Massage Articles & Information

After 30+ years of being in the Hand & Body Lotion, Massage Oils & Lotions, and the Cosmetic Industry. I realized that there wasn't a good place for people to get the proper information, news, and articles about the massage industry. Whether it be making massage products, proper techniques of massage, which oils go with what essential oils, etc... After navigating the internet for the last 10 years I noticed a small amount of websites trying to do this with little effect.

Friday, September 29, 2006

Massage Eases Alcohol Withdrawal Syndrome

In subjects undergoing alcohol detoxification, massage therapy decreased the symptoms of alcohol withdrawal, reduced pulse rate and encouraged greater engagement in the treatment process, according to recent research.
“Massage Therapy Improves the Management of Alcohol Withdrawal Syndrome” was conducted by staff of Royal Brisbane Hospital Alcohol and Drug Services, Queensland University of Technology School of Psychology and Counseling, and the University of Queensland, Australia.
Twenty-five subjects were assigned to the massage group, and 25 were assigned to a control group. All 50 participants had been admitted to an alcohol and drug detoxification unit. Forty-one were males and nine were females, with an average age of 43.8 years.
Subjects in the massage group received a 15-minute, bedside back, shoulder, neck and head massage, fully clothed, once a day for four days. Subjects in the control group rested for 15 minutes per day for four days. Patients were discharged at the end of the fourth day or on the fifth day, after detoxification.
Outcome measures were pulse rate, respiration rate, Alcohol Withdrawal Scale scores, and subjects’ responses to a questionnaire assessing the treatment process.
Results of the study showed that, as the treatment ensued, both groups had reduced scores on the Alcohol Withdrawal Scale. However, the reduction of scores in the massage group was significantly greater than those of the control group.
Pulse rate was significantly reduced in the massage group as compared to that of the control group, and respiratory function was greater in the massage group at the end of the four-day intervention.
“On a day-to-day basis, the strongest impact of massage on [Alcohol Withdrawal Scale] scores and pulse rate was postmassage day 1,” state the study’s authors. “The initial period of detoxification is physically demanding and increasing patient comfort at this time is important.”
The study also showed that people in the massage group responded to the questionnaire at a significantly higher rate than those in the control group. Eighty-six percent of subjects who reported that their meals were enjoyable were in the massage group, and 100 percent of those who reported feeling safe were in the massage group.
“The subjective experience of patients reflected those receiving massage therapy feeling more engaged in the treatment process,” state the study’s authors. “The qualitative data indicate that most of the individuals who reported feeling supported, safe and having an improved appetite were in the massage group.
“In conclusion, this study suggests that there may be a place for massage therapy in the alcohol detoxification process.”
— Source: Royal Brisbane Hospital Alcohol and Drug Services, in Brisbane, Queensland, Australia; Queensland University of Technology School of Psychology and Counseling, in Carseldine, Queensland, Australia; and University of Queensland Department of Psychiatry, Southern Clinical Division, School of Medicine, at Princess Alexandra Hospital, in Wooloongabba, Queensland, Australia. Authors: Margaret Reader, R.N.; Ross Young, Ph.D.; and Jason P. Connor, Ph.D. Originally published in The Journal of Alternative and Complementary Medicine, April 2005, Vol. 11, No. 2, pp. 311-313
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Shiatsu Techniques Help Induce Labor in Post-Term Pregnancy

A study in England on 66 post-term women (those who attended a hospital clinic after 40 weeks gestation) showed that women who employed shiatsu techniques were significantly more likely to have spontaneous labor than the non-shiatsu group who more frequently required induced labor.
"The Effects of Shiatsu on Post-Term Pregnancy" evaluated the effects of shiatsu techniques, as taught by hospital midwives, on the progress of post-term labors and deliveries. The study was conducted by staff at St. Michael's Hospital, Bristol, England, from March to July 2000.
The subjects attended a hospital consultant clinic appointment at 40 weeks gestation and were taught the massage techniques by a midwife who had completed a six-day shiatsu course. The control group consisted of 76 women who attended similar clinics but were not taught the shiatsu techniques.
Three shiatsu points were taught to the experimental group: Gall Bladder 21 (GB-21), Large Intestine 4 (LI-4) and Spleen 6 (S-6). All points were held with thumb pressure until the woman experienced a reaction. Once a reaction was felt, the woman was instructed to work the point deeply and firmly for as long and as often as was comfortable to her. Exercises and breathing techniques were also taught to the experimental group, and the women were encouraged to use the shiatsu techniques at home.
Outcome information for both groups was audited, including induction, type of delivery, length of labor and analgesia used. The women in the experimental group completed a questionnaire to document their use of shiatsu.
The women who used shiatsu were significantly more likely to labor spontaneously than those who did not (p=0.038). Of those who used shiatsu, 17 percent more went into spontaneous labor than those who were not taught shiatsu. Of those who completed the audit questionnaire, 80 percent found the shiatsu techniques helpful.
"This preliminary study raises the hypothesis that the use of specific shiatsu techniques on post-term women by midwives reduces the number of labors that need to be induced pharmacologically," the authors conclude.
— Source: St. Michael's Hospital, Bristol, England. Authors: Jennifer Ingram, Celina Domagala and Suzanne Yates. Originally published in Complementary Therapies in Medicine, Volume 13, Issue 1, March 2005, Pages 11–15. http://www.massageoil.net http://www.massagelotion.net

