Archive for the 'Medical Abbreviations and Terminology' Category

Aug 03 2009

Understanding Lymphedema

Swelling is one of the client complaints frequently encountered by bodyworkers. With implications ranging from mild to severe, there is typically great confusion about the differentiation between swelling, edema and lymphedema. Learn how to distinguish lymphedema from other conditions and the unique massage techniques needed for effective treatment.

by Nicole Cutler, L.Ac.

Defining each condition is an essential first step for every healthcare professional:

1. Swelling is a more general term, encompassing both edema and lymphedema. According to WebMD, “swelling is an increase in the size or a change in the shape of an area of the body. Swelling can be caused by collection of body fluid, tissue growth, or abnormal movement or position of tissue.”

2. Edema is a slightly more specific term, limiting the cause of swelling to fluid accumulation. According to Barron’s Dictionary of Medical Terms, edema is “an abnormal collection of fluid in spaces between cells, especially just under the skin or in a given cavity or organ.”

3. Lymphedema is even more specific, describing the fluid that has accumulated as lymphatic fluid. According to the Society for Vascular Surgery, “Lymphedema occurs when lymphatic fluid builds up in the soft tissues of your body, usually in an arm or leg.”

Why Edema Can Occur
When a blood vessel’s outward force is greater than the inward force, osmosis causes fluid to move out of the capillaries. Any condition resulting in increased outward force results in edema. Examples of this outward force are:

• After standing a long time, edema may accumulate in the lower extremities because gravity causes blood to pool in the leg’s veins. This pooling increases the capillary hydrostatic pressure, which increases the blood vessel’s outward force.

• Protein deficient malnutrition causes a decrease in capillary osmotic pressure. This pressure drop reduces the inward force, changing the relationship of forces and resulting in a greater net outward force. Once again, the greater outward force draws fluid out of the blood vessel, resulting in edema.

About Lymphedema
Clinically, lymphedema is classified as either primary or secondary. Primary lymphedema is due to congenital malformations in the lymphatic system such as defective valves or vessels. Secondary or acquired lymphedema is more common and is due to problems with the lymphatic system occurring after birth. Some of the common causes of secondary lymphedema are:

• Lymph node or vessel removal surgery (e.g., cancer surgery)
• Radiation therapy
• Cancer metastasis to lymph vessels and nodes
• Scarring of lymph vessels and nodes following infections
• Trauma
• In developing countries, a parasitic infestation known as filariasis causes lymphedema

Today’s cancer treatments have resulted in improvements in radiation and surgical techniques (such as removing smaller samples of lymph nodes). This improvement means that lymphedema is less common now than in the past. Aside from medicine’s technological advances, lymphedema develops in approximately one in four breast cancer patients who have a mastectomy with lymph-node dissection. This risk doubles for patients who also receive radiation treatments to the underarm area.

Lymphedema Symptoms
The first signs of lymphedema can be a change in a patient’s arms or legs or other affected area. Initially, skin will remain soft, but if the problem continues, the limb may become hot and red and the skin hard and stiff. The lymph fluid that collects in the tissues can be very uncomfortable, but pain is not always present. Early symptoms of lymphedema may include:

• A feeling of tightness and decreased flexibility
• Tight fitting of jewelry, clothing or footwear
• Weakness, pain, aching or heaviness in the arm, legs, or feet
• Skin that looks shiny, has fewer folds and feels taut
• Difficulty moving a limb or bending at a joint due to swelling and skin tightness
• Pitting (small indentations left on the skin after pressing on the swollen area)
• Swelling of only one foot or arm
• If the leg is involved, swelling usually begins at the foot, then progresses upward toward the ankle, calf and knee

When to Refer Out
Clients should be encouraged to contact their physician if they have lymphedema in combination with any of the following:

• Previous mastectomy
• Previous lower abdominal surgery
• Previous radiation treatments
• The affected limb becomes red, painful or hot
• The affected limb develops open sores or areas of broken skin
• Fever accompanies any swelling

Additionally, it is suggested that a bodyworker seek permission from the client’s physician prior to performing bodywork if the client has:

• A history of cancer – to make certain massage won’t spread it.
• Full body edema – is usually due to chronic cardiac, kidney, or liver problems and massage may place too much stress on that person’s circulatory system.

How Bodyworkers can Participate in Lymphedema Treatment
Lymphedema can only be managed, not cured. A number of interventions are used for managing lymphedema, including patient education, skin care, compression bandaging, compression garments, compression pumps, exercises and manual lymphatic drainage massage.

Manual lymphatic drainage is a specialized massage technique to help clear edema by facilitating lymph flow through lymph vessel collaterals and collecting ducts. Since the pressure is very low in lymph vessels, lymph drainage techniques are generally administered in a very gentle manner. Stretching of the skin, superficial fascia, and the lymphatic vessels is performed in the direction of lymph flow, and followed by a gentle release.

The basic strokes used in traditional massage styles (e.g., petrissage, effleurage, tapotement, vibration and friction) are generally applied with more pressure than manual lymph drainage techniques. Many massage therapy publications list edema as an indication for these strokes. This is correct as long as edema is being addressed, not lymphedema.

When edema occurs, the lymphatic system is overloaded, yet remains intact. Conventional massage therapy is beneficial for many forms of edema. Consult with a senior practitioner or the client’s physician if you are unsure of your client’s candidacy for massage.

Alternatively, lymphedema is always caused by mechanical insufficiency of the lymphatic system, which is unable to appropriately respond to an increase in lymphatic fluid loads. When applied appropriately to lymphedema, lymph drainage massage increases the activity of lymph vessels and moves interstitial fluid. Lymph drainage massage exerts little pressure on the skin and does not cause any increase in local arterial blood flow. This narrow function makes it ideal for preventing the additional outward force on blood vessels that typically occurs with the enhanced circulation of traditional massage therapy. Increasing the circulation of a mechanically insufficient lymph system can easily increase the swelling.

When working with clients with lymphedema, traditional massage therapy is insufficient and could even exacerbate the problem. Contributing to a client’s lymphedema management requires extra vigilance on the part of the bodyworker as the benefits of understanding lymphedema and mastering lymphatic drainage massage far outweigh the required effort.

Recommended Study:
Lymphatic Drainage Massage


Premkumar, Kalyani, Edema and Lymphedema, Massage and Bodywork, December/January 2005.

Rothenbert, Mikel A., MD, Charles F. Chapman, Barron’s Dictionary of Medical Terms, Barron’s Educational Series, Inc., p.140, 1989.

Zuther, Joachim, MT, PT, Traditional Massage Therapy in the Treatment and Management of Lymphedema, Massage Today, June 2002., Lymphedema, Rachael Myers Lowe,, June 2003., Lymphedema, VascularWeb, 2006., Swelling, Healthwise, 2006.

