Degenerative Disc Disease - Graphic for clients

Degenerative Disk Disease

 

I am seeing an abundance of clients walking in degenerative disc disease. According to what I have found on the topic, it is a term for the natural changes of our spinal discs as we grow older. It seems to have a more noticeable effect on the cervical and lumbar vertebrae (www.webmd.com) and is, of course, painful more often than not.

A couple of notes about this: This is not, strictly speaking, a disease but is an umbrella term for a multitude of damage and pain associated with a disc. Also, not everyone gets the symptoms that are associated with DDD.  According to Cedars-Sinai, those symptoms include:

• Pain that is worse when sitting. While seated, the discs of the lower back have three times more load on them than when standing.
• Pain that gets worse when bending, lifting or twisting
• Feeling better while walking or even running than while sitting or standing for long periods of time
• Feeling better changing positions often or lying down
• Periods of severe pain that come and go. These last from a few days to a few months before getting better. They can range from nagging pain to severe, disabling pain.
• Pain can affect the low back, buttocks and thighs or the neck, depending on where the affected disc is, radiating to the arms and hands
• Numbness and tingling in the extremities
• Weakness in the leg muscles or foot drop may be a sign that there is damage to the nerve root 

(Obviously, as massage therapists, it is not within our scope of practice to diagnose. I present the symptoms only to get a grasp of what the client may be going through. I feel that an understanding of the symptoms allows for a better, more focused treatment plan that will best benefit the client. I also believe that understanding symptoms allows for sympathy. Our clients don't often have the benefit of working with health professionals that do more than just "handle them". Now then, back to the topic at hand... )

I would like to take a close look at the word "degenerative". This word does not mean that back pain will get worse with time. It refers solely to the condition of the disc. A spinal disk does not repair it's own damage because there is very little blood supply in this area and that prevents healing. However, over time, the spine may stabilize the area around the damaged disk, thereby easing the pain. (Spine Health)

There are a lot of claims as to what massage can do for DDD but the only two that are agreed on across the board are the increase of blood to the area that is in pain (reduces muscle stiffness and increases range of motion ) and an increase of endorphins ( the body's natural pain killers). Those two factors alone are powerful reasons for massage to be part of a self-care plan for people suffering with DDD.

For further reading on DDD and a number of other common client complaints, massagetherapyreference.com is a wonderful website that covers every facet of how massage applies. 

Quick food for thought...

In the day to day workings of being a massage therapist, there are so many different ways of doing things and, of course, endless possibility of things to learn that make a practice more solid. If you are a relatively new therapist, don't be afraid to create a plan and stick with it. Doing things your own way is often how you get a unique spin on your business. There are too many people who are willing to criticize and try to pass it off as constructive or as sound advice. There are too many people willing to question. Take time to weigh what you are being told and ask yourself if it adds up to you. Don't be afraid to learn, to become more efficient, to make something better but also don't be afraid to move forward with your own plans. Believe in your own abilities and continue adding more skills to your "toolbox". Build your confidence through your own efforts rather than allowing someone to tear you down, no matter how good they try to make their intentions seem. You got yourself where you are and you should be able to rely on your own judgement.

Client Forms: Policy & Procedure

 

This particular form is one that I made for the client to take with them as a reference. It details how missed appointments are handled, how payment is handled, etc., etc. This is a little something extra that I find makes my life easier.

This is a word document and therefore, can be modified to suit your own needs and I encourage you to do so. 

Policy & Procedure

Client Forms: Client Agreement (signed consent form)

Because I am an independent contractor, one of the first things that I did was create many of my own forms to reflect my practice and also to explain some parameters to clients. I do out-calls and I also work in a salon. Neither of those situations require charting but I require it. First off, this conveys professionalism to clients. Secondly, it gives me protection should any disputes arise. Thankfully, that has never happened but there's no point getting sloppy. I put in the time for my education and I take pride in my work. Good documentation reflects that.

The client agreement is a form that I made that is to be attached to the clients file in your possession. They sign it at the initial session when they fill out a client history. It is a guide for how the working relationship will function, what they can expect, and what is expected from them. Because this is a word document, you can tailor it to your own needs or use it as is.