Saturday, September 23, 2006

Questions & Answers: Managing Your Practice

from Cherie Sohnen-Moe
From time to time, I will explore specific practice management and marketing questions in this column. The following four questions reflect concerns of many massage therapists:
Q: There's a new alternative medicine center opening up in several months, and I may submit an employment application. It offers a base salary of $11 per hour, plus approximately $10 more for every massage session I do, as well as health insurance and paid time off. One major disadvantage is that there is an exclusivity clause which forbids me from concurrently having a private practice which offers the same service(s). What are your thoughts about taking such a position? Are they offering a fair price? Cathy Harless, Watertown, MA
A: Working as an employee for a company such as this can be advantageous in that there is a guaranteed base income, benefits, and you can focus on the hands-on aspect of your practice. You don't have to do many of the administrative tasks. There is usually a full-time receptionist and the company handles taxes and marketing. Plus, you get to be part of a team and work in a location with amenities that you might not be able to afford (e.g., elegant furnishings and state-of-the-art equipment).Disadvantages include: working under the company's policies and procedures; the possibility of needing to alter your image, style and modalities; receiving a lower rate per session than if in private practice; and the potential for your contract being terminated at any time and having to build a practice from scratch.Most therapists spend at least $10,000 annually to run their practices. This figure includes items such as rent, utilities, phone, supplies and marketing costs. In this example, the company is offering a fair price for your services. If you estimate that you will work 25 hours per week, with 18 hours as billable sessions, you would receive $455 per week (which equals $18.20 per actual hour, but $25.27 per client). Multiply $455 by 47 weeks and you get 21,385. Add $1375 for the time off benefits package (5 weeks at $275) and the total remuneration is $22,760 for working 846 sessions. This doesn't include the other benefits they might offer such as insurance and educational reimbursement. Add the $10,000 it would cost you to run your own practice and you get $32,760 which averages $38.72 per session.This appears to be a good opportunity for a therapist who doesn't have a wide client base as well as the therapist who prefers to avoid the management and marketing sides of building a strong practice. The hazard of working with a company such as this is that it doesn't have a track record and it could be quite some time before you actually see 18 clients per week. Until it is established, I would suggest attempting to get the center to alter their exclusivity requirement. You have to evaluate your strengths, challenges, personality and goals to better decide if working for this company is in your best interest. This doesn't have to be a lifelong commitment. For many therapists, an arrangement like this is ideal. But ultimately, you have more freedom and can earn a significantly higher income if you are in private practice.
Q: I need help in building my massage practice. How do you recommend going from part time to full time with very little money? Kevin Godbee Albuquerque, NM
A: I will answer this question to the best of my ability, given the confines of this column. Whole books have been written to address this concern. Many people start out businesses on a part-time basis while employed elsewhere. This provides the opportunity to increase business without an intense financial risk. If you choose this path, be sure to set target goals for when you will take the leap to a full-time practice (e.g., the numbers of clients you have, the amount of money saved or the date).The two major aspects of building a practice are obtaining clients and retaining them. By doing great work and offering excellent customer service, clients are retained. New clients are obtained by making yourself visible. Some of the best, low-cost ways to get exposure are: writing articles; doing demonstrations; holding open houses; giving seminars and free talks; and getting interviewed by the media. After that it depends on your target market(s).The key to effective marketing is to choose several target markets and focus your time and money in attracting clients from those bases. Once you've chosen a market, then you can determine the appropriate measures. For instance if you want clients that are cyclists, consider these marketing activities: get your name in print with the local fitness publication (e.g., write a column on how massage can increase performance and reduce the likelihood of certain injuries, take out an ad, get interviewed); display brochures and fliers at the bike shops, sporting goods emporiums, health food stores and gyms; give demonstrations/talks to cyclists; sponsor a cycling team by offering reduced sessions and free pre- and post-event massage; print your name and logo on sports bottles and give them to your clients; join the cycling club; place an advertisement on a bus stop bench that's located in front of a popular sporting goods store; build alliances with other professionals that service cyclists (e.g., sports medicine doctors, physical therapists and nutritionists); and give free mini-treatments at major sporting events.You can also engage in cooperative marketing projects with companies or professionals that serve cyclists. For instance, you could arrange with a sporting goods company to provide you with items to give to your cycling clients (such as visors or sports bottles) and you could offer discount coupons for the store to give to their cycling customers or offer a massage to be given in a monthly (or weekly) drawing.
Q: I'm concerned about the products that some bodyworkers sell. Are items such as topical analgesics and orthotics in our scope of practice? Also, do we have the ability to put our professional opinion on supplements, herbal remedies and over-the-counter medications? Tim Starkey, Worcester, MA
A: I think one can ethically sell a wide range of products as long as one is cautious about the quality of the product, has solid knowledge about the class of products (e.g., if you are selling herbs, you ought to have substantive training or education), never diagnose, and always ask yourself these questions: "Is selling this product in the client's best interest?" and "Is this potentially harmful to the therapeutic relationship?"My experience is that very few practitioners sell products which can be unfortunate for all concerned. We have access to wonderful tools that can't be found in your local emporium (e.g,. high quality eye pillows and devices like the Theracane ) and books on stretching and self health care that may not be found in your local bookstore. You are offering a great service to your clients by having these products available.Of course, all product sales need to be done cautiously given the power differential that exists in any therapeutic relationship. I've never been one for high pressure, hype sales. Display your items tastefully and use them in your sessions. If a client then wants to make a purchase, s/he can initiate it.I tend to be rather cautious about product sales that require specialized knowledge or training. I'm not certain about the orthotics. Does the company that manufactures them provide fool proof fittings (such as the molds that you merely step into)? Many places that do shoe repair and make custom shoes also offer orthotics. These people aren't doctors either. The problem with offering orthotics in a therapeutic practice is that there is a perception of (or an actual practice of) some type of assessment (and yes, even diagnosis) that goes along with or proceeds the suggesting/selling of orthotics.The analgesics are a bit trickier, since the public can purchase this class of items over the counter. Again, we have access to an incredible range of products. I've never seen some of my favorite products in any store and I feel it is doing my clients a disservice to not have these products (or at least literature about them) available.I was approached by someone to endorse a "nutritional product" that really was a neutriceutical (it was a product that worked on balancing brain chemistry). Since it was supposedly beneficial for a spectrum of issues that I don't experience, I would not be able to judge the product by anything but their literature and perhaps the subjective feedback from people I know. That's not good enough for me. A product that works well on me or someone I know, doesn't mean that it will work for everyone. Even though the product appeared to be wonderful and was changing many people's lives, I couldn't endorse it for therapists to sell in their practices because I think it's beyond the scope for most therapists. Nutritional products are such a tricky item to sell and yet some people have experienced such phenomenal results that it's understandable that they feel compelled to share the product with others.I consider product sales as an adjunct service. For each product, make certain that you are extremely knowledgeable about the product's benefits as well as contraindications. Only sell reliable products, suitable for use by your clients and are a natural extension of your practice.
Q: I have a question that has become a big issue at the health club where I am employed as a massage therapist. My employer is questioning providing employee benefits for therapists who are not actually doing 40 hours of massage per week. Is there an industry standard that delineates full time work hours for massage therapists? Lee Chapman Hughes, Geneva, Illinois
A: Several surveys have been conducted that rate full-time practice as being 16-to-25 hours of hands-on client contact. Other than these surveys, there really aren't any documents stating the typical hours a massage therapist works. Part of the difficulty in setting standardized hours is that the field of massage and bodywork is so diverse. Some modalities require greater exertion than others.Contact well-known spas and resorts and ask them what they consider full time. It will help if some of the places you contact do provide benefits. Canyon Ranch (a world renown spa) in Tucson, AZ considers full-time employment at a minimum of 24 hours (no one does 40). It provides health insurance, vacation time and the ability to participate in a 401K plan (although the spa doesn't match funds). Part-time minimum is 12 hours, which includes some benefits.

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This article was brought to you by Cherie Sohnen-MoeEmail: Sohnen-Moe Associates, Inc.http://www.sohnen-moe.com/

Questions & Answers: Managing Your Practice

from Cherie Sohnen-Moe

From time to time, I will explore specific practice management and marketing questions in this column. The following four questions reflect concerns of many massage therapists:

Q: There's a new alternative medicine center opening up in several months, and I may submit an employment application. It offers a base salary of $11 per hour, plus approximately $10 more for every massage session I do, as well as health insurance and paid time off. One major disadvantage is that there is an exclusivity clause which forbids me from concurrently having a private practice which offers the same service(s). What are your thoughts about taking such a position? Are they offering a fair price? Cathy Harless, Watertown, MA

A: Working as an employee for a company such as this can be advantageous in that there is a guaranteed base income, benefits, and you can focus on the hands-on aspect of your practice. You don't have to do many of the administrative tasks. There is usually a full-time receptionist and the company handles taxes and marketing. Plus, you get to be part of a team and work in a location with amenities that you might not be able to afford (e.g., elegant furnishings and state-of-the-art equipment).
Disadvantages include: working under the company's policies and procedures; the possibility of needing to alter your image, style and modalities; receiving a lower rate per session than if in private practice; and the potential for your contract being terminated at any time and having to build a practice from scratch.
Most therapists spend at least $10,000 annually to run their practices. This figure includes items such as rent, utilities, phone, supplies and marketing costs. In this example, the company is offering a fair price for your services. If you estimate that you will work 25 hours per week, with 18 hours as billable sessions, you would receive $455 per week (which equals $18.20 per actual hour, but $25.27 per client). Multiply $455 by 47 weeks and you get 21,385. Add $1375 for the time off benefits package (5 weeks at $275) and the total remuneration is $22,760 for working 846 sessions. This doesn't include the other benefits they might offer such as insurance and educational reimbursement. Add the $10,000 it would cost you to run your own practice and you get $32,760 which averages $38.72 per session.
This appears to be a good opportunity for a therapist who doesn't have a wide client base as well as the therapist who prefers to avoid the management and marketing sides of building a strong practice. The hazard of working with a company such as this is that it doesn't have a track record and it could be quite some time before you actually see 18 clients per week. Until it is established, I would suggest attempting to get the center to alter their exclusivity requirement. You have to evaluate your strengths, challenges, personality and goals to better decide if working for this company is in your best interest. This doesn't have to be a lifelong commitment. For many therapists, an arrangement like this is ideal. But ultimately, you have more freedom and can earn a significantly higher income if you are in private practice.


Q: I need help in building my massage practice. How do you recommend going from part time to full time with very little money? Kevin Godbee Albuquerque, NM

A: I will answer this question to the best of my ability, given the confines of this column. Whole books have been written to address this concern. Many people start out businesses on a part-time basis while employed elsewhere. This provides the opportunity to increase business without an intense financial risk. If you choose this path, be sure to set target goals for when you will take the leap to a full-time practice (e.g., the numbers of clients you have, the amount of money saved or the date).
The two major aspects of building a practice are obtaining clients and retaining them. By doing great work and offering excellent customer service, clients are retained. New clients are obtained by making yourself visible. Some of the best, low-cost ways to get exposure are: writing articles; doing demonstrations; holding open houses; giving seminars and free talks; and getting interviewed by the media. After that it depends on your target market(s).
The key to effective marketing is to choose several target markets and focus your time and money in attracting clients from those bases. Once you've chosen a market, then you can determine the appropriate measures. For instance if you want clients that are cyclists, consider these marketing activities: get your name in print with the local fitness publication (e.g., write a column on how massage can increase performance and reduce the likelihood of certain injuries, take out an ad, get interviewed); display brochures and fliers at the bike shops, sporting goods emporiums, health food stores and gyms; give demonstrations/talks to cyclists; sponsor a cycling team by offering reduced sessions and free pre- and post-event massage; print your name and logo on sports bottles and give them to your clients; join the cycling club; place an advertisement on a bus stop bench that's located in front of a popular sporting goods store; build alliances with other professionals that service cyclists (e.g., sports medicine doctors, physical therapists and nutritionists); and give free mini-treatments at major sporting events.
You can also engage in cooperative marketing projects with companies or professionals that serve cyclists. For instance, you could arrange with a sporting goods company to provide you with items to give to your cycling clients (such as visors or sports bottles) and you could offer discount coupons for the store to give to their cycling customers or offer a massage to be given in a monthly (or weekly) drawing.