Posted by Editors at 02:49 PM

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

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May 19 2009

ADD Signs and Symptoms

Attention Deficit Disorder (ADD) is a chronic neurobehavioral disorder, characterized by hyperactivity and impulsive behavior. Read on to know more about ADD signs and symptoms.
You might have seen some kids who are not able to pay attention, who cannot concentrate or who are not able to follow the instructions even after explained clearly. Such kids may be the victims of Attention Deficit Hyperactivity Disorder (ADD/ADHD). ADD is a neurological disorder, which typically affects children and may persist in adulthood. Children with ADD show inability to concentrate, hyperactivity and forgetfulness. Such children have poor performance in school, troubled relationships and low self-esteem.

Causes of ADD

There are a number of factors that can contribute to develop ADD in children. Certain modifications in brain anatomy and function are considered one of the main causes of ADD. The neurotransmitter dopamine (brain chemicals) is mainly responsible for such behavioral changes. Some other causes of ADHD are heredity, exposure to environmental toxins, drug abuse and maternal smoking.

Signs and Symptoms of ADD

ADD is also referred to as minimal brain dysfunction. ADD/ADHD affects about 8-10% of school-age children. Boys are more likely to develop this disorder than girls. Children and adults affected by ADD are not able to control their spontaneous responses involving movement, attentiveness and speech, leading to hyperactivity, inattentiveness and impulsive behavior. Signs and symptoms of ADD are categorized as inattentiveness symptoms and hyperactivity-impulsive behavior symptoms.

Inattentiveness symptoms: Some of the common inattentiveness symptoms are as follows:
Children with ADD often fail to give close attention to details. Hence, they make several mistakes in schoolwork. They are not able to sustain attention in any kind of tasks or at play.
They usually tend to lose things such as toys, tools, books, etc.
These children are unable to follow the instructions properly and complete the assigned task.
Children with ADD are not able to organize tasks or activities. They are distracted easily.
They are frequently forgetful about daily activities.
You may notice that children with ADD don’t listen to you carefully, even if spoken directly.
They tend to avoid any task that involves mental efforts.
Hyperactivity-impulsive behavior symptoms: Excessive activity is one of the common symptoms associated with ADD. Certain symptoms related to hyperactivity are as follows:
Children with ADD often move their hands or feet restlessly. They have a tendency to squirm or fidget frequently.
They tend to leave their seats, when expected to remain seated.
Excessive scaling or running at appropriate timings is another important sign of hyperactivity. Hyperactivity symptoms are seen in the form of constant restlessness in adolescents.
Children with ADD are not able to play or do leisurely things peacefully. Incessant talking without a sense when to stop is common with these children.
Acting without thinking is the major sign of impulsiveness. Children with ADD have often a tendency to blurt out answers, before the questions are being finished. They have a tendency to interrupt with others’ conversations or games. They are too impatient to wait for their turn during a game. They tend to interrupt during social events and demand too much attention.

Inattentiveness symptoms are observed in children of 8-9 years of age. These symptoms usually persist lifelong. Hyperactivity symptoms start by 5 years of age and become extremely severe between 7 and 8 years of age. Children with ADD have low self-esteem, depression, anxiety and aggressive or violent behavior.

The treatment of ADD emphasizes on controlling signs and symptoms of ADD and improving child’s mental abilities. The treatment constitutes a combination of medications and various therapies. ADHD medications such as dextroamphetamine or methylphenidate can help in increasing attention and concentration and reducing hyperactivity and impulsivity. Children with ADD benefit from different therapies such as behavioral therapy, psychotherapy and family therapy. A structured classroom management and parent education also play a significant role while dealing with ADD.

By Reshma Jirage
Published: 1/12/2009

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Apr 25 2009

ADHD Symptoms

ADHD or ADD is a neurological disorder that usually affects a person during their childhood, and persists into their adulthood. Here are some of the main ADHD symptoms.
You’ve probably come across them, the kids who simply cannot seem able to sit still, the ones that can’t seem to be able to pay attention, who can’t seem to stop themselves from blurting out inappropriate things at unsuitable times, who seem willfully not to follow instructions even though they have been explained clearly. Well, these are some of the classic ADHD symptoms that these children are displaying.

So, What Exactly is ADHD?

Well, ADHD, or Attention Deficit Hyperactivity Disorder, also referred to as just ADD, or Attention Deficit Disorder, is a chronic type of neurological disorder. The children and adults affected with this condition find it difficult to control their spontaneous responses, particularly those involving attentiveness, speech, and movement, which result in their inattentiveness, impulsive behavior, and hyperactivity. According to estimates, it is thought millions of children display the symptoms of Attention Deficit Disorder, and the condition usually continues into adulthood. Those affected with ADD symptoms usually also suffer from performance problems in school or at work, experience trouble with their personal relationships, and have low self-confidence and self esteem.

Exactly what treatment should be followed in order to control the symptoms of ADD is still under debate by the medical community. Presently, doctors are prescribing psychostimulant drugs in order to treat ADHD. However, even though many of the ADHD symptoms may be controlled by these drugs, they do not cure the condition. Plus, the side effects of these drugs can be a troubling factor. Special classroom modifications, support by the family as well as the community, and counseling are some of the supportive parts of the treatment.

Symptoms of ADD/ADHD

Most physicians are of the opinion that a child should not be diagnosed with ADHD unless the principal ADHD symptoms occur early in life and result in creating significant problems at school as well as at home in a continuous manner. Most children diagnosed with this condition display the signs of ADHD before they are seven years old, sometimes even earlier. The symptoms and signs of ADHD can be broadly categorized into two types: Inattentiveness; and Impulsive Behavior-Hyperactivity.

ADHD Symptom – Inattentiveness

Some of the symptoms of inattentiveness of ADHD are:
Careless mistakes made in schoolwork and the inability to pay attention closely to details
Difficulty in maintaining attention while doing tasks or even at play
Appears not to be listening even when directly spoken to
Finds it difficult to follow the instructions given and is not able to complete schoolwork, tasks, and chores
Usually has difficulty in organizing activities or tasks
Has the tendency to dislike or avoid any work that involves mental effort for a length of time, like when doing homework or schoolwork
Tends to be distracted easily
Frequently forgetful
Loses needful things like pencils, books, tools, or toys
ADHD Symptom – Impulsive Behavior-Hyperactivity

Some of the symptoms of the impulsive behavior-hyperactivity of ADHD are:
Has a tendency of squirming or fidgeting often
When it is expected for the child to remain seated, has the tendency of leaving his/her seat often
Excessive running or climbing when it is not appropriate, in adolescents it is displayed in constant restlessness
Excessive talkativeness
Has the tendency of blurting out answers before the questions have been asked fully
Has the tendency of intruding on or interrupting the games or conversation of others
Is too impatient to wait for his/her turn
Does not seem to have the ability to play quietly
Generally, children are diagnosed as having ADHD if they display six or more of the above symptoms in each of the categories, for a period of six months or so. Plus, these ADHD symptoms should affect at least two areas of the child’s life, namely at school and at home. This helps in ensuring that it is not because of a teacher or his/her parents that the child is displaying anomalous behavior. For example, children are not diagnosed as having ADHD if they seem to be having behavioral problems only at school while getting along quite well with their family at home or with their friends. Likewise with children who are inattentive or hyperactive at home, but are quite well adjusted at school and with their friends.