Client Agreement

Color Therapy

I will admit right up front that my knowledge of color therapy is rudimentary at best. It is something that I find myself intrigued by the possibilities of and so I have taken up learning more about it. So far, the only way that I really implement color therapy is in choosing gemstones for chakra balancing but I do have some further experiments in mind to gather my own data as to the effectiveness before I begin offering this therapy in sessions. I always like to find my own results because it guides how I apply the therapy later. Additionally, I can tell clients, yes I have had this therapy and yes I have tried it a lot independently so I know it works and this will absolutely benefit you. So, more on that to come. In the meanwhile, I found this awesome graphic, courtesy of Alternative Balance's FB page that I wanted to share:

Sinus Relief

As a sufferer of sinus and seasonal allergy pain, I have a deep sympathy for my clients that come in complaining of discomfort and sniffling with their reddened eyes. This would be a great email to send to clients or to have as a print-out for your clients that are suffering. I made this graphic because I wanted it for just that purpose. Feel free to save it for your future use.

Constrast Shower Graphic

Natural Healing with Constrast Showers

 

Carrie L. Mills, L.M.T.

Contrast Showers

1/13/13, 10:34 p.m.

Chronic pain is not an easy topic to tackle. Probably the biggest reason for that is how very diverse its causes are.  Experts attest that, regardless of how it happens, around one hundred million Americans suffer from chronic pain and the cost of that suffering is $560 billion to $635 billion (2010) which, according to The American Academy of Pain Medicine, combines the medical costs of pain care and the economic costs related to disability days and lost wages and productivity.” (The American Academy of Pain Medicine, 2011)

Unfortunately, the monetary cost is not all that is involved. There are other, equally important costs associated with chronic pain. A few of those are back pain, particularly the lumbar region; neck & shoulder pain; headache & face pain. (American Heart Association , 2011) Those are the most common forms of chronic pain that I encounter in my profession as a massage therapist.

This article is in no way meant to second guess your primary care physician or any other medical professionals. The point of this series of articles about easing chronic pain are to introduce and reintroduce ideas that you may or may not have considered in an effort to address your own pain.  Please be careful to read the contraindications involved with each possible option because they are not suited to every person.

Contrast Showers:

What is a contrast shower?

Simply put, a contrast shower is one in which you alternate between hot water and cold water.  This particular treatment is a variation of contrast baths that are a staple of hydrotherapy treatments. Immersion in two tubs of water extremes is really ideal however, to make this treatment friendlier to your average person, contrast showers are a wonderful alternative. It does not have quite the same punch but it does garner noticeable results.

What does it do?

A contrast shower increases blood flow which means more oxygen, relaxes tightened (hypertonic) muscles; may help stop migraines if the shower is done when the first symptoms are noticed; alleviates fatigue; invigorates; eases inflammation.

Those who have:

§  Cardiovascular issues

§  Diabetes

§  Hepatitis

§  Kidney Disease

§  Multiple Sclerosis

§  Seizures

§  Obesity

§  Pregnancy

§  Inability to tolerate heat

§  Someone who is very frail

§  Ingested alcohol or prescriptions prior

§  Those who’ve just eaten

§  Asthma

As always consult with your physician before engaging in any behavior that might alter your condition.

How is it done?

It’s actually very simple. 

1.       Turn on the shower and let it get hot. Not so hot that it scalds. The recommended temperature is 102-110 degrees.

2.       Step in and allow yourself to become thoroughly warmed for two to five minutes.

3.       At this point, change the water to cold and remain under it for 30 seconds – 1 minute. The recommended temperature for cold is 65 degrees or less. Use your good judgment.

4.       Go back to hot water for 2 minutes.

5.       Change to cold water for 30 seconds – 1 minute.

6.       Go back to hot water for 2 minutes.

7.       For the last time, turn the cold water on and spend another 30 seconds – 1 minute under it.

8.       Towel off and dress quickly to avoid a chill.[i]  – adapted from (Marybetts Sinclair, 2008)

That, folks, is all there is to it.

Helpful Tips:

·         Bear in mind that this can be done on a smaller scale by soaking painful joints in alternating wash pans of hot and cold water. This is particularly useful for arthritis sufferers.  Swollen hands and feet can benefit tremendously from the contrast of hot and cold water.  Mind the temperature!

·         This is a useful treatment for a sprained joint.

