by Linda Fehrs, LMT

There is no getting around it; all body functions that involve movement require muscle activity. It may be as obvious as when we walk, rise from sitting or toss a ball. It may be movement we take for granted such as our heartbeat or in the iris of the eye. Muscles control the movement of food through the digestive system and enable us to breath. Some muscles are used occasionally; some are in constant use, remaining contracted to help the body maintain posture in defiance of gravity. By their very movement and resulting friction, muscle fibers provide the heat that maintains a consistent body temperature as well as assist in the pumping of blood and lymph in and out of cells.

Types of Muscle
The human body has three types of muscle – skeletal, cardiac and smooth. Skeletal muscle is responsible for posture and movement of bones. It also guards the entrances and exits of the digestive, respiratory and urinary tracts. Cardiac muscle is what the heart is made of. Smooth muscle is found in the gut, around the bronchi, within the urinary tract, the reproductive organs and in the walls of the blood vessels. Skeletal muscle moves in response to nerve impulses. Cardiac and smooth muscle fibers respond to changes in local environment, hormone fluctuation, pH balance, ions and temperature among other factors.

Skeletal Muscles
Skeletal muscles connect bone to bone with tendonous attachments. When they contract, the bones generally pull closer together or flex. When they are at rest, the bones are further apart or extended. More complicated movements, such as circumduction, supination, pronation or rotation are a combination of flexion and extension, a blending of muscular contraction and relaxation.

Normally the muscles act together in a coordinated manner, producing smooth, efficient movements. Some movements are under conscious control, especially when first learning specific tasks such as writing or riding a bicycle, other less so like the blinking of eyes or scratching an itch. With disorders such as Parkinson’s, the signals from the nervous system to the muscles are confused, producing antagonist and agonistic movements at the same time, resulting in either oscillatory movement (tremors) or persistent spasm (rigidity).

Fast Twitch, Slow Twitch
There are two basic categories of skeletal muscle – fast twitch (also referred to as fast glycolic or Type IIB) and slow twitch (slow oxidative or Type I). Within the fast twitch there is a second category sometimes referred to as intermediate, Type IIA, or fast oxidative fibers. Each has their own set of characteristics and purpose. The percentage of fast, slow and intermediate twitch muscle fibers varies from person to person. The proportion is determined by genetics but can change with physical conditioning. Certain hormones, such as human growth hormone (HGH), testosterone and thyroid hormones can also stimulate the metabolism and size of muscle fibers.

Characteristics of Fast, Slow and Intermediate Twitch

Fast Twitch (Type IIB):

• most skeletal muscles are of this type
• large in diameter
• use enormous reserves of glycogen rather than oxygen-rich blood for quick energy
• densely packed myofibrils
• few mitochondria
• generate a lot of tension
• rely largely on anaerobic metabolism
• fatigue rapidly
• appear pale to the naked eye because of low number of capillaries per unit
• fast twitch fibers appear in muscles needed for fine movements, such as the small muscles of the hand and the eye

Slow Twitch (Type I):

• are smaller than fast twitch muscles
• take about three times longer to contract after receiving stimulus
• many mitochondria
• contain a large amount of myoglobin, which carry oxygen to muscle fibers (similar to hemoglobin, which helps carry oxygen to blood)
• slow twitch fibers are needed for posture and movement, and in back muscles and muscles of the legs
• because it needs high levels of blood and oxygen these fibers may receive the most benefit from massage

Intermediate (Type IIA):

• have properties of both fast and slow twitch fibers
• similar in appearance to fast twitch fibers
• similar in endurance to slow twitch fibers

The physiology of fast or slow twitch muscles is most often utilized in sports. Athletes who run provide a good example. Those who spring short distances generally will have a higher percentage of fast twitch muscle fibers, while those who run in marathons have more slow twitch fibers.

Another example often used is the dark and light meat of poultry. The breast muscles or “white meat” of a free-range chicken consist of fast twitch muscle fibers needed for brief burst of flight, while the “red” or dark meat in their thighs and legs are used for walking and standing.

The Role of Massage
The type of skeletal muscle fiber is largely determined by heredity. Massage can’t change that. What massage can do is help to bring oxygen and nutrients to muscle cells, which in turn can help them to work more efficiently and heal quicker.

Individuals who are highly athletic or participate in competitive sports have a tendency to test their bodies to maximum endurance and, at the very least, experience sore muscles. They often get injured in their pursuit. Some injuries are serious – others are minor, involving microscopic tears in muscle tissue. When administering massage, care needs to be taken to customize the session to the athlete as well as the sport. Sport massage techniques most of which are derived from traditional Swedish massage,  have been found to be the most effective in promoting healing and maintaining optimal fitness.

