Top 15 Massage Techniques | Ebook by dejahlgriffin

THE TOP 15 MASSAGE TECHNIQUES 2019 EDITION

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TABLE OF CONTENTS AROMATHERAPY

PG 5

ASSISTED STRETCHING

PG 9

CHAIR MASSAGE

PG 14

CRANIOSACRAL

PG 19

THERAPY CUPPING

PG 24

ENERGY THERAPY

PG 33

FACE-LIFT, OR FACIAL, MASSAGE

PG 44

GERIATRIC, OR SENIOR, MASSAGE

PG 52

TABLE OF CONTENTS INSTRUMENT ASSISTED SOFT TISSUE MOBILIZATION

pg 58

LIGHT AND LASER THERAPIES

pg 63

MEDICAL MASSAGE

pg 67

MYOFASCIAL RELEASE

pg 70

ORTHOPEDIC MASSAGE

pg 76

STONE & SHELL THERAPY

pg 83

TAPING

pg 89

AROMATHERAPY

4 Ways to Use Aromatherapy in Your Spa Practice By Debora Bogart

ssential oils can be a beneficial addition to any massage, but before using them you must be properly trained and aware of your clients’ health issues, allergies and scent dislikes. Further, with aromatherapy you will be adding something to the massage medium that will be absorbed through the skin, affect your client’s metabolism and interact with their limbic system. As massage therapists, we must understand the importance of proper training before using something as potent as essential oils, because not everyone’s massage education includes this important information. After you’re educated, by doing a thorough intake and assessment you can determine how you want to proceed with your aromatherapy add-on to a massage session.

EMPLOY A DIFFUSER

Diffusers distribute essential oil molecules into the air, which gives anyone walking into the space beneficial exposure. A diffuser that allows you to change oils quickly is ideal.

Diffusers driven by an electric fan use a pad to apply a few drops of oil, and the pad is placed beneath the fan compartment. This type of diffuser allows for a quick change of oils if a therapist encounters a client who finds the current oil offensive to their senses.There are many diffusers on the market, enabling a therapist to purchase one that meets their specific needs.

USE SINGLE-NOTE ESSENTIAL OIL ADDED TO MASSAGE CARRIER OIL

Single-note essential oils, such as lavender or Roman chamomile, can be used to enhance relaxation or alleviate a depressive mood.

Have a variety of oils on hand so the single oil can be added as needed. Single-note essential oils, such as lavender or Roman chamomile, can be used to enhance relaxation or alleviate a depressive mood. A couple drops of the essential oil added to 1 ounce of carrier oil is all that is needed to complete a full, relaxing, therapeutic session.

INTENSIFY MASSAGEâ&#x20AC;&#x2122;S BENEFITS WITH CUSTOM BLENDS

Use blends the same way you use a single-note essential oil. Just place a few drops of the readymade blend into 1 ounce of a massage carrier oil. Massage the oil into the clientâ&#x20AC;&#x2122;s trouble areas or use it on the whole body. A great example would be using a muscle blend of Helichrysum and Wintergreen on an athlete who is complaining of muscle aches. Blends are a group of essential oils that usually have the same chemical components, thus creating a stronger blend. Some common blends to keep on hand would be muscle blends, relaxation blends and rejuvenating blends. It would also be helpful to have special blends on hand for fibromyalgia, sinus pain, and tension and migraine headaches.

For therapists who donâ&#x20AC;&#x2122;t have ample training or knowledge of blending, there are many massage mediums on the market that have essential oils already added for you. Even though these products are available to all therapists, a therapist still needs to be aware of indications and contraindications, as well as, the properties of the pre-added essential oils to prevent allergic reactions with clients. Most of the products will list the beneficial effects of use on the product labels.

OFFER RETAIL SALES OF CUSTOM BLENDS

Therapists who have ample training can preblend massage creams for clients to purchase and continue self-care aromatherapy treatments at home between their therapeutic sessions. This allows them to get the most complete results from their aromatherapy. Therapists who are not trained in blending can purchase pre-blended creams from an aromatherapy company or another local aromatherapist at wholesale cost. Some common retail products that clients may enjoy include diffuser single-note essential oils or diffuser blends, fibromyalgia creams, muscle relief creams and headache or sinus roll-ons. Self-massage lotion that has essential oils blended for relaxation and better sleep is a wonderful product to have on hand for most clients.

Even though such products are commonly found at department or health-food stores, clients prefer to purchase such products from knowledgeable therapists who can help them choose the best products for their needs. About the Author: Debora L. Bogart, LMT, is a certified aromatherapist and the medical massage therapist at Ellerbrock Spine and Soft Tissue in Bluffton, Ohio, instructor of an NCBTMB continuing education aromatherapy course for massage therapists and former massage theory and advanced massage modality instructor at the Institute of Therapeutic Massage in Lima, Ohio.

ASSISTED STRETCHING

How to Get Even the Most Inflexible Client to Say Yes to Being Stretched By Judy Stowers

n 2004, I watched my swim coach experiencing a stretch session. He was a high-level athlete and used stretching as a way to stay on top of his game. Having been in the massage industry for four years at that time, I was immediately drawn in to the benefits he was experiencing and wanted to be trained to provide stretch sessions to my clients. Fast-forward 14 years, having gone through certification in a few different stretching methods, it is now over 60 percent of my practice. A constant curiosity of the human body and how the fascial relationships affect different conditions has led me down a path I never imagined. Early on in my career, I wanted to focus on professional athletes. I found myself doing just that. From Olympians to the NFL, and from the Major League Baseball to collegiate sports, I was providing an increased number of stretch sessions to athletes. After taking courses, I quickly integrated stretch therapy into my practice and soon found that working with the everyday athletes, the ones who are out there having fun and staying fit, was the most rewarding. Helping them achieve their goals and stay injury free through stretching has been just the niche that has taken my practice to a new level.

It is what people are finding they need help with, and need the benefits of, in order to stay active and healthy. With need comes an incredible opportunity for growth.

8 WAYS TO MARKET ASSISTED STRETCHING

Finding ways to market assisted stretching sessions has been challenging when it isnâ&#x20AC;&#x2122;t the first thing that people think of as something that will help them to perform at their best and to feel better in their everyday lives.

...first thing that people think of as something that will help them to perform at their best and to feel better in their everyday lives.

Through the years, I have found some ways to bring attention to the general public on the benefits of stretching. Here are a few marketing strategies that have helped me build a clientele that comes specifically for stretch therapy sessions. Rest assured, if you have a Massage Magazine Insurance Plus policy, assisted stretching is included in the 350 services youâ&#x20AC;&#x2122;re already covered for.

Donate time to local gyms, running stores or triathlon stores to speak about the benefits of stretching and how it can help them perform at a higher level. Education is the key to helping people understand how your services can benefit them.

Encourage everyone to bring a yoga mat and take the attendees through a few stretches that target the needs of the group youâ&#x20AC;&#x2122;re presenting to. This allows them to FEEL how good stretching feels in their bodies and encourages them to come in for a stretch session. Words rarely sell the service by themselves, although the words can create some initial intrigue. For the potential client to feel the effects will create a strong desire for them to schedule an assisted stretching session.

Ensure your website has information on the benefits of assisted stretching so that potential clients can learn about your services. Answer questions that are relevant to the benefits of stretching and the conditions it can help overcome. A large percentage of the population does their research online before scheduling.

When you provide information, as well as a platform for scheduling, your appointments will increase. Booking online makes it easy for the consumer, which means they are more likely to book than if they have to call or email.

Create a social media presence. Offer stretching recommendations on a consistent basis to draw potential clients in. Several clients have decided to come in and try stretching after they have seen a post on a social media page. Ensure the post is engaging and that it identifies what the stretch can help with, such as low back pain, shoulder pain and plantar fasciitis. As much as we want them to come in the door, allowing the consumer to see what you’re all about and what you offer helps them choose you over other practitioners. Designing posts that trigger the “I need that” thoughts from the consumers lead to scheduling appointments. The need for a social media presence isn’t going away any time soon so this is an important piece of the marketing puzzle.

When clients are in your office for another modality, encourage they try a stretch for whatever they are in for. Ease them in with one stretch and build on that in subsequent visits. When they come in again, be sure to ask them how they felt after assisted stretching and then build on that. Offer an additional stretch at the end of their session so they begin building a toolbox of stretches that they can do on their own. Helping a client learn to help themselves goes far beyond requiring them to experience the results only from coming in to see you. They always appreciate learning and although they may not start doing stretches on their own right away, by providing the education, you give them the option of helping themselves.

I have had several stretch cards printed with the home versions of each stretch. Before the client leaves, I give them the cards of the stretches we covered so they have a reference and donâ&#x20AC;&#x2122;t have to try to remember everything we covered. They always appreciate this and comment on how much it helps them.

Attend local events and provide stretch services free of charge to the participants. Most event organizers will welcome services that complement the athlete experience.

Give them an incentive that makes sense to your business and also that helps the client experience what you have to offer with stretch.

Whether the event is for the weekend warrior or experienced athletes, a post-race stretch session can help them recover faster. Set up a booth and offer your services for free. Have business cards and fliers available so that the participant has an easy way to contact you after the event.

Consider adding a coupon or discount code to event participants when possible. This incentivizes them to schedule an assisted stretching session after their event. When people are trying something new, they look for a way to get it with a small discount. Once they are in the door, you can further incentivize them with package offers to keep them coming in. This would be the equivalent to a firsttime client offer that you may already offer. I would caution to not discount it so much that you only get them in the door once. That will only devalue your services and create a lot of one-time clients rather than the long-term client that you are seeking. Give them an incentive that makes sense to your business and also that helps the client experience what you have to offer with stretch.

Ask clients to leave reviews. When you have a Yelp.com or google.com page, the reviews are what help drive people to your business. These services are free of charge and can help potential clients find you more easily.

ADD ASSISTED STRETCHING TO YOUR MENU

With the number of people who are working hard to stay active and fit, adding stretch therapy to your menu of services will certainly help your business grow. It may take a few tries to figure out what works best for you to draw these athletes into your office. However, once you do find what works, there will be no turning back. Stretching, flexibility, and mobility fills in the gaps of other modalities and makes any movement available to any body. With its high level of safety and effectiveness, clients will not see any other option to helping them achieve their goals. Stretching will become their way of life! Judy Stowers, LMT, CST, is an educator, and an expert in exercise, massage, flexibility and stretching. She owns Apex Bodyworx in Scottsdale, Arizona. Stowers is a National Certification Board for Therapeutic Massage & Bodywork-approved continuing education provider. She wrote “Take Your Massage Results to New Heights with Assisted Stretching” for MASSAGE Magazine’s June 2018 issue.

CHAIR MASSAGE

15 Tips from Chair Massage Pros By Allison Payne

ith a quality massage chair and your imagination, you can expand your practice, build clientele, make extra money and support clients’ health. THREE EXPERTS SHARE THEIR TIPS FOR CHAIR MASSAGE SUCCESS.

Use a chair massage as a marketing tool—or your primary means of income. “[It’s] a way to build a table practice, or to create a chair practice that’s part of a table practice,” says David Palmer, founder of Touchpro International and developer of the first massage chair. “And some people choose to make chair massage their primary, exclusive way to [provide] skilled touch in the world.” Depending on your personality, you may prefer to build longer-term relationships with clients; or you may value the chance to meet lots of new people and make an improvement in their day, meaning you would take your massage chair to many different locations. “Some therapists enjoy [chair massage] for the variety,” says Dan Melmed, L.M.T., owner of Body Well Mobile Massage Professionals. “The money can definitely add up, because in a lot of cases, we’ll be going for several hours of guaranteed work. I know many therapists, myself included, appreciate the opportunity to be able to have a positive impact on so many people, in such a short period of time.” Also, Melmed adds, “there’s no laundry involved!”

Highlight the benefits of chair massage. While you may not be able to effect long-term health benefits from a single chair massage session, you will help that client feel better right there, right then. “It’s an instant attitude adjustment,” says Palmer. “It does make people feel better immediately thanks to oxytocin and a couple of other hormones that get released as soon as positive touch is encountered.”

...improving employee morale, reducing stress, decreasing the chances of injury, and other benefits.

Ralph R. Stephens, L.M.T., C.N.R.T., founder of Ralph Stephens Seminars and creator of the video series Seated Therapeutic Massage, says, “There is a therapeutic paradigm for the chair. I’ve found that even if I was in a relaxation setting, like out in public somewhere, almost everybody that got in the chair had some specific complaint.”

Reframe the idea of stress relief. “Instead of selling [massage] in the negative, sell it in the positive. [It’s] health promotion, not just stress reduction,” Palmer says. “Everybody is comfortable with the concept of health promotion: I want better health.”

Give management what they want. When you’re marketing in-office chair massage to corporate clients, make sure you explain how chair massage techniques will help their bottom line—by improving employee morale, reducing stress, decreasing the chances of injury, and other benefits. Stephens says, “Approach employers with how this is going to benefit [their] company, not just cost [their] company.”

Optimize your website for local search. According to Palmer, “We really don’t find the customer. The customers for chair massage in the workplace find us. When people want chair massage, they’ll type it into their browser … and it pops up in their geographical location.”

Nurture corporate relationships. Keep in touch with managers who have booked your chair massage services, even if they change jobs. “We’ve many times seen where a manager who’s brought in chair massage at one company leaves, goes to another company and then brings it in over there,” Palmer says.

Promote yourself—if you can. Check with the person who hired you to do chair massage, and make sure it’s OK to have business cards or brochures available. One short seated session might be someone’s first massage—and might convince that person to get table massage on a regular basis. Stephens recommends carrying business cards with you at all times, even when you are not doing massage. “Don’t go to the grocery store without cards; don’t go to the gas station without cards, because everybody needs a massage. They just don’t know it yet.”

Pack a toolkit. Palmer recommends disinfecting wipes, face cradle covers, and elastic bands for clients with long hair. You should also make sure there’s a small trash can nearby to throw away disposable items.

Make payment terms clear. Make sure the client understands whether you are charging per minute or per session, and what types of payment you accept. In a corporate setting, says Melmed, a good method is to charge a guaranteed set hourly rate, and agree on the number of hours you’ll be available to provide massage. “That way we know what we’re going to be making and we can also guarantee [that] for the therapists performing the services.”

