(also referred to as...)
Massage Therapy, Swedish Massage
Introduction
It has been theorized that massage was borne out of the instinctual rubbing and stroking observed in mammals. Even those of us unfamiliar with massage would be apt to rubbing a stubbed toe to relieve the pain. The word massage comes from the Arabic word mass meaning to press. Today, the College of Massage Therapists of Ontario (CMTO) describes massage as a "therapeutic, integral healing relationship in which the therapist assists the client in restoring, maintaining and enhancing the well-being of the client." The College goes further to describe massage therapy as "the assessment of the soft tissue and joints of the body and the treatment and prevention of physical dysfunction and pain of the soft tissues and joints by manipulation to develop, maintain, rehabilitate or augment physical function, or relieve pain."
Massage was first mentioned in writings as early as 3,000 BCE and has been written about extensively since 500 BCE. Many references to its use have been found in ancient Egyptian, Persian, and Japanese historical medical literature. Most ancient civilizations developed some form of massage, particularly China, India, Arabia, Greece, Italy and Egypt. The Eskimos, Mayans, Incas and other natives of the American continent also practiced massage.
Throughout the ages, many notable historic figures have been great proponents of massage. Hippocrates widely advocated its use and was the first in ancient Greece to describe some of its medical benefits. He called the therapeutic use of massage, oils, and herbs as anatripsis, which means to rub up. Julius Caesar had a daily ritual comprised of being "pinched all over" to relieve his neuralgia and to prevent epileptic attacks. In the 16th century, Ambrose Paré, one of the founders of modern surgery, used massage techniques for the relief of joint stiffness and to promote wound healing after surgery. There are also references to massage in Captain James Cook's diary of his third voyage around the world in the latter part of the 18th century. In it he describes how his pseudosciatic pain was relieved in an "elegant and generous ritual" performed by a Tahitian chief and his family using a method called romee.
Massage developed differently in the East and the West. For the purpose of this section I will explore the development of massage in the West, in which I have been trained. I will not even attempt to present the development of massage in the East, as I would not be able to do it justice. However, it must be noted that many ideas and techniques forming the Western approach to massage had been practiced in China for centuries previous to their appearance in the West. In fact, the resurgence in popularity of massage in the West is attributed to the French missionaries returning to Europe from China in the early 19th century. With them they brought The Cong Fou of the Tao Tse, Chinese medical writings which date back to 2,700 BCE. These writings contained extensive entries pertaining to the use of massage to treat a variety of ailments.
Per Henrik Ling is credited for the development of Swedish massage in the 19th century. He put together a program of active and passive movements for the treatment of disease and used many positions and movements of Swedish gymnastics. He taught this technique to medical doctors from throughout Europe, and by his death in the mid 19th century, his technique had gained worldwide recognition.
Since this time, many have researched the benefits of massage and have developed new methods and techniques. Dr. Janet Travell is renown for her work on myofascial pain and trigger points. Eunice Ingham developed the therapy known as reflexology. Ida Rolf's techniques came to be known as Rolfing. Dr. Delores Krieger created the therapeutic touch approach. Other modalities to have developed out of massage are bioenergetics by Alexander Lowen, polarity therapy by Dr. Randolph Stone, connective tissue massage by Elizabeth Dicke, and manual lymphatic drainage by Dr. Emil Vodder.
The increasing popularity of massage in the last few decades has been, in part, due to the realization that there are many chronic diseases which are not responding to treatment by conventional western medicine. Massage is one of the non-invasive approaches that have proven to be effective for many ailments. So wonderful and numerous are the effects of massage that it is being considered as a possible nursing intervention for people with a variety of ailments and diseases of both the body and mind.
Massage can impart physiological, psychological and emotional or spiritual effects. Physiologically, it exerts many effects on the cardiovascular and lymphatic systems. Massage can improve circulation. It does so most dramatically by increasing venous return to the heart. This can decrease heart rate, respiratory rate and increase cardiac output (the volume of blood pumped out of the heart per beat). Lymphatic circulation can be increased and edema or swelling in extremities can be decreased. Red blood cell count can also be temporarily increased. Massage can also increase nutrition to tissues, encourage retention of specific elements necessary for tissue repair (nitrogen, phosphorus, sulfur, etc.), prevent build-up of toxins, increase elimination of fluids and waste products, and improve digestion, assimilation, and metabolism in general. Muscles in spasm can be relaxed and general muscle tone can be improved. A reduction in pain, a reduction in inflammation and swelling of joints and reduction of healing time can also be achieved. Massage can be used to stretch connective tissue and help minimize the formation of adhesions and fibrosis in injured tissue. Circulation and nutrition of joints can be improved. Massage can also help keep skin healthy and pliable, enhance breathing, relieve congestion, and stimulate or relax the nervous system.
Psychologically, massage can relieve stress, anxiety, and tension. It can help calm a hyperactive or agitated person. Massage has been shown to promote the release of endorphins by the brain to relieve pain and also promote a feeling of well being. It can elevate the mood of a depressed or grieving person and improve job performance and morale. It can also help people get in touch with their own body.