By Rita Putatunda
Published: 4/12/2008

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Mar 27 2009

Bodywork for Clients With Calcium Deposits

An estimated 42 percent of Americans process calcium deposits. These bumps can be found in many different areas of the body and range from barely noticeable to painfully obtrusive. Although their diagnosis is beyond the scope of practice for massage therapists, professional bodyworkers can learn how best to handle clients with calcium deposits.

by Nicole Cutler, L.Ac.

Calcinosis is the development of hard calcium deposits that form on the skin or in the body. There are four main types of calcinosis: dystrophic calcinosis, metastatic calcinosis, iatrogenic calcinosis and idiopathic calcinosis.

1. Dystrophic calcinosis is the most common type of calcium deposit, where people do not have a higher than normal level of calcium and phosphate in their blood. Calcification tends to occur around the site of a recent surgery or wound. Simple acne or minor cuts may cause dystrophic calcinosis, which usually occurs in the presence of damaged skin or other soft tissues. Tissue damage from autoimmune disorders like lupus, rheumatoid arthritis or scleroderma can result in calcinosis around the damaged areas. An injured joint or a tumor can also damage surrounding tissue, prompting the formation of calcium deposits. Dystrophic calcinosis typically results in calcium lumps localized to the area of tissue damage. However, some autoimmune disorders that result in damage to soft tissues in multiple areas may cause a systemic distribution of calcinosis lumps.

2. Metastatic calcinosis is caused by the presence of too much calcium and/or phosphate in a person’s blood. As a result, calcium deposits tend to build easily in various locations throughout the body. The main cause of metastatic calcinosis is a failure of the kidneys to rid the body of excess calcium and phosphates. Some other causes of metastatic calcinosis include:

· Overstimulation of the thyroid gland that can produce excessive calcium and phosphates in the blood supply.

· A deficiency of magnesium, a mineral required for proper calcium absorption.

· Diseases that destroy bone tissue, like Pagets Disease, or various bone cancers that cause metastatic calcinosis.

3. Idiopathic calcinosis may arise in children born with birth defects of the soft tissues. Some conditions, like Down’s syndrome, increase vulnerability to calcium deposits.

4. Iatrogenic calcinosis is usually localized to a single site where tissues have been damaged through surgery. For example, children who undergo frequent heel sticks to withdraw blood may develop calcium deposits on their heels.

While the pathology is not fully understood, there are many locations calcium deposits are found:

· If scar tissue calcifies, old injuries can result in calcium deposits. This is most typical on tendons and bone.

· Scleroderma, dermatomyositis and systemic lupus are all autoimmune diseases that can involve the development of calcium deposits, typically in the fingers.

· Calcific tendonitis is a condition that causes the formation of a small calcium deposit within the tendons of the rotator cuff.

· Calcium deposits can form in the blood vessels causing stiffening and contributing to atherosclerosis. This is not the type of calcium deposits a massage therapist would feel.

What Does It Feel Like?
Most early calcium deposits are very soft, but after a long time, they dry up and become chalk-like, sometimes even turning into bone. The probability of a massage therapist palpating a calcium deposit will depend on its location. A likely location is on the anterior border of the tibia, a bone prone to bumps and bruises. These likely will be felt under the skin, yet are attached to the bone.

Working with Calcinosis
Because most massage therapists are not licensed to diagnose medical conditions, it is important to have a client confirm the cause of any bodily lumps and bumps with his/her physician. An evaluation by a primary care physician can rule out anything more serious than a calcium deposit.

When the therapist knows the encountered bump is a calcium deposit, take relief in knowing that they generally are not dangerous. However, as the size of the deposit increases, it can put pressure on surrounding structures, causing inflammation and pain. As long as massage does not irritate the calcifications, they can be ignored.

Of interesting note to the massage therapist is that calcium deposits generally form at the body’s weakest points. Therefore, arthritic joints are highly prone to developing these protrusions. This knowledge can prompt the massage professional to find out more about a particular location, which may enhance the therapeutic purpose of a session. For example, being aware of a calcium deposit on the knee may prompt asking a client whether any pain or weakness exists around the joint. A positive response may indicate focused work on the musculature supporting the knee to relax any tightened muscles and increase circulation around the weakened joint.

The more knowledgeable massage therapists are about the anomalies they encounter, the more safe and effective treatment they can administer. While calcium deposits do not pose imminent danger to bodywork, a massage therapist will gain confidence in understanding why the bump might be there, and how they can provide the most therapeutic massage possible.

Recommended Study:
Advanced Anatomy and Pathology


Werner, Ruth, LMP, NCTMB, Cysts, Cysts, Cysts!, Massage Today, November 2006., Calcium Deposits, Dr. Walt Stoll, 2006., Frequently Asked Questions about Calcium Deposits, Jeremy Low,, 2006., Calcific Tendonitis, Jonathan Cluett MD, About Inc., 2006., What is Calcinosis?, Tricia Ellis-Christensen, Conjecture Corporation, 2006.

Posted by Editors at 11:56 AM

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

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Mar 23 2009

5 Bodywork Tips for Restless Legs Syndrome

While many people suffering with restless legs syndrome benefit from bodywork, this review offers specific guidance for the practitioner. By being aware of the cautions and utilizing the five bodywork tips for restless legs syndrome, therapists can make a dramatic impact on this condition.

by Nicole Cutler, L.Ac.

Restless legs syndrome (RLS) describes the condition where leg sensations cause an almost irresistible urge to move the lower limbs, usually right before sleep. According to the National Institutes of Health National Center for Sleep Disorder Research, RLS affects as many as 10 percent of Americans. For the projected millions of people struggling with restless legs, bodywork is one of the favored approaches to lessen this disruptive, potentially painful, sleep-depriving condition.

Typically characterized by creeping, crawling, burning, tingling or aching, a person living with this syndrome feels a need to move their legs to relieve these sensations. Considered a central nervous system disorder, RLS often interferes with resting or falling asleep. Partial or complete relief of the sensations occurs with leg motion, and the symptoms often return upon cessation of these movements. It is easy to see why many RLS sufferers fall into an unhealthful cycle of sleeplessness.

