Are Massage Therapists Helpful in a Humble Way?

Massage therapists are known to be, in general, empathetic, caring and concerned with helping their clients. According to new research, humble people are most helpful.

In most cases, a person’s decision to help someone in need is influenced by temporary personal or situational factors such as time pressure, number of bystanders, momentary feelings of empathy or a person’s own distress, said Wade C. Rowatt, Ph.D., associate professor of psychology and neuroscience in Baylor’s College of Arts & Sciences, who led the study and co-authored the article, in a press release.

“The research indicates that humility is a positive quality with potential benefits,” Rowatt said. “While several factors influence whether people will volunteer to help a fellow human in need, it appears that humble people, on average, are more helpful than individuals who are egotistical or conceited.”

The research found:

• Participants who reported themselves as humble also generally reported that they were helpful, even when other important

personality factors, such as agreeableness, were statistically controlled.

• Humble people offer more time to help than less humble ones.

• Humility was associated with the amount of time offered to help another person in need, especially when pressure to help was low.

“The findings are surprising because in nearly 30 years of research on helping behavior, very few studies have shown any effect of personality variables on helping,” said lead author Jordan LaBouff, Ph.D., a lecturer in psychology at the University of Maine, who collaborated on the research while a doctoral candidate at Baylor. “The only other personality trait that has shown any effect is agreeableness, but we found that humility predicted helping over and above that.”

Important next steps will be to figure out whether humility can be cultivated and if humility is beneficial in other contexts, Rowatt said, “such as scientific and medical advancements or leadership development.”

The Shuffle Toward Obesity Continues

Massage can help alleviate many health conditions—and obesity is no exception. Studies have found that stress reduction assists weight loss and also lessens social anxiety disorder in obese patients, and that massage may lead to healthier lifestyle choices. Meanwhile, being overweight can exacerbate conditions that bring many people to massage, such as arthritis and fibromyalgia.

New research shows the trend toward overweight is not slowing down and by 2020 a majority of U.S. adults will be overweight, with more than half of of them suffering from diabetic conditions.

Investigators with Northwestern University created the projections and presented them to a recent meeting of the American Heart Association (AHA).

The AHA has set a target to help Americans improve their overall heart health by 20 percent in 2020. However, if current trends continue, Americans can expect only a modest improvement of six percent in overall cardiovascular health in 2020, according to a Northwestern press release.

Representative of all Americans, the study was based on patterns found in the National Health and Nutrition Examination Surveys from 1988 to 2008. The projected numbers on weight and diabetes, based on previous trends, include:

• In 2020, 83 percent of men and

72 percent of women will be overweight or obese.

• Currently, 72 percent of men and 63 percent of women are overweight or obese (people who are overweight have a Body Mass Index (BMI) of 25 to 29kg/m2, people who are obese have a BMI of 30kg/m2 or greater).

• In 2020, 77 percent of men and 53 percent of women will have dysglycemia (either diabetes or pre-diabetes). Currently, 62 percent of men and 43 percent of women have dysglycemia.

“We’ve been dealing with the obesity trend for the past three decades, but the impact we project on blood sugar is a true shock,” said Donald Lloyd-Jones, M.D., chair and associate professor of preventive medicine at the Feinberg School of Medicine, a physician at Northwestern Memorial Hospital and senior author of the study. “Those are some really scary numbers. When blood sugar goes up like that, all of the complications of diabetes come into play.”

Less than five percent of Americans currently are considered to have ideal cardiovascular health, the press release noted.

Knee Pain Common Among Women: Massage Can Help

According to the American College of Rheumatology, more than 27 million Americans over age 25 suffer from osteoarthritis—a leading cause of disability worldwide—with pain being the most problematic symptom for patients.

Massage therapy has been shown in previous research to lessen knee pain and stiffness and improve range of motion in patients with knee osteoarthritis. Knee pain also results from being overweight and injury.

Many women, especially those age 50 and older, report knee pain, according to new research.

The new research shows 63 percent of women age 50 and older reported persistent, incident, or intermittent knee pain during a 12-year study period, according to a press release. Predictors for persistent pain included higher body mass index, previous knee injury and radiographic osteoarthritis.