In Massage Therapy: Theory and Practice, Jean E. Loving presents the emotional or spiritual effects of massage. These effects can be quite profound. Loving explains that these are more a part of certain branches of massage than of Swedish massage itself. However, the effects that I have experienced in practice are that massage elevates the spirit, calms the worried mind, puts person in touch with self, helps create a state of heightened awareness or meditative state, and shares the intent to heal between the client and therapist.
Ontario and British Columbia are quickly becoming the model for therapeutic massage education and training in North America. Students in Ontario must pass a 2,200-hour course approved by the CMTO. They then must pass written and practical exams set out by the College. Once a candidate has passed the board examinations and registered with the CMTO, he/she can begin to practice massage in Ontario as an RMT (registered massage therapist). To keep current, RMTs in Ontario and many other provinces and states are required to obtain a certain number of continuing education units every period (three years in Ontario). These are units awarded to RMTs that have successfully completed a course or seminar in a massage or health related subject that has been approved by the governing body of the particular province or state (in Ontario it is the CMTO).
Ailments / Situations Where Used
The following are common afflictions massage therapists may see in their practice. However, I also tried to include some ailments or conditions that one might not think can be improved with massage therapy. Massage can be beneficial for so many people suffering from a variety of different conditions. It would be difficult to include them all in this section. If you do not find information about a particular ailment in this section, please refer to one of the many books available, some of which are mentioned in the "Contacts" section, or visit a registered massage therapist in your area to find out more. The OMTA can help you find one in your area. They are also listed in the Contacts section, towards the end of this article.
Breast Drainage
This type of treatment should be considered for anyone that suffers from a condition of poor breast drainage or circulation. This can include women that have undergone a lumpectomy, mastectomy or other breast surgery, as well as for women with pre-menstrual breast tenderness, pregnancy, post-natal breast engorgement and fibrocystic breast disease.
Generally, 85% of the lymph that flows through each breast drains into larger lymphatic vessels on the same side of the body. That is, the lymph that flows through the right breast will drain into lymphatic vessels on the right side of the body. The remaining 15% will cross over to drain into vessels on the other side of the body.
This drainage, however, is typically altered after surgery in the area, with destruction of many of the vessels. This can lead to pain due to congestion and a build up of toxins. Massage can assist the flow of lymph through the remaining vessels as well as increasing venous return, reducing the congestion and toxin build up, thus reducing pain. Massage can also help promote the formation of a healthy, mobile scar after breast surgery by influencing the scar formation process, or for the reduction of a chronically adhered scar.
Hydrotherapy applications can also prove beneficial in such cases. Cold applications can constrict superficial blood vessels and assist in venous return, alleviating congestion. Hot hydrotherapy can be used to soften connective tissue before massage is applied to the area to reduce adhesions. Contrast hydrotherapy can be used to promote tissue health.
Before any approach is attempted, one must be sure the origin of pain in the breast is known. There are some trigger points that have pain referral patterns which include the breast (see section on trigger points). The therapist can and should instruct you on how to perform self-care techniques in addition to regular massage therapy sessions. Such techniques could include hydrotherapy, stretches and self-massage.
Degenerative Disc Disease (DDD)
This refers to the degeneration of the tough, fibrous, outer portion (annulus fibrosis) of an intervertebral disc, which generally occurs in the lumbar or cervical spine. There is often pain, tearing, and scarring involved. This disease can lead to what is called nerve root entrapment due to a narrowing of the intervertebral foramen or because of a disc herniation or prolapse that puts pressure on the nerve involved. It is generally a result of repeated microtrauma. It can be caused by excessive rotation or a horizontal stress on the disc involved because of poor posture. Immobility of the spine or direct trauma can also be implicated.
Pain is the most commonly reported symptom. It is generally a dull, aching pain that is directly associated with continued degeneration of the disc. You may also experience pain and dysfunction of joints and muscles due to the presence of trigger points. The pain is often aggravated by movement, bending, coughing, or stretching, and is relieved by rest. If a nerve root is being compressed, you may feel "pins and needles", have slower reflexes, or experience muscle weakness and atrophy.
The primary goal of treatment will probably be to decrease pain, and this can be done by decreasing SNS firing as would be achieved following a protocol similar to that of stress reduction. Your therapist can also treat trigger points and hypertonic muscles or muscles that are in spasm. (Note that your therapist may not treat a muscle in spasm if it is supporting or stabilizing the area.) Your RMT can also help you maintain ROM of joints and tissue health with a variety of massage techniques and joint mobilizations. Any contributing factors should be addressed to minimize further injury to the area. Hydrotherapy can be very beneficial to help reduce muscle spasm, relieve pain, and maintain tissue health.
It is imperative to tell your therapist if you have had back surgery, especially if you have had vertebrae fused, as this may alter the course of treatment. Your therapist can also attend to any scarring as a result of the surgery.
