Thai Massage: An Ancient Form of Healing

by Winnie Cain, LMT

Is Thai Massage an ancient form of healing, as claimed by those using this modality over the past 2,500+ years?  I believe it is.  When you understand Thai Massage, you will see why it is called an ancient form of healing.

Thai Massage is based on two theories:

  1. The Four Elements of Life theory: It is the main principle in Thai traditional medicine of which Thai massage is a branch. The body is composed of four elements: Earth, Water, Air and Fire.
  2. Sen Sib (energy line) Theory:  It is the core of Thai massage. Acupressure is applied to the Sen Sib.

Four Elements of Life avatarsThe Four Elements of Life

  • Thai massage affects the Earth element at the muscle, bone and ligaments.
  • Thai massage stimulates the Water element flow through the body. It helps to maintain healthy function of the organs.
  • Thai massage helps direct the Air element to flow in the right direction for the body. The Air element provides all the energy for all activities and functions.
  • Thai massage improves circulation and helps maintain the right temperature for the body. The Fire element consists of the heat and energy of life.

Sen Sib

Thai massage helps to remove blockages that may prevent energy flow in the Sen Sib and bring balance to body, mind and spirit.

In Thai massage, the therapist works from the bottom of the feet to the top of the head, ending at the feet.  The therapist releases the fascia by doing acupressure and stretching.

 

Demo of a Thai Massage sessionThe theory of Thai massage is that a person’s health and well-being relies on the balance of the Four Elements and the life energy channels (Sen Sib).  It is believed that the Sen Sib need regular maintenance to avoid blockages or stagnation.

In Thai massage, the therapist must be comfortable and confident stretching the client. The therapist accomplishes this by using proper body mechanics. It should appear to the client that it is effortless while the therapist is lifting and stretching them. It will also feel like a meditation to both the therapist and client, from beginning to end while using the same rhythm throughout the massage, transitioning from one move to the next, like a dance.

It is an easy modality to do anywhere because the client is fully clothed, which gives on-site massage a new meaning. Thai massage can be performed on a mat or a massage table; it is a great way for the client to become energized while at the same time relaxed.


Decreasing Edema with Active Isolated Stretching

by Joshua Morton, LMP, MAISS, MMLT and Susan Guttzeit, LMP, MAISS

One main key to understanding how to reduce edema lies in stimulating the lymphatic and venous systems. Circulation needs to be restored to deeper tissues, adhesions released, and scarring reduced and realigned. One of the best ways to accomplish this is by utilizing muscle contractions and stretching to create a pushing and pulling force within the vessels. The repeated muscle contractions and stretching that occur using the Active Isolated Stretching (AIS) method create exactly that – a gentle pumping action that promotes lymphatic and venous circulation. This action in turn reduces inflammation and edema. A healthy lymphatic system is an essential component in restoring balance in the body so that it can heal.

AIS-Morton01The lymphatic system is comprised of vessels, nodes and organs. It plays an important role in maintaining stasis in the circulatory system, supplying white blood cells to fight infection and disease and removing metabolic waste products. At the cellular level in the interstitial space between arteriole and venous ends, tiny lymphatic capillaries collect, filter and absorb the remains of plasma and by-products of cellular activity and store them as lymph fluid. Most of the interstitial fluid is reabsorbed into the venous blood stream; the remainder is taken up by lymph. When there is a lymphatic blockage or dysfunction, excess fluid cannot drain effectively. The result is edema or swelling due to fluid retention or build-up. Localized swelling is common with soft tissue injuries.

The lymphatic system begins with tiny capillaries that increase in size to deeper vessels or collectors (nodes). The largest lymph vessels are called ducts and they drain into the venous system by means of the subclavian veins at the base of the neck. Lymph nodes distributed along lymphatic vessels filter lymphatic fluid and contain lymphocytes, which are an important component of the body’s immune system. This drainage system follows a specific pattern of superficial areas near the skin before entering deeper ducts such as the thoracic, cisterna chyli and iliac nodes. The lymphatic drainage territories are separated by overlapping regions called watersheds. The right arm, right shoulder and right neck drain into the right lymphatic duct. The rest of the body drains into the thoracic duct. Lymphatic flow is unidirectional and is mostly passive requiring active muscle contraction of skeletal muscles as well as the act of diaphragmatic breathing and peristalsis (Rattray/Ludwig, p. 218). Nonetheless, the lymphatic vessels themselves have been found to have a minor contractile ability. “This minor contraction is stimulated by stretching the vessels either internally, by the vessels filling, or externally by light massage” (Rattray/Ludwig, p. 217).