RLS Symptoms
Although the symptoms can be different for each person affected, most people with RLS experience the following:

· Irritation – Leg sensations are often irritating, typically described along the scale from painful to uncomfortable. Although sensations are often in the calf area, some experience them in the upper leg, feet, arms or even the hands.

· Need to Move – People with RLS often have an overwhelming urge to move. Typically, getting up and moving around can relieve the discomfort.

· Position and Time Variables – The discomfort of RLS tends to increase when a person is in a sitting or lying down position. The intensity usually escalates in the evening or at night.

· Visible Movement – When a person with RLS sits or lies down, the movement or jerking of their feet or toes may be witnessed by others.

RLS Causes
Although family history and high caffeine ingestion may cause RLS, the etiology is unknown in most cases. Restless legs syndrome can also be a secondary problem, brought on by other conditions. Examples include:

· Chronic Disease – An underlying medical problem, such as diabetes mellitus, kidney disease, Parkinson’s disease or rheumatoid arthritis could precipitate RLS.

· Pregnancy – Many women experience RLS in the last months of pregnancy. This may be related to an iron deficiency. Left untreated, the symptoms often go away after delivery.

· Iron Deficiency Anemia – A lack of iron in the blood may not allow a muscle to rest.

· Neurologic Lesions – People with spinal cord tumors, peripheral nerve lesions or spinal cord injury often report symptoms of RLS.

· Drug Side Effects – Medications including tricyclic antidepressants, anti-nausea and anti-seizure drugs, selective serotonin reuptake inhibitors (SSRIs), lithium, and some cold and allergy drugs may increase or trigger RLS symptoms. In addition, withdrawal from sedatives may trigger RLS.
Other conditions suspected of contributing to RLS include sleep apnea, narcolepsy, varicose veins, thyroid problems or problems with hand or feet nerves.

RLS Treatment
The medical community regards restless legs syndrome as a condition that can be managed, but not necessarily cured. In general, the therapeutic approach is dependent on improvement of the primary condition and the severity of the RLS.

For those with extreme pain and total sleep deprivation, medications are prescribed. The medications used for RLS are frequently “off-label” uses of the drugs, meaning they are not specifically intended for RLS, but have been found to help with symptoms. The following are the medications most prescribed for RLS and how they might impact bodywork:

· Benzodiazepines – These medications are depressants that artificially promote sleep. Unfortunately, the sensations of RLS are usually not suppressed with this class of drugs. Of concern to bodyworkers, hypotension (low blood pressure) is a typical side effect of benzodiazepines. Any client at increased risk of hypotension requires extra attention during a position change or when rising from a massage table.

· Dopaminergic Agents – Used to treat Parkinson’s disease, these drugs reduce motion by affecting the level of dopamine in the brain. Common examples include pramipexole (Mirapex), pergolide (Permax), ropinirole (Requip), and a combination of carbidopa and levodopa (Sinemet). Hypotension is also a typical side effect of dopaminergic agents. Again, any client at increased risk of hypotension requires extra attention during a position change or when rising from a massage table.

· Opioids – These narcotic drugs are used as painkillers to reduce severe RLS symptoms. Examples of these drugs include the combination of oxycodone and acetaminophen (Percocet, Roxicet) and the combination of hydrocodone and acetaminophen (Vicodin, Duocet). Because clients taking opiods are likely to have decreased pain sensation, bodyworkers must be extra careful with their depth and pressure.

If medications are not used, most healthcare providers advise one or more of the following approaches:

· Massage – Habitual leg massage has been reported to ease RLS.

· Hydrotherapy – Advising clients to take a warm bath often demonstrates favorable results. On the other hand, some people find relief with the application of cold packs.

· Moderate Exercise – While moderate exercise early in the day benefits leg circulation and therefore leg pain, strenuous exercise could potentially aggravate RLS.

· Avoid Alcohol, Caffeine and Nicotine – Refraining from these substances, especially in the evening, can help reduce RLS severity.

· Compression – Wrapping the legs in ace bandages, or wearing compression stockings or tight pantyhose can reduce RLS sensations.

Five Bodywork Tips for RLS
Massage therapy is one of the most well known approaches for helping RLS. While concentrating on bodywork for the lower half of the body is the general rule, below are five specific tips for the administering therapist:

1. When treating RLS, it is always advisable to first seek the client’s physician’s approval.

2. Releasing the piriformis muscle typically yields dramatic improvement in RLS symptoms.

3. Some favored modalities for preventing the energetic accumulation common with RLS are myofascial release, trigger point therapy, deep tissue massage and sports massage techniques.

4. Increasing circulation in the hamstrings can relieve uncomfortable sensations in the legs.

5. Bodyworkers should be aware that in some cases, deep relaxation may aggravate RLS.

Although there is no surefire way to get rid of RLS, bodywork is one of the most effective ways to deliver relief and reinstate a healthy sleep schedule. Being familiar with the symptoms, possible causes and treatment options for this condition will help bodyworkers deliver topnotch care to the many suffering from restless legs syndrome.

Recommended Study:

Deep Tissue Massage
Myofascial Release
Neuromuscular Therapy
Sports Massage

References:, Restless Legs Syndrome – the Basics,, Inc., 2007.

Pharmacology Guide for Massage Therapy, Natural Wellness, 2007.

Russell, Meg, LMBT, Massage Therapy and Restless Legs Syndrome, Journal of Bodywork and Movement Therapies, April 2007., Restless Legs Syndrome, American Academy of Sleep Medicine, 2007., Restless Legs Syndrome,, 2007., Pathology for Massage Therapists, Julie Onofrio, LMP,, 2007.

Posted by Editors at 12:49 PM

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

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Mar 13 2009

Caution: Stiff Neck – or Torticollis?

Most of us have had the experience of waking up in the morning with a stiff neck. For some, this painful sensation is a severe and recurring problem. More than just a stiff neck, torticollis is characterized by involuntary contractions or intermittent spasms of neck muscles. Learn how valuable massage therapy can be to clients with torticollis, as well as the precautions to be aware of when approaching this condition.

by Nicole Cutler, L.Ac.

Torticollis belongs to a broad category of disorders describing abnormal flexion, extension or twisting of the neck muscles. A neck twisted to one side is typical of torticollis. Although the exact cause of torticollis is uncertain, the following are potential scenarios where it may develop:

· In those with a family history of this disorder, symptoms may be present at birth or develop slowly
· As a result of some sort of trauma, torticollis can be acute
· From an adverse reaction to certain medications

When it can be traced to a genetic disorder, the condition is referred to as spasmodic torticollis. Although considered rare, spasmodic torticollis affects close to 90,000 people in the United States. Spasmodic torticollis has three variations of neuromuscular dysfunction:

1. Tonic (a sustained contraction)
2. Clonic (head shaking)
3. Mixed (both tonic and clonic)

Trauma that involves bending or twisting the neck too far can lead to acute torticollis. The acute form can also be the result of keeping the neck muscles in shortened positions for a prolonged period of time. A person who has slept in an awkward position or in a cold draft may awaken to acute torticollis.