It is important to minimize the progression of the disease. Your therapist can design a remedial exercise program, which includes stretching and strengthening, to cater to the presentation and stage of degeneration you are experiencing. Movement is important. You can try exercises in a pool to reduce the effects of gravity, and thus weight, on your back. Your RMT can help you find a back self-help or support group in your area.
Hypertension
People suffering from hypertension may be able to receive massage even though the effects of many techniques normally employed during a massage may not be desirable. If the hypertension is severe, consultation with your M.D. may be required to determine the appropriateness of massage, or for any treatment modifications that may be necessary.
Hypertension occurs when blood pressure readings are 140/90 mm Hg or higher. The upper reading is called the systolic pressure and is a measurement of pressure exerted on the walls of the arteries during contraction of the heart. The lower number is a measurement of diastolic pressure, which demonstrates the level of elasticity of the arteries and arterioles as well as the level of function of the aortic valve. This occurs during the period of relaxation when the heart fills with blood.
There are two types of hypertension. One type is considered benign (a.k.a. primary, essential or idiopathic hypertension). It is a silent and long-term condition of unknown origin. The other type is called malignant or secondary because it is secondary to another pathology such as diabetes or atherosclerosis. This type has a potentially rapid progression.
At the massage therapy clinic your blood pressure will be taken both before and after each treatment. Massage can be used to decrease peripheral resistance by increasing peripheral vascular flow. Thus, the therapist will work primarily on your hands, arms, legs and feet. S.N.S. activity should also be decreased, which can lead to a decrease in heart rate, decrease in force of contraction of the heart and reduction of constriction of peripheral vasculature. This can be achieved with slow, non-painful techniques and breathing work. Your therapist will not want to increase venous return to the heart; therefore short, local techniques will be applied, as opposed to long, general strokes used during a typical relaxation massage.
There may also be some positioning modifications. You will probably be positioned supine or lying on your right side to prevent any undue stress on your heart. Your head and upper trunk may also be propped up to decrease intrathoracic pressure.
And after all of this you can finally receive a massage. Relay any concerns you have to your therapist, and together, you can come up with a course of treatment that is safely catered to your condition and that you can enjoy.
Migraine Headaches
Migraines are excruciating headaches often accompanied by nausea, vomiting, blurred vision, hypersensitivity to stimuli or other neurological phenomena. The pain may be unilateral or bilateral. These headaches are vascular in nature. The cause is unknown, but it seems to be a period of abnormal vasoconstriction of blood vessels of the head, followed by a period of vasodilatation. Several theories have been offered that point to heredity, neurological malfunction, allergies, viral infections, hormonal or chemical responses, and emotional or physical tension. There also seems to be common triggers such as food (particularly red wine and chocolate), weather, stress, low blood sugar, sleep disturbances, sensory stimuli (flashing lights, certain smells), and hormonal shifts.
Migraines in children are often referred to as abdominal migraines because they can present as sudden recurrent nausea, vomiting, and sever abdominal cramps without head pain. Generally, at least one parent has a migraine history.
If massage is sought during a headache, the aim of treatment will be to reduce pain via a slow, soothing massage (see Relaxation/Stress Reduction). Between headaches, massage can be used to increase local circulation, decrease muscles spasm, decrease hypertonicity, and relieve trigger points of affected muscles; those in the upper back, neck, and head may be tight and weak. Your therapist should test for these as they may be contributing to the headache or other problems. You should also be assessed for possible joint dysfunction in the cervical spine, as this may also be a contributing factor. Hydrotherapy can be very effective in treating migraines. However, different temperatures are effective at different stages. It is important to be clear with your therapist about whether or not you are experiencing a headache or if you feel one coming on. Stretches and hydrotherapy can be prescribed, which you can do at home between headaches, in attempt to decrease severity, duration, or frequency of them. Your therapist can also help you identify any potential triggers so that you can steer clear of them as much as possible.
Muscle Spasm / Cramp
There are several reasons as to why a muscle may be in spasm. The spasm may be due to reflex muscle guarding, that is the muscle is in spasm because of a painful stimulus directly on/in the muscle and is splinting itself to prevent any further injury. If the source of pain is not the muscle in spasm, the spasm may be used to splint the injured tissue to prevent movement, and again, to prevent further injury. (Your therapist may not attempt to treat the spasm if it is splinting an acute injury as doing so may compromise stability of the joint or area involved.) If the source of pain is relatively far, the spasm could be an expression of referred pain. (Note: muscle spasm and trigger points are not the same thing -- refer to the section entitled "Trigger Points"). Improper warm-up/cool-down and lack of stretching before activity can also lead to spasm.
When an intrinsic muscle (i.e. Colon) goes into spasm, it may be in response to local circulatory changes or a nutritional deficiency. Thus, anything that can reduce nutritional supply and increase metabolic waste build up via local circulatory changes can cause a muscle spasm. Since muscles use calcium ions to contract, alterations in blood calcium levels can also lead to spasm. The sympathetic nervous system can influence muscle tone, therefore, patients that feel "stressed" are more likely to suffer from a muscle spasm (see "Stress Reduction/Relaxation").
