive effleurage for calming the nervous system and pushing fluid, petrissage for easing muscle tension, compression for spreading muscle fibers and restoring blood flow, broadening strokes to lengthen tight muscles, and compressive effleurage as a finishing stroke to soothe the athlete. Stretching can relieve muscle tension and restore range of motion while reciprocal inhibition can relieve muscle cramps not due to dehydration. Athletes usually look forward to a post-event massage because the benefits are experienced immediately.

Maintenance Massage
Sports maintenance massage is performed when an athlete is not competing in an event. An effective maintenance program focuses on an athlete’s strength, flexibility, coordination, biomechanics, posture, stress patterns, scar tissue and existing injuries. It is important to determine if an injury is acute or chronic, as this will dictate the appropriate technique to use and prevent exacerbation of the injury.

A sports massage maintenance program designed to meet a specific athlete’s needs can add a significant edge to his/her performance. McGillicuddy advises a sports massage therapist to design a maintenance program based on information gathered from discussing the athlete’s existing goals and watching the athlete’s workouts or competitions. In addition, recording current or previous injuries, evaluating prior treatments and setting specific performance goals with the athlete contributes to designing an ideal maintenance program.

Rehabilitation Massage
Even with preventive maintenance, athletes’ muscles cramp, tear, bruise and ache. While rehabilitative sports massage should only be performed in conjunction with proper medical care, it can significantly speed healing and reduce discomfort.

Because rehabilitative sports massage techniques can temporarily increase pain and inflammation, massage on acute injuries is traditionally followed by cryotherapy. When assisting the proper formation of scar tissue, McGillicuddy suggests using effleurage, compression and cross-fiber friction, followed by ice treatment and movement. Additional techniques employed for rehabilitation include lymphatic and trigger point massage. In the acute stage of injury, lymphatic drainage massage can decrease swelling and accelerate the healing process. Trigger point or neuromuscular therapy can reduce spasms and pain in both the injured muscles, and those compensating for the injury.

An accomplished sports massage therapist applies the correct sports massage technique in every situation. Dr. Mally suggests beginning with the gentlest methods, then progressing toward those that are more active. Trial and error typically helps delineate what is most beneficial for the athlete. Learning about common sports injuries, mastering the principles of each technique and fully comprehending musculoskeletal anatomy and kinesiology all play a part in becoming a successful sports massage practitioner.

Recommended Study
Sports Massage


Mally, Dr. James. Sports Massage, Abundant Health Resources, 2002.

McGillicuddy, Michael. Three Key Principles of Sports Massage, Massage Today, May, 2003.

McGillicuddy, Michael. The Art and Science of Pre-Event Massage, Massage Today, July, 2003.

McGillicuddy, Michael. The Art and Science of Post-Event Massage, Massage Today, September, 2003.

McGillicuddy, Michael. The Art and Science of Sports Maintenance Massage, Massage Today, December, 2003.

Posted by Nicole at 10:53 AM

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

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Mar 18 2009

Reduce Spasms and Improve Flexibility with Reciprocal Inhibition

The fundamental mechanism of how our bodies maintain posture and produce movement is based simply on the balance of continually contracting and relaxing opposing muscles. Discover how using this principle, reciprocal inhibition, helps reduce spasms as well as strengthens and improves flexibility in your clients.

by Nicole Cutler, L.Ac.

Originally used by osteopaths, athletic trainers, physical therapists, kinesiologists and physiotherapists, reciprocal inhibition is a simply learned stretching principle capable of amplifying the benefits of massage therapy treatment. Defined as a muscle’s automatic relaxation response to accommodate the contraction of its opposing muscle, reciprocal inhibition provides for optimum joint function and longevity. Commonly used in sports massage, reciprocal inhibition is the application of resisted tension to the opposing muscle group.