Q: I'm concerned about the products that some bodyworkers sell. Are items such as topical analgesics and orthotics in our scope of practice? Also, do we have the ability to put our professional opinion on supplements, herbal remedies and over-the-counter medications? Tim Starkey, Worcester, MA

A: I think one can ethically sell a wide range of products as long as one is cautious about the quality of the product, has solid knowledge about the class of products (e.g., if you are selling herbs, you ought to have substantive training or education), never diagnose, and always ask yourself these questions: "Is selling this product in the client's best interest?" and "Is this potentially harmful to the therapeutic relationship?"
My experience is that very few practitioners sell products which can be unfortunate for all concerned. We have access to wonderful tools that can't be found in your local emporium (e.g,. highquality eye pillows and devices like the Theracane ) and books on stretching and selfhealth care that may not be found in your local bookstore. You are offering a great service to your clients by having these products available.
Of course, all product sales need to be done cautiously given the power differential that exists in any therapeutic relationship. I've never been one for highpressure, hype sales. Display your items tastefully and use them in your sessions. If a client then wants to make a purchase, s/he can initiate it.
I tend to be rather cautious about product sales that require specialized knowledge or training. I'm not certain about the orthotics. Does the company that manufactures them provide foolproof fittings (such as the molds that you merely step into)? Many places that do shoe repair and make custom shoes also offer orthotics. These people aren't doctors either. The problem with offering orthotics in a therapeutic practice is that there is a perception of (or an actual practice of) some type of assessment (and yes, even diagnosis) that goes along with or proceeds the suggesting/selling of orthotics.
The analgesics are a bit trickier, since the public can purchase this class of items over the counter. Again, we have access to an incredible range of products. I've never seen some of my favorite products in any store and I feel it is doing my clients a disservice to not have these products (or at least literature about them) available.
I was approached by someone to endorse a "nutritional product" that really was a neutriceutical (it was a product that worked on balancing brain chemistry). Since it was supposedly beneficial for a spectrum of issues that I don't experience, I would not be able to judge the product by anything but their literature and perhaps the subjective feedback from people I know. That's not good enough for me. A product that works well on me or someone I know, doesn't mean that it will work for everyone. Even though the product appeared to be wonderful and was changing many people's lives, I couldn't endorse it for therapists to sell in their practices because I think it's beyond the scope for most therapists. Nutritional products are such a tricky item to sell and yet some people have experienced such phenomenal results that it's understandable that they feel compelled to share the product with others.
I consider product sales as an adjunct service. For each product, make certain that you are extremely knowledgeable about the product's benefits as well as contraindications. Only sell reliable products, suitable for use by your clients and are a natural extension of your practice.


Q: I have a question that has become a big issue at the health club where I am employed as a massage therapist. My employer is questioning providing employee benefits for therapists who are not actually doing 40 hours of massage per week. Is there an industry standard that delineates fulltime work hours for massage therapists? Lee Chapman Hughes, Geneva, Illinois

A: Several surveys have been conducted that rate full-time practice as being 16-to-25 hours of hands-on client contact. Other than these surveys, there really aren't any documents stating the typical hours a massage therapist works. Part of the difficulty in setting standardized hours is that the field of massage and bodywork is so diverse. Some modalities require greater exertion than others.
Contact well-known spas and resorts and ask them what they consider fulltime. It will help if some of the places you contact do provide benefits. Canyon Ranch (a worldrenown spa) in Tucson, AZ considers full-time employment at a minimum of 24 hours (no one does 40). It provides health insurance, vacation time and the ability to participate in a 401K plan (although the spa doesn't match funds). Part-time minimum is 12 hours, which includes some benefits.


This article was brought to you by Cherie Sohnen-Moe
Email: Sohnen-Moe Associates, Inc.
http://www.sohnen-moe.com

Monday, September 18, 2006

Three Way To Improve Your Massage

Three common problems often confront beginning and advanced therapists. First, many therapists fall into a rut by performing the same routine on every client. The second is not accurately listening to what the client needs. The third is not being in a neutral, healing space during the session. By avoiding these three pitfalls, therapists can go from good to great!

Vary your session to suit your client
One of the common occurrences for massage therapists is getting into the habit of performing the same routine on every client. Even therapists who have studied multiple modalities often have a tendency to perform the same routine, especially if the client offers no specific ailments to be addressed. Every client deserves a treatment that is designed to suit him or her specifically. Creating a unique session for each client is achieved through both technique and evaluation. The therapist must have a variety of different techniques that they can use on their client. These may include; Deep Tissue, Neuromuscular Therapy, Lymphatic Drainage, Cranial Sacral, Reflexology, Myofascial Release, Polarity Therapy, Ayurvedic Styles, Energy Work, stretching and more styles- with Swedish massage being the foundation of most work. If the therapist lacks experience in modalities other than Swedish, they can still enhance their work by varying the technique. For example a therapist can use faster strokes for an energizing massage, slower strokes for a sedating massage, or slower strokes and more pressure for a penetrating, muscular massage.
Even with therapists who know many techniques, it is still possible to fall into the trap of performing the same routine on everyone. This is where the ability to assess each client is essential. Assessment is the most important part of giving a unique massage to every client.
Sometimes clients are used to jumping on the table without any evaluation. In this case the therapist will need to educate the client by letting them understand that you can help them more by taking a few minutes to first evaluate them in whatever way you know how. I recommend the evaluation be something that happens before you begin the massage session. In this way you can create a complete treatment plan prior to starting. Additionally, performing the evaluation first communicates to the client that massage can do more than offer simple relaxation or stress relief, and helps to increase the professionalism of our entire industry.
One modality that offers a unique method of assessment is Polarity Therapy. The Polarity practitioner compares the pulses at the ankles and neck. The pulses should be balanced top to bottom and side to side. From this evaluation the practitioner can determine what mode of touch to use- light, penetrating or stimulating, in Sanskrit called Satvic, Tamasic and Rajasic. The entire session would be performed using that specific quality of touch, and at the end of the session the pulses are revaluated for balance.
Ayurvedic Medicine also contains useful evaluation techniques for the massage therapists. Ayurvedic practitioners evaluate clients based on their body type and general nature- called their Dosha. The three Doshas are Vata, Pita and Kapha. Once the client's Dosha is determined there are a number of techniques that the practitioner can perform to balance that Dosha. Ayurveda is different from western massage modalities in that the primary focus is on using substances such as herbs and oils, to treat the person. In Ayurveda, the practitioner giving a massage would use different oil for each Dosha, as well as a different mode of touch.
Western massage modalities tend to classify what clients need according to their condition. Clients that feel fine and just need to relax receive Swedish massage. Those with injuries receive deep tissue and neuromuscular styles, and those with long-term postural distortion or lingering injuries receive myofascial release. If the client has edema, or a suppressed immune system, lymphatic drainage is the technique of choice. Headaches, injuries to the head and neck, or clients that feel scattered, often receive cranial therapy. Of course these are generalizations and there are many other modalities. The point is that western styles, we use different modalities to treat the client, while eastern styles tend to use the same techniques in a different way on each client.
Consequently, clients that come in with no specific injury can still receive a massage tailored to their needs. If the therapist knows some myofascial release, they could evaluate for fascial restrictions before the client gets on the table. Some structural bodywork styles like deep tissue or Neuro-Muscular Therapy include evaluation techniques based on range-of-motion tests, postural evaluation, or resistance tests in cases of pain. Therapists with this type of training can use these evaluations on every client, not just the ones with injuries or pain. In this way the therapist can better serve their clients.
Another very simple way to give your client a unique session is to ask yourself (or your client) whether they need the massage to be energizing, sedating or penetrating. This follows the three modes of touch from Polarity Therapy. From here you can adjust your work during the session and stay away from giving the same routine to each client.

Listening to your client
The second pitfall is in not asking, hearing, or acting on what the client needs. I have experienced again and again therapists, who after hearing my list of specific aches and pains, proceed to give a general sequence that address everything equally. Listening skills are not often taught at massage schools, but are one of the most important parts of being a successful therapist. The first step is to ask your client if they have any specific needs that they would like addressed. Then the therapist should repeat verbally back to the client what they heard. This is as simple as saying- "So your lower back is a little sore, your left wrist hurts when you open jars, and your neck feels tight on the right. Is this correct?" Second, as discussed above, evaluation techniques should be performed to get a deeper picture of what is going on. During the session, therapists should address the client's needs first- i.e. work on the wrist, neck and lower back first before moving to other areas. Many therapists always start in the same area, no matter where the client needs work. By working on the areas that the client has requested, or the evaluation has revealed, the therapist demonstrates that they have heard what is needed and are immediately addressing the client's needs. This lets the client know that you heard them. General relaxation techniques should be applied only after the client's specific needs have been addressed.