Bring the guys. Melmed feels there’s less gender discrimination surrounding chair massage. “For male therapists looking to get more work, I’ve always recommended chair massage because most of our corporate clients are really not as concerned with gender. If we’re sending a team of therapists, they’ll often request some balance of male and female.”

Make your needs known. Have a conversation with the manager who booked your services, explaining what you will need to do your best work possible, or even provide a list in writing. Discuss details such as how long you will work, when you will need bathroom, lunch or stretch breaks, and how many clients you will see. “There can be misunderstandings, because the person coordinating it at the company may not fully respect the therapist’s needs or how hard they’re working, and the fact that they actually need a break,” Melmed says.

12 Discuss details such as how long you will work, when you will need bathroom, lunch or stretch breaks, and how many clients you will see.

Be legal. Generally, says Melmed, you don’t need permits for events that take place on private property, such as within a company’s offices, but you may need a permit to provide massage at festivals or other outdoor venues. Some places, such as public parks, may also require proof of insurance.

Don’t settle for low rates. “You want to find places with people who can afford you,” says Stephens. He also recommends watching your overhead, especially in places where you rent a kiosk, like malls or airports. “Make sure that space isn’t so expensive that you wind up not making much money.”

Keep your massage chair ready. “Don’t fold your chair up every time you bring it back to your office,” says Stephens. “If somebody comes in [with] very acute back pain, one of the most painful things for them to do is lie down on the table and get back up off of it. You can have them straddle that chair, sit down and calm that low back down in the first 10 or 15 minutes of your treatment, and either move on to the table or maybe you can resolve their complaint in the chair.”

Set realistic intentions and expectations. “Making sure that the expectations of the customer are in alignment with the intention of the practitioner is crucially important to the massage transaction,” says Palmer. “If they think you’re doing therapy, and you’re only doing relaxation massage, you might have a problem.”

That’s why Palmer always makes chair massage clients a promise he can keep: “No matter what you feel like when you sit down in the chair, you’ll feel better by the time you get up. I think that’s a very powerful and appropriate guarantee.” Allison Payne is associate editor of MASSAGE Magazine and managing editor of futureLMT.com, MASSAGE’s publication for student and beginning massage therapists. She wrote “The Top 3 Ways to Make Money with Your Massage Chair” for MASSAGE Magazine’s November 2015 issue.

CRANIOSACRAL THERAPY

Craniosacral Therapy: An Ideal Modality for Treating Inflammation By Tim Hutton, PhD, LMP, CST-D

ranioSacral Therapy (CST), because of its ability to engage specific tissues in the body with great precision, is an ideal modality with which to address the immune system. Using CST it is possible to directly map inflammation in the body, on a micro level. One can tell exactly which tissues are inflamed, what aspects of the immune system are involved in that inflammatory process, and to some extent to what the immune system is reacting, all simply by palpating the movement of the immune system in response to the craniosacral rhythm. The immune system, which consists of a loose network of 10 to 50 billion cells of various kinds, all acting together and communicating with each other chemically and energetically, can often seem a bit esoteric. Tissue is easy to palpate and is easily affected by manual therapy. It is less obvious that this is true of the immune system. The immune system, however, is involved in every issue that we treat as manual therapists. If the client is experiencing a symptom, there is some degree of inflammation, and the immune system is involved. This involvement may be primary, as in the case of an infection or an autoimmune condition, or it may be secondary, in which case simply releasing fascial restrictions may be enough to allow the inflammatory response to completely abate. Most often, the situation is somewhere between these two extremes, however,

and simply releasing fascial restrictions does not completely eliminate the inflammation. Thus it is critical that we as manual therapists be able to address this important system of the body. These types of white blood cells help the immune system.

A BRIEF HISTORY OF CRANIOSACRAL THERAPY

While there are some similarities between Cranial Osteopathy and CST, there are also major differences.

CranioSacral Therapy was developed by John Upledger, D.O., O.M.M., in the mid-1970s and derives out of the osteopathic tradition. Andrew Taylor Still developed osteopathy itself in the late 1800s. Osteopathy is based upon the principle that the body possesses its own Inner Wisdom and ability to heal, though sometimes the body needs additional resources to do so. The role of the therapist is to provide those additional resources to the Inner Wisdom. The therapist does not directly make changes to the tissue; the therapist supports the Inner Wisdom and the Inner Wisdom makes the changes the Inner Wisdom deems to be important. Thus, the role of the therapist becomes that of a facilitator. Andrew Still had a student in the 1920s named William Sutherland, D.O. Sutherland was intrigued with the movements of the bones of the skull and developed an approach to therapy he called Cranial Osteopathy. While there are some similarities between Cranial Osteopathy and CST, there are also major differences. In the early 1970s, Upledger had the opportunity to assist a surgical procedure that involved exposing the dural tube of the patient (the membrane which surrounds the spinal cord). During this surgery, Upledger directly witnessed a rhythmic expansion and contraction of that tube. Intrigued, he initially went and studied Cranial Osteopathy. His research led him in a different direction, however, and ultimately, he developed CST. Cranial Osteopathy focuses primarily on the bones of the skull. Practitioners have a very detailed understanding of the sutures of the cranium, and many subtle techniques to free up those bones. Upledger felt that while the sutures were important, problems were most often caused by tensions in the membrane system to which those bones

attach. These membranes line the cranium and attach strongly to the sacrum, hence the name CranioSacral. (Tensions may come from anywhere. It is not uncommon for a sprained ankle or twisted knee, for example, to produce a tension that pulls up into the cranium. In such a case, treating the membranes in the cranium can be helpful, but if the twist in the knee or ankle is not addressed the results will often only be temporary. Thus, despite the name, a CranioSacral therapist will address the entire body, not just the head and tailbone.) Addressing these membranes requires that very light force be used. Too much force and the body will guard. Typical force used in CST at the site of the tension is about 5 grams, or the weight of a nickel. (The therapist may need to apply more force than that to the tissue, in order to apply just the right force at the depth of the restriction.)

CRANIOSACRAL THERAPY AND MUSCULOSKELETAL PAIN

Life is about compensation. We all have tension and internal conflicts due to various traumas that we have experienced. So long as we can compensate around those internal tension patterns, there will be no symptoms. Absent direct palpation of a tension pattern, one would not even know it is there. It is only when the tension overwhelms the bodyâ&#x20AC;&#x2122;s ability to compensate that these symptoms occur. However, symptoms show up at the weak linkâ&#x20AC;&#x201D;not necessarily where the tension is. Symptoms are not a reliable indicator of where the origin of a problem lies, and simply treating symptoms often will yield only temporary results. CST directly addresses those internal tension patterns. Reducing internal tensions gives the body back room to compensate, often resulting in a reduction of symptoms. This is true even in cases where the proximal cause of the symptoms was not directly addressed.

Give the body enough room to compensate and the symptoms may abate anyway. Thus, CST is potentially beneficial for just about any condition. Reducing internal tension and conflict allows the body to function better no matter what is going on. CranioSacral Therapy can be used to treat, often in conjunction with other therapies, a wide variety of pain conditions, particularly headaches and musculoskeletal pain. It can be useful in treating neurological and circulatory issues, digestive issues as well as problems with other internal organs. Any condition may respond positively to CST if the internal tension in the body can be reduced.

Upledger Institute International (UII) teaches CST through a series of four-day seminars.

Because CST employs very light force, typically about 5 grams, there are very few contraindications to its use. Contraindications generally fall into two major categories: compromise to the structure of the membrane system around the brain and spinal cord, and anytime a small transient increase in intracranial pressure could conceivably cause a problem. Examples of the former are epidural leaks from lumbar puncture and open cavity head wound. Examples of the latter include acute stroke, severe concussion with consequent swelling of the brain and unstable cerebral aneurism. (Chronic stroke, where there is no longer a danger of causing a clot or bleed to recur, is very much an indication for CST.)

BECOMING A CRANIOSACRAL THERAPIST

Upledger Institute International (UII) teaches CST through a series of four-day seminars. There are four seminars in the core curriculum: CranioSacral Therapy 1, CranioSacral Therapy 2, SomatoEmotional Release 1, and SomatoEmotional Release 2. In addition to these four courses, UII teaches numerous seminars on more specialized topics in CST, such as pediatrics and obstetrics, working directly on the brain, and as discussed, working directly with the immune system. UII also has a certification process that is available to students. There are two levels of certification, the first of which can be undertaken after having complete CranioSacral Therapy 2, although the

certification process is really meant for students who have been in practice for several years and have a lot of experience doing CST. To become certified, students must pass an open book essay exam, and they must demonstrate competency in CST during a hands-on practical examination. (Certification does not provide a legal right to practice. Certification can, however, demonstrate to clients the competency of the therapist, and is meant to be a learning experience.) Tim Hutton is a licensed massage practitioner in the state of Washington and has been in private practice at the Natural Health Clinic in Bellingham, Washington, doing CranioSacral Therapy, since 1994. He is also certified in CranioSacral Therapy at the Diplomate level (C.S.T.-D.) and teaches a variety of courses in CranioSacral Therapy for Upledger Institute International.

CUPPING

Cupping as Manual Therapy By Anita Shannon, L.M.T.

ust as there are many different approaches to massage, there are many types of cupping therapy. A cup replaces the hand in vacuum manual therapies, where a machine is used to create a sucking effect. We cannot create suction with our hands. The cup is held in the hand and the practitioner performs movements as they would with massage, except it is done with suction. A cup may also be used for meridian and point work in traditional cupping therapies. Hybrids of these two approaches are coming into use as well. The beauty of adding cups into bodywork is the synergistic aspect of an integrated treatment. Synergy means â&#x20AC;&#x153;made up of aspects or parts that work well togetherâ&#x20AC;? (Encarta Dictionary). Traditional Chinese Medicine, for example, features the concept of yin and yang as synergistic forces. We have all noticed more impressive results as we learn and integrate new modalities into our work, because synergy increases the benefits of our treatment. Massage cupping combines well with other modalities, is easy to integrate into a massage session, and is valuable as an assessment tool. The vacuum creates a lift and separation in tissue that complements the compression of most manual therapies.

You can add cupping to other techniques you have learned and use in your practice. For example, with a pin-and-stretch technique you could try using the cup to pin, or place it on a trouble spot along the muscle and perform the movement as you usually do.

BENEFITS OF CUPPING

Cupping affects several areas, including circulation, fascia, lymph and muscle tissue.

Circulation: The vacuum creates vasodilation, which draws blood flow into the tissue. The expansion of blood vessels also offers a vehicle for release of deep inflammation to the skin surface. (If the skin becomes hot during vacuum therapy, it is usually a good time to move on to another area of the body.) Fascia: Separation of strands of fascia is profound when tissue is stretched in multiple directions by the cup. Observe the tissue in and around the cup to see that the stretch often extends into the surrounding tissue. Separation of the strands and structures creates space for fascia to move properly. (View Strolling Under the Skin, a video presentation on fascia by Jean-Claude Guimberteau, MD.) Lymph: The vacuum is used to release adhesions that can block drainage and create congestion and vascular stress in the affected area. Adhesions are defined as â&#x20AC;&#x153;the joining of normally unconnected body parts by bands of fibrous tissueâ&#x20AC;? (Encarta Dictionary). This can be scar tissue; tangled and torqued fascia; and even a compression mark from such clothing as bras, tight bike shorts or socks; or marks from a chair where the person sat and worked for years. (Apply moist heat prior to treatment for better drainage of congestion, scar tissue release, and hydration of stiff, hard tissue.)

Once the restriction of flow is removed, congestion can be liquefied and directed to the nodes using a combination of manual and vacuum therapies. Vacuum therapies also work well in combination with lymphatic taping techniques and manual lymph drainage.

Vacuum therapies also work well in combination with lymphatic taping techniques and manual lymph drainage.

Muscle tissue: Using the vacuum cup on all types of muscle tissue produces effective results. The tissue visibly softens, feeling plump with hydration and blood flow when palpated. Attachments can be toned or released depending on the techniques used. The park-and-manipulate technique, for example, enables the practitioner to lift attachments as the joint is slowly moved through its range.

AN OVERVIEW OF CUPPING

Cup size matters. A larger cup will provide the best evaluation of the tissue in and around the cup, and also disperse a stronger suction over a larger area for more comfort. Smaller cups allow for precise work in challenging areas such as the face, neck, hands and feet. When working on a muscular athlete, using extralarge cups that can cover a large portion of the muscle or muscle group has benefits that cannot be produced with the hands. Pre-treating with vacuum therapy prior to deep tissue techniques significantly increases the effectiveness of manual methods, along with less strain on both therapist and client. Softening and decompressing the lateral leg structures is crucial when working with lower back and gait issues or athletic performance regimens, and the vacuum cups can do this very comfortably.

Pumping modes and continuous suction are effective in different ways: •

• •

Pumping, which creates a vacuum effect inside the cup, begins the gentle separation of fascia strands without the stress of continuous suction. Pumping is a technique that creates suction and then releases the tissue. Pumping can be very superficial, using a fast timing on the suction and release, or deeper if the suction is held longer. Static, or constant, suction is used to glide across the tissue or perform other movement that requires the cup to maintain suction until manually released. Pumping can encourage tone in hypotonic tissue, while long, gliding movements or traction are beneficial for loosening hypertonic tissue. Pumping is best for gentle work, while continuous suction techniques work well for those who have limited sensation due to congested or dense tissue. Pumping is useful for working lightly over lymph nodes, and continuous suction is used to separate and decongest tissue. Pumping is often used to stimulate tissue and is especially beneficial for organs and weak vascular walls.

ZONE BY ZONE

Abdominal work: Cupping therapies combine well with colon therapies and are used to release the diaphragm and intercostals. These techniques are always an important part of working with scoliosis. Head and neck: Vacuum therapy techniques merge with chiropractic and a variety of manual therapy techniques by releasing tissue prior to the adjustment or movement, allowing free realignment of the skeletal system. Small cups and pumping modes can be used to address a variety of issues in the face, head and neck. Sinus and ear congestion and headaches are some of the conditions that benefit from such applications.