In the U.S., the Centers for Disease Control and Prevention estimates job-related OA costs $3.4 to $13.2 billion per year, according to the press release, and prior studies suggest knee osteoarthritis, specifically, is associated with impaired physical function and substantial societal burden.

Details of this longitudinal study, “Self-Reported Knee Pain Prevalence in a Community-Based Cohort Over 12 Years,” are available in Arthritis & Rheumatism, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology.

Effects of Healing Touch in Clinical Practice

Energy-based healing practices have been part of various cultures throughout history. Use of these complementary therapies, referred to as biofield therapies, is gaining popularity in the U.S.

The theory behind energy-based healing practices is that humans have an energetic dimension necessary for sustaining life. A healthy person’s energy field is symmetrical and balanced, allowing optimal energy flow. Imbalances in the energy field might result in pathological physical and psychological symptoms.

Scientific study of the biological mechanisms, effectiveness and safety of biofield therapists is limited. However, this month’s Massage Therapy Foundation research column reviews an interesting, systematic, evidence-based approach study of the biofield therapy Healing Touch that was conducted at the University of Virginia, Charlottesville, and recently published in the Journal of Holistic Nursing.

Healing Touch is a “hand-mediated” therapy involving the practitioner using his or her hands, either on or above the client’s body, to restore, energize and equilibrate imbalances in the client’s energy field, with the goal of health, well-being or to alleviate specific conditions. Healing Touch originated in the nursing field in the late 1980s as a patient-centered modality in which the practitioner and client both participate in the healing process. Reported benefits include reducing stress, anxiety, pain and depression symptoms, while increasing relaxation and an overall sense of well-being.

This published systematic review evaluated data from randomized clinical trials (RCTs). The systematic review examined the clinical effectiveness of Healing Touch as supportive care for medical conditions. Electronic databases (MEDLINE, CINAHL, and ClinicalTrials.gov) were searched for peer-reviewed articles about Healing Touch. Of the 332 potentially relevant articles, five were included in the review (327 articles were excluded). The five articles selected, involved studies which used random assignment to the treatment condition. Some of the five articles were selected because they employed a blinded study design, which means the studies had data collectors or participants who did not know what type of treatment the participants received (e.g. treatment or control).

The five selected studies involve the use of imagery, stress-relaxation therapy, prayer, therapeutic massage, Healing Touch, mock Healing Touch and presence (as in the presence of someone with the participant, but who did not perform any type of treatment). The sample sizes ranged from 62 to 237 participants. The participants included both men and women who had a mean age between 50 and 65 years old. The studies included multiple conditions including cancer, coronary artery bypass surgery or surgery to enlarge coronary arteries blocked by plaque (percutaneous coronary intervention).

While one study had no significant results with Healing Touch alone, the other four studies show significant findings. One study showed that recipients had significant improvements in respiratory rate, heart rate, blood pressure, pain and mood disturbance after receiving Healing Touch. Two of the studies showed that recipients who received Healing Touch had a significant increase in overall functioning, satisfaction, emotional role functioning, mental health and health transition and a decrease in worry. And the fifth study showed that Healing Touch recipients had a significant decrease in anxiety and the length of their hospital stay.

More studies about the clinical effectiveness of Healing Touch for improving health-related quality of life are required, given the inconclusive findings and limitations of the studies reviewed. Limitations included one study which did not include a “usual care alone” group, i.e. a control group, which is a group of participants that received only the usual medical care and no biofield therapy or other type of therapies. Usual care alone groups are essential when making comparisons with the standard of care. One study used a standardized Healing Touch method involving a “modified” chakra connection, but the modification was not explained. This makes replicating the study difficult. In another study, music was played during Healing Touch treatments; in this case, theoretically the music could have been the reason recipients felt more relaxed. Also, a standard Healing Touch protocol was not used and recipients had different types of cancer. Both of these factors could have potentially contributed to some of the variability in the results. Further, one of the studies used Healing Touch involving different lengths of treatment without the use of a standard protocol, again making replication of the study difficult.

None of the studies justified the protocol or length of time chosen for the Healing Touch treatments. Additionally, because there are several levels of training, the experience of the Healing Touch practitioners should have been described.

Additionally, a limitation of systematic reviews is that studies with positive results are more often published than those with negative results which can lead to a bias toward the publication of studies that are more positive rather than representing all RCT findings.