·         If the extremes of hot and cold are simply too much for you, begin slowly with a warm and cool shower.  You will still reap benefits from this.

·         It is useful to know that while chronic pain is often exacerbated by other issues such as fatigue, contrast showers do address that and through that you may find yourself experiencing a lesser degree of pain and it may even lessen depression brought on by the fatigue. Pain is a tiring thing and fatigue is a beast all its own. Don’t underestimate what fatigue can do to you.

·         The best way to know if something is working for you is to keep a journal in which you record the pain you are experiencing on a daily basis. Chronic pain can give the impression that it is never better because it is always present. The easiest method I know is to use the pain scale of 1-10, 1 being the least amount of pain and 10 being excruciating.  Find what works for you.

·         I am a massage therapist, not a doctor. I cannot prescribe anything to you. I can barely suggest things to you. As always, use your judgment and if in doubt, call your doctor.

Chronic pain is manageable and I would urge you to believe in your ability to heal as well as your right to be the first one is charge of your health. Take an active part to take care of you because no one else can ever do it so well.  Whether it is following doctors orders, taking contrast showers, utilizing a future topic we cover, or a method all your own, be proactive about your well-being.  The positive aspects of that alone can make a difference. (Did you know, for example, that feeling in control and feeling as though you are helpless, evoke two very different physiological responses? One, you run at a more optimum level, thoughts clear, a sense of well-being, heightened immunity…the other causes sickness through lowered immunity, less urine output, and depression. I will let you guess which one is which.) 

I would also urge you to do your own research into the benefits of hydrotherapy. There are many different treatments out there for you to explore.  Find what best suits you.  I will leave off with a quote about water that I love and hopefully you will too…

"We must pay respect to water, and feel love and gratitude, and receive vibrations with a positive attitude.  Then, water changes, you change, and I change.  Because both you and I are water"

--Masaru Emoto, "The True Power of Water"

Works Cited

American Heart Association . (2011). Heart Disease and Stroke Statistics.

Marybetts Sinclair, L. (2008). Modern Hydrotherapy for the Massage Therapist. Baltimore: Lippincott, Williams, & Wilkins.

The American Academy of Pain Medicine. (2011). AAPM Fact & Figures About Pain.

---

Scalenes

 

The scalenes are a grouping of a pair of three muscles  that run laterally on the neck. They originate from C-2 to C-7 on the transverse processes and attach on the first and second ribs. 

So far, the majority of my clients come in with complaints that stem from these particular muscles. Sharon Sauer, CMPT, and LMT of the MYO Pain Clinic, even went so far, in a c.e. class I had with her, to aptly call them the "entrappers". Nerve entrapment is not uncommon due to the immediate proximity of the brachial plexus. Also, trigger points in the scalenes can mimic Thoracic Outlet Syndrome (Carpal Tunnel being an associated syndrome), and may be confused with cervical radiculopathy. TrP's here also cause headaches, some of them migraine caliber.The list goes on and on. In short, this is often a troublesome area.

Clients that suffer with shortened scalenes are definitely affected in their posture because it pulls the side of the head lower, at a tilt, and it also pulls on the ribs. In a client with a head-forward position, it is usually the anterior scalene that has such a taut pull on the cervical vertebra that contributes to this posture. Keep in mind that the scalenes are involved in inspiration, right alongside the sternocleidomastoid so when these muscles are suffering, it affects the body in a number of unpleasant ways.

When I work these muscles I personally get very cautious because the brachial nerve is right there among the scalenes and they are admittedly delicate. I also find that I have the most success by working origins and attachments so that does take some of the strain off the caution area. I do apply a broad effleurage to the area and use the broad pads of my fingers when isolating individual scalenes and this helps minimize touching directly on that nerve. Slow and steady has gotten me the best results thus far. Trigger points are far more willing to undo themselves when they aren't under a direct attack and working the area slowly allows for a minimum of discomfort.

This video is really wonderful for the intense focus on the scalenes and clearly demonstrates how to work the area.

And this is a handy, dandy trigger point illustration from AskTheTrainer.com...

Further Reading and Resources:

Great article and breakdown of the scalenes

American Academy of Manual Medicine

Point-by-point

Thoracic Outlet Syndrome 

Love this article and how thorough it is!