To maximize the effectiveness of your massage, make sure to ask your clients about any physical training they participate in, whether it be recreationally or professionally. Knowing this may help you determine just which massage techniques will be best for them.

by Nicole Cutler, L.Ac.

Initially, some supporters of complementary medicine might think that a massage therapy practitioner lies on the opposite end of the healing spectrum from an orthopedic surgeon. In a last ditch hope to reduce pain, drain edema, improve function and restore range of motion, a staunch western medical cynic may perceive submitting to arthroscopic knee surgery as a loss of hope. Unfortunately, such a view enforces the separation of allopathic medicine from alternative styles of healing – like massage therapy. Massage therapists can help their clients in this situation by teaching them about the true strength of integrative medicine. In this specific context, utilizing the power of massage therapy soon after knee surgery offers the client the best of both wellness approaches: surgical repair of the damaged tissue AND bodywork to aid in the tissue’s healthful recovery.

About Arthroscopic Knee Surgery
A viewing instrument in the shape of a long tube, an arthroscope is used during arthroscopy – a surgical procedure in which the internal structure of a joint is examined for evaluation and treatment. The arthroscope contains optical fibers and lenses, and can be inserted through small skin incisions to enter the affected joint. Projecting a present time image onto a monitor, the arthroscope’s camera enables the surgeon to “see” the joint’s interior. An arthroscope used for knee surgery is only about 5 millimeters in diameter.

Because the knee doesn’t need to be totally cut and opened up, arthroscopic surgery typically results in less tissue trauma, less pain and promotes a quicker recovery. Common knee injuries for which arthroscopy is considered include:

• meniscus tears
• ligament strains and tears
• deterioration of cartilage under the patella

The effectiveness of knee arthroscopic surgery varies greatly, with some reports claiming it to be no better than a sham surgery and others demonstrating a significant improvement to the knee’s function and pain. Individuals who are candidates for this high-tech knee surgery should know that experts believe the success of this procedure frequently lies in the patient’s commitment to his or her rehabilitation.

Recovery with Massage Therapy
Rehabilitation from arthroscopic surgery typically lies with physical therapy. While physical therapy is a crucial part of the recovery process, there is more that can be done. A modality that induces relaxation, affects soft tissue and invigorates circulation, massage therapy can offer a great boost to recovering from arthroscopic knee surgery. This view is shared by many in the profession. The American Massage Therapy Association (AMTA) has even taken the position that massage aids in postoperative pain relief. According to the AMTA, research indicates that massage therapy can:

• decrease postoperative pain

• decrease postoperative pain unpleasantness/distress

• decrease sympathetic responses to postoperative pain

• accelerate the rate of decline in the intensity of postoperative pain

• decrease doses of analgesics

• increase levels of calmness/feelings of well-being

Further supporting massage’s general benefit for postoperative pain, a study published in the winter 2010 edition of the Iranian Journal of Nursing and Midwifery Research concluded that massage therapy was a valuable tool to reduce pain severity following arthroscopic knee surgery.

While great care is warranted in addressing a postoperative knee, massage therapy that is gentle and properly applied can be of great benefit in:

• unlocking the quadriceps musculature

• improving lymph circulation in and around the knee

• smoothing out myofascial  restrictions

• prohibiting scar tissue formation

• draining local edema

All of the strengths listed above help reduce pain, increase range of motion and function, and speed the healing process.

Considering how desirable bodywork’s influence can be following arthroscopic knee surgery, it’s surprising that more orthopedic surgeons and massage therapists don’t work closely together. People seeking the best solution for a problematic knee are advised to consider how integrative medicine can work for them. If knee arthroscopy is warranted, following up with a regular physical therapy AND massage therapy program is one of the best ways to claim a successful surgical outcome.

Discover which acupressure points on the body and on the ear can relieve even the most severe menstrual cramp pain.

By Nicole Cutler, L.Ac.

A majority of women in their childbearing years are all too familiar with the monthly onslaught of menstrual cramps. Traditional Chinese Medicine (TCM) can guide practitioners in helping their clients who suffer from this type of pain. By stimulating certain points on the body and the ear, bodyworkers can provide an alternative to the liver and stomach damaging drugs traditionally used to treat dysmenorrhea.