Active Isolated Stretching (AIS) is a dynamic flexibility system developed by Aaron Mattes. It is grounded in physiological laws and clinical observations. Utilizing the physiological mechanism of reciprocal inhibition and a 2-second contraction of the synergistic muscles creates a brief window that allows the antagonist muscles to be stretched gently without traumatizing tissue. To illustrate one example of how this works, when you extend your knee using your quadriceps, neurological signals are sent to your hamstrings to relax in order for your knee to straighten. Physiologically, the contraction of agonistic and synergistic myofascial structures allows antagonistic muscles and fascia to relax and lengthen naturally. This creates an optimal environment to safely open up tissues. The act of contracting and stretching is repeated many times to create a pumping action that stimulates lymphatic and venous flow. This flushes the tissues with restorative blood and nutrients and returns blood and lymph to organs for processing and elimination. As the process continues, scar tissue softens and realigns while myofascial adhesions restricting circulation are loosened.

When edema is caused by acute trauma, such as a rolled ankle or twisted knee, the resulting swelling is part of the injury healing process. Tissues become inflamed immediately due to tissue damage and the burden placed on the lymphatic and venous systems. Usually our body is able to cope with most of these disruptions well enough without intervention; however, sometimes the injury is much more than our body can handle on its own and it requires outside help before healing can occur.

Scar tissue in the form of extra fibrin is laid down to knit together torn tissue. The scarring that takes place does so indiscriminately, attaching to anything close at hand to lend to stability. This process can include other tissues, even bone. Scarring must be addressed to fully restore circulation to the affected joint and surrounding tissues. The repeated muscle contractions associated with AIS realign scar tissue in the direction of movement initially and have the potential to permanently remodel the tissues by aiding and stimulating the body’s natural ability to reabsorb the collagen that has been laid down. Homeostasis is restored to the body allowing the body to heal.

There are three main principles behind how AIS works and why it is effective. The first is Sherrington’s Law of Reciprocal Inhibition, which illustrates why active muscle contractions are an important component to any stretch. What occurs physiologically is the initiation of a neurological signal that innervates one muscle to contract and inhibits the opposite one to relax. This is what allows movement to occur. Without this mechanism, you could not bend or straighten your elbow smoothly, throw or catch a ball with force, or push off from one leg to the other gracefully when walking. Adhering to active versus passive movement enables the body to take advantage of this law.

The second principle follows Wolff’s Law. Dr. Wolff observed that the body adapts to the stresses placed upon it. If the stress is abnormal, the result will be an abnormal adaptation. By taking into consideration every possible joint angle and the fundamentals of joint movement, the AIS system ensures that stretches are done with the joint in proper alignment to avoid compensations and to stay within the joint’s own ability to move. These specific movements, repeated numerous times, create the optimal cellular environment to allow for tissue remodeling that can go as deep as the bone. For example, when you are running and consistently pounding the pavement, your bones become denser in most cases. This is the same principle we are dealing with when we perform stretches repeatedly.

The cornerstone of the AIS technique, the third principle, lies in the mechanism behind the stretch reflex. Spindle cells located in muscle bellies (and more recently discovered in fascia) (Hammer, 2014) act as monitors for every stretch. When the spindles are stimulated by a stretch that could injure muscle and fascial tissue, they act to protect the endangered soft tissue by sending a signal to it to contract. The purpose of the contraction is to protect the muscles from being torn by being over-stretched. The stretch reflex is triggered by three different stimuli. The first is when you try to stretch a muscle beyond its tensile ability. The second is when a muscle is stretched too quickly and the body cannot keep up with the speed at which the muscle lengthens. The third trigger is holding a stretch too long. The approximate time it takes for the spindle cells to trigger a protective muscle contraction is 2 seconds. The AIS system avoids this contraction by holding a stretch for no more than 2 seconds. Each stretch is done gently to avoid triggering the myotatic reflex and to sedate the nervous system with its rhythmic movement and deep breathing. The stretches are then repeated numerous times for greater effectiveness.