Research in biofield therapies is difficult because there is a question about whether it can be analyzed using conventional scientific approaches, such as RCTs. Few clinical trials use adequate research methods, including the use of blinding and control treatments; which can result in exaggerated treatment effects. Sometimes trials do not have large enough sample sizes. Another issue is that biofield therapy practitioners are not always involved in developing research protocols and researchers might be unfamiliar with the language used in complementary therapies. Yet another potential problem is that many different types of subjective assessments can be used to determine treatment outcomes; this makes it difficult to compare studies. An approach using mixed-methods including both quantitative and qualitative data, might prove vital to understanding the effects of Healing Touch.

How exactly Healing Touch has an effect is currently unclear. The biofield has only recently begun to be measured. Future research in biofield therapies such as Healing Touch should continue to improve in rigor and detail, as well as investigate whether the effects of these therapies are comparable to the effects of other complementary modalities such as massage therapy.

In closing, though inconclusive, the results of the effects of Healing Touch are promising. It is encouraging that research is increasingly being done to address the effectiveness of therapies based on ancient healing practices involving the human energy field. The current challenge in this field of inquiry is to develop rigorous and replicable scientific research protocols that will demonstrate both the effectiveness and therapeutic capabilities of biofield therapies such as Healing Touch.

Source: Anderson, Joel G., Taylor, Ann Gill. Effects of Healing Touch in Clinical Practice: A Systematic Review of Randomized Clinical Trials. Journal of Holistic Nursing. Published online 12 January 2011; DOI: 10.1177/0898010110393353
The online version of this article can be found at: http://jhn.sagepub.com/content/early/2011/01/12/0898010110393353

Practice Building with Postural Analysis

Postural analysis photos can be utilized like X-rays, CAT scans and MRIs to evaluate, educate, design customized treatment plans and document progress. They are a great tool for attracting new clients and selling treatment packages and can help you build your practice by taking a quick postural analysis and delivering your objective findings using the technology carried with you daily.

Pictures

Keep the process simple by using the camera and screen built into smart phones, iPhones, tablets and iPads, as they are powerful assessment and educational tools. They allow you to instantly take and review a series of photos. Showing patients pictures of their posture adds a whole new meaning to the saying “a picture is worth a thousand words” (Photo 1). The impact of patients seeing a picture of their high shoulder or forward head posture is very powerful. A lasting impression is made on the patients of your ability to quickly identify the musculoskeletal cause of their pain, provide visual evidence (objective findings) and provide a logical treatment plan.

postural analysis photos Photo 1: Educate patients using postural analysis photos. Having photos taken can be stressful to anyone, so make patients more comfortable by letting them wear their regular clothing. To show the postural changes caused by wearing high heels, it is sometimes helpful to take postural analysis photos with the patient wearing and not wearing their shoes.

Prior to taking postural photos have the patient complete a health intake form that gives you permission. Photos should be treated as confidential medical records.

Reference Lines

Viewing the mid sagital, coronal and transverse horizontal planes against the body makes it easy to spot asymmetries and a logical reason to use a postural analysis chart during assessments. The chart is most effective when used in conjunction with a weight or plumb bob suspended from a line. Hang the plumb line from the ceiling, approximately three feet in front of the posture analysis chart. This distance will allow clients of all sizes to stand between the posture chart and the plumb line without touching either one. The plumb bob should be suspended from the ceiling and hang approximately ¼” from the floor (Photo 2a & 2b). To get the plumb line out of the way and conserve space when not in use, simply hook it over one of the pins holding the chart on the wall. If your chart hangs on the back of a door, hook the plumb line on a hook next to the door frame (Photo 2c).

postural analysis chart Photos 2: A postural analysis chart and plumb line makes it easy to spot distortions. Front & Back

Position the patient’s heels approximately shoulder width apart and equally spaced from the plumb line (center line). The plumb line will indicate the position of the midsagittal plane in the photos. Also be sure the client’s heels are the same distance away from the posture chart to avoid creating a twist, torque or rotation in the body. By positioning the feet using the medial and posterior aspects of the heels, the client is free to rotate the lower extremities. Step back, align the plumb line with the centerline of the posture chart and take the photo (Photos 2a).