Working With the Scalenes

Psoas, low back pain, and stretching to release...

 

The psoas (Also known as iliopsoas because it merges with the iliacus) is one of the largest muscles in the body. It has a distinct disadvantage these days as more and more people are finding themselves in sitting jobs. This puts the psoas in a shortened position more often than not and it becomes accustomed to being at a shortened length. This, in turn, is what leads the psoas to cause back pain.

The psoas originates on the lumbar spine and attaches onto the lesser trochanter of the femur. It runs through the abdomen on its way to the femur and so when it becomes shortened, the pull is felt in the lumbar where it originated. When low back pain comes up in an intake, it is absolutely necessary to be mindful of the role the psoas plays.

Ida Rolf

"Let us be clear about this: the legs do not originate movement in the walk of a balanced body; the legs support and follow. Movement is initiated in the trunk and transmitted to the legs through the medium of the psoas."

(Rolf, 1977: Rolfing, the Integration of Human Structures, pg. 118)

FYI: To locate the psoas, have the client lay in a supine position, place the hand on the lower abdomen, to the far left or right of the belly button; ask the client to raise a foot off the table (on the same side you are) and you will feel it tense beneath your hand.

There are some good stretches available to give clients for homework to relieve the psoas of its tension by lengthening the muscle back out.

This is a reasonably easy stretch to begin with. As always, caution clients against overstretching. As trying as it can be, slow and sure is an excellent method of getting the body back to a health state.

This is a more intense stretch and caution should be exercised on the part of the client.

In addition to these stretches, a yoga routine that includes triangle and warrior provide an excellent way to stretch the psoas.

Rosemary Oil (Rosemarinus Officinalis)

 

Rosemary is a much loved plant for me and I adore the one I have growing by my porch. It has grown to be quite the lovely monster and it is a never-ending source of pleasure for my family and I to gently run our fingers through its spiky limbs. The aroma is heavenly! I use the fresh herb under my pillow for better sleep quality and I find it is very effective for clearing the mind. Rosemary is one of my most favorite oils and as far as the fresh plant goes, it is beyond easy to grow because it is drought tolerant. This plant is not high maintenance at all.

The therapeutic uses are stress reduction ( a 2007 study located at http://www.sciencedirect.com/science/article/pii/S0165178106000114 shows that five minutes of smelling rosemary seriously reduces cortisol, thereby dropping dangerous stress levels), creative boost (very useful to have on hand for tests or other times when memory must be sharp),  immunity boost, respiratory relief, and then there are many cosmetic uses as well.

*Not suitable at all for pregnant or breastfeeding women or those with epilepsy. Avoid if hypertensive.*

Perfumery Note: Middle

Blends well with: Cinnamon, tea tree, eucalyptus, citronella, lavender, black pepper, basil, frankincense, cedarwood, bergamot, clary sage, grapefruit, geranium, lemon, thyme, pine

Benefits of massage for cancer patients (Feel free to print out and use)

Benefits of Massage for Cancer Patients

· Massage reduces anxiety & depression.

· Massage improves immune function including increased natural killer cell number.

· Massage reduces pain perception by an average of 60%, decreases anxiety by 24%, and enhances relaxation by 58%. [Ferrel-Torry & Glick (1003)]

· Massage stimulates the lymphatic system.

· Massage reduces muscle tension.

· Massage aids in the healing of the body post-surgery including mastectomies.

“Healing takes courage, and we all have courage, even if we have to dig a little to find it.” ~ Tori Amos

Basic Chakra Balancing Routine

 

I have spent some time becoming acquainted with energy work and, so far, chakras hold the most appeal for me. That is the concept that hits home the most and something that I read about for years prior to my career as a massage therapist. Chakra balancing is something that I absolutely believe is necessary to balanced mind, body and spirit. So, this is a quick run-down of only one way to do chakra balancing for your clients and is focused primarily on energy work.

To use energy work in this capacity, concentrate on intention while giving either light touch to the area of the chakra or keep the hands off the body but able to feel the energetic field. The most important part of this is intention and connecting with your client. Have the client visualize a swirling ball of energy in the appropriate color while silently repeating a word, such as grounding (root chakra) and this will increase the benefit that the client is receiving. Be sure that your client is taking deep, steady, relaxed breaths!