Maintain a healing presence
The power of massage is a mixture of technical ability, anatomical specificity, and healing presence. Many therapists focus on learning technique, and forget that their peaceful presence is equally important. This explains why some practitioners who have only basic Swedish training, are 'better' than some practitioners with thousands of hours of training. The missing link is the healing presence. For example, if you tend to think about other things while giving massage, spend time during a session talking about your life to your client, or find yourself only able to perform vigorous, fast massage, you may need to work on your healing presence. Whenever the massage is more about you than your client, then you know there is room for improvement.
How do you foster a healing presence? The first step is slowing down internally. This can be accomplished by performing yoga, tai chi, meditation, quiet contemplation, or anything that allows you become calm. The second step involves creating a healing space within yourself that the client can resonate with. When the session is in progress, your job is to be totally loving, expansive and gracious- and to hold the possibility of the clients' highest potential. Presence is a feeling-state. When the therapist enters it the client can feel it and will respond on an unconscious level. This state of being is healing for the therapist as well as the client, and is one of the main reasons why people like giving massage. Healing Presence is a feeling that is hard to describe, but most massage therapists know it when they are in it.
It takes work to maintain a healing presence with every massage. Carrying on conversations during a massage diminishes the amount of healing presence that you can bring to the session. Under these conditions both therapist and client lose out. Make sure that you have people that you can talk with outside of work, so that your clients don't have to fill this need.
Maintaining a healing presence, listening to your client, and varying your sessions to match each client's needs are three ways that you can keep your work powerful and effective. These fundamental skills may not be taught in all massage schools, but are the foundation of every great massage. Where can you improve?

About Sean Riehl
Sean Riehl is the author of the videos Deep Tissue and Neuromuscular Therapy, Myofascial Release, Lymphatic Drainage, Heal Your Wrist Pain and Anatomy and Pathology for Bodyworkers. He has been a presenter at the AMTA CA convention, written articles for Massage Magazine, and has been teaching massage since 1993. He is the president of Real Bodywork. Real Bodywork has produced over 20 educational massage videos.

SunSign Oils

Massage----Good for what ails you....

Ask the average person what they think of when you say massage therapy and they most likely will mention getting sore or tight muscles rubbed, getting relaxed or reducing tension. These are probably the main reasons most people seek out massage treatments.

This article reviews the very broad scope of treatment that massage addresses every day. Many of these conditions may not directly apply to you, but you may know someone — a family member or friend — who is affected. At the very least, you should find it interesting to learn just how beneficial massage therapy is to all of us in our quest to lead a happy and healthy life.

The medical conditions that people find therapeutic massage can help include:

allergies
anxiety
arthritis
asthma & bronchitis
carpal tunnel syndrome
chronic & temporary pain
circulatory problems
depression
digestive disorders
headache, especially due to tension
insomnia
myofascial pain (where the muscles connect)
reduced range of motion
sinusitis
sports injuries
stress
TMJ (noise and/or pain in the jaw joint)
As interest in massage therapy grows, more studies are being conducted to verify the anecdotal results clients have reported for years.

As an example, several studies offer evidence that immune function is strengthened by massage therapy — in both healthy people as well as those who are fighting disease.

"‘In one study after another, research is suggesting that massage therapy has a positive impact on immune function,’ said Diane Zeitlin, research associate at the Center for Research in Complementary and Alternative Medicine, Kessler Medical Rehabilitation & Education Corporation, West Orange, N.J.

"‘An increase in white blood cells and natural killer-cell activity better prepares the body to fight off possible invading cells,’ said Zeitlin. ‘These cellular changes suggest the immune system benefited from the massages, and these findings fall in line with previous research.’"

In a study conducted by the Touch Research Institute (TRI) at the University of Miami on women who had been diagnosed with breast cancer, the women received regular massage therapy (three times a week for five weeks), with 80 percent showing improved immune function.

"‘These are the first studies that show an effect of massage therapy on an immune function test, which can support the use of massage therapy to alleviate stress, relax muscles and now possibly serve as an alternative medical practice,’ said Michael Ruff, Ph.D., research associate professor at Georgetown University Medical School."

Another TRI study addressed fibromyalgia (a chronic condition characterized by muscular pain, aching, and/or stiffness and afflicting an estimated 3 – 6 million Americans). A portion of the study group received 30 minute massages twice a week for five weeks. The rheumatologists that evaluated the results determined that this group experienced decreases in pain, fatigue, stiffness and improvements in the quality of sleep.

If you are fortunate enough to have excellent health, consider what benefits massage can provide for you. What is becoming evident from the growing number of studies on massage benefits is that massage is helping people to enjoy more optimal physical functioning. And this in turn can lead to a better mental outlook.

The next time you hear someone say that massage is only a luxury, you’ll know that massage is really a tool that can help improve a body’s ability to regain and maintain proper function. Making you feel terrific is just a wonderful bonus!

SunSign Oils

Sunday, September 17, 2006

Massage Chair For A Healthy Family

We often face the problem of stress and strain that ends up in both physical and mental problems. We live in a hectic world where we are always running to keep ourselves alive in the fast competition. We need respite from that strain.

Researches show that massages can be a great reliever to free your mind and body from complex thoughts and stress and are effective if carried out daily. To hire a professional for a massage everyday is something that many cannot afford. To solve this problem we have massage chair out in the market to help us feel relaxed after a day?s hard work. It boosts up our energy level and we are ready o face the challenge of life in great spirits once again.

Massage chairs come in different models with different types of functions. You have to know the type you want or else it will totally be wastage of time and money. Cost of a massage chair may vary from a few hundred dollars to a few thousand dollars. The more expensive one will in fact act as a stimulator as they provide massage with mechanical fingers starting from your back and down to the legs. The less expensive models don't have this facility; they are just like a vibrator to increase your blood flow and make you feel relaxed.

You can shop for massage chairs at specialty shops or furniture stores. You can also find them online with special pricing. But before purchasing you should know the type you want. Another important aspect is you should be aware of the warranty as well; some companies offer extended warranties for the user?s benefits. So buy the massage chair that will not only improve your life style but will take proper care of your investment as well.

Massage chair has gained popularity nowadays. Elderly people find it to be of great relief to help with theft body pains and lethargic attitude. A ten minutes massage during morning will activate your nerve cells and keep you running without making you feel tired for the rest of the day. It even has a strong hold on your nervous system and helps you to maintain a normal blood pressure level. You can also try the massage chair in the night. It will not only relax your muscles but will put you into a deep, sound sleep that you have craved for years.

SunSign Oils

Body Massage Oils for Healthy Living

The holistic application of physical touch to affect the systems of the circulatory, body-the muscular, skeletal, elimination, endocrine, respiratory, lymphatic, emotional, mental digestive, and nervous systems is called Body massage.An expert?s massage with aromatic massage oil does much more than create a pleasant sensation on the skin. The massage oil penetrates into the skin working on the soft tissues (the muscles, tendons, and ligaments) to improve muscle tone. The massage oils reach beneath the deep layers of the skin and possibly stimulate the affected organs for instant relief. Massage oils thus stimulate blood circulation and assist the lymphatic system (which runs parallel to the circulatory system) thereby improving the elimination of waste throughout the body.Massage oils like Grapeseed oil, Jojoba oil and Sweet Almond oil are very light on the skin as they soak quickly leaving the skin soft, nourished and moisturized with out any greasy feeling. Massage oils can be categorized as the following to serve four different purposes: ENERGIZINGEnergizing Massage Oils boost your spirits and energy as well as relax your muscles. Most Energizing Massage Oil contains peppermint, lemon, rosemary, spearmint and tangerine as essential oils. RELAXINGRelaxation Massage Oils is beneficial at the time of stress, muscle cramps and tension. They make your body muscles relaxed and releases tension. The Relaxing Massage Oil blend generally contains ylang, clary sage, bergamot essential oils, and lavender. SPORTSSports massage oils relieve you from spasms, muscle cramps, tension and reactivate your muscles to face the challenge once again. Sports Massage Oil mostly contains lavender, rosemary, peppermint, eucalyptus, and ginger essential oils. SENUSOUSThe Sensuous Massage Oils are for those intimate moments; to make your partner go wild for you. These types of massage oils contain sandalwood, patchouli and rose essential oils. Massage oils thus in general help us to:1. Relaxing.2. Soothing.3. Healing.4. Releasing tension, stiffness, cramps and pain.6. Improving breathing.7. Improving circulation.8. Enhancing well-being.Tip: It is important that you do not go out in the sun for at least 8 hours after using any of the massage oils as you may get skin irritation if exposed to sun. Body massage is not prescribed for pregnant women or children under the age of 3. It is always advisable that you undergo allergy test prior to using body massage oil for safety purposes.
About the Author
Rory H. Hawkins writes about massage oils and other interesting topics. For more information on body massage oils visit us today.