Side Views

Position the client so that the plumb line is immediately anterior to the lateral malleolus. This position allows the plumb line to represent the coronal plane to the body. Ask the client to place their hair behind the ears to expose the external auditory meatus: an anatomical landmark used as a reference point to determine the position of the head to the coronal plane. Step back, align the plumb line with the centerline of the posture chart and take the photo (Photos 2b).

Findings

charts Photo 3: Support your objective finding with charts. One front and side view photo, in many cases, is all that is needed to give a quick overview of your postural analysis findings. Photos make it easy for patients to understand the stresses their musculoskeletal system is enduring as you zoom-in on different postural analysis views and explain how your treatments can help. Reference the tables labeled Anterior View and Lateral View for the relationship of surface anatomy to anatomical structures (photo 4).

Support

Have all the answers at your fingertips with trigger point, joint range of motion and muscle movement charts to explain the myofascial components of the patient’s pain. Explain the relationship of your postural analysis and other objective findings to their pain (Photos 3).

Market

Stand out from your competition and market how your assessments and treatments are special. Provide postural analysis as part of a package or to attract new patients. Build your practice by taking a quick postural analysis and delivering your objective findings.

 

surface anatomy & structures

Photo 4: Tables show the relationship of surface anatomy to anatomical structures.

Back Pain: Often a Pain in the Gluteus Medius

Each week, I treat several clients who complain of “low back pain.” For many patients, however, the primary cause of their pain is not the lower back but the gluteus medius muscle. No matter what kind of massage practice you have, a great deal of your success will depend on how quickly you are able to determine the origin of a patient’s complaint and your ability to produce measurable results. This article will review some ways to identify when the gluteus medius muscle is responsible for causing pain.

 

Anatomy

The gluteus medius muscle lies superficial to the gluteus minimus muscle and deep to the gluteus maximus muscle. Proximally, it attaches along the external surface of the ilium between the anterior and posterior gluteal lines. Distally, it attaches to the lateral surface of the greater trochanter of the femur. (See Figure 1) The gluteus medius muscle “abducts the hip joint; the anterior fibers medially rotate and may assist in flexion of the hip joint; [and] the posterior fibers laterally rotate and may assist in extension.”1 It also helps to keep the pelvis level when the opposite leg is raised during activities such as walking, running, or standing on one leg.

Intake and History

The first step to designing and implementing an effective treatment plan is to understand the client’s medical history and current circumstances. Utilizing health history intake forms will help you gather the appropriate information; they will also reveal important factors that could be relevant to a patient’s condition.

Using pain scales to document a client’s pain patterns are beneficial, as well. Ask the client to color the diagram form illustrating where on the body he/she experiences pain. Then ask the client to add modifiers that adequately describe the pain, followed by a number from 1-10 to rate its intensity. (See Figure 2) This diagram provides a helpful visual tool that you can reference during the session. You will also see how pain patterns often match common trigger point patterns, which are discussed in more detail below. (Read “Charting Your Progress: Visuals for Success,” Massage Today February 2008.)

Gluteus Medius Ask the client if any of his/her daily activities are affected by the pain. If the answer is “yes,” ask the client which muscles hurt, what movements aggravate the pain, and what he/she believes caused the pain. Ask if the client has recently started or modified an exercise program. Answers like walking, running, tennis, aerobics and other types of activities may indicate gluteus medius involvement. Has the client had any falls or sustained any hip injuries? What is the client’s occupation? Does the client place a wallet or tools in a back pocket? All of these questions will help you narrow down the origin of pain. (Read “Questions With Direction,” Massage Today September 2008.)

Gait and PosturalAnalysis

Observe the client as he/she walks. A painful or “weak gluteus medius muscle forces the client to lurch toward the involved side to place the center of gravity over the hip; such movement is called an abduction, or gluteus medius lurch.”2 Show your client the relationship between posture and pain, and describe how you can help. Just like chiropractors who advertise free “spinal exams” to attract new patients, you could provide free postural analysis to attract new clients. Market the postural analysis as a value that you include during the initial visit; then include a second postural analysis taken upon completing a series of treatments. This is a great way to sell packages, and it also demonstrates postural progress. (Read “Getting Comfortable With Postural Analysis,” Massage Today July 2008.) When conducting a postural analysis, look for signs of gluteus medius muscle involvement. Shortness of the gluteus medius muscle “may be seen as a lateral pelvic tilt, low on the side of tightness, along with some abduction of the extremity.”1