Spasms are self-perpetuating. The contraction of a spasm causes a lack of blood supply in the area, which causes pain, which causes more muscle guarding or spasm, and so on. The therapist should try to break this cycle and reduce the spasm by decreasing pain, helping you to relax and improving local circulation. This may be done through relaxing massage strokes to decrease SNS firing. Ice massage might also be used to numb the pain and decrease SNS firing as well. Your therapist should also attend to any other problems that may arise because of the spasm, such as trigger points or decreased range of motion. Causative factors should be pinpointed to prevent any recurrences. Your therapist can help you identify them and come up with possible alternatives in posture, movement, etc., if they seem to be causing or propagating the spasm.
Muscle Strain
A muscle strain is an injury to a muscle which results in partial or complete tearing of the muscle. This can be caused by repeated microtrauma, overuse, a very forceful contraction, an excessive stretch, sudden movement, and being unprepared for activity.
There are various degrees of injury:
1st degree --> up to 20% of the muscle fibres have been torn
2nd degree --> 20-75% of the fibres have been torn
3rd degree --> 75-100% of the fibres have been torn
A muscle strain is often very painful, but a complete rupture can be pain-free. There may be muscle weakness and/or muscle spasm. Heat, redness, and swelling are often present, and you may be able to feel a gap in the tissue where the muscle has been torn. If it is not properly treated, excessive scar tissue may develop and hinder the normal range of motion of the muscle.
Myofascial Trigger Points
A myofascial trigger point has been defined as "a hyperirritable spot in skeletal muscle, associated with a hypersensitive, palpable nodule in a taut band of muscle" (Rattray). This spot is painful on compression and may give rise to characteristic referred pain or tenderness, motor dysfunction, and autonomic phenomena. (There are other types of trigger points, for example, periosteal or ligamentous, but for the purpose of this section, I will refer to myofascial trigger points as trigger points.) This may all sound severe and perhaps unusual. Although the pain caused by trigger points can be debilitating in some cases, they are very commonplace. In fact, Dr. Janet Travell and her colleagues estimate that trigger points become a painful part of nearly everyone's life at one time or another. Yet, trigger points receive very little, if any, consideration as a major source of pain and dysfunction in conventional western medicine. Often, when unrecognized, the symptoms of trigger points are diagnosed as neurotic, psychogenic, or behavioural in nature.
The symptoms of trigger points can manifest anywhere between painless restriction of movement to incapacitating pain. It usually presents as a poorly localized, regional ache in muscles and joints. Pain often refers toa distant site in a pattern that is characteristic of each muscle (referred pain pattern). Occasionally, there is numbness or paresthesia instead of pain. Trigger points can also lead to disturbances of autonomic functions such as abnormal sweating, persistant lacrimation and or acute rhinitis, excessive salivation, pilomotor activities (hair standing on end), vertigo, blanching of the skin over the injured muscle, and itchiness or nausea.
A trigger point is begun as an initial irritation of the muscle. After this trauma, the trigger point becomes symptom-free until a second perpetuating factor causes its reactivation. This secondary factor is usually some type of mechanical abuse via either an acute, sustained, or repetitive overload of the muscle. Leaving the muscle in a shortened position, as may occur during sleep, or secondary to another injury (arm in a cast) can also activate a trigger point. They can also be triggered by fatigue, stress, referred pain (from other trigger points), cold drafts, direct trauma, electrolyte imbalances, nutritional deficiencies, visceral disease, arthritic joints and joint dysfunction, anemia, chronic infections, emotional distress, and radiculopathy.
The pain elicited by trigger points are often mistaken for other conditions such as cardiac pain, appendicitis, toothaches, or fibromyalgia (note that fibromyalgia and trigger points are not the same thing but can occur concurrently). Trigger points in several different muscles are implicated in tension headaches. Therefore, rather than using analgesics to reduce pain, a massage that addresses the trigger points causing the headache can provide drug-free relief.
Hydrotherapy and stretching are often employed to help treat trigger points. They can also be treated using ischemic digital compressions, stretch-hold-relax technique, muscle stripping, and spray and stretch. They can also be treated through injection of the trigger point, however, this is out of the scope of massage therapy. All of these techniques cause a reduction of pain by inactivating the trigger point. Complete and effective treatment also requires dealing with the cause of the trigger point, identifying and correcting or eliminating any perpetuating factors, and helping to restore or maintain the muscle's normal function. A relaxation massage would also help in reducing the symptoms of trigger points. This is because their dysfunction is modulated by the sympathetic nervous system.
Osteoarthritis (OA), Degenerative Joint Disease (DJD),
Osteoarthrosis, or Hypertrophic Arthritis
OA is the most common joint condition an is often associated with the "wear and tear" of joints with age. It affects synovial joints, particularly weight-bearing ones like hips and knees. It is caused by trauma, overuse, advancing age, and poor posture.