Research on 50 subjects with chronic, nonspecific neck pain, published in Complementary Medicine Research in 2017, found those who received cupping massage “reported significantly less neck pain post intervention” than those assigned to a wait list. “Cupping massage appears to be effective in reducing pain and increasing function and quality of life in patients with chronic non-specific neck pain,” the authors noted. “More rigorous studies are needed to confirm and extend these results.” Shoulders and back: Once the neck structures are released, the anterior and posterior muscle groups of the upper trunk must be addressed. Pectoral hypertonicity with trapezius hypotonicity is a common problem that pulls the shoulders forward.

The most familiar application of cupping therapies is on the back.

One of the most effective parts of anterior release techniques is working along the sternum and pectoral attachments, moving into the muscle mass and then up to the shoulder attachments. The cups also make it very easy to work deep in the axilla to liberate the joint from restriction of movement. The most familiar application of cupping therapies is on the back. The goal of long, gliding movements along the erector spinae and intervertebral structures is to create space for the discs and relieve pressure or compression. Another favorite area on which to use vacuum cups is the typically stiff thoracolumbar fascia of the lower back. Arms and legs: If there is a complaint of carpal tunnel syndrome, the work begins with the head, neck, shoulders and back, and then continues into the arm and hand to identify and release chronic issues resulting from repetitive movement patterns or old injury. Small cups and strong suction used on the wrist and hand after the other areas have been addressed can then produce effective results. Results of a randomized controlled trial on 52 outpatients published in 2009 in the Journal of Pain indicated, the authors noted, that “[c]upping of segmentally related shoulder zones appears to alleviate the symptoms of carpal tunnel syndrome.”

Plantar fasciitis is very similar in that the treatment begins with the back and hips and works down to the feet to discover the true origin of the imbalance. Many people with lymphatic challenges in the legs experience loss of sensation or pain in their feet, and vacuum drainage of lymphatic congestion combined with taping works well to relieve pressure on the nerves and blood vessels. Skin: The skin is often overlooked in bodywork, but observation of this tissue in and around the cup can reveal clues to client conditions. Restrictive patterns can be seen and traced, tissue inflammation can be detected if the skin becomes hot, and old debris from life experiences can be seen and sometimes smelled coming through the skin. (Read more about this in the section titled “Debris in the Tissues?” below.)

The skin is often overlooked in bodywork, but observation of this tissue in and around the cup can reveal clues to client conditions.

The skin can also be tightened and toned using vacuum therapies, providing a great preparation or even alternative to surgical treatments. (Note, however, that the information in this article does not replace medical advice.) Facials and other skin care procedures such as dermabrasion have included vacuum therapy for decades, well before the recent resurgence of interest. If you hold a certification or credential that puts skin care within your scope of practice, cupping could be a valuable addition to your clients’ care.

DEBRIS IN THE TISSUES?

There is much dissension on the subject of toxins and debris in the tissues of the body. Toxins are defined as “a substance that accumulates in the body and causes it harm” (Encarta Dictionary) and are usually associated with slow poisoning. We are exposed to quite a few substances in our daily lives, from the cacophony of synthetic scents we are assaulted by to fuel exhaust and other pollutants. The experiences we have had in classes and at trade shows are puzzling. During one demonstration, a student being treated had worked in baggage

handling for over 10 years before becoming a therapist nine years prior to the class. During the cupping therapy, we had to have everyone leave the classroom after the smell of jet fuel became overwhelming. While there may not be an easy explanation, the experience left a vivid memory and many questions.

It appears that the body is not able to eliminate the residue from medications, pollutants, injuries, surgeries and other life events, and it finds a safe place to store the material.

The discolorations under the skin that we often see from cupping therapies might provide perspective on this therapyâ&#x20AC;&#x2122;s effect on pollutants in the body. My opinion is that many people have compromised immune function and are not able to effectively eliminate all of the residue from surgeries or injuries that could not be eliminated by the immune and lymphatic systems. Based on in-session experiences, I believe that a dark purple or black color can indicate a very old injury, graduating to brown colors and then red tones from more recent issues. When working on the upper back over the lungs of smokers, a yellow-and-gray discoloration will often appear. People exposed to things such as secondhand cigarette smoke, campfires, fireplaces, and wood or pellet stoves often present a gray color in the skin on their back during cupping therapies. We see these things when we work with vacuum cups, but without a body of research into this therapy we donâ&#x20AC;&#x2122;t have substantiated explanations for them. It appears that the body is not able to eliminate the residue from medications, pollutants, injuries, surgeries and other life events, and it finds a safe place to store the material. It would seem that the vacuum will often pull that material from storage and the body will then eliminate it via the lymphatic and eliminatory systems, just as it would be eliminated at the time of injury.

THE FUTURE OF CUPPING

There are a plethora of classes available today, but nothing replaces a live workshop. Because it can be difficult to travel to a class or you are not sure if this modality fits into your work, there are also online classes that will provide a vast amount of information. Begin with an online course and practice on willing volunteers, and then attend a workshop to study with an experienced instructor, as well as hear questions and experiences from other students. Cupping is an ancient art that is finding a new place in modern health care. However, research into cupping is lacking.

Massage cupping is an effective tool and vacuum therapy is a modern technique.

One review of cupping in athletes, published in the Journal of Alternative and Complementary Medicine in March 2018, looked at 11 trials—and while the authors found that “cupping was reported as beneficial for perceptions of pain and disability, increased range of motion, and reductions in creatine kinase when compared to mostly untreated control groups,” they also noted that most of the trials had “an unclear or high risk of bias” and that further research is needed. Vacuum therapies, or massage cupping with vacuum action, do combine with current medical practices as an integral part of surgical preparation and recovery, along with injury rehabilitation, functional medicine and wellness. Medical professionals refer to practitioners, often after a patient or two comes in and shows them a big shift in their issue, such as a change in dense breast tissue or in post-surgical scarring. Massage cupping is an effective tool and vacuum therapy is a modern technique. Both may benefit your clients in ways your hands alone cannot. As research into cupping matures, so too will the opportunities to practice it in a variety of venues.

Take this quiz to determine if contemporary vacuum therapies would be an added asset to your business! The quiz is appropriate for all health care providers, including nursing, PT, OT, chiropractic, and massage therapy. About the Author: Anita Shannon, LMT, (massagecupping.com) has been licensed in massage therapy and cosmetology since 1983. An educator since 1990, she appears at national chiropractic, massage, and spa conventions and currently presents workshops on ACE Massage Cupping and MediCupping at international locations since developing these brands of bodywork in 2002. She has created five educational videos on vacuum therapies. She was inducted into the Massage Therapy Hall of Fame in 2011. Her articles for MASSAGE Magazine include “Conquer Clients’ Confusion About Massage Cupping.”

ENERGY THERAPY

The Massage Therapist’s Guide to Reiki By Allison Payne

hat Is Reiki? Reiki, which originated in Japan, is a form of energy work administered with very light or no touching of the body; the word Reiki comes from the Japanese words “rei” (life force) and ki (energy). Reiki is based on the idea that a life force energy flows through us, and that fluctuations in this energy affect our physical health, according to the International Center for Reiki Training (ICRT). In a typical Reiki healing session, the client remains fully clothed and either lies down on a massage table or sits comfortably in a chair. As in a massage session, a serene, peaceful environment is created for the session, often with quiet music. The Reiki practitioner, employing either very light handson touch or holding his or her hands close to the client’s body, then moves the hands systematically through different positions, with the intention of discharging negative energy and replacing it with positive energy. The Reiki practitioner may spend more time in certain areas, depending on the clients’ needs or goals for the session. Because Reiki derives its benefits from an energy that is universally accessible to anyone, anywhere, proponents of Reiki may also offer what are called distant sessions, in which the receiver is not physically in the practitioner’s presence.

Recipients of Reiki say receiving it feels “like a wonderful glowing radiance,” according to the ICRT. Proponents of Reiki say sessions can be helpful in improving the condition of those suffering from a variety of physical issues, from chronic, serious illnesses such as cancer to more minor conditions like insomnia. “Professional massage therapists are naturally in tune with the human body and its energy, blockages and flow. Adding an energy healing technique such as Reiki is a perfect complement to expand their offerings,” reiki expert Linda LaFlamme told MASSAGE Magazine via email. “Becoming trained and certified in Reiki and a registered Reiki professional can help expand a massage business and will expand the therapist’s range of offerings,” she added.

You can actually... be giving Reiki at the same time you’re doing a massage...

William Rand, a senior Reiki master and teacher and president of the Center for Reiki Research, told MASSAGE Magazine that the healthy touch of massage therapy and the energy of Reiki healing complement each other well, and that about 10 percent of students in his Reiki trainings are professional massage therapists. “You can actually ... be giving Reiki at the same time you’re doing a massage,” he said.

A BRIEF HISTORY OF REIKI

According to Rand’s book, Reiki: The Healing Touch, Reiki began in Japan, where it was practiced in several different styles; however, Mikao Usui is regarded as the founder of the typical style of Reiki with which most people are familiar, now known as Usui Reiki. In Tokyo in 1922, he established a school of Reiki, to which many people came seeking guidance as well as help with their ailments. Mikao Usui also developed teaching methods with which to pass along his knowledge and taught more than 2,000 students before his death in 1926.

A succession of several students in turn led his organization after he died. Hawayo Takata is the woman credited with bringing the practice of Reiki to the U.S. in 1937, and she developed and adapted it in a number of ways for American Reiki practitioners. The Reiki healing method by which a student of Reiki is initially introduced to the energy by a Reiki master is called an attunement. The history of a person’s Reiki instruction, because it is passed down from teacher to student and then to that student’s students, is referred to as a practitioner’s lineage.

THE DIFFERENT KINDS OF REIKI

Karuna Reiki was developed with the intention of relieving suffering...

There are several different kinds of Reiki—and every practitioner brings his or her own style to bear on what he or she was taught—but there are two main types most commonly used in the U.S.: Usui and Karuna. Usui Reiki, the style which is most familiar in the West, began in Japan with Mikao Usui and eventually came to the U.S. with Hawayo Takata in 1937. It is typically used to promote relaxation, stress reduction and balance, which can in turn promote healing. Karuna Reiki was developed with the intention of relieving suffering; the word karuna is Sanskrit for “any action that is taken to diminish the suffering of others” and can also be translated as “compassionate action,” according to the International Center for Reiki Training. Karuna Reiki was developed by William Lee Rand, from the Usui Reiki in which he was originally trained. (Rand and the ICRT introduced another variety, Holy Fire Reiki, in 2014.)

REIKI SYMBOLS AND WHAT THEY MEAN

Usui and Karuna Reiki both use a number of special symbols to help practitioners’ access and channel the energy on which the practice of Reiki is based; these are introduced to the Reiki student during his or her attunement, when the student learns to associate each symbol with the specific type of energy it represents. By recalling a symbol, the practitioner can also tap into that energy when needed during a session. The Reiki symbols themselves are derived from the Japanese kanji system of writing, and also Sanskrit in some cases, according to the ICRT. Usui Reiki uses these symbols: • • • • •

Power (Choku Rei); Mental/Emotional Harmony (Sei Hei Ki); Distance/Connection (Hon Sha Ze Sho Nen); Reiki Master (Dai Ko Myo); Completion (Raku).

Karuna Reiki uses these symbols: • • • • • • • • •

Om/Aum (the sound of eternal oneness, typically associated with meditation); Zonar (karmic issues); Halu (a deeper form of Zonar); Harth (heart issues); Rama (male/female energy); Gnosa (mind/higher self ); Kriya (healing); Iava (personal power); Shanti (peace).

WHAT ARE SOME REIKI BENEFITS?

“Some of the many benefits of Reiki may include stress reduction, comfort and sheer relaxation,” said LaFlamme. “Many clients report a feeling of enhanced well-being, peace and of feeling grounded after a session or series of sessions.”

In addition to the benefits to the client who receives Reiki, giving a Reiki session can benefit the practitioner as well. Because Reiki is believed to balance life energy, being an active participant in that process helps both you and your client. “A Reiki practitioner also receives some of the healing benefits of Reiki while giving Reiki, as an added wonderful bonus,” LaFlamme said. “Professional massage therapists [who perform Reiki massage] give so much of themselves in their beneficial and loving practices. “Offering Reiki to clients ... is a refilling of the well while providing value at the same time,” she continued. “Everyone benefits, sometimes in profound ways.”

...the results can be measured, and there’s extensive research on that.

Whether you offer just Reiki or decide to work as a Reiki massage therapist, both you and your clients will reap rewards from this energy work.

WHAT DOES SCIENCE SAY ABOUT REIKI?

Rand said no “solid evidence” for Reiki’s effectiveness yet exists, though practitioners and clients often cite anecdotal evidence to back up Reiki’s various benefits. “In terms of the energy itself, it seems to beyond scientific measurement,” Rand said, “but the results can be measured, and there’s extensive research on that.” He described one study in which 45 participants with health issues were divided into three groups: the first received no intervention; the second received what he called “sham Reiki,” in which a person posing as a Reiki practitioner went through the motions of providing Reiki; and the third received authentic Reiki from a trained practitioner. (The sham Reiki group was used to control for the placebo effect, in which people experience benefits purely because they believe an intervention will be effective.)

During the study, standard care and sham Reiki “had some effect, but it was very marginal,” Rand said. In the Reiki group, the subjects experienced significant decreases in heart rate and diastolic blood pressure, according to the study’s abstract. Write-ups of this study, along with a number of others, are available to read on Rand’s research website. While research into this modality is challenging for many reasons, Rand recognizes the importance of achieving scientific validation of Reiki’s benefits through formal research. “We want to do a large-scale study with 300 patients ... that science [would] consider as an adequate, large-scale study,” he said.

...by its nature it often touches the spiritual side of both practitioners and clients.

IS REIKI RIGHT FOR YOU?

To be an effective, sought-after Reiki practitioner, “being honest and having a sincere desire to help others” is essential, Rand said. He also notes that good organization and business skills are important, just as they are in massage therapy, especially if you are a sole practitioner who is self-employed. While Reiki is not a religious belief system and does not require any particular faith, by its nature it often touches the spiritual side of both practitioners and clients. For that reason, Rand said, a certain openness of mind and heart is critical to being a practitioner of this modality. “You have to at least be open to that, the spiritual ideas—that there are energies available that you can tap into,” he said.

WHAT YOU NEED TO GET STARTED PRACTICING REIKI

Getting started with Reiki is fairly simple; Rand notes you can begin using it almost immediately after your first class.