Gluteus Medius Trigger Points

“Myofascial trigger points (TrPs) in the gluteus medius are a commonly overlooked source of low back pain.3 There are three trigger points frequently identified in the gluteus medius muscle. TrP1 (Figure 1) is located lateral and superior to the posterior superior iliac spine (PSIS) just below the iliac crest. TrP1 refers pain and tenderness over the sacrum, above the iliac crest into the lumbar region, and throughout the gluteal region on the same side of the body as the trigger point. TrP2 (Figure 1) is positioned midway between the anterior superior iliac spine (ASIS) and the PSIS just below the iliac crest. “Pain referred from TrP2 is projected more laterally and to the midgluteal region; [and] may extend into the upper thigh posteriorly and laterally.”4 TrP3 (Figure 1) is rarely present and can be located just posterior to the ASIS and just below the iliac crest. Referred pain is primarily produced over the sacrum bilaterally.

Educate your clients about trigger points. Use wall charts or flip charts to demonstrate their location on the body. Using charts and other aids will not only help the client, but it will also build your credibility with the client. This is also an excellent time to explain how the muscle affects posture.

Pain is a symptom. As massage therapists, our job is to address the cause of the pain and work to prevent its return. Educate your clients. Discuss proper ergonomics, stretching and strengthening. Identifying the gluteus medius as a source of back pain is easy once you have the knowledge.

Shoulder Impingement

The glenohumeral joint is a highly complex articulation. It has the greatest range of motion of any joint in the body. However, its increased motion occurs at the expense of stability, requiring the soft tissues to play a more critical role in maintaining joint integrity.

As a result of increased mechanical demands, numerous soft-tissue injuries occur in the shoulder. In fact, shoulder pain is the third most common musculoskeletal disorder, following low back and cervical pain.1

Chronic injuries are common in the shoulder, and develop from the movement requirements in repetitive upper-extremity activities such as sports (e.g., tennis, swimming) and assorted occupations. Also problematic are activities requiring that the shoulder be held in an elevated position for prolonged periods. One of the adverse effects of repetitive motion or holding the shoulder in a static position for long periods is shoulder impingement. Shoulder impingement involves compression of soft tissues between the head of the humerus and the underside of the acromion process or coracoacromial ligament. Impingement might lead to tendinosis, rotator cuff tears, calcific tendinitis, bone spurs or subacromial bursitis.

There is a region in the shoulder composed of the acromion process, coracoacromial ligament, and coracoid process known as the coracoacromial arch (Figure 1). Several tissues are susceptible to compression under the arch: the upper margin of the glenohumeral joint capsule, coracohumeral ligament, supraspinatus muscle-tendon unit, tendon from the long head of the biceps brachii, and the subacromial bursa. Any of these tissues might be compressed against the acromion process or coracoacromial ligament.

Anterior-lateral view of the shoulder showing the coracoacromial arch and tissues at risk of impingement. Figure 1

Anterior-lateral view of the shoulder showing the coracoacromial arch and tissues at risk of impingement.

(3-D anatomy image courtesy of Primal Pictures Ltd. www.primalpictures.com). Impingement might result purely from the structure of the coracoacromial arch, but commonly results from a combination of architecture and repetitive motions, especially those involving flexion and internal rotation of the humerus. In some cases, bone spurs or osteophytes develop on the underside of the acromion process and serve to further decrease the subacromial space and impinge tissues.

There are three progressive stages of impingement syndrome.2 Stage 1 is more common in patients 25 years old or younger. It is characterized by acute inflammation, edema and hemorrhage in the affected tissues. Repeated overhead use of the upper extremity usually is involved. Stage 2 occurs more often in patients between the ages of 25 and 40. There is a progressive degeneration in the rotator cuff structures that involves fibrosis and tendinitis. Stage 3 usually affects patients older than age 40. Tears of the supraspinatus and long head of the biceps tendon might occur. In addition, bone spurs and osteophytes might develop along the underside of the acromion and further contribute to subacromial impingement.