Very smooth, hard articular cartilage covers the bone surfaces within a joint to reduce friction among the opposing surfaces. The joint is lubricated with synovial fluid to further reduce friction. Abnormal biomechanics lead to damage of the articular cartilage. The body cannot repair the damage done to the collagen fibres that make up the cartilage, and there is loss of chondroitin sulfate from the cartilage as well. This softens the articular cartilage and it is unable to withstand the stresses placed upon it. This can lead to changes in the joints margins and in the subchondral bone (bone just beneath the cartilage). This is followed by inflammation and restricted joint motion. In later stages, osteophye formation may occur, further restricting joint movement and increasing pain.
Osteoarthritis can also result secondary to another condition such as a previous injury or congenital deformity, gout, rheumatoid arthritis, osteoporosis, and some endocrine disorders (like osteomalacia). Excessive steroid injection into a joint and some metabolic disorders can also lead to the development of OA. Some neurological disorders, which result in hypermobility or reduced proprioception of the joint , as well as some infections can also result in OA.
Signs and symptoms reported in early stages include pain with use, which is relieved by rest. You may experience stiffness of the joints in the morning that is relieved after a short period of activity. The muscles crossing the joint may be hypertonic or in spasm. You may experience a slight decrease in the joint's ROM. In the later stages you may feel pain that is not relieved by rest. The joints can be affected by changes in barometric pressure. There may also be a noticeable enlargement of the joint along with a decrease in it's ROM.
The aims of treatment in the early stages will revolve around restoring optimal joint usage, whereas in the later stages the aims will be to maintain tissue health and slow the degenerative process. Your therapist can decrease SNS firing to help decrease the pain. Pain relief can also be addressed by working on any trigger points and reducing muscle spasm. Your RMT can use techniques to maintain or increase circulation to aid in the removal or metabolic waste products. Range of motion of joints and health of joint tissues (especially cartilage) and be maintained through use of rhythmic techniques or joint play. Some techniques may be contraindicated if osteophytes have formed in the area.
Many people respond very well to hydrotherapy applications for OA. The use of deep, moist heat in the form of a whirlpool, epsom salt bath, hydroculator, etc., can help to remove waste products and decrease pain. Parafin wax treatments can also be beneficial. Be aware that hot hydrotherapy applications are contraindicated for replaced joints because the metal implants may painfully retain heat.
Remedial exercises are important in the maintenance of joint mobility and health for sufferers of OA. Regular aerobic exercise is important. Short periods of movement, stretch and rest, several times a day can also help. Resistance exercises can help keep muscles surrounding the joint/s strong.
Rheumatoid Arthritis (RA)
RA is a chronic, systemic, inflammatory, autoimmune disorder. It is characterized by periods of exacerbation (of inflammation) or flare-up followed by periods of remission. Often the presence of rheumatoid factors in the blood aid in the diagnosis of this disease. It presents as bilateral joint pain, stiffness, and reduced joint mobility. The onset is often preceded by fever, fatigue, and malaise. Morning stiffness that does not subside with movement is frequently reported.
For unknown reasons, the body produces antibodies which attack the synovial lining of the joints. Inflammation and pannus (granulation tissue) formation follow. Other than the synovial membrane, the inflammation can affect the articular cartilage and the joint capsule. If severe, the ligaments and tendons crossing the joint can also become involved. This eventually leads to destruction and deformity of the joints. Other manifestations of the disease include arteritis, neuropathy, scleritis, pericarditis, lymphadenopathy and splenomegaly.
You can receive massage during or between flare-ups, however, the treatments may be quite different depending on your presentation that particular day. Your RMT may suggest a treatment of short duration as many people with RA fatigue very quickly.
During a flare-up, your therapist can help to reduce SNS firing, which can help reduce inflammation and pain. Thus, the focus is on relaxation. Hydrotherapy used during a flare-up should be whatever helps. Generally, cold applications will help decrease inflammation and pain. If you cannot tolerate ice, your therapist may try using cool, wet towels to produce the same effect.
During periods of remission, your aims may be to reduce pain, maintain existing joint range of motion and reduce any adhesions that have formed (as long as they do not provide stability to the joint). Addressing muscle spasm and trigger points, along with deep moist heat or parafin wax baths can help reduce pain. The wax bath and joint mobilizations (if the RA is not severe) can help to maintain joint ROM. A contrast bath of hot and cold can help maintain tissue health and promote circulation.
Your therapist can prescribe some gentle movements to help maintain mobility and strength in the joints and muscles. It is important not to overdo it. Many people find that performing exercises in pools with warm water effective -- the heat helps with decreasing pain while the bouyancy provided by the water helps to decrease weight (and thus stress) on your joints. Deep breathing exercises or meditation are also beneficial to help decrease stress.
Stress Reduction / Relaxation
The sympathetic nervous system (S.N.S.) is the part of the central nervous system that controls what is known as the "fight or flight" response. This is the part of our brain that alerted and prepared us for danger when we used to live in a more "uncivilized" era -- that is, to confront the danger or to flee from it. It prepared us by dilating pupils to bring in more light, increasing heart rate, respiratory rate, and muscle tone. The S.N.S. also affects hormone activity that can affect blood glucose levels, renal functions, etc.