“You don’t have to study for a long time to learn Reiki; you receive what’s called an attunement,” he said. The attunement gives you the ability to use the technique on yourself and others, though you should be honest about your skill level and not offer it professionally until you receive further training. “You can take a class in a weekend and actually doing Reiki on yourself and others that is effective,” Rand said. “It’s not based on skill so much as it’s simply the energy that you receive during the attunement; there is some skill involved, of course, and that comes with experience, but immediately, as soon as you have taken the class and you put your hands on someone, the energy starts flowing.”

Rand recommends waiting until you’ve achieved at least level two before you begin using it professionally.

Because Reiki is simple to learn and begin using, practitioners often begin offering it even with only level one certification, which typically involves a one- or two-day class. Rand recommends waiting until you’ve achieved at least level two before you begin using it professionally. “I would say at level two, you could start a business and start giving sessions, and you would be effective and your sessions would be worthwhile,” he said. Some people then learn beyond level two to the advanced and master levels and, if they want to teach, can train to become Licensed Reiki Master Teachers (LRMT), a credential offered by ICRT. According to the ICRT’s website, that credential takes three or four years and about 1,000 hours of study to achieve.

DO YOU NEED A CREDENTIAL TO PRACTICE REIKI?

Whether or not you need a Reiki credential depends on where you live. “Most of the states in the U.S. do not require one to be licensed to do Reiki,” said Rand. Because Reiki does not require the practitioner to manipulate tissue, it typically does not fall under the definition of massage.

Among states that do require licensure or impose other restrictions on Reiki practice, the rules vary widely. Laws about the practice of Reiki usually exist under the umbrella of massage therapy. That means you’ll probably be able to get information on regulations concerning its practice by contacting your state’s massage therapy board or other governing body in charge of massage therapy licensure. The states of Florida and Texas, for example, require a person to have a massage therapy license in order to perform Reiki. States such as Colorado and California do not require a license but do require giving clients certain disclosures about the service you provide.

Laws about the practice of Reiki usually exist under the umbrella of massage therapy.

In states such as Mississippi, you can perform Reiki without a massage therapy license as long as you do not touch or manipulate tissue or perform it while doing a tissue-manipulating modality such as massage. In addition to becoming familiar with your state’s requirements for Reiki practice, it is also a good idea to inquire about any local ordinances that might apply. “When starting a Reiki practice, one should become familiar with local, city, and state or province laws, if any, regarding the practice of Reiki,” said LaFlamme.

HOW MUCH DOES REIKI CERTIFICATION COST?

The costs of Reiki training and certification vary widely, Rand said, and those variations may or may not reflect the quality of the education provided. For example, he said when he first started looking into training beyond level one, in the 1980s, a few programs cost $10,000; while another, the one he eventually took, only cost $500. (That $500 in the 1980s equates to about $2500 today, he said.)

Because of the wide variation in costs and curriculum quality, Rand recommends researching what content is included in the course, as well as several other factors, before deciding on a program. “I would look at their background ... the lineage of the teacher,” he said. How long has that person been teaching? “Get a feel for their level of spiritual development,” he continued. Talk to the teacher, and others who have taken the program if possible. If it seems like the instruction being provided is “ego-based,” Rand said, keep looking.

Rand recommends researching what content is included in the course, as well as several other factors, before deciding on a program.

“Does it sound like they want people to come to them because they project themselves as being the center of Reiki ... better than anyone?” he said. This kind of attitude runs counter to a core principle of Reiki, that the life energy being worked with is universally available and that anyone is qualified to learn to channel and use it. Finally, trust yourself. “I tell people to follow their own inner guidance, their intuition, in terms of [choosing] a teacher to study with,” Rand added.

DO I NEED REIKI INSURANCE?

Reiki liability insurance is essential. No matter how careful you are, accidents happen; and getting sued can easily bankrupt your business. Many entities offer Reiki insurance, including Massage Magazine Insurance Plus. When shopping for Reiki insurance, it’s important to look for a plan that offers professional liability coverage (for claims of malpractice); general liability coverage (for accidents, such as when someone trips and falls); and product coverage (for damages resulting from products used during sessions). Some Reiki insurance policies may also offer benefits such as rental damage coverage, identity protection, or reimbursement for stolen equipment.

You should also know the coverage limits of your policy, and whether it is occurrence-form or claimsmade. In occurrence-form coverage, an incident is covered as long as you were covered on the date the incident occurred; in claims-made, you must be covered at the time the claim is filed, regardless of when the incident took place.

WHAT TO CHARGE FOR A REIKI SESSION

How much should you charge clients for a Reiki session? Rand recommends using your rate for a massage as your reference point, while taking into account such factors as where you live and what your competitors charge.

Reiki can provide added value and an added dimension to existing massage sessions or as a standalone service.

“Look around in your area and see how much people are charging for a massage session and charge a similar amount,” he said, noting that could mean anywhere from $35 to $150, depending on your location. If you offer Reiki in conjunction with massage, or blended into a Reiki massage therapy session, you can also think about pricing it as an add-on or charging a higher rate for the combined session.

ADDING REIKI TO YOUR MASSAGE PRACTICE

“Reiki can provide added value and an added dimension to existing massage sessions or as a standalone service,” said LaFlamme. You probably already discuss with clients some of the positive effects regular massage therapy can have on their well-being. Energy work such as Reiki also has a place in a person’s wellness routine, alongside other healthy habits. “Reiki is one part of a general wellness program that may include diet, exercise and self-care,” LaFlamme said. “Receiving regular massage and Reiki sessions can benefit the body, calm the mind and soothe the soul.”

Apart from the benefits it offers clients, Reiki sessions also offer the practitioner a chance to provide a valuable service that isnâ&#x20AC;&#x2122;t as physically taxing as massage therapy, at a comparable price per session. â&#x20AC;&#x153;Reiki is done with a gentle, static touch, which provides a break for the professional therapist in contrast to techniques that require greater pressure,â&#x20AC;? LaFlamme said.

CAREERS IN REIKI

Many practitioners offer Reiki sessions in private practice and are either in business for themselves or working in a multidisciplinary setting with other providers, such as massage therapists, chiropractors, reflexologists, or practitioners of other types of energy work. Due to the increasingly wide acceptance of integrative therapies as an adjunct to traditional medical care, many hospitals and other health care facilities now need Reiki practitioners, as well. Once you have enough experience and training, you may also choose to teach Reiki.

FACE-LIFT, OR FACIAL, MASSAGE

Bamboo Facial Massage Improves Clients’ Health with All-Natural Elements By Michelle Mace

he face is a truly complex creation of skin, muscles and sinew—so why do we ignore it most of the time, suggesting a massage session that focuses on desk-ravaged shoulders or a treatment for overworked feet rather than a facial massage? Over the years, I’ve noticed that clients often claim facial massages are messy, and sometimes simply unnecessary. My response is, “A face is just as important as your hands, hips and back, is it not?” Indeed, it is, and it’s about time we acknowledge its importance. While the hunch of your shoulders and noticeable limp speak volumes, so do the lines on your face and the dryness of your skin. When someone is sleep deprived, in pain, stressed or unwell, their face presents these issues like an open book. The solution is simple: a facial massage. Taking into account the structures of the visage, therapists can reduce tension, improve health and brighten overall appearance, along with a myriad of other advantages that are linked to the basic concept of handson therapy. But coupled with all-natural elements of bamboo massage tools, and we suddenly see more than merely an improved completion.

With a small dab of rice oil and heated bamboo massage tools, clients will be relaxed into a whole new state of nirvana. Even though this approach is a blending of these two techniques, it is considered to be primarily a massage and does not require the use of facial products. A bamboo massage facial session is a unique addon for massage therapists and estheticians alike.

LET’S GET TO KNOW THE MUSCLES OF THE FACE

Before applying bamboo facial massage techniques, it’s essential to understand the various muscles you’ll be working on, as well as their specific function.

Each muscle has a different role to play in facial movement and control facial expressions.

Under the facial skin, there is a group of approximately 20 flat skeletal muscles. These facial muscles are positioned around facial openings, such as the ears, nose, eyes and mouth, or stretch across the skull and neck. Each muscle has a different role to play in facial movement and control facial expressions. Depending on their position, these muscles can be grouped into different categories. Now, let’s do a quick review of the primary muscles affected by a facial massage, as well as their various functions. Orbicularis Oris: This muscle of the face encircles the mouth and helps to pucker the lips and close the mouth. Depressor Labii Inferioris: Situated beneath the lower lip, this facial muscle assists in depressing the lower lip. Levator Labii Superioris: Located above the upper lip, this muscle of the face helps to elevate the upper lip. Buccinator: This muscle forms the anterior part of the cheek, the wall of the oral cavity, and the muscular base of the cheek. The Buccinator muscle aids in chewing and helps to hold food in the proper position, inside the mouth.

Mentalis: Between the chin and lower lip is a groove, and that’s the location of the mentalis muscle. Also known as the pouting muscle, Mentalis helps in contracting the chin. Risorius: Known as the laughing muscle, Risorius forms the depression of the cheek, in the angle of the mouth. Unsurprisingly, this muscle helps one to smile. Zygomatic major and minor: Beneath the cheekbones is the zygomatic arch, formed by the zygomatic major and zygomatic minor muscles. While the major help in smiling, the minor aids in frowning. Frontalis: This muscle of the face is also known as the epicranius muscle as it covers parts of the skull. Found near the frontal belly and occipital bone, this muscle helps in facial expression.

The truth is, there’s a lot more to a bamboo facial massage session than just a calming muscle rub.

THE BENEFITS OF BAMBOO FACIAL MASSAGE

Many clients aren’t aware of the benefits of a bamboo massage treatment. If they were, they’d make sure to ask their therapist for one at every appointment. The truth is, there’s a lot more to a bamboo facial massage session than just a calming muscle rub. Aside from that blissful state of relaxation, your clients are also profiting from rejuvenation benefits. Additionally, as with the rest of their body, facial muscles need movement and exercise to maintain health and keep them looking youthful. Relieves Face and Neck Tension As massage therapists, we’re well aware that muscles hold tension, and that includes the facial muscles. In fact, some clients keep the majority of their stress in their head and neck, making them prone to headaches, migraines and vertigo. Esthetically-speaking, more facial tension means more facial wrinkles. Bamboo massage techniques reduce tough tension while smoothing out and moisturizing skin.

Boosts And Improves Circulation Facial muscles require the same amount of TLC as the rest of the body. After all, they’re just as important as any other muscle, yet they’re often neglected. Increase oxygen and blood flow to the face by using specialized bamboo facial massage maneuvers that address the entire face, forehead and neck. Yubi sticks create effleurage strokes on the cheeks and forehead. This stick increases blood flow to the facial tissues. Provides A Natural Facelift Stimulating the face muscles with regular massage helps to bring oxygen to that area, which is a natural form of anti-aging skincare.

There is nothing as soothing as a professional bamboo facial massage.

Enhanced blood flow to the locale increases collagen production, giving a healthy and natural glow to the complexion. It also helps tighten muscles, improve muscular strength and enhance tone. Induces The State Of Nirvana There is nothing as soothing as a professional bamboo facial massage. Since there are many nerve endings in the head, a facial massage produces a state of sheer relaxation. During this deep state of tranquility, dopamine and serotonin—the “feel good” hormones—are released into the bloodstream. In essence, bamboo facial massage doesn’t just affect your facial muscles; it also affects your mind, energy and consciousness.

AN OVERVIEW OF THE PHYSICAL AND MENTAL BENEFITS OF MASSAGE THERAPY

As therapists, we see a multitude of health benefits firsthand every time we treat clients.

Some claim this natural therapy has improved their sleep while others insist it has lowered their blood pressure. Sure, we’ve learned about the many positive results of massage on the body in school, but how many therapists can name each and every health and mental benefit as they’re reading this article? Do you realize how many changes take place in your client’s body during a one-hour session? In merely 60 minutes, the person on your mat or table will experience improved sleep, reduced stress, a stronger immune system, less headaches, lower blood pressure—and the list goes on and on. The truth is, relaxing tense muscles is just the tip of the iceberg, it’s merely the superficial label attached to massage therapists everywhere. In the end, our clients are in for so much more during their appointment than merely less tension in their upper traps. Relieves Muscle Pain If there’s one thing that massage therapy is known for, it’s muscle pain relief. Often, the vast majority of clients that seek out massage are looking for help with their muscle tension and pain. By stimulating the release of the body’s “feel-good” hormones—endorphins—muscle manipulation helps with conditions such as neck and back pain, persistent headaches and migraines, chronic fatigue syndrome and fibromyalgia, to name just a few. The wonderful thing about massage treatments is, it decreases the need for certain pain medication as it naturally relieves pain, regardless of its root cause. Promotes Flexibility and Relieves Inflammatory Conditions Massage can treat inflammatory conditions such as bursitis and arthritis by relaxing and loosening muscles.

With frequent therapy, clients gain a wider range of motion and increased joint flexibility. Thanks to regular massage, clients see a marked improvement in movement, a physical fluidity that decreases the likelihood of muscle injuries. Improves the Lymphatic System A healthy lymphatic system results in lower susceptibility to various illnesses. But that’s now all, your body also benefits from a heightened ability to heal itself due to a healthy lymphatic system. Massage therapy sessions stimulate this system, enhancing the body’s natural defense mechanisms and immunity. Improves Circulation Massage therapy improves blood circulation, thus resulting in a better supply of nutrients to cells throughout the body, as well as better cell waste material transport.

During a massage session, cortisol is released into the system.

Additionally, this circulatory improvement encourages healthier, softer and clearer skin, and that’s because skin cells are more nourished with oxygen and nutrients. Therapeutic Abilities In hospital and clinic settings, massage therapy is regularly used to treat surgery and trauma patients to help them rehabilitate and recover. In some states, post-operative massage is employed to reduce in-hospital stays. Relieves Stress During a massage session, cortisol is released into the system. This different kind of hormone is in charge of lowering the body’s stress levels. The great thing about lower stress levels is, the body has an easier time to heal itself. Furthermore, this relaxed state decreases anxiety, makes it easier to breathe and lowers blood pressure levels.