Torticollis causes discomfort and pain, forcing many to hold their head straight or rotated to one side. Unilateral in nature, torticollis is irritated when the affected side of the neck’s muscles are activated or even touched. As a contralateral rotator, the sternocleidomastoid (SCM) muscle is most commonly involved in acute torticollis, as any position rotating the head to its opposite side for long periods may cause this condition.

A massage therapist should confirm that a physician has properly diagnosed any client with torticollis. In some cases, torticollis is mistaken for muscular dystrophy, epilepsy or Parkinson’s disease.

To assess the condition, the practitioner will be able to palpate and/or observe shortening and hypertonicity in the neck muscles. The head and neck are held in a non-neutral position, often with rotation to the opposite side. The SCM on the affected side is likely to be more prominent than on the other side. In the clonic variation of spasmodic torticollis, there will be some shaking of the head.

The cervical muscles will likely be tightened due to a local muscle spasm. In some chronic cases, the practitioner will be able to palpate fibrotic changes in the affected musculature. Active and passive motions rotating the head in the opposite direction of the contraction are likely painful and limited. There may be pain associated with further rotation to the contracted side depending on the severity of the condition and the percentage of muscle fibers recruited for the activity.

Symptoms of acute torticollis generally resolve in a couple of weeks. Western medicine’s top offering for this condition is an injection of Botox® to temporarily paralyze the muscles. For those seeking to avoid this toxic injection, the pain and contraction of torticollis responds well to massage. Considering neck muscles in either a tonic or clonic state are highly sensitive, extreme care must be used with any hands-on modality.

With a gentle approach, bodywork’s goal for torticollis is release of the contracted neck muscles. Such a release typically entails:

1. Enhancing circulation in and around the spastic musculature
2. Enlisting passive and active stretching techniques to elongate shortened muscles

While most massage modalities enhance circulation, a gentle technique must be chosen for torticollis. The increase in circulating cerebrospinal fluid accomplished through cranial-sacral therapy (CST) is an ideal match for a contracted neck. CST typically uses the equivalent of a dime’s weight of pressure for its maneuvers, making it an extremely gentle option. Even some of the simple cranial holds of CST can allow the contracted tissues of torticollis to unwind at their own pace. Additionally, the application of heat in a warmth-producing topical gel, heat lamp or hot pack is a non-invasive and safe way to invigorate local blood circulation.

Osteopathic medicine’s passive and active stretching techniques offer a gentle route to lengthening contracted muscles. Myofascial release techniques are ideal for increasing the range of motion that is restricted with torticollis. Additionally, some of sports massage’s stretching techniques are ideal for lengthening neck contraction. All within the realm of osteopathic medicine, some of the applicable stretches in sports massage include:

· strain-counterstrain
· reciprocal inhibition
· proprioceptive neuromuscular (PNF) stretching
· isometric stretching

A client with torticollis may come for a massage after receiving medical treatment from their physician. Bodyworkers need to be aware that an injection of the Botox® toxin causes motor loss and has no effect on sensory perception. Massage or early manipulation of the injection site can speed up absorption and spread the toxin. Therapists are advised to avoid the injection site to avoid paralysis of the injected as well as adjacent muscles.

The gentle techniques garnered from cranial-sacral therapy, myofascial release and sports massage stretching can be safely and effectively applied to relieve torticollis. A massage therapist familiar with the described methods and the pathology of torticollis will be successful in delivering pain relief and increased range of motion to a client who awoke with a stiff neck.

Recommended Study:
Cranial-Sacral Therapy
Myofascial Release
Sports Massage


Lowe, Whitney, LMT, NCTMB, Understanding Torticollis, Massage Today, December 2004.

Premkumar, Kalyani, The Doorway to Muscle Contraction, Massage and Bodywork, February/March 2005., Cervical Dystonia, Dystonia Medical Research Foundation, 2004., Torticollis Overview, WebMD, 2006., A Pain in the Neck – Acute Torticollis, Phylameana lila Desy, About, Inc., 2006., Spasmodic Torticollis, Merck & Co., 2006.

Posted by Editors at 10:00 AM

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

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Mar 13 2009

Keep it Moving: Lymph’s Role in a Healthy Body

While most massage professionals have a general understanding of the lymphatic system, few are fully aware of the critical role it plays in our overall health. Find out for yourself how manipulation of the lymphatic system can be beneficial to your clients and what conditions would prevent you from its use.

by Nicole Cutler, L.Ac.

By warding off disease and healing injury, the lymphatic system supports every other system in the body. Despite the crucial role it plays, Western medical practitioners typically only evaluate the lymphatic system when there is a specific lymph problem, such as infection or congestion causing swelling or cancer affecting lymph tissue. Many would be surprised to learn that the body contains twice as much lymph fluid as blood. This precious fluid continuously bathes each cell, draining away debris in a circulatory system powered only by muscle contractions, breathing and movement. Because its stagnation can clog the entire system and allow toxins, bacteria and cellular waste to congregate, lymphatic fluid must be in motion.

Basic Lymph Anatomy
Through a network of vessels, lymph attends to nearly every cell in the body. Strung along lymph vessels like pearls knotted on a string, lymph nodes serve as a series of cleaning filters, working to rid the body of harmful bacteria and debris. In addition to the lymph nodes and vessels, there are various other components comprising the fascinating lymphatic system.

One of the lymph system’s crucial functions is generating and storing infection-fighting white blood cells. In addition to lymph nodes, principal lymph organs include the bone marrow (where B-lymphocytes are made), the spleen, tonsils and the thymus gland (where T-lymphocytes are made). A large concentration of lymph tissue also surrounds the intestines. This tissue absorbs fats and actively separates nutrients from pathogens, providing defense whenever needed.

Moving the Lymph
With its elaborate network of vessels and nodes, the lymph system circulates lymph throughout the entire body without a central operating pump. Dependent upon muscle contractions and manual manipulation, lymph manages to isolate and eliminate infection and cellular waste. Without a motor driving its circulation, deep breathing, exercise and massage are great ways to encourage lymph’s flow and to maintain the health of this essential system.

Inactivity can significantly restrict lymph’s flow. The movement created by combining deep breathing with stretching, such as yoga, has been shown to be an effective lymph circulation enhancement practice. Additionally, many experts claim that jumping on a trampoline is the perfect exercise for restoration and maintenance of the lymphatic system.