In a more relaxed state, the level of S.N.S. firing decreases and the parasympathetic nervous system (P.N.S.) comes to the forefront. It is known as the "rest and digest" part of the nervous system. It constricts pupils, decreases heart rate and respiratory rate, and increases digestive functions, among other things. The restorative functions of the body occur when the body is in a relaxed state.
Stress induces the S.N.S. to react. Because of this there are many conditions which are directly associated with high levels of constant stress such as, heart disease, chronic pain, panic attacks, insomnia, and a variety of gastrointestinal disturbances just to name a few. The increase in muscle tone caused by the S.N.S., if long term, can lead to tension headaches and other related problems. Stress also seems to suppress the immune system, rendering the individual somewhat compromised. Due to the integral role stress plays in so many conditions, relaxation massage is often employed as part of the treatment for these conditions.
A massage treatment for stress reduction is aimed at decreasing the activity of the S.N.S. while allowing the P.N.S. to induce relaxation and to perform its restorative functions. Massage can help decrease muscle tone and help relieve pain caused by such. It can also aid blood and lymph flow to eliminate the waste products of metabolism while increasing cellular metabolism itself. Hydrotherapy and aromatherapy are often used in adjunct to massage to assist the relaxation process.
Systemic Lupus Erythematosus
Lupus is a chronic inflammatory disease of unknown origin, marked by periods of flare-up and remission. The disease affects various organs. Systemic complaints are common at onset such as fatigue, weight-loss and fever. There are several ways the disease can manifest itself: skin rash, polyarthralgia, arteritis, pleurisy, pericarditis, anemia, or a variety of neurological conditions. Arthritis develops in 75% of patients and arthralgia in 95%. The most common sites for these being the proximal interphalangeal and metacarpal-phalangeal joints of the hands (knuckles), the wrists and knees. Morning stiffness in these joints is commonly reported.
An assessment from an M.D. is generally recommended for internal organ or other systemic involvement, so treatment modifications may be implemented if necessary. The general focus of treatment is stress reduction to reduce S.N.S. firing and for tissue maintenance (see Stress Reduction/Relaxation). Joints that are experiencing arthritis and that are not currently inflamed can also be treated (see Osteoarthritis or Rheumatoid Arthritis).
Tendinitis
Tendinitis is defined as an inflammatory condition of the tendons as a result of repeated microtrauma. It is also referred to as a repetitive strain injury. There is resultant painful scarring within the tendon and pain upon use of the affected muscle.
Tendons have a limited blood supply, and thus, the healing process is prolonged. People often return to activity before healing is complete, re-injuring the tendon. Adhesion formation is common.
Tendinitis usually presents gradually. Pain is present mostly when the affected muscle is contracting. You may feel a dull ache or no pain when the muscle is at rest. The muscle is weak and the range of motion of the joint(s) crossed by the muscle may be reduced. Heat, redness, and swelling are often present. If left untreated the condition may lead to partial loss of function, reflex hypertrophy of the muscle (not the desired kind of hypertrophy), or degeneration of the tendon.
Your therapist will perform specific tests and palpate the area to get a feel for how great the trauma is and what degree of scarring may be present. He/she will also assess how the injury has affected the biomechanics of the area and muscle strength.
Massage can be used to decrease inflammation and swelling if present. Adhesions and scar tissue can be reduced using a variety of methods. One methods often used to reduce scar tissue is called frictioning. Essentially, the scar tissue is manually broken down and the resulting inflammatory process is controlled and used to realign scar tissue to reduce restriction. (Due to the potentially deep nature of this particular method and because of the ensuing inflammation, it is imperative to inform your therapist about all anti-inflammatory medication or analgesics you may be using at the time.) Hypertonicity and spasm can be reduced via a reduction in sympathetic nervous system firing. Trigger points in the affected and adjacent muscles should also be attended to. Circulation to compromised tissue should be increased to hasten healing.
Your therapist can help with maintaining range of motion in affected joints to maintain cartilage health and prevent contractures. Long-term goals would include restoring muscle strength, length, and complete range of motion of joints. You should also discuss any perpetuating factors with your therapist to prevent recurrence. Your therapist can also prescribe appropriate hydrotherapy and remedial exercises you can do at home to reduce healing time.
Typical Session(s)
The CMTO has outlined in the Standards of Practice specific guidelines that RMTs must follow. This is to assure high quality of care and protection for you, the client.
The therapist will begin with an interview to find out your primary areas of concern. You should relay to the therapist what your treatment goals are. The therapist will also take and record your health history. This is particularly important. The therapist will need to know if your are suffering from any condition other than the one that brings you to the clinic, as it may require him or her to modify the treatment or refrain from treating you altogether. The case history can also help pinpoint the cause of the injury or condition so that the therapist can help the client eliminate or modify the troublesome action, posture, etc. Rest assured that all information obtained by the therapist is confidential, as RMTs are bound by the same confidentiality laws as other health care professionals are.