The symbolism of yin yang is akin to human muscular anatomy, where a healthy functioning unit is comprised of two contrasting forces. Just as there could be no concept of dark without light, flexor muscles need their opposing extensors to function properly. Our muscles primarily operate in pairs; when one contracts (the agonist) its partner (the antagonist) relaxes. The body naturally and brilliantly orchestrates this mechanism during activities like running, where muscles opposing each other are engaged and disengaged sequentially to produce coordinated movement. This alternation of contraction facilitates movement ease and safeguards against injury. Classic examples of opposing muscle group partnerships include the biceps and triceps, as well as the hamstrings and quadriceps.

If a muscle becomes engaged for a prolonged period, such as a cramp, spasm or chronic tension, the opposite muscle becomes correspondingly inhibited. This response to dysfunction inhibits normal joint performance, which can result in deterioration of muscle, tendon and joint tissues. In the case of affected upper arm musculature, spasms in the biceps will likely lead to a discovery of weakened triceps. Whenever the agonist is much stronger than the antagonist, the agonist can overpower and injure the antagonist. This relationship is why most strength training programs revolve around balanced muscle pair exercises. While not exhaustive, the following list comprises nine common agonist-antagonist muscle pairs that can assist a practitioner when using reciprocal inhibition techniques:

1. Biceps – Triceps
2. Deltoids – Latissimus Dorsi
3. Pectoralis Major – Trapezius/Rhomboids
4. Iliopsoas – Gluteus Maximus
5. Quadriceps – Hamstrings
6. Hip Adductor – Gluteus Medius
7. Tibialis Anterior – Gastrocnemius
8. Anterior Deltiod – Levator Scapula
9. Forearm Flexors – Forearm Extensors

Inhibition of the antagonistic muscles is not required for every muscular contraction. In fact, co-contraction can sometimes occur. This can be observed during a sit-up, where one might assume that the stomach muscles inhibit the contraction of the muscles in the lumbar region of the back. However, sit-ups engage contraction of both the spinal erectors as well as the abdominal muscles. This reciprocal inhibition exception is one reason why sit-ups are good for strengthening both the back and stomach muscles. Thus, careful evaluation of the musculature involved is a precursor to choosing reciprocal inhibition stretching techniques.

Activation of an opposing muscle group with resisted tension forces the contracted muscle to relax. For example, a cramp in the posterior, lower leg can be relieved by applying resisted tension to the anterior, lower leg muscles. When stretching, it is easier to stretch a muscle that is relaxed than to stretch a contracted muscle. By inducing the antagonists to relax during a stretch due to contraction of the agonist, massage therapists can take advantage of reciprocal inhibition by getting a more effective stretch.

An additional key to maximizing stretching is to have the client consciously relax any muscles used as synergists by the muscle attempting to be stretched. For example, a gastrocnemius stretch can be accomplished by contracting the tibialis anterior through foot flexion. However, since the hamstrings use the gastrocnemius as a synergist, have the client also relax the hamstrings with quadriceps contraction by keeping their leg straight.

The principle behind reciprocal inhibition stretching is that the muscle not contracting is inhibited because the stretch suppresses contractibility. Prior to working with a muscle, initiating the reciprocal inhibition response will enhance the results of any stretching regimen. Applying reciprocal inhibition to the appropriate muscle groups can stop a muscle spasm, build strength and flexibility in opposing muscle pairs, prevent re-injury to a vulnerable area and dramatically increase your client’s flexibility. Learning to perform this specific type of stretching allows massage therapists to utilize their knowledge of anatomy and physiology for maximizing their therapeutic effectiveness.

Recommended Study:
Anatomy Review for Professionals
Sports Massage

References:, Inhibition and False Positives, Applied Motor Control, 2007., Physiology of Stretching, Brad Appleton, 2007., Anatomy, International Fitness Association, 2007., Using Reciprocal Inhibition in Stretching, Jim Biancolo, 2007., Flexibility: A physiotherapist explains the science behind the importance of keeping flexible, Chris Mallac, Peak Performance, 2007., Glossary, Sport Specific Fitness Corporation, 2007.