Massage therapists consider an increase in circulation to be the primary effect their work has on the body. While this benefit is largely attributed to circulation of the blood, many of bodywork’s successes also stem from its effect on the circulation of lymphatic fluid.

While all forms of massage will have some sort of effect on the lymph system, lymphatic drainage massage has the greatest impact. Although lymphatic drainage massage has little effect on blood circulation, its light pressure can increase lymph flow by up to ten times its normal rate. This style of massage is especially therapeutic for anyone with edema, swollen glands, toxic sludge build-up throughout the body, or chronic low immunity.

If considering a client with a recent or past history of cancer in the lymph system, a practitioner must obtain physician permission prior to beginning a session. Once malignancy is in the lymph system, every effort needs to be made to prevent its spread.

In addition to regular exercise and lymphatic drainage massage, some additional suggestions for maintaining lymphatic health include:

· Drink six to eight glasses of purified or filtered water per day. Staying hydrated helps maintain proper lymph fluid levels.

· Practice deep breathing. Breathing deeply from the diaphragm and through the nose is one of the best ways to move lymph fluid throughout the body.

· Support your body’s natural detoxification through perspiration. A weekly sauna or steam bath can facilitate the healthy removal of waste through the skin’s pores, lessening the load on the lymph system.

· Avoid restrictive clothing that presses on lymph nodes. Bras with under wires or garments that are too tight can impede lymph flow.

A properly functioning lymphatic system is crucial to all aspects of our health. A very complex network, congestion of the lymphatic system is considered by many to be at the heart of most diseases. As medical researchers focus more on the lymph system’s universal role, it will become increasingly clear that measures to prevent lymph stagnation result in people living healthier, longer lives. In addition to the suggestions listed above, learning to administer lymphatic drainage massage can benefit every one of your clients. By draining, facilitating and maintaining lymph flow, bodyworkers can learn to be an integral part of a disease prevention and wellness program.

Recommended Study:
Advanced Anatomy and Physiology
Lymphatic Drainage Massage

References:, What is this thing called lymph?, JMP Enterprises, LLC, 2007., Lymphatic Drainage Massage, Sean Riehl, Biotone, 2007., Swollen Glands, American Institute for Preventative Medicine, 2007., Your Lymphatic System: Self-Care Techiques, Center for Lymphatic Health, 2007., The Lymph System and Your Health, Marcelle Pick, OB/GYN, NP, Women to Women, 2007.

Posted by Editors at 02:35 PM

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

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Mar 11 2009

Massage Therapy Provides Pain Relief From Osteoarthritis

Caused by the breakdown and eventual loss of cartilage of one or more joints, osteoarthritis is the most common type of arthritis, affecting over 20 million people in the United States. Whether performed in an office or spa, discover what bodywork methods can effectively relieve the pain and discomfort of osteoarthritis.

by Nicole Cutler, L.Ac.

Also known as degenerative arthritis, osteoarthritis occurs more frequently as we age. With aging, the water content of cartilage increases and the protein makeup of cartilage degenerates. Over the years, repetitive use of the joints irritates and inflames the cartilage, eventually eroding it away. In advanced cases, there is a total loss of the cartilage cushion between bones, causing friction that leads to pain, inflammation and joint mobility limitations.

Osteoarthritis can occur within any joint, but most often affects the hands and weight-bearing joints such as the knee, hip and spine. While the severity can vary widely, typical symptoms of osteoarthritis include:

· Joint pain following repetitive use of the joint
· Joint pain that worsens later in the day
· Swelling of the affected joint
· Warmth or redness of the affected joint
· Joint creaking
· Pain and stiffness after extended periods of inactivity
· Persistent OR intermittent pain
· Development of painful bony spurs at joint locations

There is no magic pill or surgical intervention that offers a risk-free, reliable solution to cartilage degeneration and repair to the damage done by osteoarthritis. The goal of treating osteoarthritis is to reduce joint pain and inflammation while improving and maintaining joint function. Treatment for degenerative arthritis typically consists of:

· Weight reduction to minimize the weight-bearing responsibility on arthritic joints
· Avoiding activities exerting excessive stress on the affected joint cartilage to relieve pain and swelling
· Physical and occupational therapy to strengthen surrounding muscles, increase joint motion, and devise innovative plans for daily functioning
· Wearing mechanical support devices to reduce joint stress
· Medications administered orally, topically or via injection to decrease joint inflammation and pain
· A last resort, surgery may be performed to repair cartilage tears (arthroscopy), remove bone for realigning deformity (osteotomy), fuse degenerated joints together (arthrodesis), or replace a degenerated joint with an artificial joint (arthroplasty)

While medications or surgery may seem like ideal solutions for osteoarthritis pain, many people who have tried these options report otherwise. Medications for arthritic pain generally fall into the following categories: anti-inflammatories, muscle relaxants and steroids. These drugs demonstrate three primary drawbacks – they have limited effectiveness, have a wide range of side effects, and may create dependence and tolerance, requiring progressively higher dosages for relief. Invasive surgery can also be problematic, either by not fixing the problem, causing more problems or offering only temporary relief.

Bodyworkers aim to relieve arthritic pain by increasing blood circulation to the affected area. Since there is a relatively poor network of vasculature in cartilage, an increase in local circulation brings fresh, oxygenated blood to an injured area and ushers out waste. In addition to reducing inflammation and pain, improving local circulation increases joint mobility. It is no surprise that bodywork is an ideal match for a person suffering with osteoarthritis.

Swedish Massage
Researchers from Yale Prevention Research Center and the University of Medicine and Dentistry of New Jersey recently concluded that massage therapy is a safe and effective way to reduce pain and improve function in adults with osteoarthritis of the knee. Their 16-week study set out to identify the potential benefits of Swedish massage on osteoarthritis patients with pain, stiffness and limited range of motion. Participants in the trial’s massage intervention group received a standard one-hour Swedish massage twice a week for four weeks, followed by Swedish massage once a week for the next four weeks. After the first eight weeks of massage therapy, participants had improved flexibility, experienced less pain and improved range of motion. When reassessed eight weeks after completion of the massage intervention, the benefits of massage remained significant, although the magnitude of effect was somewhat reduced. “Massage is free of any known side effects and according to our results, clearly shows therapeutic promise,” said senior investigator of the study David L. Katz, M.D., associate adjunct professor in the Department of Epidemiology & Public Health at Yale School of Medicine and director of Yale’s Prevention Research Center.