A further classification of impingement pathologies divides them into primary or secondary. Primary impingement is predominantly caused by the architecture of the subacromial region.3 Primary impingement is directly related to the variations in shape of the acromion process. There are three variations in the shape of the acromion process (Figure 2),4 which are described as Types 1, 2, and 3. A Type 1 acromion has a flat undersurface; Type 2 has a curved undersurface; and Type 3 is referred to as a hooked acromion. The hooked acromion is associated with a greater incidence of impingement syndrome.5

Three types of acromion process Magee D. Orthopedic Physical Assessment. Figure 2

Three types of acromion process Magee D. Orthopedic Physical Assessment. 3rd ed. Philadelphia: W.B. Saunders; 1997.

Secondary impingement occurs without any specific alterations in the shape of the acromion process.

It is mostly a result of dysfunctional shoulder biomechanics, and is exacerbated by excessive motion or long periods of compression. Several biomechanical factors can contribute to secondary impingement, including rotator cuff muscle weakness, joint capsule restrictions and dysfunctional coordination of scapulothoracic muscles.6

Shoulder impingement is a challenging problem to treat because many of the affected tissues lie underneath the acromion process. However, in many cases, such as secondary impingement problems, repetitive motion and altered shoulder biomechanics aggravate the condition. In these cases, massage is a highly effective treatment to address the muscular dysfunction that leads to the biomechanical stress. Identifying which tissues underneath the acromion are affected is essential for constructing an effective treatment plan. A future installment of this column will investigate how to determine which of the different tissues are affected.

I’m a Massage Therapist

When meeting someone new, the most frequently asked question is “What do you do for a living?” It happens all the time, everywhere you go. Our occupation defines us on so many levels; it has become the all-time introductory question.

In the sea of massage therapists, the answers don’t vary much. “I am a massage therapist,” or “I am a Reiki practitioner,” or “I am a licensed body worker.” The answers are basically all the same. And truth to tell, most people aren’t inspired by those answers.

Often, when I am at a networking group or working with professionals who are introducing themselves, I hear a diatribe of details about them. Ranging from education, certifications, locations or sales numbers, many people feel these details are what can make or break a sale. Nothing is further from the truth. A potential client wants to learn what you can do for them. They want you to be interested in talking about them and their issues, not you and your practice. The acronym WIIFM stands for “What’s In It For Me?” and should be the mantra of all introductions.

Imagine you have a toothache and go to the dentist. The dentist welcomes you, sits you in the chair, straps the bib on and starts to sell you of her certifications, licenses and latest procedures. Only after she finishes talking about herself does she address your tooth. Sounds crazy? Yet, that’s what most massage therapists do when they meet a potential client.

Don’t despair. You were probably trained to introduce yourself this way. You may have been encouraged in school to develop a sound bite or elevator speech for meeting new people. I have personally taught my undergraduate students to prepare a speech for meeting new people. This comes from being new in the field and needing to gain confidence and establish your credibility. Even if you came to massage therapy from another profession, you were green when you graduated and needed to practice introductions by listing your experience, modalities and schooling. However, now that you are a graduate and attempting to build a thriving practice, change it up. Your credibility will be established from the questions you ask, not from your verbal resume.

People love talking about themselves. Even more, people like talking about their problems. As massage therapists, I am sure you know way too much about complete stranger’s frozen shoulders, arthritis and low back pain. Call it an occupational hazard; it comes with the territory. But if you meet someone who may be a potential client, try this. Introduce yourself, state what you do and start asking questions. Get them talking. Find out about them and from that, glean how and if massage therapy can help. If you can answer WIIFM, you are on the right track. Save explaining why you’re the right massage therapist for the job until you’ve really identified their specific wants or needs. If they have questions about your background or expertise, they’ll ask. Keep the focus on the person you are speaking with and you’ll increase the likelihood that if you have the right skills, you’ll be the massage therapist they choose.

For many massage therapists, it is hard to meet new people. It is even harder to try to sell yourself and your skills. But if you can forget that is what you are trying to do, have an honest conversation with someone and keep the focus on them, you’ve got a good chance at gaining a new client. Remember, it’s not all about you.