About Dysmenorrhea
Menstrual cramps are either classified as primary dysmenorrhea or secondary dysmenorrhea. Primary dysmenorrhea involves no physical abnormality and usually begins six months to a year after menstruation begins. Secondary dysmenorrhea involves an underlying physical cause, such as endometriosis or uterine fibroids. Signs and symptoms of dysmenorrhea typically include:

• Dull or throbbing pain in the lower abdomen
• Pain that radiates to the lower back and thighs

Easing the pain of secondary dysmenorrhea requires treatment for the underlying cause. Possible treatments might include antibiotics for infection, surgery to remove fibroids or polyps, or hormone therapy to treat endometriosis. Easing the pain of primary dysmenorrhea often includes:

• Over-the-counter non-steroidal anti-inflammatory drugs
• Low-dose oral contraceptives for severe cramping (only when prescribed by a physician)

Note: If your client proclaims that her menstrual cramps have recently changed and are now much more severe than before, refer her to a gynecologist.

TCM for Cramps
Upon confirming your client has primary dysmenorrhea, a practitioner must discern if the imbalance is excessive or deficient. In general, this difference can be determined by:

1. Qi and Blood Stagnation – This excessive condition is evidenced by cramps that occur prior to or during menstruation. Symptoms for qi stagnation include more distention than pain, bloating, breast tenderness, stuffy chest, belching, irritability and a short temper. Symptoms for blood stagnation include more pain than distention, stabbing pain, abdominal pain worsened by pressure and passing of blood clots. Good acupressure points for either pattern are Liver 3, Gallbladder 34, Urinary Bladder 32, Spleen 8 and Spleen 6.

2. Blood Deficiency – This deficient condition is characterized by dull cramping following menstruation. Symptoms for blood deficient cramps are a reduction of the pain with pressure, fatigue, dizziness, palpitations and scanty menses. Blood deficiency is common following childbirth. Good acupressure points for this imbalance are Urinary Bladder 18, Urinary Bladder 20, Urinary Bladder 23, Liver 8, Spleen 6 and Spleen 10.

Auricular Acupressure
According to TCM, there are a variety of microsystems that can be used to diagnose and treat the entire body. Ideal for bodyworkers, one of the most commonly used microsystems is located on the outer ear. Known as auricular acupressure, exact point location here is crucial because of the small size and near proximity of points.

Since the diameter of acupoints on the ear are literally the size of a pinhead, applying ear seeds is one of the most effective applications for point stimulation. Purchased from an oriental medical supplier, small seeds or metal beads are held in place with adhesive tape, similar to a small bandage. Clients retain them for several days and are instructed to press on the beads periodically to stimulate the point.

A study published in the March 2009 edition of the Journal of Alternative and Complementary Medicine investigated the effects of auricular acupressure for relieving primary dysmenorrhea. In this Taiwanese study, ear seeds were placed on the following three points:

1. Liver
2. Kidney
3. Endocrine

The researchers found that participants with primary dysmenorrhea who were wearing and stimulating their ear seeds experienced substantial menstrual pain relief. Thus, auricular acupressure was determined to be a noninvasive complementary therapy for women with primary dysmenorrhea.

Auricular Tips for Bodyworkers
Before purchasing and using ear seeds on your clients, consider these guidelines:

• Confirm that using ear seeds is within your local and state massage therapy licensing laws.

• Only use ear seeds contained in sterile packaging.

• Make certain you know the locations of the points you want to use. Find an auricular acupressure chart and practice finding the liver, kidney and endocrine points on differently shaped ears first.

• Before adhering the seeds, make sure the ear is cleaned well. Individually packaged alcohol pads are ideal for this purpose.

• Instruct clients to apply pressure three times a day, and to remove the seed if it is irritating.

• Clearly advise your client to remove the seed within five days of its placement; otherwise it can bore into the skin and invite infection.

For relieving menstrual cramps, traditional and auricular acupressure are ideal supplements to massage therapy. After differentiating between an excessive or deficient imbalance and establishing your comfort using ear seeds, bodyworkers may find success in helping their clients overcome primary dysmenorrhea.

By Linda Fehrs, LMT

While those approaching retirement years are, in general, healthier than some of the generations before them, there are those who eventually may have to use some kind of assisted walking device to get around. It may be just temporary because of an injury or it might be long-term due to an ongoing deterioration, such as arthritis, or a chronic disorder such as multiple sclerosis, amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease) or Parkinson’s disease.

Proper Use of Canes, Crutches and Walkers
Canes and other assisted walking devices, such as crutches and walkers, are used for various disorders – not just leg or hip injuries. They are also used in helping individuals with balance problems caused by stroke, inner ear disorders, medication side effects and more.