Balneotherapy is a therapeutic approach to health involving bathing. Inclusive of many bathing mediums, including hot or cold water baths, massage in water, vapor baths, bathing in water enriched with a variety of minerals, mud baths and other applications, balneotherapy is becoming increasingly popular in spas. Researchers at the Institute of Rheumatology at the University of Siena, in Siena, Italy, the Section of Epidemiology and Biostatistics at the University of L’Aquila, in L’Aquila, Italy, and the Section of Clinical Hydrology at the University of Milan, in Milan, Italy found that two weeks of mineral baths and mud-pack applications per year, two years in a row, significantly improved symptoms of osteoarthritis and reduced the amount of hospital stays, missed workdays and necessary medication associated with this disease. Researchers from the Asaf-Harofe Medical Center, in Zerifin, Israel, and the Tel Aviv University Sackler Faculty of Medicine, in Tel Aviv, Israel reported similar results. Following a study of 72 subjects with osteoarthritis of the knee, Israeli clinicians concluded that soaking in hot mineral pools once a week significantly improved the symptoms of osteoarthritis and reduced the amount of medication taken by people with this condition.

While treating one of the 20 million Americans with osteoarthritis with Western medicine may be a daunting task, there is tremendous promise in approaching this condition with massage and spa therapy. The three reputable studies referenced above leave no doubt that invigorating circulation with Swedish massage and balneotherapy can help a person with osteoarthritis. As more clinical trials demonstrate alternative medicine’s effect on joint health, an increasing number of physicians will recommend and prescribe bodyworkers’ services for their patients’ recovery.

Recommended Study:
Integrative Massage: Earth
Pharmacology for Massage
Swedish Massage

References:, Balneotherapy Eases Osteoarthritis, Massage Magazine, Inc., March/April 2005., Spa Therapy for Osteoarthritis, Massage Magazine Inc., July/August 2004., Osteoarthritis, William C. Shiel Jr., MD, FACP, FACR, MedicineNet, Inc., 2006.

www.medicalnewstoday, Swedish Massage Benefits Osteoarthritis Patients, MediLexicon International Ltd., December 2006., Swedish Massage Benefits Osteoarthritis Patients, ScienceDaily LLC, December 2006., Arthritis Basics, WebMD Inc., 2007., Swedish Massage Benefits Osteoarthritis Patients, David L. Katz, MD, Yale University, December 2006.

Posted by Editors at 02:56 PM

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

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Mar 02 2009

Solutions and Sports Massage Techniques for Achilles Tendonitis

Learn about ten commonly advised solutions you can discuss with clients suffering from acute or chronic Achilles tendonitis. Also, find out two specific sports massage techniques that can help repair this potentially crippling condition.

by Nicole Cutler, L.Ac.

As the largest and most vulnerable tendon in the body, the Achilles tendon joins the gastrocnemius and soleus muscles of the lower leg to the calcaneus. Accounting for 11 percent of all running injuries, inflammation of this tendon is appropriately named Achilles tendonitis. Although the slow healing time for Achilles tendonitis is due to scant localized vasculature, bodyworkers can play a key role in restoring this tendon to its pre-injured state.

Achilles Tendonitis
Providing the power in the push-off phase of the gait cycle, the Achilles tendon can become inflamed when the gastrocnemius is stressed. Although this tendon is strong, its lack of flexibility can easily lead to inflammation, tear or rupture. Achilles tendonitis can be acute or chronic. Signs of an inflamed Achilles tendon include:

· Tendon pain during exercise. Achilles pain gradually comes on with prolonged exercise and typically dissipates with rest.

· Swelling over the Achilles tendon.

· Redness over the skin.

· Sometimes, a creaking can be felt when pressing the fingers into the tendon while moving the foot.

Often more difficult to treat, chronic Achilles tendonitis may follow if the tendon is not treated properly or allowed to fully heal. When this problem becomes chronic, the pain typically disappears after a warm up, yet returns once the person stops training. If the Achilles is repeatedly stressed, the injury worsens until it is impossible to run. In addition to the symptoms of acute Achilles tendonitis, additional signs of a chronic problem include:

· Pain and stiffness in the Achilles tendon in the morning. This pain may be described as diffuse along the tendon rather than specific.

· There may nodules or lumps in the Achilles tendon, particularly 2 cm above the heel.

· Pain in the tendon when walking up a hill or up stairs.

An injury typically occurring from overuse, Achilles tendonitis usually comes on gradually. Ignoring the early warning signs of Achilles pain causes the symptoms to increase until activity is too painful to continue. In general, the more fatigued the calf muscles are, the more stressed the Achilles tendon, and the higher likelihood of tendonitis developing. The most commonly reported causes of Achilles tendonitis include:

1. Overuse – Excessive activity before adequate warm-up causes most overuse injuries.

2. Running Up Hills – Running up hills causes the Achilles tendon to stretch more than normal on every stride, which fatigues the tendon sooner than normal.

3. Overpronation – Overly pronating the foot increases the strain placed on the Achilles tendon. As the foot rolls in and flattens, the lower leg rotates inwards causing a twisting motion. This twist puts an additional strain on the Achilles.

4. Tight or Weak – A tightness or weakness in the calf musculature easily leads to fatigue. Once the gastrocnemius fatigues, it tightens and shortens, thus putting additional strain on the Achilles.

10 Solutions for Achilles Tendonitis
For best results, a sore or achy Achilles tendon responds best to immediate attention and rest. Left untreated, Achilles tendonitis could cause persistent pain or cause the tendon to rupture. A ruptured Achilles tendon may require surgery to correct the damage. Ten commonly advised solutions for treating Achilles tendonitis include:

1. Resting the calf muscles.

2. Applying cold therapy or ice to minimize inflammation.

3. Wearing a heel pad to raise the heel, thus taking some of the strain off the Achilles tendon.

4. Wearing arch support insoles or orthotics to prevent overpronation and improve foot biomechanics.

5. Taking anti-inflammatory medication.

6. Taping the back of the leg to support the Achilles.

7. Applying a plaster cast for more severe cases.

8. Applying ultrasound treatment to encourage the tendon to heal.

9. Administering sports massage to the lower extremities.

10. Strengthening the calf muscle to help reduce the stress on the Achilles tendon. Toe raises, balancing on the toes and wall stretching are useful exercises.

Whenever discussing approaches to Achilles tendonitis with clients, always emphasize avoiding excessive stretching. Taking this action has the potential to aggravate an already stressed Achilles.

Sports Massage
Two sports massage techniques put bodyworkers on the top of the list for Achilles tendonitis treatment: transverse friction massage and strain-counterstrain techniques.

Transverse friction massage is a massage technique that is often used for tendonitis. The massage strokes of transverse friction massage are deep and applied directly to the affected area, perpendicular to the direction of the tendon. When done properly, transverse friction massage can help reduce pain, improve blood flow to the surrounding area, and prevent or reduce the formation of scar tissue and adhesions in the connective tissue.