On top of all these advantages, massage also satisfies the body’s inherent need for touch. As such, regular sessions promote the sensation of being nurtured thus improving emotional well-being. The end result is lowered anxiety and stress levels. Improves Concentration Concentration and focus are promoted via the calm and relaxed state that massage induces. This tranquil frame of mind perpetuates productivity and creatively. Also, massage therapy makes people more mindful of their body, which assists them in identifying what their body needs.

...massage also satisfies the body’s inherent need for touch.

Promotes Better Sleep For some individuals, sleep is unattainable, and those who suffer from depression, anxiety or other issues that result in nighttime tossing and turning this problem can seem like it takes over your life. As massage promotes the relaxation of both body and mind, it’s a great way to help the body learn to “switch off” for the night. Fatigue, lack of concentration, and irritability are all results of lack of sleep, since our nightly rest is the time where the body refreshes, rebuilds and heals itself.

BAMBOO MASSAGE CAN SAVE YOUR HANDS

Injury is a common occurrence among massage practitioners and other manual therapies, but it can be prevented. Without a doubt, massage therapy is physically demanding. We’re in a field that promotes health and well-being to clients, only to ignore our own physical ailments and emotional issues. Even if you’ve been a bodyworker for years, that doesn’t mean you can’t enjoy a nice, long, lucrative career. That’s why it’s vital that massage therapists not underestimate the risks involved in pursuing such a physically demanding vocation.

At some juncture in your career, you’re likely to suffer an injury, be it a work-related incident or burnout. If you haven’t considered the importance of selfcare, then you’re walking a dangerous road. When you learn bamboo massage for the face—a technique that is not demanding on the body— you’re adding to your repertoire of massage knowledge, all while saving your precious hands. Michelle Mace-Lambert, LMT, is founder of Barefoot Masters, and has been instructing courses in barefoot techniques for several years. She has traveled to Asia and studied chavutti thirummaltechniques with the master himself, Prabhat Menon. She offers nine different handsaving techniques and over a dozen CE classes for massage. As a 20-year veteran of massage, her passion is to create career-saving options for massage therapists. She wrote “With Ashiatsu, You Hold Your Client in Your Two Feet” for massagemag.com.

GERIATRIC, OR SENIOR, MASSAGE

The Future Will Be Filled with Seniors— And Senior Massage By Seraine Page

y 2050, America’s 65-andover population is projected to nearly double from 48 million to 88 million, according to the National Institutes of Health. “Older people are a rapidly growing proportion of the world’s population,” said National Institute on Aging (NIA) Director Richard J. Hodes, M.D., in a 2016 NIA statement. “People are living longer, but that does not necessarily mean that they are living healthier,” he added. “The increase in our aging population presents many opportunities and also several public health challenges that we need to prepare for.”

BATTLING LONELINESS

With such a significant increase in that particular demographic come challenges of finding long-term care solutions. Many people will end up in assisted living facilities where loneliness and depression can often plague even the most sociable of people. Between 1 and 5 percent of elderly living in community are depressed, while that figure rises to 11.5 percent in hospitalized elderly, for example. Marc Silverstein saw it with his own mother. A normally talkative and personable woman, she shrank into herself when she moved into assisted living, Silverstein said. There were plenty of regular activities, such as bingo and social events, but his mother wasn’t having any of it.

As someone who personally received plenty of massages, he noticed that geriatric massage wasn’t available at his mother’s facility. “With all the services and amenities that were offered, the one thing they never offered her was massage therapy,” he said. “I thought odd that the one thing that could help her wasn’t offered, so I decided to do something about it.” In 2010, he founded Tender Touch For All, a nonprofit that provides on-site massage therapy services to seniors, veterans, and those with disabilities or chronic conditions at their residential or treatment centers.

Tender Touch For All also offers massages to support staff and families on site, usually in a chair or massage desktop portal.

Tender Touch For All also offers massages to support staff and families on site, usually in a chair or massage desktop portal. “Nurses, social workers, they have very physically and emotionally demanding jobs,” said Silverstein. “We do a lot of staff appreciation events for people in nursing homes and assisted living facilities, built around holidays like National Nurses Week.” Tender Touch For All services reach 7,500 people annually. Seniors are the largest demographic of massage recipients in the program, but staff reach clients at hospice centers and wellness events, too.

BENEFITS OF MASSAGE

Multiple studies indicate the physical benefits of massage therapy in those suffering with osteoarthritis. One particular pilot study done by the Department of Veterans Affairs showed significant improvements in self-reported osteoarthritis-related pain with regular use of Swedish massage. A 2016 published study also reported knee osteoarthritis pain in elderly reduced with a combination of modalities including massage, yoga, and tai chi. Aside from alleviating physical pain, massage is thought to reduce symptoms of depression and anxiety as well.

Facility administrators at sites where Tender Touch For All therapists visit attest to it on a regular basis. For the last three years, CareRite Centers Network has employed Tender Touch For All therapists at six of its locations. The nursing center’s mission statement embodies the idea of holistic opportunities for its rehab facilities and liked the philosophy behind Tender Touch For All. Most of all, the stories of healing have cemented the company’s decision to work with the nonprofit, said Ashley Romano, national director of patient experience and research development at CareRite Centers.

Additional benefits have included an increase in appetite and positive displays of behavior.

“The residents have expressed a reduction in stress and anxiety and enjoy the opportunity to receive non-pharm interventions as part of their regular routine,” said Romano. “Additional benefits have included an increase in appetite and positive displays of behavior.” Above all, residents always request return visits, said Bonnie Nogin, director of community affairs at CareRite Centers. “A female resident who was a participant in the spa program and signed up for monthly visits told our recreation therapist that she was going to put on a wig and glasses so she could pretend to be a different person and get two massages that day,” Nogin said. Other massage recipients can often be moved to tears. “One family member had been sleeping bed side with her spouse who was terminally ill on hospice care,” said Nogin. “The Tender Touch therapist was spending time with the patient and took the family member aside and said, “I’ve noticed that you’ve been here for the last month and I’d like to offer you a massage to ease your mind.”’ It isn’t uncommon to see interactions like that with therapists and residents, Nogin said, and is one of the joys of working with Tender Touch For All.

TRUST MATTERS

When massage therapist Lauren Jill MorettVij, L.M.T., worked at an adult day care for developmentally disabled adults, she remembers one 70-year-old client who would yell at her to leave the moment she saw Morett-Vij. Now, she offers hugs and insists on being MorettVij’s first massage client of the day. Another client, who has been wheelchair-bound for 40 years, never wants to let go of Morett-Vij’s hands. For nearly three years, Morett-Vij has worked with the elderly and blind in the Long Island and Queens areas on behalf of Tender Touch For All. She’s also worked wellness events and at a facility for traumatic brain injuries. “The Tender Touch For All organization is unique, it offers compromised and confined people who would not ordinarily be able to go out and receive this care a personal hands-on experience that benefits their body and soul,” she explained. Trust, she said, is a big part of that whole-body benefit. Offering a hand massage first allows her clients to ease into the idea of being touched. Once trust is established, she’s able to work on other parts of the body more easily. Witnessing her clients immediately benefit—such as seeing a relaxed smile at the end of a session—is one of Morett-Vij’s favorite parts of the job. With many clients in wheelchairs or with walkers, it can be hard to imagine a different, younger person. But part of her job is to see the whole person, past and present, which allows her to connect more personally to clients, she said. One client, an 86-year-old retired librarian once told her: “Every time you massage me you know exactly how to renew me. Your hands are intuitive.” Responses like that are why Morett-Vij said she is proud to be a part of Tender Touch For All.

“It allows me to be a positive change and benefit in their daily, present life,” she said. “ I enjoy knowing that when I leave my Tender Touch For All patients, I have been instrumental that day in giving them quality of life.”

NATIONAL EXPANSION

Silverstein believes massage is good for everybody. He’s seen it personally, and now with his program, he’s witnessed positive changes in thousands of lives. With that evidence in hand, he hopes to expand the program nationally to reach more people in need of healing human touch.

It allows me to be a positive change and benefit in their daily, present life.

“My vision is for this to be a national organization,” remarked Silverstein. “We would love to work more with veterans.” While passion and great therapists drive the program, time and resources also play a factor. The nonprofit survives on grants, program fees and occasional fundraisers, Silverstein said. The facilities where the therapists visit pay for the program to be brought in, which in turn usually makes the program free to recipients. Sometimes there is a low fee associated with it, but more often than not it is a free service, Silverstein said. Stress Relief for a Cause is one ingenious fundraiser his marketing team developed. Tender Touch For All therapists visit a location, such as a college campus during finals week, and offer 10- to 15-minute chair massages. All proceeds benefit Tender Touch For All, and if a location signs up for a minimal monthly program—one therapist for three hours—for 12 months, it can fund a program at a senior care or veterans facility for an entire year.

For Silverstein, offering a holistic option at reducedrates for vulnerable populations is something he hopes catches on and grows far and wide. While not a massage therapist, he greatly respects the profession. “I’m just someone who sees the benefits,” he said. “It’s a hands-on approach that makes people healthier physically, mentally and emotionally.” Seraine Page is an award-winning journalist based out of Southwest Florida. She enjoys writing about health, wellness and travel. Her work has been published in Discover Kitsap, A AA Journey Magazine, DAYSPA Magazine, Bainbridge Island Review, and others. She has written many articles for massagemag.com, including “A Whole-Family Model of Massage” and “This is How to Get a Job Working on Olympic Athletes.”

IASTM

Your New Massage Tool: Instrument Assisted Soft Tissue Manipulation By Jill Magee

any massage therapists use tools in their massage sessions. Instrument Assisted Soft Tissue Manipulation (IASTM) is rapidly becoming a popular tool and something for massage therapists to look into for use in their practices. IASTM is a manual therapy approach to musculoskeletal injuries using tools. IASTM tools can be used to address fascial restrictions as well as areas of the body that exhibit soft tissue fibrosis, chronic inflammation or degeneration. As a rehab tool, IASTM reduces pain and increases range of motion. There are many things to consider when purchasing and using IASTM tools in your practice, including: how the tool feels to you and the client you are working with; how it fits into your practice; and the type of massage you do. The price of the tool and how much you want to use the tool in your work should also be considered.

IASTM IN SESSION

Understanding how the body responds to the different uses of IASTM tools will help you utilize the tool to its full potential with your clients. Methods and uses of IASTM tools differ widely among practitioners. This is for you to decide and educate yourself on. One of the ways IASTM tools work is by causing stimulation to an area of work, which initiates a local inflammatory response. The controlled microtrauma facilitates the bodyâ&#x20AC;&#x2122;s healing.

How the client responds to the tool is a big part of why it’s a good idea to have multiple tools on hand. Different tools work better on different parts of the body. Some tools offer varied sides and edges, so they are multi-use. Different tools also provide different session outcomes. Open communication with your client on feel is key. Talk to your clients and get their feedback. Some clients prefer a lighterweighted tool with blunt edges or a longer tool with a sharper edge.

You can use a tool that lets you feel the body more and therefore acts as an extension of your hand...

Some massage therapists feel they aren’t interested in tools because they do more “soft tissue and relaxing massage”—but taking a tool course or diving into how adding a tool to your practice can help your clients will support your understanding of tools, and aid you in communicating a tool’s benefits. It’s all in how you use the tool. IASTM isn’t just for deep tissue or sports massage. Bamboo sticks can provide a nice, even glide to relax the body, for example. Look into adding tools to your relaxation massage as well. You can use a tool that lets you feel the body more and therefore acts as an extension of your hand so that you can feel what it is doing to the tissue underneath. You can use tools for varying reasons and outcomes desired for clients. Oftentimes I use an IASTM tool to locate issues on my clients. I’ll run the tool lightly over the muscles and feel if there is any congestion in the tissue. Then I’ll use the tool to address the problem area. I think the old notion that tools are only for aggressive work is finally fading, and the new science on how therapists can utilize tools is coming out. I encourage you to map out why you want to add IASTM tools to your practice and then look up the varying educational courses that correspond with the outcomes you want for your clients. Taking courses on multiple methods is always a good option and keeps you updated on continuing education and new methods.

I’ve taken courses and talked with educators of most of the IASTM methods, so I can easily talk to clients about their options and how tools added to a session can help them. Using outdated methods or unproven science with IASTM tools damages the reputation of massage therapists, so keeping updated and educated is a must. Some clients don’t understand the varying options, and when you pull out tools they might get a little nervous. In my practice, I talk with them about options and how the tools work and feel— and I have yet to have any clients not want me to use tools with them.

PROPER CARE

Hygiene is a big factor when you use tools. Use alcohol to wipe tools off and regularly clean all of your tools thoroughly. I have a sports performance business, and staph infections are something clients deal with in the locker room—and if tools aren’t cleaned properly, it can easily be spread. If you use the tools on feet, you must either wipe off the tool or have multiple tools available so when you work on other parts of the body you won’t spread bacteria or germs. Keep alcohol wipes close by and also soak or spray tools with 91 percent isopropyl alcohol after every use to keep them clean. Keep your tools in a clean carrying case so they don’t get nicked up or dirty when you travel. You can use an emollient like a beeswax mix or coconut oil for better glide for the client. Take out what you need or apply it to the clean tool so that cross contamination between clients doesn’t occur.

TOOLS FOR LONGEVITY

Many massage therapists have added tools to their practices because doing so will help keep them working longer with less stress on their hands and bodies.

When incorporating tools into massage work, ergonomics is one of the first things to look at. How a tool feels to you and the client is a big part of finding the right tools for your practice. Many of the massage therapists I talk with say how the tool fits in their hand and its workability over the course of the day is a big part of why they choose the tools they do. In my massage therapy education, we learned about tools and how to use them and were encouraged to try everything from the expensive, professionally made stainless steel tools to the blunt end of a butter knife and a thick plastic soup spoon. I encourage you to try multiple tools and have a few on hand in your practice.

IASTM tools can be expensive, but are well worth the investment.

I own both stainless steel and plastic tools. I personally like the feel of the stainless steel over plastic, but I travel quite a bit with my athlete clients and having a plastic tool is necessary for TSA compliance when I have a tool in my carry-on luggage. I also work with tools in different sizes. I see multiple clients a day and work long hours, so grip is important for me because my hands will hurt if the grip isnâ&#x20AC;&#x2122;t right for my hand. I also change up how I hold a tool and how much pressure I use during sessions.