The art of the massage.

Ebony; 8/1/2004; Hughes, Zondra
THE massage has always endured the dubious reputation of being a luxury reserved solely for the rich and those seeking a risqué rendezvous at the hands of a relaxing stranger.
But now, more than ever, the massage is kneading its way into the mainstream with everyday people getting rubdowns in record numbers. Adding credence to this ritual of touch are the scores of health practitioners who are creating an unprecedented level of legitimacy in the medical field.
Some health experts argue that the rhythmic touch of massage--at the hands of a professional masseuse or masseur--has physical and mental benefits, making it the cornerstone of rehabilitative medicine and a major selling point behind the multimillion-dollar holistic health industry.
According to the American Massage Therapy Association, therapeutic massage has been found to lessen the symptoms of insomnia, arthritis, asthma, chronic and acute pain, sports injuries and stress. And a recent American Hospital Association survey found that among hospitals that utilize complementary alternative therapy, a whopping 82 percent surveyed use massage therapy for pain management and relief.
The word must be getting out in the 'hood, too, as national statistics indicate that nearly 20 percent of all adults have had a massage within the last year, and about one-third of them are African-Americans.
CNN Headline News health anchor Kat Carney began getting professional massages about two years ago, and today she swears by her bi-monthly treatments. "I used to be really tense, especially from working in the news industry," Carney says. "Sometimes, I didn't realize it when the tension was there, especially around my neck and shoulders."
On a whim, Carney received the Thai massage because she heard that it relieved stress. Today she loves the Thai massage technique so much that she vacationed in Thailand to, in her words, "experience the most authentic version available ... all day, every day. They say that the Thai massage is the lazy man's yoga. You lie on the floor mat and the masseuse is sometimes standing on you, or walking on you. He is pulling you into different positions and you just relax into it," she says. "I received 4-5 hours of massage every day for 12 days. I've never been so relaxed. All my stress is gone."
Massage moves: Rejuvenate, relax, renew
If you're a novice, you may not want to begin with the strenuous Thai massage treatment, advises licensed, nationally certified therapist Amber Blevins, assistant spa manager of the Relache Spa at the Gaylord Texan Resort and Convention Center in Dallas.
"The Swedish massage, a basic, all-over massage, is great for first-time clients," Blevins says. "Time Swedish technique is more therapeutic, and it allows you to get comfortable with massaging. This technique improves your circulation--which is the No. 1 benefit of massage--and also assists with stress, sleeplessness or headaches."
Other popular massage techniques include the therapeutic deep-tissue massage that penetrates the deeper layers of muscle to relieve past injuries or chronic pain; the healing stone massage, which incorporates smooth, warm river stones to caress the body in sequence with your masseuse's moves; and the Shiatsu massage, a fully-clothed massage that utilizes the Japanese pressure-point technique to reduce tension.
Stop making excuses--go pamper yourself!
So what's holding you back from the throes of pure relaxation?
Here are a few popular excuses:
NO MONEY. You don't have to wait until payday to get a massage--many salons offer affordable massage treatments to suit your taste and budget.
In Chicago, the Honey Child Salon and Spa offers the "Twenty Minute Table Tune-Up" a 20-minute relaxing massage (fully clad) for just $25. If you're going to need a little more than that, you can also opt for the $150 "Tandem" massage treatment, where two therapists rejuvenate your body simultaneously.
NO TIME. Time is money. And if you have even less time than you do money, you can still get access to a set of soothing hands.
In California, the Health Spa Napa Valley offers several "compressed" spa packages for clients on the go, such as the 25-minute "De-Stress Massage" that concentrates on tension-retaining areas such as the neck. Many spas all across the country recognize that you shouldn't have to spend hours at a time to get a little relaxation unless you absolutely want to, and offer similar spa indulges that you can experience during your lunch hour.
NO BABY-SITTER. Do you need a baby-sitter? Okay, many salons offer big, playful romper rooms for your children--complete with qualified attendants--so that busy morns and doting dads can go and relax in peace.
NO SPOUSE-SITTER. Need a baby-sitter for your grouchy spouse? Okay, many newer spas offer spa treatment rooms exclusively for couples so that the two of you can unwind and relax together.
GUILTY CONSCIENCE. Every working Sister may feel a pang of guilt whenever she considers doing something for herself. Blevins says that you need to get over it. "It's normal to feel guilty because motherhood is a full-time job," she says. "But ... the more you receive, the more you'll have to give to others. You can't take yourself out of the equation."
And Bettye Odom, owner of Bettye O. Day Spa in Chicago, says it's essential to take that "me" time so that you can rejuvenate and be ready to take on life's next challenge or even enjoy life's next pleasure. "Especially with African-Americans, there's always someone else who we're concerned about. You have to learn to be a bit selfish--treat yourself well, so you can be good to somebody else," says Odom, who opened her South Side spa in 1978. "You should try to do it every day if you can afford it, every week if you think you can afford it, but at least every couple of weeks."
STRESSED ABOUT GETTING UNDRESSED? You don't have to take your clothes off to enjoy a good massage, says avid massage recipient Kat Carney. "Call your spa ahead of time and talk with your massage therapist," she says. "Let him or her know your concerns about getting undressed. Remember, you can always wear your undergarments or even a bathing suit and still receive an effective massage."
Blevins agrees, adding that you can also choose the person who will give you the massage. "Have a one-on-one conversation with the therapist, and tell him or her that you'd prefer to wear your undergarments. And you can always request a male or female. You should be totally relaxed about your experience."
How to get the most from your spa experience
1 Make sure you are dealing with a certified, licensed massage therapist operating out of a clean, reputable salon.
2 Visit your doctor prior to scheduling a massage to make certain that you do not have any pre-existing health conditions that could be aggravated. Also, give your massage therapist accurate information about any injuries or health concerns that may be worsened by stretching or rigorous, rhythmic touching.
3 Do not eat prior to your session.
4 Communicate with your therapist before (i.e., letting him/ her know your needs), during (i.e., letting him/her know if you feel any discomfort or if the room isn't suitable to your taste) and after your massage. Let your therapist know immediately if you feel there is inappropriate action going on.
5 Arrive at least 30 minutes before your appointment so that you can unwind; if you're running late or arrive in a rushed state of mind, it will be harder for you to relax during your massage.
6 Relax your body. Take a deep breath and let your masseuse/masseur do the job. Tightening your muscles during a massage is counterproductive.
7 Drink hydrating fluids immediately after your massage, Also, unwind in a quiet room or rest area to fully absorb the benefits of your session.

Is Massage Useful in the Management of Diabetes? A Systematic Review. (From Research to Practice/Complementary & Integrative Medicine).