decreasing edema w AIS - sample protocolAIS utilizes the same concepts taught in manual lymphatic drainage (MLD) by starting proximally and working distally from there. First we start by freeing-up the subclavian terminus and opening up the thoracic duct in order to drain the lymphatics. A typical approach begins by releasing myofascial restrictions in the cervical and pectoral area moving from proximal to distal. Opening up the lymphatic ducts on the side of the neck between the trapezius and SCM (sternocleidomastoid) and the subclavian ducts located medially inferior to the clavicle should be the first step. “While there are no nerves shown to become entrapped from a tight pectoralis major, lymph vessels from the breast pass in front of and around the muscle.” (Morton, 2009, Shoulder chapter, p. 15). From there move on to free the axillary ducts by stretching the shoulder girdle down to the hands if you are working with upper extremity swelling. If the swelling you are addressing is in the lower extremity or extremities, continue on from the chest into the lumbar, pelvic, inguinal and lower leg lymphatic ducts in the popliteal space and then finish by draining the foot. Specific attention should be focused on the cisterna chyli, the inguinal and popliteal lymph nodes. Adding manual resistance to all of these stretches produces a more powerful pumping action to stimulate lymphatic and venous flow. Once these areas have been worked in this order, continue to follow MLD protocol and direct your work back up towards the thoracic duct, doing the stretches and resistance work in the opposite order. This stimulates lymphatic circulation back towards the primary ducts for filtration.

There are generally no contraindications to doing this type of work, but there are always precautions that are relevant for any manual therapy modality. A sudden increase in swelling, pain that doesn’t go away, nausea, dizziness are just a few symptoms that might warrant immediate medical attention or referral to the patient’s physician. Since active muscle contractions affect the lymphatic and venous systems indirectly (there is no direct manual pressure placed on the tissue), the usual contraindications for MLD are not applicable for AIS with the exception of increasing circulation when it is undesirable, such as in cases of acute infections, especially systemic infections and thrombosis. Restoring a healthier environment for the body to heal presents the best possibility for a positive outcome. The advantages of the AIS approach go beyond simply reducing edema via increased circulation. Improved mobility, greater uptake of oxygen and nutrients into the tissue, soothing the nervous system with breathing and gentle movements, and establishing a baseline of strength are some additional benefits of this work.

References:

Clinical Massage Therapy: Understanding, Assessing and Treating over 70 Conditions by Fiona Rattray and Linda Ludwig, Talus Inc., Toronto, Canada, March 2000.

Balance is Possible F.R.O.M. Head to Toe by Joshua Morton, 2009 (Unpublished)

The Fascial System is a Sensory Organ, by Warren I. Hammer, D.C., April 2014: http://www.acatoday.org/content_css.cfm?CID=5438


Hospice Massage vs Spa Massage

by Robert Amaro, LMT

Those in the hospice and palliative care business tend to overlook the value and positive effects massage has on our patients. Perhaps it is due to a misunderstanding of what we do in hospice compared to what we might do in a traditional spa setting. The difference between spa services and the type of massage we do with hospice and palliative care patients is a little like comparing apples and oranges; they are night and day.

A few of the services offered in a traditional spa setting would never work for our patients. Massage services such as deep tissue, Swedish massage and hot stone would never go over well for the patients we deal with on a day-to-day basis. Another service you might see offered at a spa is the body wrap, and some wellness centers even have pre-natal massage. The list is endless of the types of specialty massage services offered at upscale spas and salons. Of course none of these massage services will work for our hospice and palliative care patients.