Another sports massage technique, applying strain-counterstrain on the calf muscles can unload the excessive stress these tightened or weakened muscles place on the Achilles. As published in the September 2006 edition of The Journal of the American Osteopathic Association, researchers found that applying strain-counterstrain techniques on the soleus of those with Achilles tendonitis produced a 23.1 percent decrease in localized stress. The investigators noted a similarly significant response when strain-counterstrain was applied to the lateral and medial heads of the gastrocnemius.

While early and persistent attention to this injury often results in a full recovery, making sure the original cause of the tendonitis is addressed is the only way to prevent its recurrence. In addition to tackling the reason for Achilles pain, most practitioners recommend some combination of the above ten solutions to help an inflamed Achilles heal. A massage therapist using strain-counterstrain and transverse friction massage techniques can play an important role in the timely healing of an inflamed Achilles tendon – and can even help prevent this injury from turning into a hard-to-treat chronic case of tendonitis.

Recommended Study:
Sports Massage


Howell JN, et al., Stretch reflex and Hoffmann reflex responses to osteopathic manipulative treatment in subjects with Achilles tendonitis, The Journal of the American Osteopathic Association, September 2006., Natural Remedies for Tendonitis, Cathy Wong, About, Inc., 2008., Achilles Tendonitis, Elizabeth Quinn, About, Inc., 2008., Achilles Tendinitis, Mayo Foundation for Medical Education and Research, 2008., Achilles Tendonitis, Sports Injury Clinic, 2008.

Posted by Editors at 11:59 AM
© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute.

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Mar 02 2009

Chronic Pain, Fibromyalgia and Therapeutic Touch

Living with fibromyalgia often means having different kinds of pain on any given day. Because gentle, energetic bodywork is occasionally called for with fibromyalgia, practitioners who can include Therapeutic Touch have an advantage when working with this chronic pain syndrome.

by Nicole Cutler, L.Ac.

As the predominant gender afflicted with fibromyalgia, more and more women are being diagnosed with this chronic pain syndrome. Even though an estimated two to five percent of our population lives with this painful disorder, Western medicine can only offer side-effect laden symptom relief for a relatively small portion of those affected. As an alternative to taking prescription drugs, the pain identifying this ailment can be reduced by safe, non-invasive bodywork techniques. For those interested in a natural approach, massage therapists are one of the most likely sources a person with fibromyalgia will tap to fulfill their pain relief needs. As such, practitioners who include Therapeutic Touch in their treatments have a proven practice for providing relief to those suffering from this condition.

Because bodywork is being increasingly recognized by the healthcare community as a means to reduce pain, massage therapists are often recruited for fibromyalgia. However, the complexity of fibromyalgia requires extensive knowledge and skills to competently address it. Knowing about its nuances means understanding that having one set massage regimen for people with fibromyalgia is insufficient. Since the needs of a person with fibromyalgia can vary form day-to-day and from person-to-person, a practitioner must possess the following to be most effective:

· A variety of modalities mastered to choose from
· Good communication skills to adjust their treatment based on client feedback
· Flexibility to change their style mid-session
· A gentle, energetic approach for highly sensitive clients (or those having a highly sensitive day).

As published in the June 2007 edition of The Nursing Clinics of North America, researchers from Texas affirm that although the clinical proof is in the beginning stages, the value of energy therapies is promising. They confirm that studies of Therapeutic Touch, Healing Touch and Reiki suggest that these healing modalities are effective in reducing anxiety, improving muscle relaxation, aiding in stress reduction, relaxation, and sense of well-being, promoting wound healing and reducing pain.

About Fibromyalgia
Fibromyalgia is an illness that causes chronic pain in the soft tissues of the body. A person with this syndrome likely has pain in their muscles, ligaments and tendons. Most people with fibromyalgia report aching all over, often saying their muscles feel like they are pulled or overworked. Sometimes symptoms include muscle twitches and burning sensations. In addition to muscular pain and stiffness, this ailment can also cause fatigue, sleep problems, depression and an inability to think clearly.
Scientists have several theories but no concrete understanding of what causes fibromyalgia. While a simple blood test or x-ray will not indicate fibromyalgia, the American College of Rheumatology has outlined the requirements for a fibromyalgia diagnosis:

· Muscle pain must be present for longer than three months
· Pain must occur at 11 out of 18 specific tender points on the body.

Because the quality, location and severity of fibromyalgia pain is constantly changing, therapists dealing with this disorder must be equally adaptable.

Therapeutic Touch
Developed by Delores Krieger, RN, Ph.D., and Dora Kunz in the early 1970s, Therapeutic Touch (TT) is an energetic style of bodywork adapted from several different healing traditions. Commonly applied by nurses for a wide range of health conditions, TT has been shown to help reduce the pain and anxiety associated with fibromyalgia:

· As published in the May/June 2004 issue of Holistic Nursing Practice, Kansas researchers tested the effectiveness of TT on the experience of pain and quality of life for people with fibromyalgia. Their findings demonstrated that those with fibromyalgia had a statistically significant decrease in pain and improvement in quality of life associated with each TT application.

· As reported in 2007 by the Midwest Nursing Research Society, medications, exercise and stress reduction is only moderately effective in controlling the pain of fibromyalgia syndrome. Lead researcher Cate Stiller, Ph.D., conducted a study comparing the effects of TT and placebo on the pain and anxiety of 46 participants with fibromyalgia. The investigators concluded that the most important recommendation for nursing is that nurses can help their fibromyalgia patients manage their pain and anxiety by recommending TT as an effective therapy.

With an estimated 5 million Americans living with fibromyalgia, massage therapists who are well-versed in this chronic pain syndrome are best equipped to help those affected. The inconsistency of fibromyalgia pain’s location, quality and severity requires bodyworkers to have various skills ready to match their client’s current experience. Especially appreciated when a person with fibromyalgia is particularly sensitive, practicing an energetic type of bodywork is often the best fit. When included in a therapist’s repertoire, Therapeutic Touch can be a key modality for gently bringing pain relief to a fibromyalgia sufferer.

Recommended Study:
Fibromyalgia and Massage
Healing Energy and Touch


Denison, B., Touch the pain away: new research on therapeutic touch and persons with fibromyalgia syndrome, Holistic Nursing Practice, May-June 2004.

Engebretson J, Wardell DW, Energy Based Modalities, The Nursing Clinics of North America, June 2007., Symptoms, Fibromyalgia Network, 2008., Therapeutic Touch, Aetna Intelihealth, Inc., 2008., The Effect of Therapeutic Touch on Fibromyalgia Pain and Anxiety, Cate Stiller, PhD, Virginia Henderson International Nursing Library, 2007.

Posted by Editors at 10:58 AM
© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute.

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