CHOOSING TOOLS

IASTM tools can be expensive, but are well worth the investment. I suggest choosing a tool company that you can have ongoing communication with and that has education and support associated with their tool. Then you can be a part of a community, and stay up-to-date on new science and in contact with others using the same tools. Talking to people who utilize tools in their practice and have similar backgrounds and work is another great way to learn various ways to use tools and options in client care. The great thing is, as the popularity of IASTM use in massage practices increases, affordable options and education will also increase with demand.

Many popular product companies have now introduced IASTM tool options and education into their product lines. Make sure the IASTM tools and education you are considering are high-quality products by looking at reviews and what other reputable massage therapists are using in their practices. Be diligent in looking at the quality of the product and how you can use it. Overall, education and experience with IASTM goes a long way toward having a positive outcome with your clients. It took me awhile to feel comfortable using tools in my practice because I rely so much on the feel of the tissue when working with my clients, but after much practice and trying different methods and education, I canâ&#x20AC;&#x2122;t imagine not utilizing IASTM in my work. My clients have been great with feedback and even have their favorite tools for use in their sessions. The use of IASTM tools in massage therapy is growing, and it is time to look into it for yourself and for your clients. Jill Magee, CMT, is an expert in the field of body mechanics and muscle balance with specialization in athletic assessment and corrective training. She is a RockTape ambassador and RockFit instructor, holds a bachelorâ&#x20AC;&#x2122;s degree in exercise science and sports coaching, and is a certified personal trainer.

LIGHT AND LASER THERAPIES

The Return of Color Light Therapy By Ronel Corbin

olor light therapy, also called chromotherapy, is the therapeutic use of light to improve health and is re-emerging as an “old new age” therapeutic option embraced by some health care practitioners. Proponents of color light therapy healing say it can help prepare a client’s body for massage, achieve more profound results and induce deeper levels of relaxation.

A COLORFUL HISTORY

In 1903, Niels Ryberg Finsen, the developer of a device that produced synthesized light, was awarded the Nobel Price in Medicine for this discovery. Since that time, the health benefits of color have been studied but not in depth. For one study on the effect of color on the body, see “The Effects of Baker-Miller Pink on Biological, Physical and Cognitive Behaviour,” published in the Journal of Orthomolecular Medicine. Additionally, according to color therapist Constance Hart, “In 1938, the Worchester State Hospital in Massachusetts did effective testing on patients with colored lights, revealing that red had a stimulating effect while blue had a soothing effect.” In 1958, Robert Gerard, Ph.D., of UCLA, did substantial testing to [indicate] that blood pressure increases under red light and decreases under blue light. (Color Psychology and Color Therapy, Birren, 1950.)

And in the article “Let There Be Light; The Healing Art of Spectro-Chrome,” Steven Ross, Ph.D., wrote, “The effects of color and light on the human system are subjects of scientific investigation … An example of this effect is found in the medical practice of treating premature babies with Bilirubin Syndrome (jaundice) by exposing them to blue light.”

BATHE THE BODY WITH COLOR LIGHT THERAPY

...some health care practitioners are turning toward light and color therapies.

Meanwhile, some health care practitioners are turning toward light and color therapies. Vanessa Cisneros, a doctor of Chinese Medicine practicing at the Healing Elephant Clinic in Miami, Florida, has dedicated her professional life to the combined learning of color, light and sound therapies, which can transform the mind and deeply heal the body. Cisneros serves on the board of the International Light Association and was invited to represent it at the recent Nobel Peace Prize concert in 2016. “I can produce quicker and more accurate results with color and sound than with any other therapy,” Cisneros said. Cisneros says she takes color light therapy very seriously and uses only authentic color therapy tools that have the correct healing frequency. She bathes the body in light with the SpectroChrome system, which dates back to the late 19th century and uses the best source of light from an incandescent bulb that emits a selected continuous light spectrum. When combined with specific color filters, this spectrum supports healing. Some of the other color tools she uses to apply color to smaller areas are the Bioptron and the Molimed color-light system. The Bioptcron, in particular, she says, reduces swelling and inflammation.

Directing focused colored lights on acupressure points stimulates the healing energy that “naturally occurs in our bodies,” according to text on the business page of Sound Color Acupuncture. “Color can assist with emotional releases, a deeper sense of self, which brings about insight, clarity and harmony. It is very useful in relieving stress and anxiety,” that site said. Cisneros says she has learned much of what she knows from attending educational conferences where she is exposed to the latest therapeutic uses of color light therapy as well as the latest equipment. As Darius Dinshah noted in the article, “Color Therapy: An Old New Age Therapeutic Option,” there is “a difficult point for many to understand: How can colored light possibly cause a physiologic effect inside a human (or animal) body?”

TWO RECEPTOR ORGANS

Color light therapy can establish or improve health in a gentle, biophysical way. In the human body, there are two receptor organs for light, which are formed during embryonic development: the eyes and skin. Besides what we see through the eyes, colors do not in fact exist as such; they exist only as wavelengths that also contact the skin. An example of this effect is found in the medical practice of treating premature babies with Bilirubin Syndrome (jaundice) by exposing them to blue light.“Light applied to the skin causes a chemical reaction (photo-oxidation) in blood circulating under the skin, effectively lessening bilirubin levels with the aid of the liver,” Dinshah said. Color combines both physiological and physical characteristics. The two most studied colors for treatment are blue and red light, and it has been established that red corresponds to the stimulating effect of the sympathetic nervous system, while blue affects the regenerating and relaxation of parasympathetic nervous system.

“Additional light exposure is well-known to cause a beneficial change in seasonal affective disorder (SAD), a condition believed to be caused by insufficient light energization through the eyes to the hypothalamus thence to the pituitary gland, which controls the endocrine system,” said Dinshah. There is no question that light, color (and sound) can be an important therapeutic tool that aid everyone. They will allow for deeper relaxation and improve the healing response from the body after a massage. Ronel Corbin is a physician of Chinese medicine who has been in the holistic health and wellness field for more than 24 years. She wrote this article on behalf of The International Light Association, which will hold its 14th Annual Conference April 30 to May 3 in Fort Lauderdale, Florida. Hosted in North America for the first time in six years, the conference, themed “The Power of Light,” will feature presentations from 17 of the most renowned light therapists and researchers from across North America, Europe and Asia.

MEDICAL MASSAGE

New York Hospital Makes Medical Massage Therapy a Priority By Christina DeBusk

isters of Charity Hospital in Western New York State is a health care institution that offers hospital-based medical massage therapy.This program gives patients access to a variety of massage services, including deep tissue, orthopedic and Swedish massage. Founded in 1848 by the Daughters of Charity of St. Vincent de Paul, Sisters of Charity Hospital reports that it is Buffalo’s first hospital. Massage therapist and massage department manager Susan Hanlon has been with Sisters of Charity for nine years in April, with 18 years’ experience as a massage therapist in general. Hanlon says that roughly 80 percent of Sisters of Charity Hospital’s medical massage therapy clients are seen on an outpatient basis, mainly due to no-fault (auto accident injuries) or workers’ compensation claims. The massage therapists at the hospital also receive orders from physicians to see patients in the hospital. For instance, on Wednesdays, Hanlon and her team can often be found providing services to patients with cancer. “We do 10 to 15-minute massages on them while they’re getting chemo,” she says.

The National Center for Complementary and Integrative Health (NCCIH) shares that this can be beneficial, as many reviews and studies have found that, “at least for the short term, massage therapy for cancer patients may reduce pain, promote relaxation, and boost mood.” The NCCIH also adds that special precautions must be taken with patients with this type of medical condition, such as not massaging directly over tumors and avoiding areas that could be sensitive due to radiation therapy.

HOSPITAL-BASED MEDICAL MASSAGE THERAPY

In fact, it is these types of situations that Hanlon says drew her to providing massages in this type of setting. It’s more of challenge, she says, because each patient is different in regard to his or her massage needs based on the injuries sustained. This gives her the opportunity to practice different techniques, a factor that Hanlon also enjoys. “I like the variety,” she says, “and not doing the same technique over and over again.” Increasing the challenge and the variety even more, Hanlon shares that, many times, what works for a patient one time may not work for them the next time. It takes “a lot of communication,” she says, to ensure patients are receiving the hospital-based medical massage therapy they need. Of course, the main difference between seeing massage therapy patients in a hospital setting is that there are more physical medical issues to deal with says Hanlon, whereas at a spa the focus is often on relaxation.

TRAINING REQUIREMENTS

To work in this type of setting in New York, massage therapists must be licensed by the state, says Hanlon.

These license requirements include receiving more than 1,000 hours of instruction in massage-related subjects and passing the New York State Massage Therapy Examination. Alternatively, if massage therapists are licensed elsewhere and want to transfer to New York, they may be eligible for licensure by endorsement, which also carries the requirement of 1,000 hours of education and passing a comparable exam. Massage therapists employed by a hospital should possess a liability insurance policy that covers many modalities and protects them in case of client accident or injury. Although no special training is mandated to provide massage services within a hospital setting, Hanlon says that massage therapists interested in providing services to hospital patients should take some classes in myofascial release, specifically. She also advises that flexibility is required, as methodologies used vary tremendously. Christina DeBusk is a freelance writer dedicated to providing readers relevant, research-backed content related to health and wellness, personal development, safety and small business ownership.

MYOFASCIAL RELEASE

Thumb Pain and The Therapist: Advanced Myofascial Techniques By Til Luchau

hank goodness for the thumb. Its unique opposability allows us to grasp, hold, squeeze manipulate; its enormous strength gives power to our grip; and its unmatched sensitivity (matched by an colossal portion of the brain dedicated to its sensations) helps us feel the most minute differences in texture, size or pressure. Thumbs are good at so many things that they are commonly overused, causing tissue and joint irritation, pain, and eventual damage. For example, the increasing use of small-device keyboards means that thumbs are more active than ever in awkward, repetitive movement patterns that are needed to type out texts, posts, and tweets. Massage and manual therapists are vulnerable to thumb over-reliance. In our Advanced Myofascial Techniques seminars, we see practitioners in most every workshop suffering from the effects of thumb overuse; sometimes the symptoms are severe. The structure of the thumb gives it special qualities but predisposes it to unique vulnerabilities. The thumbâ&#x20AC;&#x2122;s joints are the most mobile of all the digits, allowing the thumb its distinctive opposability and adaptability.

As with the fingers, the articular ligaments provide some stability, but because of its highly mobile joints, the thumb gets most of its stability from coordinated active muscular tension. The muscles of the thumb are arrayed in all directions around it, much like guy-wires around a pole or mast. Moreover, these muscles stay busy; given that so much of the thumb’s stability comes from the tension of these muscles, most thumb muscles are active during most thumb movements.1 It is no wonder our thumbs get tired.

...the thumb gets most of its stability from coordinated active muscular tension.

The origins of the word “thumb” go back to the Old English word thūma, from the Indo-European word tum or “swelling” (which also gave us “tumor” and “thigh”). The swelling in the thumb’s case is thought to be its round shape, or the thumb’s rounded thenar eminence (the muscular portion of the palm at the base of the thumb). The thenar eminence often takes the brunt of thumb overuse and repetitive strain. There are at least two reasons for this:

Since the thenar eminence contains the primary muscles involved in finger-to-thumb gripping, activities or occupations that involve repeated or prolonged use of small instruments or fine tools (dentistry, electronic manufacturing, handwriting and so on) can be associated with thenar eminence overdevelopment, fatigue and pain.

Since its three constituent muscles (abductor pollicis brevis, flexor pollicis brevis and opponens pollicis) are some of the thumb’s bulkiest, the thenar eminence also provides the lion’s share of palm-to-thumb grip strength. (For example, when using large tools such as hammers, shovels, or in manual therapy techniques involving squeezing or kneading.)

THE CARPAL TUNNEL CONNECTION

Overuse of the thenar eminence is also intimately connected to neurovascular compression, inflammation, and the symptoms of carpal tunnel syndrome (such as hand, palm or wrist pain; numbness; and tingling). Because all three of its muscles have direct connective tissue continuity with the carpal tunnel’s flexor retinaculum, repeated or heavy use of the thenar muscles can contribute to tension, strain or thickening of this carpal ligament, which could narrow the carpal tunnel space and compress its contents. This thenar eminence/carpal tunnel connection works in both directions—the thenar muscles can contribute to tunnel compression, and tunnel compression can cause thenar pain. While the ulnar nerve, which does not pass through the carpal tunnel, innervated most palm muscles, the thenar eminence is typically innervated by the median nerve, which does pass through the carpal tunnel. Compression and irritation of the median nerve is most often responsible for the pain of carpal tunnel syndrome. In fact, thenar eminence pain is one of the most common effects of median nerve compression and atrophy of these muscles is a possible long-term result of unresolved carpal tunnel neurovascular compression. Direct myofascial manipulation of the thenar eminence has been observed to lessen carpal tunnel compression symptoms, but if you suspect that your client has muscle atrophy accompanied by thenar or wrist pain, referral to a rehabilitative specialist is clearly indicated.2 It is also important to remember that median nerve symptoms can be related to irritation anywhere along the median nerve’s length, from the cervical nerve roots, distally through the brachial plexus, or in the arm, elbow or forearm—not just in the wrist or hand.

THENAR EMINENCE TECHNIQUE

Carpal tunnel symptoms are not the only reason why we would work the thenar eminence. Anyone who uses his or her hands will truly appreciate focused local work with the structures of the thumb’s base. The Thenar Eminence Technique uses the knuckles of the practitioner’s soft fist. Note that a soft fist is open, which makes it more sensitive and adaptable than a hard, closed fist. In this position, hand stability is achieved by aligning the arm, carpal and metacarpal bones, rather than by contracting the muscles.

The Thenar Eminence Technique uses the knuckles of the practitioner’s soft fist.

This means that the wrist must be in a neutral or slightly flexed position. As with the thumb joints, avoid wrist hyperextension With your non-working hand, cradle your client’s hand from below. This will provide you with extra sensitivity and control, as you can tune the position of your client’s hand to allow the soft fist to engage just the right layer. Use your soft fist’s MPJ joints (the proximal metacarpal phalangeal joints at the base of the fingers, or the first knuckle) to feel into the hand’s layers. With the broad tool of the fist, you can anchor larger sheets of palmar fascia. Once engaged, ask for slow, active client movement: “Let your hand open and close”; or “Open your thumb.” This will slide and differentiate the tissue layers under your pressure, and give clients control over the technique’s intensity. Work from the center of the palm outwards, starting superficially with the palmar fascia and then working deeper, layer-by-layer, until you are deep within the thenar eminence.