Posted by Editors at 03:31 PM

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

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Mar 13 2009

6 Considerations for Performing Massage on a Cruise Ship

Those in the massage therapy field often regard employment on a cruise ship as the ultimate job. Although there are many benefits to this type of work, find out why only certain individuals are suited to withstand cruise ship employment’s many challenges.

by Nicole Cutler, L.Ac.

Regarded as one of the more opulent vacation options available, cruising can be an amazing way to spend a holiday. For many cruising vacationers, nothing spells luxurious relaxation more than splurging on a massage. In addition to top-of-the-line spas, cruise ships typically offer just about anything one could want within one vacation such as:

· Endless buffets
· Unique shopping
· Beautiful ocean views
· High quality entertainment
· Pools and hot tubs
· Visits to several desirable destinations
· Casino gambling and other types of gaming
· Sports and other recreational activities

In the ship’s spa, massage therapists are an invaluable part of the staff. Those lucky enough to be a passenger on a cruise ship might consider what it would be like to work on one of these lavishly appointed moving cities. In fact, performing massage on an ocean-going vessel is a dream job for some people. However, the daily life of being a cruise ship staff member can be grueling for others. Before setting your heart on being a massage therapist on board a cruise ship, make sure this lifestyle is for you.

Six Considerations
Having some insight into the reality of working on a cruise ship can make certain that it is worth your effort to land this kind of job. Below are six reasons that you might want to consider or abandon a goal of working for a cruise line:

1. Hard Work – Because they are on vacation and looking to relax and be pampered, cruise passengers are highly likely to schedule a massage treatment. This translates to a busy schedule for the practicing therapist. For five and a half days a week, back-to-back sessions over a 10 to 12-hour shift is typical for massage therapists on a large ship. Only those who are energized by their work, use proper body mechanics, center themselves between each client and don’t mind repetition can happily survive this type of scheduling.

2. Rocking Boat – Regardless of how much it may feel like you are in a small city, a ship often traverses rough seas. Big waves cause significant movement on board. In addition to the added challenge of giving a massage while the ground beneath you is rocking, many people on board succumb to motion sickness. Although there are temporary remedies for motion sickness (acupressure wrist bands, scopolamine patches, or over-the-counter medicines such as Dramamine or Bonine), you may not wish to deal with this awful sensation on a regular basis. Some people are particularly prone to motion sickness on a boat while others seem to be hardly affected at all.

3. Living Quarters – The staterooms for paying passengers can be pretty fancy, including amenities like a balcony, vanity and sitting area. However, accommodations for crew members are far from luxurious. It is typical for ship staff to share a tiny cabin with a fellow employee on the lower decks, possibly without a window and just enough space for sleeping. If you cherish your privacy and are prone to claustrophobia, working on a cruise ship could prove difficult for you. On the other hand, if you are comfortable in tight living quarters and enjoy the social opportunity afforded by a roommate, working on board could be a good career move.

4. Ports of Call – Unless specifically seeking employment on a cruise-to-nowhere (yes, these do exist), each cruise typically docks in several ports of call. For many of the crew, this is an incredible and inexpensive way to travel and have new experiences. If your day off coincides with the ship being at a port, the destination is yours to explore. However, a lot of the money you were hoping to save can easily be spent in tourist locations. For therapists aiming to build up their finances by working on a cruise ship, restraint on extraneous spending is required.

5. Commitment – Once hired and trained to work on a cruise ship, a sizeable commitment is required. While some cruise lines hire massage therapists directly, the majority of them contract with Steiner Leisure Ltd. Steiner operates spas and salons on 118 cruise ships, as well as in 52 resort spas and two day spas. Once chosen by Steiner, applicants must complete a mandatory training program and then commit to an eight-month contract. Upon completion of the eight months, massage therapists can sign up for subsequent contracts of shorter length. For those without family and other obligations at home, a guaranteed eight months of work may be greatly appreciated. However, being away for nearly three quarters of a year could be a struggle for others.