Stem the Tide of Cardiovascular Disease

The central question is, what can we do as massage therapists to stem the tide of cardiovascular disease? Heart disease is a progression that expresses itself in many forms, lowering the quality of life for millions and is the cause of death for a citizen in this country every 60 seconds.1

My premise and clinical experience suggests that we can literally create more space for the heart within the thorax. This is achieved by increasing the suppleness and length of the soft tissues both within the chest and those of the outer wall, enhancing the mobility of the thoracic joints, and by reducing the pressure within the cavity itself.

The heart expands and contracts to send blood out over approximately 60,000 miles of vessels.2 By creating more room for the heart to expand, potentiates its capacity for gathering together and pushing more blood. The quantity of blood and the strength of the push during the contraction phase are both assisted by reducing the resistance to the heart’s expansion phase. Something this simple can make a significant contribution.

Our touch, when guided by intention, perception and knowledge can truly make a difference.

freeing the heart In the book, The China Study, the author cites a study of autopsies done during the Korean War that identified that all of the 22-year-old young men in the study showed the beginning signs of moderate to severe heart disease.3 A rather chilling reference for us to consider that the progression of heart disease actually can begin this young. Yet, it offers us an anchor point in our awareness that most of our clients would benefit from our attention to “freeing the heart.”

Let’s begin with a method for quickly assessing the tension and pressure of the chest.

With your next 10 clients:

  1. Softly depress their chest on either side of their upper sternum, toward the table.
  2. Then compress the sides of their ribs toward the midline, first one side, then the other.
  3. Next, slide your hands and fingers under their back and lift the rib angles.
  4. With their knees bent, contact the medial costal arch and softly glide it laterally (do both sides).

With each palpation, memorize the quality of the resistance to your palpations. The reason for assessing 10 people is to develop a continuum for your kinesthetic memory. It’s a random sampling. You might want to do this same thing with an infant, a child, a teen, various adults and, people in your life that are over 60 years old to further develop your kinesthetic awareness to establish a continuum of what healthy distensibility of the thorax feels like.

It’s been my repeated experience that resistance to compression, pliability, and distensibility, just beneath the breast area between ribs 5 and 6, is the most significant tip-off that the heart is unable to expand to its fullest capacity. This becomes even more significant if either side of the diaphragm muscle resists lateral excursion.

As our profession has so many different technique orientations, my intention in this series will be to outline the most critical perceptual, kinesthetic and anatomical reference points that my clinical experience has demonstrated to be effective in “freeing the heart.”

One of my galvanizing experiences that prompts me to write this series is the feedback from a client in his 80’s that his cardiologist had “never seen a left ventricle” that had been enlarged for 30 years shrink back to its normal size. The client has been seeing me on a regular basis since his mid-70’s. None of us can promise or even assert with confidence that such functional changes will happen, but my clinical experience suggests it is possible.

Pediatric Massage and Autism

For Clarice, incorporating nurturing touch into the life of her family was natural. Her young son, Elliot, enjoyed receiving massage on a regular basis. When he was 3 years old, Elliot developed sensory issues.

He started to refuse touch of any kind; clothing, the feel of grass, the feel of any food that he had experienced before, the feel of warm or lukewarm water. His muscle tone began decreasing and by the time he was 3 ½ years old, he had lost all of his language abilities (previously he was bilingual), refused all eye contact and was unable to stand for more than 30 minutes at a time. He would not eat or drink anything other than milk, eventually regressing to the point when he could not verbally communicate and refused to eat.

Eventually his family would begin to unravel the mystery of how their little boy could be diagnosed with PDD-NOS, Autism, mental retardation and sensory integration disorder.

Autism Defined

The incidence of autism and autism spectrum disorders (ASD) is on the rise. In the United States, the Centers for Disease Control believe there are as many as 1 in 80 children affected by this group of disorders, and boys are affected 4 to 5 times as often as girls.

Autism is a complex developmental condition. Most children with autism are perfectly normal in appearance, but spend their time engaged in puzzling and disturbing behaviors which are markedly different from those of children who are developing on a typical spectrum. Autism, as we now know it, is incurable and the behaviors associated with the disorder persist throughout the child’s lifetime. Less severe cases may be diagnosed as pervasive developmental disorder (PDD) or Asperger’s syndrome (these children typically have normal speech, but they have many “autistic” social and behavioral problems).