Place the hands gently over the area of each chakra and sense the energy flowing around it. The chakras may spin clockwise or counterclockwise and this is where you have to use your intuition to determine the direction and work with it. Holding the same imagery in your mind as your client, is useful to gaining strong results. Visualization is vital.

To begin, place the right hand over the root chakra and the left over the throat chakra. Set your intention and connect to your client before beginning work on individual chakras. Next, divide the work throughout the session to maintain flow. So, while the client is prone, work on the root chakra, the heart chakra and the throat chakra and when they are supine, work on the sacral chakra, solar plexus chakra, third eye chakra, and crown chakra.

Enhancements such as breathing exercises, steam towels, and aromatherapy are other options to add more dimension to your treatment.

Remember to always ground yourself after energy work to avoid taking on the other persons energy accidentally!

Chakra Words:

Root: Grounding

Sacral: Creativity

Solar Plexus: Clarity

Heart: Harmony

Throat:Truth

Third Eye: Intuition

Crown: Wisdom

Cerebral Palsy Facts & Considerations

Massage Considerations for Cerebral Palsy: Fact Sheet

Cerebral Palsy: CP is a congenital, central nervous system disorder affecting motor skills, muscle tone, and movement.

There are four main types of CP:

v  Spastic: Too much muscle tone and tightness results in movements that are stiff and awkward. This often manifests in awkward leg and arm movements and this type of CP is present in 50-75% of all cases.

v  Ataxic: This type of CP involves poor control of coordination, and affects depth perception, as well as balance. This type of CP occurs in 5-10% of CP sufferers.

v  Dyskinetic or Athetoid: This type of CP is characterized by low muscle tone often making it difficult for CP clients to sit up straight or walk. Also present are slow, uncontrolled movements. This occurs in 10-20% of CP cases.

v  Mixed: This is a combination of all of the above types of CP. The result is over-tight muscles in some areas and lack of tone in other areas which leads to stiffness coupled with uncontrolled movement.

Massage Modality Considerations:

v  Gentle massage modalities have proven beneficial for all levels of CP. Even if there are no measurable signs of physical improvement, massage reduces stress levels for sufferers of CP.

v  Rolfing has shown promise in increasing the mobility of CP clients with mild to moderate cases, though severe cases WILL NOT benefit from this, and it may make the symptoms worse for the client.

v  Reikisage gives CP clients the benefit of healing energy work and while this is still being explored, the initial results show great promise in increasing control, flexibility, and decreasing stress.

v  Craniosacral therapy is a common modality used for CP clients that often creates noticeable, measurable results in the client.  It has proven to be the most successful modality thus far for CP clients.

v  Aromatherapy should not be overlooked as a way to enhance a session for a CP client as it has the ability to not only relax the client, but to also combat headaches and similar complaints that may be brought on by the state of their muscles.

Considerations for Client Comfort:

v  Be aware of how you are addressing your client. Speak respectfully to your client and be careful not to ignore them should a caregiver be present.

v  Be aware of how you are touching your client. Are you handling them or are you touching them with care?

v  A CP client may have respiratory issues, so be prepared to move them and readjust bolsters however often as is necessary.

v  Your client may be wheelchair bound, and this requires some flexibility on the therapist’s part to deliver a healing session.

v  Some people with CP do not have the ability to verbally communicate well or at all in some instances. This is the time for a system to be mutually created between you and the client that accurately allows you both to communicate with each other through the session.

v  DO NOT attempt strenuous range of motion techniques. In CP the body structure is compromised and broken bones could result.

Other Considerations

v  In severe cases, gain written consent from the client’s physician clearing them for massage.

v  Make yourself aware of other health professionals that your client may be working with such as chiropractors or physical therapists. Obtain consent to contact them and together create a master plan that best benefits the client’s needs.

Additional Resources:

Functional evaluation of Rolfing in cerebral palsy http://www.ncbi.nlm.nih.gov/pubmed/7319140

Craniosacral Therapy for Cerebral Palsy http://www.cerebralpalsysource.com/Treatment_and_Therapy/craniosacral-therapy/index.html

Aromatherapy and Cerebral Palsy (article) http://annadannfelt.com/2010/02/11/aromatherapy-cerebral-palsy/

Copyright © 2011 Carrie L. Mills. All rights reserved.