6. Salary – One of the benefits of working on a cruise ship is that your room and board are paid for, leaving any money you make free for other uses. Estimates of the actual earning capacity of massage therapists on cruise ships vary greatly. While reports of massage therapist salaries on a ship have claimed up to $3,500 per month, this appears to be an inflated estimate. Although staff members receive a weekly retainer, the majority of a massage therapist’s income comes from commission via tips or product sales. In addition, the more modalities you are trained in, the more likely you are to be booked. Massage therapists offering sessions beyond Swedish massage, especially sports massage, deep tissue, reflexology, and hot stone massage can book more appointments – and thus earn more money. Don’t forget that while on board, your necessary living expenses are all paid for. If you can refrain from unnecessary spending on the ship or in a port-of-call, are customer service oriented and are comfortable selling related products, massage on a cruise could be very lucrative.

There are benefits and drawbacks to any business venture, and the cruise industry is no different. Massage therapists hoping to travel like paying passengers need not apply for cruise ship employment. If you are game for hard work, not bothered by a rocking boat, comfortable in small, shared living quarters, enjoy traveling for long periods of time without lavish spending, are trained in various modalities and are fueled by commission-based work, performing massage therapy on a cruise ship can be a rewarding, adventurous and profitable venture.


Bemis, Mary, A Delicate Balance, Can Spas and Massage Therapists Coexist?, Massage & Bodywork, April/May 2006.

Johnson, Ruthanne, Cruise Industry Employment, Massage & Bodywork, October/November 2003.

Versagi, Charlotte Michael, LMT, How Can I Get A Job on a Cruise Ship?, Massage Magazine, January/February 2001, Steiner Info,, 2007., Cruise Line Massage Therapy Jobs, Massage Certification, 2007., Employment on Cruise Ships: Not Your Everyday Job,, 2007.

Posted by Editors at 09:45 AM

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

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Mar 08 2009

How to Avoid Dry Skin from Frequent Hand Washing

Washing your hands before and after every massage client is hygienically necessary, yet doing so typically dries out the skin of healthcare providers. By implementing these five solutions for keeping their hands healthy, massage therapists can avoid the sore and irritable skin damage attributed to frequent hand washing.

by Nicole Cutler, L.Ac.

In the healthcare profession, hand washing is essential to stop the spread of potentially serious infections. To prevent transmitting pathogens, massage therapists are constantly washing their hands – before a client, after a client, before eating, after eating and after going to the bathroom. For a therapist who sees eight clients in a row, that can add up to over 20 hand washings during one day at work! While this habitual cleansing is mandatory for a healthy environment, it can also result in dry, chapped hands – which can eventually progress to dermatitis. To prevent the spread of germs and maintain healthy skin, bodyworkers have to pay extra attention to the condition of their primary diagnostic and treatment tool: their hands.

Skin 101
The largest organ of the human body, our skin protects us from our environment. With an outermost epidermal layer only 1/250th of an inch, and the dermis being only 1/50th to 3/25ths of an inch thick, the skin’s protective function can be interrupted without difficulty. Repeated hand washing easily leads to drying of the skin and microscopic cracks.

Since healthy skin has a slightly acidic pH, exposure to alkaline substances (such as many commercial cleansers and hand soaps) contributes to a disruption in the skin’s integrity. While a homeostatic repair mechanism repairs the skin’s barrier, continued exposure to alkaline substances will slow down this repair by inhibiting normal skin acidity. Used in most soaps, sodium lauryl sulfate is a foaming agent naturally derived from coconut and/or palm kernel oil. In its concentrated raw form, it has an approximate pH of 10, which is very alkaline and drying to the skin.

Once the top layer of the skin cracks due to recurrent wet/dry cycles, especially in conditions of low humidity where drying occurs rapidly, it results in inflammation. This is how irritant hand dermatitis begins. The swollen, reddened and itchy skin characterized by dermatitis is familiar to many frequent hand washers.