Although there is some sliding involved, I suggest not using oil or lotion, as the friction will provide a therapeutic tension to the palmar and muscular fascias; it should not be uncomfortable if you work slowly enough.

If your client’s thumb symptoms continue to be troublesome, a shift in your approach or in the client’s habits is indicated.

As always, be sure your pressure is not too painful for your client. If he or she is gripping or contracting elsewhere in the body as a result of your pressure or speed, you are working against yourself. Slow down and let the layers melt away. Think about how much of the brain’s sensory cortex this little area occupies—so why rush it? If your client’s thumb symptoms continue to be troublesome, a shift in your approach or in the client’s habits is indicated. Given that the thumbs are so active, you may find that clients with highdemand occupations or activities may need this kind of work on a regular basis in a maintenance and prevention capacity.

THANK YOU, THUMBS

Of course, the Thenar Eminence Technique is especially suited to bodyworker self-care; just lay your own hand down on the table at the end of your day and lean into your thenar eminence with the knuckles of your soft fist (or your elbow). Slowly open and close your “client” hand, releasing any thumb tension and fatigue. This would be a great time to say a silent “thank you” for the wonder of thumbs—thank goodness we have them.

Excerpted from Til Luchau’s Advanced Myofascial Techniques, Volume 1: Shoulder, Pelvis, Leg and Foot, Chapter 12: The Thenar Eminence. Handspring Publishers, 2015. Footnotes 1. Austin, NM, (2005). “Chapter 9: The Wrist and Hand Complex.” Levangie PK, Norkin CC, eds. (2011) Joint Structure and Function: A Comprehensive Analysis (4th ed.). Philadelphia: F. A. Davis Company. 2. Goodwin, S. (2003, December/January). Carpal Tunnel Syndrome and Repetitive Stress Injuries. Massage & Bodywork, 66-78. Til Luchau is the author of the Advanced Myofascial Techniques DVDs and books (Handspring Publishing, 2016), a Certified Advanced Rolfer and lead instructor in the Advanced-Trainings.com faculty, which offers online learning and in-person seminars throughout the United States and abroad.

ORTHOPEDIC MASSAGE

Orthopedic Perspectives on Tendon Pathology and Treatment By Whitney Lowe

assage therapy is used with much success for treating chronic overuse tendon pain, which is one of the most common soft-tissue disorders. However, there are also situations in which the treatment seems less effective. Current research is helping us learn more about tendon structure, function and what is behind painful tendon disorders. A better understanding of these common tendon disorders helps us be more effective in the treatment room. Tendons are composed of multiple strands of collagen fibers primarily oriented in a parallel direction. This parallel fiber orientation provides the greatest tensile strength in a longitudinal direction. The primary mechanical load on tendons is the pulling force of muscle, so longitudinal tensile strength is very important. The main function of tendons is to connect muscle to bone and thereby transmit the pulling force of muscle contraction to the bone. The shape and size of the tendons are dictated by the muscles they are attached to and the force loads those muscles generate. Some tendons are small and rounded, such as the distal wrist flexor tendons. Others, such as the iliotibial band, are large and sheet-like, so there is much more surface area for muscle attachment.

TENDON PATHOLOGIES

The main pathology involving tendons is pain from chronic overuse or repetitive loading. Previously this condition was called tendinitis as it was believed to be an inflammatory reaction to excessive loading. Once research studies established the absence of inflammatory activity in many tendon disorders, these problems were more commonly referred to as tendinosisor tendinopathy simply indicating some type of pathology in the tendon. The primary clinical symptoms of tendinopathy included localized tendon pain (especially with loading), tenderness to palpation (usually increased when the tendon is loaded) and impaired function.

Similar to compression pathology excessive friction during repetitive movement plays a part in tendon pathology.

Tendinopathy can usually be traced back to one or more key factors: â&#x20AC;˘ Chronic tensile loading (excess pulling from muscles). The chronic tensile load frequently occurs with repetitive motion disorders, such as those present in many occupations or recreational activities. â&#x20AC;˘ Compressive loading. While tensile loading from repeated muscle pulling is the most common cause of tendon disorder, repeated tendon compression can also cause tendinopathy. There are numerous locations where tendons are compressed against a nearby bony prominence. An example is the insertion of the Achilles tendon at the calcaneus (Figure 1). The repeated compression of the tendon can lead to degenerative changes in tendon structure.1 â&#x20AC;˘ Friction. Similar to compression pathology excessive friction during repetitive movement plays a part in tendon pathology. Tenosynovitis (inflammatory reaction between the tendon and surrounding synovial sheath under retinacula in the distal extremities) is a good example of friction stress on the tendon.

â&#x20AC;˘ Medications. We have known for some time that corticosteroids (cortisone injections) and a family of antibiotics called fluoroquinolones are associated with tendinopathy. Medication induced tendinopathy appears to affect large tendons (those attached to powerful muscles and significant tensile loads) the most. However, smaller tendons such as the wrist and hand may be affected as well.2 Despite our understanding of these common causes of tendinopathy, there are still some mysteries of its presentation. It is baffling why tendon pain is so prevalent, persistent and why it comes and goes with little reason in many cases.

Medication induced tendinopathy appears to affect large tendons the most.

Starting in the 1980s high-tech imaging studies caught many clinicians and researchers by surprise when they showed an absence of inflammatory cells in many overuse tendon disorders. Since that time there has been a consistent move away from focusing on an inflammatory component of these problems. However, more recent research has suggested that there may actually be inflammatory activity going on in some cases and at certain stages, so the idea of an inflammatory component should not be abandoned. The model of the tendon pathology continuum described by Cook and Purdam (described later in this article) gives a good explanation for why we may sometimes encounter inflammation and other times not.3

WHAT MAKES TENDONS HURT?

Formerly the primary idea behind the pain of tendinopathy was that the pain was a direct result of tissue damage within the tendon. The presence of localized pain that is persistent with palpation and specific tendon loading reinforce this idea.

However, recent imaging studies have called that idea into question as there are numerous cases of tendon damage evident on imaging with no pain at all. This would suggest other factors may also be involved in chronic tendon pain. So, what causes a tendon to be painful? It is clear that excess tendon loading is a primary factor in most painful tendon disorders. However, dysfunctional signal processing in the nervous system is now recognized as a likely cause for pain in many of these conditions, and this has important ramifications for treatment.4

It is clear that excess tendon loading is a primary factor in most painful tendon disorders.

Another interesting pattern with tendinopathy is that there seems to be a warm-up effect. Patients frequently report symptoms gradually diminish with activity, but often recur with great intensity after the activity has ceased. It is likely that there is some type of neurological gating or nociception inhibition during activity that is involved in this process. Current research suggests a role for the central nervous system in ramping up the alarm of the body’s pain system. Essentially this occurs when the central nervous system gets out of calibration and sets off the pain alarm when it shouldn’t. This is a process called central sensitization and it appears to be linked with many chronic pain conditions. It is likely that long-duration tendon disorders may have some degree of central sensitization as a primary cause of the persistent pain. One possible suggestion for the cause of tendon pain is a ‘mis-regulation’ of tendon load and the perception of potential damage which then leads to persistent pain. If this type of central neurological processing error is occurring, then local tissue-based interventions aimed directly at the tendon may have limited effectiveness.

A NEW MODEL OF TENDON PATHOLOGY

Cook and Purdam suggest that common overuse tendon disorders may not be just one type of pathology, but instead lie on a continuum. This could be one reason that various symptoms are inconsistent and treatments are inconsistent in their effectiveness. Treatment success is more dependent on what stage of the continuum the condition is at.(3) Cook and Purdam’s three stages of the continuum(3): • Stage 1: Reactive Tendinopathy: noninflammatory phase with tendon thickening— often from a burst of physical activity. May be either excessive compressive or tensile loading—often seen in younger individuals. • Stage 2: Tendon Dysrepair: similar to reactive tendinopathy but with greater matrix breakdown. Hard to identify this stage, but there may be some focal tendon thickening and some more significant changes visible on imaging studies. An older person with less tendon adaptability may move more quickly into this stage of degeneration. • Stage 3: Degenerative Tendinopathy: seen more common in elderly people, but also present in younger individuals with chronically loaded tendons that have not been able to adapt. Typical presentation is middle aged athlete (the weekend warrior) with Achilles tendon pain and thickening. There are often repeated bouts of tendon pain that seem to occur as the person is gradually working toward some degree of adaptation. If extensive, degenerative tendinopathy can lead to rupture. It is much harder to rebound from degenerative tendinopathy once it has reached this stage.

There is a strong suggestion that tendon loading and soft-tissue treatments like massage are beneficial in the healing process, especially at specific stages along this continuum. Some of the benefits may be related to actual mechanical loading of the tendon and in other cases it may be related to regulation of neurological processes that help decrease pain.5

KEY TAKEAWAYS FOR ASSESSMENT AND TREATMENT

Tendon disorders are very common in clients seeking massage therapy.

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Physical examination is still very important to identify potential tendon pathology and evaluate if there is consistency with diagnostic imaging results that may have been performed. Presentation clinical factors are very important, so comprehensive physical assessment is crucial.

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Consider that the tendon pathology may be at varying stages depending on your client’s age and activity levels, for example.

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Treatment approaches should focus on methods that are not just tissue oriented (like friction). Those that engage higher-order neurological processes (like active engagement techniques) may have added benefit for tendinopathy.

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The more frequently treatment, loading and movement strategies are reinforced, the better and more long-lasting those effects are likely to be.

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Tendon disorders are very common in clients seeking massage therapy. Keeping up with current research, such as that presented in this article, helps us better understand these conditions, which helps us deliver the most effective treatment strategies for our clients.

Footnotes 1. Cook JL, Purdam C. Is compressive load a factor in the development of tendinopathy? Br J Sports Med. 2012;46(3):163–8. 2. Berger I, Goodwin I, Buncke GM. Fluoroquinolone-Associated Tendinopathy of the Hand and Wrist: A Systematic Review and Case Report. Hand. 2017;12(5):NP121-NP126. 3. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409– 16. 4. Rio E, Moseley L, Purdam C, Samiric T, Kidgell D, Pearce AJ, et al. The pain of tendinopathy: Physiological or pathophysiological? Sport Med. 2014;44(1):9–23. 5. Rio E, Kidgell D, Moseley GL, Gaida J, Docking S, Purdam C, et al. Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. Br J Sports Med[Internet]. 2016 Feb [cited 2016 Feb 8];50(4):209–15. Available here. Whitney Lowe, LMT, directs the Academy of Clinical Massage. He teaches continuing education in advanced clinical massage through the academy, and offers an online training program in orthopedic massage. He is a regular contributor to MASSAGE Magazine. His articles include “Clinical Reasoning as a Component of Orthopedic Massage.” This article was excerpted from Lowe’s upcoming new edition of Orthopedic Assessment in Massage Therapy, due out in 2019.

STONE & SHELL THERAPY

How to Use Hot Stone Meridian Technique By Patricia Mayrhofer

he Hot Stone Meridian technique involves the artful application of pressure via warmed stones along the body’s energetic pathways, or meridians. The value of working with massage stones has been misunderstood. Many therapists and clients alike think massage stones constitute more of a pampering treatment than a therapeutic session; however, there are tangible benefits of working with the heat and energy of stones. Heated stones make deep penetration into the tissue easy to achieve. In addition, a greater release of muscle stress and strain helps to release toxins. Pain reduction is an additional benefit of this technique. M. Cathy Calabria-Kane practices several touch techniques, including massage therapy, shiatsu and hotand-cold stone techniques. After working as a therapist for 10 years, she decided to incorporate stone therapy into her shiatsu sessions— and the benefits, she says, are evident.“It has been a tremendous assist in speeding up the healing of my clients, not just physically but also emotionally,” she says.

SHIATSU’S PATH

Tokujiro Namikoshi is credited with the development of shiatsu, which is based on Western anatomy and physiology. (The word shiatsu means “finger pressure” in Japanese.)

At age 7, Namikoshi wanted to help his mother, who was suffering from rheumatoid arthritis, and began using pressure with his thumbs and palms to give his mother some relief from pain. Namikoshi went on, as an adult, to found the Japan Shiatsu College in 1940. A student, Shizuto Masunaga, created the zen style of shiatsu, which is based on traditional Chinese medicine. Another practitioner, Tadashi Izawa, established meridian shiatsu, which incorporates the meridian theory of traditional Chinese medicine into shiatsu.

Each of the 12 meridians mirrors a particular organ or function of the body, and each is an energy channel related to acupuncture points.

This Japanese technique has evolved into yet another healing modality: the Hot Stone Meridian technique, which draws upon both shiatsu and Swedish massage to offer clients a potent means of effecting positive physiological change.

RELEASE ENERGY BLOCKAGES

Each of the 12 meridians mirrors a particular organ or function of the body, and each is an energy channel related to acupuncture points. Practitioners of Asian healing arts believe meridians connect all body parts. The Hot Stone Meridian technique was developed for Natureâ&#x20AC;&#x2122;s Stones by massage therapist and shiatsu practitioner Elisabeth Ott, in cooperation with shiatsu practitioner Carol Livesay, and is based on the principles of meridian shiatsu. In shiatsu, disease is regarded as the result of an energy blockage or imbalance. Therefore, shiatsu is about balancing the body by directly addressing points along the meridians. Shiatsu points are located along meridians, and are related to the central and autonomic nervous systems. Treatment involves the whole body. In the Hot Stone Meridian technique, heat from the stones can release stagnation in the meridians more easily than just the fingers, thumbs and palms.

The energy held by the stones is undeniably important in affecting the movement of stagnation in the meridians. Stones have developed a powerful energy after thousands of years of being tumbled in oceans and rivers and being exposed to the sun, moon, winds and tides.The energy of the stones combined with the energy of the practitioner allows the meridians to release their stagnation with more ease. A focused practitioner who is sensitive to energy provides an extra dimension by connecting to the body with both hands; one hand works and one hand feels the pulse of the body.