Diabetes Spectrum; 9/22/2004; Cox, Mary
In Brief
Massage is among the fastest growing complementary used in the United States. This article systematically reviews the available evidence on potential benefits and adverse effects of massage for people with diabetes. Massage at injection sites may increase insulin absorption. In addition, uncontrolled studies suggest that massage may have a positive effect on blood glucose levels and symptoms of diabetic neuropathy. However, randomized, placebo-controlled studies are needed to confirm any short- and long-term benefits of massage as a complementary treatment for diabetes and to further define an optimal massage treatment.
Massage has been recommended for diabetes for nearly 100 years. (1) However, the usefulness of massage for people with diabetes remains unclear as evidenced by a recent exchange on an Internet diabetes message board. One writer posts the message, "Does anyone know if massage can help diabetes?" The only reply is another inquiry: "Hi! If you find out any information on massage therapy, please let me know. I just want to help my 16-year-old daughter, who has been diagnosed with diabetes. How do you think massage can help? Even type 2 diabetics, do you think?" (2)
If these writers were to surf the World Wide Web in search of answers to their questions, they would likely be left confused and frustrated. Internet information on this topic is fraught with unsubstantiated claims. One site actually suggests that diabetes can be prevented through self-massage. (3) Another reports on an individual who allegedly had the bottoms of his feet massaged, eliminated large amounts of sugar in his urine during the second week of treatment, and then recovered from his disease. (4) How, then, do consumers decide, or clinicians advise, about the usefulness of massage to people with diabetes?
This article aims to clarify what is and is not known about the usefulness of massage for people with diabetes by summarizing a systematic review of the scientific literature using Cochrane review methodology, (5) a method specifically designed to maximize comprehensiveness and minimize bias. Through this method, all relevant studies that meet prespecified inclusion criteria are included in the review regardless of their results.
Using this method, we will address four frequently asked questions:
1. Can massage improve insulin absorption, for example, by increasing serum insulin in type 1 diabetes or increasing tissue insulin sensitivity in type 2 diabetes?
2. Can massage help normalize blood glucose levels?
3. Can massage provide relief of symptoms associated with diabetic neuropathy?
4. What are the known adverse effects, contraindications, or precautions related to massage for people with diabetes?
MASSAGE OVERVIEW
Trends in Use and Attitudes Toward Massage in the United States
Utilization of massage is rising, making the examination of this issue quite timely. From 1990 to 1997, the proportion of U.S. consumers using massage jumped from 7 to 11% of the population, the most statistically significant increase of any complementary medicine (CM) modality. (6)
Despite stereotypical images of people receiving massage as a way of pampering themselves, nearly three-fourths of those who seek massage do so for a specific health complaint for which they have already consulted a physician. (7) Among rehabilitation outpatients, massage ranks as one of the most common CM therapies sought. (8) Among general practice patients, 32% report using massage, and this proportion exceeds that of individuals reporting the use of herbs, megavitamins, or meditation. (9)
Not only is massage use increasing, but survey evidence indicates that utilization will continue to rise as health plans provide reimbursement. A recent health insurance survey found that respondents were not only willing to pay more for their insurance if CM therapies were covered but also ranked massage as the number one CM therapy they would be most likely to use if it were covered by their health plan. (10) Third-party payers, however, cite lack of efficacy data as the primary reason for their reluctance to reimburse CM. (11)
Massage is among the CM therapies with the highest physician referral rate, (12) and family practice physicians rate bodywork as the CM therapy most likely to be beneficial and least likely to be harmful. (13) Given the growing popularity of massage, it is not surprising that magazines for people with diabetes have begun to offer information about the therapeutic effects of massage. (14)
Types of Massage/Bodywork
Swedish massage is the most widely practiced type of massage in the United States. Developed in 1914 by Per Henrik Ling, this method is considered one of the first scientific approaches to massage, aiming specifically to affect the circulatory, lymphatic, and nervous systems. Long, gliding strokes (referred to as friction) are used to enhance blood and lymph flow; kneading (called petrissage) is used to relax muscle tension; and tapping, cupping, and hacking movements (called tapotement) are used to stimulate nerves. (15)
There are other popular forms of bodywork in the United Stares. Trager uses a gentle, rhythmic, rocking motion to help the body relax. (16) Rolfing uses intense deep-tissue manipulation to restructure fascia. (17) Craniosacral therapy aims at gently influencing the rhythm and flow of the cerebrospinal fluid. (18) Neuromuscular therapy manipulates the deep soft tissues to improve circulation, release nerve entrapment, and deactivate trigger points. (19) Manual lymphatic drainage lightly redirects subcutaneous lymphatic stasis or blockages into functional lymphatic channels. (20)
Swedish Massage Procedure
Swedish massage is the manipulation of the soft tissues of the whole body to bring about generalized improvements in health. Generally, sessions range from 30 to 90 min. The procedure usually begins with a medical history. Then, the massage therapist leaves the room while the person receiving the massage disrobes and lies under a sheet or flannel blanket on a massage table.
The massage usually begins with the patient lying supine. The therapist administers massage first to the arms, neck, and head and then progresses to the torso, feet, and legs. The patient then lies prone, and the legs, hips, and back are massaged. Massage lotion or oil may be applied to minimize friction on the skin.
Trained massage therapists work in spas, health clubs, private practices, chiropractic offices, physical therapy practices, and hospitals.
Physiological Effects of Massage
Several studies have documented the relaxing effects of massage. Massage has been demonstrated to reduce muscle tension in both subjective self-reports (21) and objective electromyo-graphic testing. (22)
Relaxation from massage has been demonstrated to be greater than that brought about from rest alone. (23) Massage can reduce heart rate and blood pressure, two features of the relaxation response. (24)
Additionally, massage has been shown to decrease anxiety in a variety of patient populations, including people with diabetes. (25-27) These stress reducing benefits of massage have raised the possibility that massage may be of benefit to people with diabetes by inducing the relaxation response, thereby controlling the counter-regulatory stress hormones and permitting the body to use insulin more effectively.
LITERATURE SEARCH
Methods
A Medline search was conducted for the years 1966 to 2001. Search terms included "massage," "touch," "chiropractic," "Trager," "Rolfing," craniosacral therapy," "neuromuscular therapy," "acupressure," "Shiatsu," and "manual lymphatic drainage." These search results were combined with a search of the terms "diabetes," "blood glucose," "diabetic neuropathy," "hyperglycemia," and "insulin."
Searches were also made of EMBASE (Excerpta Medica Database), PsychInfo, MANTIS (Manual Therapies Information Systems), CAMPAIN (Complementary and Alternative Medicine and Pain), CCTR (Cochrane Controlled Trials Registry), Cochrane Collaboration Complementary Medicine Field Trials Registry, the Bodywork Knowledge Base, (28) and the Touch Research Institute Database. (29)
Trials reported in any language were included if the study:
1. involved the administration of massage either manually or mechanically to patients with diabetes, and
2. measured at least one relevant primary diabetes outcome (i.e., insulin absorption, blood glucose, [HbA.sub.1c], or symptoms related to diabetic neuropathy) or a potentially relevant secondary diabetes outcome (i.e., induction of relaxation response, anxiety level, quality of life, sense of well-being, depression, cortisol level, blood pressure, or heart rate).
Results
Results of the literature search identified one study (30) pertaining to the first of our four frequently asked questions, three publications of two studies (25-27) and one unpublished study pertaining to our second question, one study (31) pertaining to our third question, and one report (32) pertaining to our fourth question.
Studies were found pertaining to Swedish massage and acupressure. No studies were identified pertaining to the other brand names of bodywork or chiropractic therapy. Therefore, these were omitted from further analysis.
Question #1: Can Massage Improve Insulin Absorption?
Our searches identified one study (30) on insulin absorption in type 1 diabetes. No studies were found examining whether massage can increase insulin sensitivity in the peripheral tissues resulting in increased glucose clearance in type 2 diabetes.
Dillon (30) observed that eight lean, well-controlled patients with type 1 diabetes, using their usual dosages of regular and intermediate-acting insulins, who massaged their insulin injection sites with an electric vibrator for 3 mm at 15 mm post-injection, experienced higher insulin levels and lower serum glucose levels by 15 mm after the start of massage and 29 mm post-injection. At this interval, changes were not statistically significant. Serum glucose levels, however, fell 8.3% lower (P < 0.05) 30 mm after massage and 44 mm post-injection compared to the control day when participants did not massage their injection sites, and this was significant. At 45 mm post-massage, the difference in glucose levels was even more striking (76 mg/dl [+ or -] 6%) when compared to the control day (89 mg/dl [+ or -] 4%).
The same report (30) revealed 2-year follow-up data on these eight patients, as well as on 18 others who had been massaging their injection sites for 3 mm at each meal in order to achieve a beneficial postprandial rise in insulin levels. After 3-6 months of massage, the mean [HbA.sub.1] for the 26 patients fell from 10.56 [+ or -]1.73 to 8.55[+ or -]1.69%. (Normal [HbA.sub.1] was <8.2% according to the laboratory assay used.) After 12-18 months of injection-site massage, 8 patients had normal [HbA.sub.1] levels, and the remaining 18 patients had mean [HbA.sub.1] levels of 8.41 [+ or -] 1.58%, a significant improvement from baseline (P < 0.001). Dillon proposed that injection-site massage can improve conventional insulin therapy by increasing the bioavailability of insulin in the postprandial state.
Question #2: Can Massage Help Normalize Blood Glucose Levels?
Three published results (25-27) of two trials and one unpublished preliminary study have examined the effects of massage on normalizing blood glucose.