Once a complete health history is gathered, the therapist should then ask for your consent to proceed with a physical assessment specific to your ailment. Your therapist should tell you what he/she proposes to do and why. The RMT will most likely take your blood pressure at this time, particularly if it is your first visit or if you have a cardiovascular condition. This is also a great opportunity for you to ask questions about what the therapist will be assessing, so that you are more informed about your condition. Only after you have given verbal consent should the therapist conduct the proposed assessment. If this is not your first session, a re-assessment may be performed to note any change in your condition. If after the assessment the therapist finds that massage therapy is contraindicated for your condition, he/she should refer you to another qualified health care professional that may be able to help you.
Once the assessment is complete and massage is indicated, the therapist will develop a treatment plan and go over it with you. This will include the goals of treatment, modalities to be used, possible outcomes to treatment, any potential risks, the benefits of massage for your condition, areas of the body to be treated, and the fee. You should also be informed that you could stop or modify the treatment at any time for whatever reason. This is also another great opportunity to ask the therapist any question you may have surrounding the treatment that has just been proposed, your condition, or massage in general. You can also request any modifications to the treatment that you like. The therapist should be able to accommodate you providing the request is within the R.M.T.'s scope of practice. Once the treatment plan has been established and your consent has been given, the treatment can begin. If this is not your first treatment, and your condition or goals have changed, the treatment plan may be modified and your consent will be required to continue with the revised treatment.
The therapist will instruct you on dressing and undressing and on draping procedures. You only have to undress to a level that you feel comfortable with. However, the effects of massage are greatest with skin to skin contact. Rest assured that only the area to be massaged at the time will be undraped. The rest of your body will be covered under a sheet. Massage therapists spend a lot of time as school practicing draping procedures, so by the time we graduate we are very proficient at it. If you need help undressing due to an injury or other condition, the therapist can assist you. Otherwise, the therapist will be out of the room while you undress. The therapist will also instruct you on positioning on the table and the positioning of pillows. Again, if assistance is necessary to get on the table, your therapist can help you. Once you have undressed, positioned yourself on the table and covered yourself with a sheet, the therapist will re-enter the room and begin the massage.
Anytime throughout the treatment, feel free to ask any questions that you have about your condition, the techniques being used, or anything else you feel is pertinent. Throughout the massage the therapist should ask you about your pain or comfort level. The therapist will also instruct and/or assist you in changing positions so that all areas that require treatment can be treated.
At the end of the massage, after you have come off the table and redressed the therapist can prescribe self-care remedial exercises and/or hydrotherapy to do at home. The therapist should show you proper technique and request to see you perform the exercises for them to be certain that they are being performed correctly. The therapist will record the entire session in your file and your next appointment can be arranged.
Contraindications / Precautions / Warnings
The following is a list of the contraindications and precautions regarding massage therapy. RMTs are kept current on what conditions constitute contraindications or precautions as some of them change with the growing knowledge of the effects of massage therapy. If you are unsure about your condition, talk to your therapist.
Absolute Contraindications
General -- Massage therapy is not appropriate for the following:
- Acute conditions requiring medical attention such as anaphylaxis, appendicitis, cerebrovascular accident (CVA), diabetic coma, insulin shock, epileptic seizure, myocardial infarction (MI), pheumothorax, atelectasis, sever asthmatic attack, status asthmaticus or syncope
- Acute pneumonia
- Advanced kidney, respiratory or liver failure (a modified treatment may be possible with a physician's consent)
- Diabetes with complications such as gangrene, advanced heart or kidney disease or very unstable or high blood pressure
- Eclampsia
- Fever of 38.5°C (101.5°F) or above
- Hemophilia
- Hemorrhage
- Post CVA or post MI where the condition is not yet stable
- Severe atherosclerosis
- Severe and unstable hypertension
- Shock
- Some highly metastatic cancers not judged terminal
- Systemic contagious or infectious condition
Local -- Massage is not appropriate directly in the affected
area with the following conditions:
- Acute flare-up of inflammatory arthritides
- Acute neuritis
- Aneurysms deemed life-threatening (may be general contraindication depending on location)
- Ectopic pregnancy
- Esophageal varicosities
- Frostbite
- Local contagious condition
- Local irritable skin condition
- Malignancy
- Open wound or sore
- Phlebitis, phlebothrombosis or arteritis (may be general contraindication depending on location)
- Recent burn
- Sepsis
- Temporal arteritis
- 24 to 48 hours post any anti-inflammatory injection
- Undiagnosed lump
Precautions
General -- The following conditions require treatment modifications.