150315 cranialmassageThere are several massage modalities that can be incorporated specifically into the needs of the hospice/palliative care patient. First and foremost is a technique called CranioSacral Therapy (CST). CST is a light touch approach that can create dramatic improvements to one’s body because it directly affects the cranium, the spinal cord and the sacrum. Its goal is to release tension deep within the body, thereby relieving pain. The modality has a direct effect on the central nervous system. In fact, there are some interesting studies on the profound effects CST has on a variety of end of life pathologies such as Parkinson’s disease, Dementia, Alzheimer’s, Amyotrophic Lateral Sclerosis (ALS), Cerebrovascular Accident (CVA) and Chronic Obstructive Pulmonary Disease (COPD).

Manual Lymphatic Drainage (MLD) is another technique used frequently in the hospice and palliative care field. Many cancer patients develop edema in their upper and lower extremities. MLD simply moves the fluid out. The results can be instantaneous when this technique is used correctly.  Many patients with edema fear they can’t be touched and nothing can be done to help them but this technique has had some astounding results.

Another technique used to help patients relax when they are agitated or restless is Reiki. This is an energy technique that lightly palpates the body or, in some cases, uses the patient’s aura to communicate with the body without the need for touch. The patient’s body simply responds to its own energy fields with a massage therapist’s assistance. Yes, even patients who are obtunded and unresponsive still have energy in their bodies and that energy can be affected in a positive manner.

The massage therapists at Nathan Adelson Hospice are highly skilled at what they do. One of the best compliments I ever received was from a nurse who said, “When you get done doing your work, my patients are less agitated and they need less medication.” Less medication at this point and time is one of the great benefits of massage therapy. This is a strong testament to the type of work we do and the results we can achieve.

All of NAH patients can benefit from massage therapy. Whether the patient is alert, lethargic, obtunded or unresponsive, massage therapy can have a profoundly positive effect.

RAmaro-2009Robert Amaro, LMT, is a massage therapist in the Las Vegas, NV, area and has been practicing Hospice and Palliative Care massage for the last four years. His current employer, Nathan Adelson Hospice, has offered him immense opportunities and challenges. To help people find comfort at the end stages of life is one of the most rewarding positions he has ever had – it is Robert’s pleasure to share some of his experiences.

 

originally published at http://www.nah.org/blog/entry/hospice-massage-vs-spa-massage
reprinted with permission

AMTA’s Health Care Relationships – Advancing the Massage Therapy Profession

AMTA’s Health Care Relationships 2013
An Update of the Association’s Relationships
and their Impact on the Massage Therapy Profession

The American Massage Therapy Association® (AMTA®) continues to be involved in ongoing interactions with health care, wellness and medical organizations with several goals and objectives in mind:

  • To influence the health care community so it acknowledges the value of massage therapy and professional massage therapists;
  • To educate all in the health care and wellness industries about the benefits of massage therapy and the growing body of research that supports its value;
  • To increase collaboration between AMTA, its members and other health care and      wellness industry leaders;
  • To enhance the potential for massage therapists to practice in collaboration with other health care providers  and in integrative care; and,
  • To increase the overall acceptance of massage therapy and advance professional opportunities for all massage therapists.

AMTA’s Health Care Relationships

Massage is increasingly accepted by consumers as an important component of their health and wellness.  Meanwhile, new clinical massage research is also getting the attention of more people in the medical community.  The health care situation in the U.S. is constantly changing and is even more complex in light of the Affordable Care Act.

“We have gained the respect of many in health care and they recognize AMTA as the best resource for information about massage therapy,” says AMTA President Winona Bontrager.  “They appreciate AMTA’s approach to massage therapy and health care and look to us for input to better understand how massage therapy and massage therapists can continue to be more integrated into health and wellness care.”

Involvement in National and International Health Care Meetings

As part of its involvement with leading health care organizations, AMTA has been an active participant in several industry meetings in 2012-13.  These have included the International Research Congress on Integrative Medicine and Health; the International Medical Program’s Integrative Oncology Healthcare Professional Training Conference; the Annual Integrative Healthcare Symposium; the International Congress for Educators in Complementary and Integrative Medicine; and, the Third International Fascia Research CongressThese meetings continued to validate that leaders in health care are acknowledging that health care in our country needs change; and integrative approaches for patient care are important trends that need cultivation.  They also provided opportunities for AMTA to forge new relationships with many leaders in health care who can influence the further acceptance of massage therapy.