Fields and colleagues, describing a single-group, pre/post-test design in two publications of the same study population, (25,26) reported that after 1 month of parents administering nightly full-body massage to their children with diabetes (n = 14), the children's glucose levels decreased from an average of 158 to 118 mg/dl. Exactly when and how often blood glucose levels were measured was not stated.
The authors also reported that both parents' and children's anxiety and depression levels decreased immediately after massage. However, the methodology for measuring these levels was not reported.
Vest (27) trained clinical staff to administer 15-mm sessions of breathing instruction, light touch, and acupressure to diabetic patients for 6 consecutive weeks using a one-group, pre/post-test design (n = 12). Outcomes were blood glucose, persistence of physical symptoms, and perception of well-being. Patients experienced a reduction in blood glucose, anxiety, headaches, depression, work stress, and anger. Self-reports also indicated the patients were sleeping better and had improved relations with their families. No P values were cited. When and how often blood glucose was measured, the length of follow-up time, definitions of clinically significant blood glucose changes, and proportions achieving the various changes were not reported.
Preliminary data were available from one small randomized trial comparing people with type 2 diabetes receiving 45-mm, full-body massage three times a week for 12 weeks (n = 6) to similar patients on a waiting list for massage (n = 2). (M.C., unpublished observations). Researchers found that of the six patients receiving massage, [HbA.sub.1c] decreased in three patients from a baseline of 7.9, 8.3, and 9.8% to 7.3, 8.1, and 8.6%, respectively. In the other three patients receiving massage, [HbA.sub.1c] increased from a baseline of 7.4, 8.2, and 8.0% to 7.9, 10.0, and 8.5%, respectively. These patients, whose glycemic control deteriorated while receiving massage, were obese, injecting insulin, or both. None of the group whose glycemic control improved with massage had either of these characteristics. In the waiting list control group, [HbA.sub.1c] level also declined from 7.3 and 8.6% to 6.9 and 8.4%, respectively.
Question #3: Can Massage Provide Relief for Symptoms Associated With Diabetic Neuropathy?
Our searches identified one trial (31) assessing the effects of massage on the symptoms of dia betic neuropathy. This single-group, pre/post-test design assessed 25 patients with symmetrical diabetic neuropathy of the lower extremities and complaints of burning, tingling, pain, itching, restless legs, paresthesias, and often loss of reflexes. The duration of disease was 6-17 years, and the duration of neuropathic symptoms averaged 14 months.
All patients were treated with syncardial massage, a mechanical leg massage technique in which a cuff inflates at the moment an electrocardiogram pulse wave passes beneath it. The cuff releases when the R wave of the electrocardiogram signals. It is believed that the pressure provided by the cuff aids the arterial elasticity in providing a fuller contraction so that the flow of blood through the limb is increased.
In this study, the cuff was initially placed around patients' thigh and then around their leg for the last half of the treatment. Syncardial massage was administered every 2 days with the total number of treatments ranging from 20 to 30 in those who appeared to benefit. Therapy was discontinued after the tenth treatment for those who experienced no benefit.
Subjective outcomes were defined as no effect, improved (decrease of patients' symptoms to the extent that they considered the treatment worthwhile and wanted to continue it after the first 10 treatments), or good (complete disappearance of symptoms or symptoms becoming so slight that patients considered themselves to need no further treatment). At the 1-month follow-up, results showed good response in 14 cases (56%), improvement in 8 cases (32%), and no effect in 3 cases (12%).
Question #4: What Are the Known Adverse Effects, Contraindications, or Precautions Related to Massage for People With Diabetes?
A potential adverse effect of massage for diabetes appears to be the risk of inducing hypoglycemia in insulin-using patients. This risk is extrapolated from massage studies using healthy volunteers. (33,34) None of the studies of massage and diabetes reports adverse effects. However, it is not clear from the reports whether adverse effects did not occur or whether they did occur but were just not measured or not reported.
In the study of massage for diabetic neuropathy, (32) Kurashova specifically cites contraindications and precautions for people with diabetes. In the beginning, it is recommended only to use continuous effleurage (a light long stroke around the contours of the body, during which the massage therapist does not press down into the tissues but rather glides always in the direction of the heart). Massage should begin with 5-7 min on the back, then proceed to the thigh, and then to the calf. Approximately 20-30 min can be spent effleuraging the posterior side of the body and 10-15 mm effleuraging the front of the legs and the arms.
For patients suffering from peripheral nerve damage, gentle friction of the lower extremities can be added only after a sufficient amount of effleurage has been completed. This may require 7-10 treatments of effleurage before introducing friction.
Because vascular dysfunction may render the tissues of a person with diabetes fragile, friction should be done lightly to avoid vascular damage or bruising. In swollen areas, friction should be avoided because the direct pressure into the tissues that is characteristic of friction may further close the dysfunctioning vessels. Pressure should be sufficiently light so that the massage creates no pain.
DISCUSSION
We have examined the literature pertaining to massage as it relates to diabetes, particularly to insulin absorption/sensitivity, blood glucose levels, diaberic neuropathy, and contraindications. However, important questions remain unanswered.
Although studies indicate that massage may influence insulin uptake at the injection site and decrease blood glucose levels, it should not be assumed that this is always a desirable effect. Rather, the circumstances in which this would be a desirable, even salubrious, effect versus an undesirable effect need further elucidation. For example, if massage induces a relaxation response, thereby controlling counter-regulatory stress hormones and allowing the body to use insulin more effectively, this would be a desirable effect. However, if massage concomitantly induces a precipitous drop in blood glucose into the hypoglycemic rather than the normoglycemic range in patients using hypoglycemic medications, this would be an undesirable effect. Likewise, if massage over time assists in normalizing glycemic control, as suggested by Fields and colleagues, (26) that is a desirable effect. However, if drops in blood glucose from massage make it more difficult to normalize glycemic control and titrate medications, that w ould be an undesirable effect.
Given the possibility that injection-site massage can increase serum insulin as well as decrease blood glucose, more understanding is needed about the appropriate timing of premassage insulin injection as well as about the differences in the potential risks and benefits to people with type 1 versus type 2 diabetes. From this knowledge, ways to maximize benefit and minimize risk can be ascertained.
Although the existing studies suggest that massage can help normalize blood glucose, important questions need to be addressed before this can be accepted as true. For example, most trials do not report the proportion of patients who actually responded in a clinically significant way. Although a clinically meaningful drop in blood glucose was defined as 15% in one study, (25'26) there is no mention of the proportion of subjects who achieved this clinically meaningful change. Instead, it is noted only that the post-treatment blood glucose group average more than achieved a 15% reduction over the baseline average. This is problematic because group averages are notoriously vulnerable to large changes in just a few patients and can lead to falsely optimistic conclusions about an intervention based on one or two very good responders.
Reporting standard errors with group means makes means more interpretable. However, these statistics were not provided. Medians and quartiles, on the other hand, are largely invulnerable to skewed data, and, similar to reporting proportions improved/not improved, can provide a more complete profile of how the study populations responded overall.
A further limitation exists in the selection of study designs. Most of the identified studies used single-group, pre/post-test designs, which do not control sufficiently for confounders. For example, in one study, (26) dietary and insulin compliance increased during the same 1-month experimental massage treatment period, but this was not offered as a possible explanation for decreases in blood glucose. Remissions related to the natural history of a disease or symptom as well as placebo effects can also be major confounders. For example, in one drug intervention study of diabetic neuropathy, (35) 15% of the placebo group reported having no pain by the end of the study, and 33% in the placebo group had at least a moderate improvement on the Patient Global Impression of Change scale. Clearly, for a symptom such as pain from diabetic neuropathy, which can have both placebo effects and natural fluctuations in severity, a control group is necessary before any inference of treatment effectiveness can be made.
How Can the Existing Studies Guide Clinical Practice?
Based on the available literature, there is little to suggest that massage may be harmful or contraindicated for people with diabetes. However, common sense can prevent potential problems. Clinicians wanting to refer people with diabetes for massage should keep three things in mind.
First, clinicians should provide guidance to insulin- or sulfonyureatreated patients. Specifically, these patients should monitor their blood glucose levels carefully before and after massage to watch for decreases. If pre-massage blood glucose levels are low or normal (<120 mg/dl), patients may wish to eat something before their massage. A blood glucose taken immediately after massage can guide patients about whether the amount they ate was appropriate. If pre-massage blood glucose levels are high enough to use supplemental insulin, patients may wish to use a less-than-usual amount of insulin before massage.
For these insulin- or sulfonylureatreated patients, monitoring blood glucose three to four times a day (fasting, before lunch, before dinner, and before bedtime) can provide insight into how massage may affect blood glucose and aid in determining whether medication changes are needed. As with exercise guidelines, patients should be instructed not to schedule massage during the peak of insulin activity. For intermediate-acting insulins (lente or NPH) injected at breakfast, this would be approximately 8 h later, in mid-afternoon. For rapid-acting insulins (lispro or aspart) or short-acting insulin (regular), this would be anywhere from 1 to 3 h after injection.
Second, clinicians may wish to suggest a practitioner who is trained in Swedish massage, given that most of the identified massage research has utilized this massage technique.