Affecting all types of healthcare workers, dry skin and dermatitis are two conditions linked to frequent hand washing. In fact, the National Institute for Occupational Safety & Health (NIOSH) states that skin injuries and diseases account for a large proportion of all occupational injuries and diseases. A recent study conducted in collaboration with NIOSH and the American Academy of Dermatology focused on 100 healthcare workers in Cleveland who washed their hands at least eight times daily. Participants completed questionnaires identifying the frequency of hand washing, family history of dermatitis and medical condition history. Researchers used patch tests to determine how easily detergents irritated the participants’ skin and to predict which patients were at risk for hand dermatitis.

According to Susan T. Nedorost, dermatologist and associate professor of dermatology at University Hospitals Case Medical Center in Cleveland, “Our findings confirm that healthcare workers who wash their hands repeatedly are at an increased risk of developing hand dermatitis, which can take months to heal. This knowledge can help workers at risk for the condition to practice good hand care and follow preventative tips to decrease their risk factors on the job.”

Of particular interest, analysis of the data highlighted that the most important factor in predicting those at risk for hand dermatitis was a reaction to the detergent sodium lauryl sulfate (SLS). Specifically, the large percentage of participants who reacted positively to SLS and developed hand dermatitis far outweighed the number of participants who did not react positively to SLS, but subsequently developed hand dermatitis. Considering the highly alkaline pH of SLS, it’s not surprising that it was associated with dermatitis in this study.

5 Solutions
Since repeated hand washing is required for massage therapists, taking good care of their hands is very important. Suggestions for preventing the damage to the skin typically inflicted by frequent hand washing include:

1. Choose your skin cleanser carefully. Make sure to use a pH-balanced skin cleanser and, if sensitive to SLS, use hand cleaners free of this foaming agent.

2. Especially important if not working with oils or lotions during a session, make sure to moisturize after every hand washing. Moisturizers coat the skin with oil, block evaporation of the skin’s natural moisture and trap water in its surface. While they can’t cure dry skin, moisturizers provide protection, relieve the dry, itchy feeling and reduce the tendency to crack. Although most of the water in the cream or moisturizer evaporates, the oil stays on as a lubricant, enabling the skin to retain moisture. In addition, apply a good hand cream every night before bed.

3. Give your hands a weekly paraffin treatment to help them recover from all of the hand washing. Paraffin is soothing to the skin because the wax is mixed with mineral oil. The heated seal that the wax creates allows the oil to penetrate the skin deeply for moisture restoration.

4. When not at work, protect hands from further damage. Minimize direct exposure to cold, dry weather by wearing gloves when submersed in these elements.

5. Maintain moisture inside and outside your body by drinking plenty of water and using a humidifier if the air in your home is dry.

As the single most important step towards infection control, healthcare professionals must wash their hands frequently. As such, massage therapists often encounter the consequences of washing their hands ten times a day or more. Make sure to pay extra attention to your hands’ moisture and periodically pamper your mitts. By making good hand health a priority, even bodyworkers can avoid dry, cracked, itchy and irritated hands.

References:, New Study Finds Frequent Hand Washing Puts Health Care Workers at Increases Risk for Irritant Contact Dermatitis, American Academy of Dermatology, February 2008., FAQ, Earthscience, 2008., Heal Chapped, Dry Hands, Health Magazine, 2008., Handwashing: Breaking the Chain of Infection, Amy Walker Barres, Virgo Publishing, LLC, 2008., Dermatitis, Mayo Foundation for Medical Education and Research, 2008., What Should I Recommend for Severe Dry, Cracking Skin?, Margaret A. Fitzgerald, MS, APRN, BC, NP-C, FAANP, Medscape, 2008., Excessive Hand Washing Linked to “Hand Dermatitis”, Laura Walter, Penton Media Inc., February 2008.

Posted by Editors at 03:16 PM

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

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