One important note of clarity is that the diagnosis of Autism is one diagnosis under the umbrella of autism spectrum disorders (ASDs). It can be confusing to understand that there is a spectrum of diagnoses based on symptoms rather than all children being affected by the diagnosis of autism.

Having a diagnosis of autism interferes with normal development of the brain in the areas that influence reasoning, social interaction, motor skills, communication skills and attention. Developmental disorders occur across a spectrum, affecting individuals differently; some children lose the ability to speak, some might have motor impairment, and many lack social and emotional awareness. Behaviors range from hyperactivity to serious self-injury. Families and healthcare professionals often report that children might show lack of eye contact, as well as, have an aversion to touch and tactile stimulation. These disorders make it difficult for children with ASD to communicate with others, leading to frustrated social isolation.

Pediatric Massage Benefits Autistic Children

Researchers have found that children with autism spectrum disorders show less stereotypical autistic behavior, are more social and attentive after receiving massage therapy and have less anxiety. Pediatric massage might provide relaxation, stress reduction and calm muscle spasms. Over time, the child typically becomes more accustomed to tactile stimulation and the regular intervention of pediatric massage might be beneficial in reducing inattentiveness, touch aversion and withdrawal.

It is estimated between 56 percent and 83 percent of children with autism spectrum disorders experience sleep disturbances. Often, by incorporating massage therapy into daily routines, children with autism experience decreased issues with sleeping. When utilized by caregivers, massage therapy might help strengthen the emotional bond between parent and child.

Considerations for Pediatric Massage

It is important to remember that each child with an autism spectrum disorder will have his or her own individual symptoms of autism. A diagnosis is only one factor in determining the best care of the pediatric client.

Patience, patience and more patience is the first key to success. The child must feel safe and that respectful connection takes time. Often, there is susceptibility to sensory overload. So, it is important to begin with proper intention and gradually provide deeper tactile stimulation, while being very aware of non-verbal communication. Always speak to the child with the intent that he or she understands. Investigate what forms of communication are being used (i.e. ASL, picture boards, spoken language and written language). To the best of your ability, incorporate these communication methods in the session.

Respect and incorporate parents to help them understand this is a journey and not a sprint. It might take time to achieve optimal results. Acknowledge that each and every change is a small victory and a step in the right direction. Realize on some days, there will be a plateau and even possibly a regression.

Utilize structure around your sessions. Children with autism prefer structure and have difficulty with transitions and sudden change. Take your time to allow the child to become comfortable with the environment and you, if you have entered their safe space. Never insist that a child participate in the massage session. Speak calmly and lovingly, take your time and introduce slowly. Request that caregivers have items the child likes available during the session. A favorite blanket, toy or flashlight could become the engagement item the child needs to be comfortably present.

The Mystery Unravels

With Elliot, pressure and patience was the key. Pediatric massage was introduced slowly everyday, and sometimes even 3 – 4 times a day. We would avoid the feet, hands, shoulders and head. Once he realized there was no threat, he let me touch his back and face. The face is still a difficult area to receive touch. The success of introducing touch therapy to other areas of his body is surely attributed to mom continuing nurturing touch between our therapeutic sessions.

It is now, after four years of practicing this regimen, that both mom and I can provide a full body massage for Elliot. Now, he even loves his feet being massaged but can only tolerate deeper pressure on his hands and fingers, no soft touch at all. Mom has learned to brush his skin during bath time and then provide firm “washing” with a rough textured towel. Whenever these activities are incorporated, he makes lots of eye contact and motions for more. He now enjoys a rich sensory diet of activities such as being placed in a large comforter and rolled very snug, skin brushing and deep pressure pediatric massage.

When Elliot experiences a “meltdown” (outbursts due to sensory overload, specifically for Elliot issues with lights, shiny floors and balance), he now knows how to self-calm by taking deep breathes, holding something tight or hugging himself. In this way, he is beginning to utilizing touch and breathing as everyday self-calming mechanisms.

For massage therapists and bodyworkers working with children on the spectrum, remember the diagnosis does not give you the entire picture. There are no hard and fast rules for massage due to their individual preferences stemming from their ability to process sensory stimulation.

However, through the use of massage therapy, our basic human need for safe, nurturing contact is met with often wonderful results. For children with autism, it provides not only a positive experience of being touched but the effects hold lifelong benefits for the child and their entire family.