Third, because some states require no credentialing of massage therapists, a massage therapist holding a national certification from the National Certification Board of Therapeutic Massage and Bodywork or the American Massage Therapy Association would be preferred.
Massage therapists can exercise caution by ascertaining during the initial phone conversation whether a person has diabetes and, if insulin is used, when and where it is generally injected. Massage therapists should book treatments when insulin is not at its peak activity.
How Can the Existing Studies Guide Future Research?
Insulin injection-site massage compared to no massage in people with type 1 diabetes appears to increase blood levels of insulin and decrease blood glucose. (30) A next step would be to examine whether massage can be used in type 1 diabetes to reduce and stabilize blood glucose. Another research issue would be to examine whether massage can augment tissue insulin sensitivity similar to exercise (36) in people with type 2 diabetes so that endogenous insulin can be used more efficiently.
Before a large randomized trial is conducted, potential mechanisms of action should be explored, and an optimal massage protocol should be established. This can be accomplished through a series of small pilot studies. Efficacy, by definition, is the assessment of an optimal treatment under ideal conditions, and an optimal massage treatment protocol for diabetes needs to be systematically and scientifically developed.
Specific characteristics of the massage protocol that would need to be examined in pilot studies would include the relative contribution of 1) body surface area, 2) depth of massage, 3) rate of massage, 4) duration of treatment, and 5) frequency of massage administration on outcomes of insulin sensitivity (measured by insulin clamp analysis), blood glucose levels (measured three to four times per day and also measured by fructosamine for a 2-week average glucose measure), and the relaxation response (measured by heart rate, blood pressure, self-report, and salivary cortisol).
Depression and sense of well-being should also be measured. People with diabetes experience a fourfold elevation in the risk of depression over the general population, although the reasons are not well understood. (37) The massage studies measuring depression (25-27) noted that depression improved. The unpublished study (M.C., unpublished observations) showed improvements in sense of wellbeing. If these findings are replicable in controlled trials, this would be an important contribution of massage to diabetic patients independent of blood glucose effects.
Pilot studies may also allow observation of potential drug-massage interactions. For example, massage may have a harmful interaction with insulin and sulfonylureas, which can cause hypoglycemia, whereas massage may interact in a therapeutically positive way with insulin-sensitizing drugs.
In pilot studies, one could also look at duration of response and whether there are any preliminary trends suggesting that massage can assist in normalizing glucose levels. One could also investigate whether there is a glucose level above which massage would be detrimental. For example, patients with diabetes are typically encouraged not to exercise when blood glucose levels are >250 mg/dl for fear of causing these levels to rise even higher. This is because the gluconeogenic effect of catecholamines appears to predominate when patients are hyperglycemic--a time when ambient insulin levels are low. This would not be anticipated to occur in patients receiving massage therapy because counterregulatory hormones would not be expected to increase; however, this remains an unexamined possibility.
Following are potential research questions related to specific characteristics of massage. These would need to be studied while holding all of the other characteristics constant.
Surface area. A major question exists about whether a full-body massage that covers a maximal surface area should be the optimal treatment or whether massage of the large muscle groups would be sufficient or even preferred. (38) This could be tested by comparing two randomly assigned groups: one that receives a full-body massage and the other that receives massage of just the large muscle groups for the same time period.
Depth of massage. If massage pressure is partly responsible for increased absorption at injection sites, then it may also be true that pressure plays some role in increasing insulin sensitivity of the tissues. If that is so, then deeper treatments, such as those provided in neuromuscular therapy, (19) might be more effective than the milder pressure of a Swedish massage for those without progressive disease. This could be tested by sing the same massage techniques (i.e., friction, effleurage, and petrissage) and altering only the pressure.
Rate of massage. It has been suggested that decreases in blood glucose may, in part, be modulated by interstitial exchange. (34) If that is so, then a quick hand motion might maximize interstitial exchange. On the other hand, if decreases in blood glucose occur primarily through the relaxation response, one would opt for slow stroke techniques s that induce that response. (24)
Duration of treatment. Given the same type of massage, is 60 min of massage superior to 30 min? If it is found that there is no additional benefit to be gained in the 60-min group, then this has implications for devising an optimal, yet cost-effective dose. If there is an additional benefit, then a 30-min treatment in efficacy trials might be considered a suboptimal dose.
Frequency of treatment. Massage can be administered on a weekly or even daily basis. What is an optimal therapeutic frequency? Kurashova (32) suggests that twice-weekly massage can be beneficial for people with diabetes. This remains to be examined.
Duration of benefit, possible cumulative effects, and therapeutic versus maintenance dosing. There is little in the literature to suggest how long a treatment effect may last. Although it may not be practical to keep patients hooked up to an insulin clamp to determine duration of benefit, monitoring blood glucose several times a day would provide some insight. Additionally measuring fructosamine would provide a 2-week average of potential benefits on blood glucose. If benefit is noted, then one could examine whether treatment effects last longer with more treatments (cumulative effects), a trend one would wish to see if massage truly assists with normalizing blood glucose. If there is some evidence of a cumulative effect, then one could explore whether a less-frequent maintenance dose can sustain benefits in responders.
Selection of population. The justification for the selection of a study population should be well considered. Because the potential risks and benefits may vary according to whether a patient has type 1 or type 2 diabetes and whether a patient uses hypoglycemic medications, a homogeneous study population is suggested. For example, a study sample of people with relatively well-controlled type 2 diabetes could help determine whether increased insulin sensitivity results from massage and whether this can translate into changes in insulin or hypoglycemic medication doses.
Regardless of the population sample, the selection of a homogeneous population is preferred because investigators should not assume that the same type of massage may be equally efficacious for all groups. Different exercise regimens are needed for different groups of people with diabetes, (36) and this point should be well taken in massage research. A pilot population that is too heterogeneous may fail to identify benefit in a specific subgroup.
Once an optimal treatment protocol has been established, that protocol can be used in a larger, randomized controlled trial. In the selection of an optimal treatment, one should also have determined a least- or less-optimal treatment protocol as a control group.
A randomized, controlled trial could involve three arms: the optimal treatment, the least-optimal treatment, and a delayed treatment or waiting-list control. The waiting-list control would provide insight on natural fluctuations in the outcome measures in this population but would not measure placebo effects. The least-optimal massage group could control for placebo effects.
Because even a least-optimal massage treatment may elicit some nonspecific physiological effects that are beyond the placebo effect, it is imperative to be sure in advance that the least-optimal massage treatment protocol will not physiologically approximate the optimal massage treatment. Administering two physiologically similar massage treatments would greatly narrow between-group differences causing huge increases in sample size requirements or, if ample sample size is not anticipated in advance, leading to a type II (false-negative) error.
Any randomized trial should provide treatment for at least 3 months. This would permit changes to become evident in the [HbA.sub.1c]. Trials measuring [HbA.sub.1c] should also have a 2-month lead-in period during which values are measured but no intervention is given in order to obtain valid baseline measures.
Changes in [HbA.sub.1c] may demonstrate whether massage may, in fact, be able to alter disease outcome. The sample size for a large, randomized controlled trial, therefore, should be calculated based on a clinically important change in [HbA.sub.1c]. A 1% decrease in [HbA.sub.1c] reflects a 30 mg/dl decrease in blood glucose.
Further research is also needed regarding the uses of massage for diabetic neuropathy. To date, no trials assessing manually applied massage have been reported. The positive results of the mechanical syncardial massage trial offer a proof of principle that massage may be beneficial in diabetic neuropathy, but clearly more needs to be done to understand the potential benefit, possible mechanisms of action, and contraindications of manually applied massage. By assessing outcomes used in other diabetic neuropathy trials, (35) one can explore whether massage can be beneficial in neuropathy as well as explore which massage techniques (effleurage versus petrissage versus friction) are of optimal benefit.
SUMMARY
Massage at an insulin injection site can significantly increase serum insulin action, thereby decreasing blood glucose levels in people with type 1 diabetes. We do not know whether massage can improve insulin sensitivity and therefore be a useful adjunct to the management of diabetes for those with type 2 diabetes.
Uncontrolled studies suggest that massage may help normalize blood glucose and symptoms of diabetic neuropathy. Randomized, placebo-controlled studies are needed to further clarify what an optimal massage treatment might be and to elucidate any short- and long-term benefits of massage as a complementary treatment for diabetes.
Acknowledgment
We would like to thank Richard Va Why for his assistance in identify in relevant studies an or making the Bodywork Knowledge Base available for this project.
Jeanette Ezzo, MsT, MPH PhD, an epidemiologist, is research director of JPS Enterprises in Tokoma Park, Md., and a practicing massage therapist in Baltimore, Md. Thomas Donner, MD is an assistant professor of medicine in the Division of Endocrinology, Diabetes, and Nutrition at the University of Maryland School of Medicine in Baltimore. Diane Nickols, BS, PA-C, is the regional manager of training and development at MedQuist Mid-Atlantic in Columbia, Md. Mary Cox, Ms T, BS, is the research director of the Baltimore School of Massage in Baltimore, Md.
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