Medical consultation may be required:
- Any condition of spasticity or rigidity
- Asthma
- Cancer
- Chronic congestive heart failure
- Chronic kidney disease
- Client is immunosuppressed
- Coma (may be a general contraindication depending on the cause
- Diagnosed atherosclerosis
- Drug withdrawal
- Emphysema
- Epilepsy
- Hypertension
- Inflammatory arthritides
- Major or abdominal surgery
- Medication use by the client that alters sensation, muscle tone, standard reflex reactions, cardiovascular function, kidney/liver function or personality
- Moderately sever diabetes or juvenile onset diabetes
- Multiple sclerosis
- Osteoporosis, osteomalacia
- Pregnancy and labour
- Post CVI or post MI
- Recent head injury
Local -- Modified treatment to the area is required:
- Acute disc herniation
- Aneurysm (may be general contraindication depending on location)
- Acute inflammatory condition
- Any anti-inflammatory injection site
- Chronic or long-standing thrombosis
- Buerger's Disease (may be general contraindication depending on location)
- Chronic arthritic condition
- Chronic abdominal or digestive disease
- Chronic diarrhea
- Contusion
- Endometriosis
- Flaccid paralysis or paresis
- Fracture while casted and post cast removal
- Hernia
- Joint instability or hypermobility
- Kidney infection or kidney stones
- Mastitis
- Minor surgery
- Pelvic inflammatory disease
- Pitting edema
- Portal hypertension
- Prolonged constipation
- Recent abortion
- Recent vaginal birth
- Trigeminal neuralgia
"Real Life"
A woman walked into the clinic one day. She had been suffering from pain in her right shoulder. The pain was so intense she could not abduct her arm more than 60° (typically, abduction of the arm measures 180°). She did not recall any sort of trauma to her shoulder, but she reported that it had been this way and getting progressively worse for two months. She was a middle-aged woman that worked at a computer for much of the day. Her job seemed moderately stressful to her. Other than this pain, she was in good health. She had been to two other health professionals that practiced different modalities, but they could not alleviated her discomfort, nor did they pinpoint the cause or source of her problem.
After an initial assessment we determined the treatment plan. I then began to massage the client. When I focussed in on her right shoulder I was able to find a trigger point in her right subscapularis muscle (the muscle between the shoulder blade and the rib cage). As I palpated the trigger point, the client indicated to me that I had recreated the pain that she felt in her shoulder when she attempted to raise her right arm. I released the trigger point as much as possible during the treatment (long-standing trigger points often require more than one treatment to resolve). Once the massage was completed I reassessed the client and found that she was able to raise her arm almost the full 180°. She reported a significant decrease in pain and was very thankful for it. It seemed that the trigger point was the source of pain and poor posture and stress activated it. I demonstrated some stretches that she could perform for her shoulder and suggested some changes she could implement to her workspace to decrease the likely-hood of aggravating the trigger point. We arranged for another appointment the following week.
When the client returned, she reported that her shoulder was feeling much better, and a reassessment indicated that her shoulder was functioning better than when she first had come to the clinic. I treated this client four more times over four weeks until she was able to raise her arm the full range and was pain-free.
For More Information
Organizations
College of Massage Therapists of Ontario (CMTO)
1867 Yonge Street, Suite 810
Toronto, ON
M4S 1Y5
Tel.: 416.489.2626
Toll Free: 1.800.465.1933
Fax: 416.489.2625
Web: www.cmto.ca
Email: cmto@interlog.com
Ontario Massage Therapist Association (OMTA)
365 Bloor Street East, Suite 1807
Toronto, ON
M4W 3L4
Tel.: 416.968.6487
Toll Free: 1.800.668.2022 (Ontario only)
Fax: 416.968.6818
Email: omta@collinscan.com
American Massage Therapy Association (AMTA)
820 Davis Street, Suite 100
Evanston, IL
60201
Tel.: 847.864.0123
Fax: 847.864.1178
Web: www.amtamassage.org
Books:
Medicine Hands: Massage Therapy for People with Cancer by Gayle MacDonald
This is an excellent book that anyone who is a bodyworker or living with cancer should read.
Magazines & Journals:
Massage Magazine
You can subscribe through their web site at www.massagemag.com but some health food stores and bookstores carry it. It is a US publication.
Journal of Soft Tissue Manipulation
You can subscribe to this through the OMTA. You don't have to be a therapist to subscribe.
Massage Therapy Journal
You can subscribe through the AMTA web site at www.amtamassage.org.
Websites:
www.massage.ca -- good and brief
www.miami.edu/touch-research/index.html -- check out the database for massage therapy abstracts
www.massageresource.com -- good info for lay people and massage therapists
www.libraries.wayn.edu/shiffman/altmed/therapy/massage.html -- lots of links
www.qwl.com
www.pediatricmassage.com -- good information, unfortunately only workshops in the US, but if you contact the CMTO or your local hospital, they may have workshops near you
www.knowyourbodybest.on.ca -- great place to shop for products and books
www.yoga.com/raw/massage/info/faqmassage.htm -- good descriptions of different kinds of massage and links to other sites
www.mtwc.com -- lots of information for therapists and the general public alike
www.MassageTherapyHomepage.com -- again, lots of information for all
www.massagenet.com -- they have a discussion forum where you can ask questions and people can reply to them
Ailment / Situation Listing