The therapist works with no oils or lotions, and applies pressure with her fingers, thumbs and palms to release the stagnation in points on the meridians.

“After determining which meridian to begin treating, the giver places the stones along the pathway, gently supporting the opening of the channels and assisting the chi to move freely,” Calabria-Kane explains. “The stones allow the giver the freedom to move to other pressure points on that meridian while supporting the receiver throughout the entire cycle, no matter where the giver is working.” Releasing the shiatsu points will unblock and rejuvenate the meridians that run throughout the entire body, aiding in healing mind, body and spirit. “Once the giver gently removes the stones from the specific points along the meridian, the giver can begin thumbing and palming over these pathways,” Calabria-Kane says. “The heat from the stones stimulates circulation of chi to flow freely through the channel, and the stones support me, as the giver, in assisting the opening of blocked meridians so the physical body can begin the process of healing itself.” Shiatsu is usually performed on a floor mat, and the client is always clothed. The therapist works with no oils or lotions, and applies pressure with her fingers, thumbs and palms to release the stagnation in points on the meridians. Stretching is also incorporated.

The Hot Stone Meridian technique is performed on a table rather than on a floor mat, for several reasons: Because hot stones need to be repeatedly replaced during a session, the practitioner would have to interrupt his rhythm to stand up to get fresh stones. He would also have to be aware of the placement of the heater so as not trip on it. Also, it would be tiring for the practitioner to repeatedly get up and down. It was determined, after much consideration and trial and error, the best and safest method was to practice on a massage table. Shiatsu practitioners will have to adjust to working on a table instead of the floor. They may find it will take some time to overcome their uncertainties, but they will soon see they can connect effectively when their client is on the table.

STRESS RELIEF

Western massage uses long, smooth strokes, kneading and palpating layers of muscle tissue using massage oil, cream or lotion. As you know, this technique is most commonly performed on a massage table with the client unclothed. There are extensive benefits to massage therapy, including increased circulation, stress relief, pain relief, reduced muscle spasms and cramps, an enhanced immune system, reduced postsurgical adhesions and swelling, releasing of endorphins, reduced migraine pain, and lessened depression and anxiety. Stress relief is one of the most profound benefits of massage therapy. The American Medical Association estimates stress is a factor in more than 75 percent of all illness and disease today. Shiatsu is said to be a natural way to help people relax and cope with such issues as stress, muscle pain, nausea, anxiety and depression. Some say it contributes to healing specific illnesses, although this has not been scientifically proven. There are many clients who attribute their well-being to shiatsu sessions.

Calabria-Kane recalls one client who commented on a Hot Stone Meridian technique session by saying, “‘The floodgates have opened.’ “The stones support my clients to deeply relax and release on an emotional level, letting go of storedup tension and anxiety deep within the connective tissue,” Calabria-Kane adds.

EAST MEETS WEST

Shiatsu and hot stones are a great combination. Through the combination of Eastern and Western modalities, the practice of the Hot Stone Meridian technique brings a new dimension to shiatsu and hot stone massage.

The ultimate objective is to have energy and blood flow freely with no restrictions or stagnation.

Energy and heat combine to achieve a path of good health. Stretching aids in releasing stagnation in the meridians, and heat relaxes the body efficiently, allowing for a greater stretch. The heat from the stones also releases toxins that in turn help the client to feel less pain. Working the meridians that run through each constricted muscle improves the flow of the body’s energy, allowing the body to heal. The increased flow of energy makes a person less susceptible to disease and illness, according to the shiatsu philosophy. The ultimate objective is to have energy and blood flow freely with no restrictions or stagnation. A few shiatsu practitioners have asked whether or not a Hot Stone Meridian technique practitioner can really feel the pulse of a meridian through a stone. This sensation is entirely possible to experience after studying with an instructor and learning to properly work with the stones. The combination of energy from the practitioner and the stones allows the meridians to release stagnation more freely. The practitioner will notice a sensation similar to a hammer pounding as stagnation releases.

PRACTICE SUCCESS

I believe one massage stroke with a hot stone is equivalent to 10 strokes by hand. The Hot Stone Meridian technique is a breakthrough for shiatsu practitioners and massage therapists trained in working with the meridians. It offers variety and intensity to a practice, along with healthy results that keep clients returning. Education on properly handling the stones is most important. There are many safety issues that need to be addressed, such as temperature, pressure and the care and cleaning of the stones and equipment. Proper education will produce excellent treatments; excellent treatments mean happier clients; happier clients mean a successful practice. “With all my clients, I encourage sequential treatments until both the receiver and the giver feel the balance and harmony of the body, mind and spirit,” says Calabria-Kane. “In most cases, my clients have asked to continue stone therapy in their treatments because of the initial results of feeling more open and the duration of how well they feel after a treatment.” As interest in Asian healing methods grows, by both consumers and therapists, shiatsu will also continue to grow in popularity. In today’s economic environment, therapists need that extra edge to help them stay successful. The Hot Stone Meridian technique gives the therapist that needed edge. Pat Mayrhofer is the founder and president of Nature’s Stones Inc., a massage-stone training company offering seminars internationally in many modalities for massage therapists, estheticians, shiatsu practitioners, reflexologists, nail technicians, physical therapists and chiropractors.

TAPING

Why You Need to Be Taping Movement, Not Muscles By Adam Wolf

ver the course of my 12-year career as a massage therapist and physical therapist, my thought processes have evolved, compelling my treatments to become more effective. For example, by placing more emphasis on the nervous system than the musculoskeletal system, I have learned we can create neurological opportunities for change through touch and movement; kinesiology tape can help lengthen the opportunity while also helping to guide movement. Movement therapies have customarily focused on isolated muscles rather than motion for treatment outcomes. However, in reality, the body knows movement not muscles. Knowledge of isolated muscle is necessary and yet it doesnâ&#x20AC;&#x2122;t reflect integrated movement, as tradition dictates muscles are named for the isolated, shortening action rather than the lengthening action. For example, the quadricep can extend the knee and often does, yet in upright function, the quadricep (along with tissue above and below) controls knee flexion and simultaneous frontal and transverse motions. The body controls and reacts to gravity, ground reaction forces, mass and momentum, and injury often occurs at the hypermobile region(s) when it is unable to. (For more information on this topic, see my book, REAL Movement: Perspective on Integrated Motion & Motor Control.)

Prior to my introduction to the concept of taping movement, not muscles, kinesiology taping didn’t fit into my thought process or treatment paradigm. I couldn’t rationalize why I’d tape an individual muscle, let alone distal-proximal or proximal-distal to facilitate or inhibit it. Nonetheless, after my introduction to this new framework of taping motions instead of muscles, lengthening the skin (not the tape) made sense. This taping method fits into my philosophy of modulating the nervous system more than the musculoskeletal system, recognizing the two systems are interrelated and interconnected via a neuromusculoskeletal system.

The body knows motions and how to control them, while the brain knows individual muscles.

Fundamentals of my practice include understanding the principles of anatomy, physiology, biomechanics, neurology, the mechanisms of pain, and an ability to apply my understanding logically. A working knowledge of anatomy is important as it allows for easier communication regarding the region, and also when tissue needs to be worked in isolation—similar to how a map provides an idea of where you are. Real life is different from a map— similar to how a movement paradigm recognizes individual muscles and isn’t limited to the construct that they solely produce motion instead of controlling the presented forces. The body knows motions and how to control them, while the brain knows individual muscles.

NEGATIVE FEEDBACK LOOP

Understanding biomechanics is important, because whether pain is biomechanically driven or not, it becomes biomechanical if not addressed because people move around pain, not through it. In these situations, combinations of tissue on one side of a joint and body stay short relative to the other longer side, which remains relatively lengthened. This leads to tissue not getting fully long or fully short or experiencing the pressure changes necessary to pump fluid through the tissue, resulting in lack of oxygenated fluid moving through it.

Due to the lack of both pressure change and oxygen to the tissue, physiological and neurochemical processes occur, resulting in acidic responses that can sensitize the nerve peripherally and progress centrally. In these situations, a concurrent crosslinking of the tissue- layer interfaces also occur, limiting the ability to slide past other tissue and creating a negative feedback loop. Improving biomechanics even temporarily, what current research demonstrates occurs with jointand most soft-tissue mobilizations, is still valuable, because changing input provides an opportunity to create, temporarily, moments of easier movement. Pain-free movement creates a feed-forward mechanism, leading to more pain-free movement and less anxiety around movement.

...tape affects the nervous system more than the musculoskeletal system.

In other words, changing biomechanics temporarily opens a neurological window of opportunity that can be helpful in changing input, recognizing pain is an output. Kinesiology tape can help the window to stay open longer. For me, an important revelation in practice was that tape affects the nervous system more than the musculoskeletal system. Research demonstrates that various sympathetic processes occur with pain, including inhibitions and reduced somatosensory representation in the painful region.1,2Therefore, early interventions should be geared toward creating parasympathetic responses and concurrently driving nonthreatening input to the affected region. Put another way, thereâ&#x20AC;&#x2122;s a predictive process associated with pain, including decreased proprioception to the painful region and contributing behaviors to the painful experience.

PAIN IS AN OUTPUT

For someone in pain, changing input is important because pain is an output. Touch and interaction with the skin are two effective strategies because the skin is the bodyâ&#x20AC;&#x2122;s largest organ and an extension of the brain.2,3 Embryologically, skin develops alongside the brain.

In painful situations, often the surrounding skin has a limited gliding ability in specific directions, compared to the other side, while also being more sensitive and more difficult to lift. Movement—specifically, nonthreatening, controlled movement that lengthens combinations of tissue and is based on quality and thresholds—is another strategy to alter input. Combining movement with touch stimulates proprioceptors, improving awareness in space, and also creates input change, which are all important for behavior change and improving movement.

TAPING APPLICATIONS

While numerous rationales for kinesiology tape exist, the primarily applications are for pain, decompression and neurological re-education, focusing on the nervous system more than the musculoskeletal system. Research demonstrates that those in pain have limited awareness of the painful body parts in space, while other research shows that in a functional MRI, putting a piece of adhesive elastic tape on the vastus medialis oblique lit up the part of the brain responsible for the vastus medialis oblique.2 This means that tape can improve tactile acuity and somatosensory cortex representation, which are both important for changing output. Research also indicates that kinesiology tape pulls toward middle, creating a lifting and decompression effect on the tissue underneath compared with what’s around it. Recall that lack of motion results in lack of fluid being pumped around the body, resulting in less blood and oxygen reaching the tissue. When this happens, there’s a cascade of effects that results in a cascade of events that ultimately limit the slide of tissue.

Therefore, due to the lifting effect the tape has on the superficial skin, it can assist in increasing blood and oxygen to tissue, in addition of providing a reminder about where someone is or is not positioned in space, which is important for the process of learning something new.4 For example, I often see people with cervical, shoulder or low-back pain who happen to sit for long periods of time in the same position at their desk. The behavior of extended sitting is a behavior to change, and helping people become aware of pain when in that position will create the awareness necessary to influence change.

Oftentimes runners experience pain from a lack of appropriate stride, including cross-over striding or over-striding.

Simple vertical stability strips along the mid-back can help bring awareness to position, especially when sitting in a bad position that will tension the tape, alter sensation and bring awareness to poor positioning. Another example of how tape can assist in creating behavior is with runners. Oftentimes runners experience pain from a lack of appropriate stride, including cross-over striding or over-striding. The behavior of inappropriate stride contributes to overloaded tissue and possibly a pain response, and so awareness of undesirable running mechanics is beneficial. A piece of tape on the posterior thigh (hamstring) or a piece running down the lateral line when crossing the midline bring awareness when over-striding. In both instances, the tape brings awareness to a movement or behavior that could potentially contribute to pain.

INPUT CHANGES

The paradigm of taping movement instead of muscles is consistent with the concept of affecting the nervous system more than the musculoskeletal system, although it is an interrelated spectrum.

When working with people in pain, it’s important to change input, including touch, vibration, pressure, tension, temperature, words and emotions, because pain is an output. Therefore, creating strategies that include as many input changes as possible is a good way to deal with pain in initial stages of intervention. Using kinesiology tape for movement is a great adjunct for manual therapy, because the framework of application is grounded in an understanding that the body knows movement. References

Using kinesiology tape for movement is a great adjunct for manual therapy...

1. Nijs J, Daenen L, Cras P, Struyf F, Roussel N, Oostendorp RA. Nociception affects motor output: a review on sensory-motor interaction with focus on clinical implications. Clin J. Pain. February 2002. 28(2);175-81. 2. Callaghan MJ, McKie S, Richardson P, Oldham JA. Effects of patellar taping on brain activity during knee joint proprioception tests using functional magnetic resonance imaging. Phys. Ther. June 2012. 92(6); 821-30. Doi: 10.2522Epub 2012 Jan 26. 3. Di Pietro F, George P, O’Connell NE. “Tactile thresholds are preserved yet complex sensory function is impaired over the lumbar spine of chronic non-specific low back pain patients: a preliminary investigation.” Physiotherapy. December 2010. 96(4); 317-23. 4. Macefield VG, Norcliffe-Kaufmann L, Goulding N, Palma JA, Fuente Mora C, Kaufmann H. “Increasing cutaneous afferent feedback improves proprioceptive accuracy at the knee in patients with sensory ataxia.” J Neurophysiol. Feb. 1, 2016; 115(2) 711-6.

Additional references: “Short term effects of kinesiotaping on acromiohumeral distance in asymptomatic subjects: a randomised controlled trial” (Manual Therapy, 2013). “The effect of applied direction of kinesio taping in ankle strength and flexibility” (30th Annual Conference of Biomechanics in Sports, 2012). “Initial effects of kinesio taping in patients with patellofemoral pain syndrome: A randomized, double blind study” (Journal of Sport Rehabilitation, 2011). Adam Wolf, PT, LMT, FAFS, is co-owner of REAL pt in Chicago, Illinois. His professional career spans nearly two decades and includes clinical, management, consulting, education, performance/ strength and conditioning, as well as ownership roles. He is the author of REAL Movement: Perspective on Integrated Motion & Motor Control. Wolf is also a RockTape Functional Movement Techniques instructor who presents to fitness and rehabilitation professionals internationally.

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