For example, AMTA’s participation in the International Medicine Program’s 1st Annual Integrative Oncology Healthcare Professional Training Conference in February 2013 allowed AMTA to gain valuable insight and perspective from one of the foremost integrative oncology programs in the country. This perspective will assist AMTA as it continues its approaches to healthcare.  The goal of the conference was to review the principles and disciplines of integrative oncology and to identify indications and contraindications for complementary therapies within the cancer population. The conference was designed for physicians, nurses, social workers, dieticians and other healthcare professionals who care for cancer patients and have an interest in better understanding integrative oncology.

The networking connections made at this conference will also help reinforce AMTA’s commitment to quality massage education and our willingness to be collaborative partners in projects that will help advance the art, science and practice of massage therapy.

AMTA Relations with the American Medical Association (AMA)

Susan Rosen of Washington State continues to serve as AMTA’s representative to the AMA’s Current Procedural Terminology (CPT) Health Care Professionals Advisory Committee (HCPAC).  As AMTA’s Primary Advisor to HCPAC, she is the massage therapy representative on the committee. HCPAC serves in an advisory capacity to the AMA CPT Editorial Panel. This relationship gives AMTA and the massage therapy profession input on review of CPT codes associated with massage therapy.

AMTA also continues to provide the AMA with an updated description of the massage therapy profession for its Health Care Career Directory. This directory provides information on recognized health care fields and is also used as a resource by those in a variety of health care professions.

Massage Therapy and the Affordable Care Act

AMTA has been actively engaged with federal agencies and U.S. congressional offices, since the Affordable Care Act was introduced more than three years ago, about its impact on massage therapists and those they serve.  AMTA is approaching the ACA in a very practical and systematic way, which will promote and protect the best interests of massage therapists and avoids jumping in too quickly and making assumptions that might prove counter-productive.

The association is moving forward with a plan for vetted research to make the case for massage as an integrated part of health care.  This will provide a foundation for all we do at the national level and what we will pursue in each state.  This also will ensure that what we bring forward is valid and relevant to the process of achieving acceptance within the framework of the ACA.

Anyone following the evolution of the ACA is likely aware that dates for implementation, as well as interpretations of its meanings and legal decisions, are still very much in a state of flux.  Therefore, AMTA is continuing to directly engage both the congressional offices of those who developed the legislation and the government agencies that will be implementing the new law.

Public Education and Engagement with Health Care Centers

  • Since spring 2012, AMTA has issued three Research Roundups that summarize a variety of research on the health benefits of massage therapy.  These Roundups were distributed to health and medical publications, as well as consumer media outlets.  Excerpts from them and the research they cite has been published by several medical and health care publications and online sources with a total audience reach of well over 100 million.
  • AMTA’s 2013 Massage Therapy Tour, which primarily reaches out to consumers to educate them on the health benefits of massage therapy included educational stops at the American College of Sports Medicine annual meeting and offices of the U.S. Centers for Disease Control and Prevention in Atlanta.  AMTA members engaged these health care professionals in discussions about the growing body of research on massage therapy, how to find qualified massage therapists and how massage therapy is being integrated into health care in a variety of settings.
  • Through a collaboration of relationship building and communications, AMTA is engaged in ongoing conversations with major medical centers about integration of massage therapy into patient care

 

What Does All of This Mean for Massage Therapists?

The American Massage Therapy Association is actively engaged every day in advancing the profession.  These relationships with the health care/medical communities provide a strong voice for those massage therapists who seek to work within health care, while recognizing and protecting the rights of those massage therapists who practice in other sectors of the massage therapy profession.

Further acceptance of massage therapy as a viable part of health care and wellness will benefit all in the profession.  Not only will it present new potential for those who want to work within health care, it will provide all massage therapists with confirming support for what they do, whether it is in private practice, in a spa or health club, a massage therapy franchise, or with a sports team.

As the body of research on the efficacy of massage therapy is expanded and results published, AMTA will continue to use the research and its relationships in health care to advance the massage therapy profession in the eyes of the medical profession and the public.