These devices can be purchased without a prescription, and therefore used without an initial consultation or instruction on usage. There are some suggested dos and don’ts which can be helpful in avoiding unnecessary injuries and discomfort.

• Size matters!
o Crutches:The top of the crutch should reach between 1 and 1.5 inches below your armpits when you are standing up straight.
o Canes:The top of the handle of the cane should be at the same height as the bone on the outside of the wrist (somewhere between the pisiform bone and the styloid process or head of the ulna). The cane should be comfortably held with the elbow bent at a 30 degree angle.
o Walkers: The height of the walker follows the same basic rule as the cane. The top of the walker should reach to about the top of your wrist crease when standing with arms down at the side of the body.

• Walkers and crutches are used with both arms, but a cane is used only on one side. It should be held in the hand opposite the injured or weak leg. When walking, the cane moves with the weaker leg – if the weak leg steps out in front, so does the cane. Both the cane and the weaker leg should hit the ground at the same time.

• Wear flat, sturdy, no-skid, comfortable shoes. No high heels, flip-flops or other flimsy footwear. You need a good base for balance.

• Make sure the rubber tips are in good shape. A worn or torn tip can catch on a rug or other item and cause a fall.

• Avoid entrances with revolving doors. They can catch the cane or other device and pull it away from the user.

• Don’t rush. Trying to move too quickly can cause an accident. Moving slowly allows the user to watch where he or she is going and avoid potential falls.

Exercises Using a Cane
Using a cane or other device can weaken some muscles. It may strengthen others and create an imbalance in the body. It is possible that clients using a cane or other device were not given any kind of exercises to do keep the body balanced.

Some of the simplest exercises to do include grasping the cane with both hands, palm down, and lifting over the head.  Similarly this can be done with the palms facing up. Repeat this at least 12 times. Steps can be added by bending at the waist laterally, as well as twisting the torso to the left and right. These should be done slowly, taking about 10 seconds for each singular move.

Adding a resistance band can increase the number of exercises that can be done with a cane. Attaching the ends of a long band to the cane enables the user to do leg stretches, which may help to strengthen a weakened limb.

The crook of the cane, the part that is held by the hand, can also be used to ease muscle soreness, especially around the medial and lateral borders of the scapula. Grasping the middle of the cane, the end of the hook can be placed over the shoulder and against the back. By pulling the body of the cane, the hook can apply pressure to sore points. Pressure should be held for a few seconds and then released.

Massage for Discomfort Caused by Cane Use
Using walkers or crutches will usually result in bilateral weaknesses or soreness. Canes present with a different problem because they are unilateral and the user is using the muscles much more on one side than the other. The body also begins to rely on this “third leg” for strength, balance and proprioception. While this is not a big problem when first using a cane, the sudden abandonment of use can result in some minor disorientation until the brain reacquaints itself in the use of two healthy legs.

Massage on the back and shoulder muscles using basic Swedish massage techniques can help relieve the soreness and reduce spasms in areas that tend to get overused and tired. Adding stretches will help keep balance as well as give strength to the arms and shoulders.

An improper cane height may cause carpal tunnel syndrome. Massaging the hands and using mobilization techniques  can help to maintain flexibility in the joints and lessen the effects of an over-extended wrist.

Advising clients to schedule a weekly massage while they are using a cane or other assisted walking device will help make them more comfortable and at ease with their bodies

By Nicole Cutler, L.Ac.

As one of the first kinds of healthcare professionals sought for help with musculoskeletal pain, it is no surprise that massage therapists are the preferred choice for helping to relieve neck pain. A skilled massage therapist can offer great relief to those with this prevalent problem; however, the relief may be temporary or can recur. Thus, the suggestions given below are intended to give clients self-reliance tools to prevent the reoccurrence of neck pain – or at least to assist in their pain management efforts at home.

Fortunately, most cases of neck pain are not serious. Ruling out a traumatic incident, a tumor, fracture, pressure on the spinal cord, an infection and a cardiovascular blockage, the most likely culprits of neck pain are strained muscles and osteoarthritis.

Neck muscle strain can be a result of repeated movements or maintaining sustained positions. Some examples include:

• Poor sitting alignment while at a desk or computer.
• Working with the shoulders forward which causes the head to tilt back.
• Sleeping in an awkward position.
• Sitting in a car longer than usual.
• Looking up repeatedly – for example: painting a ceiling or star gazing.

Arthritis or age-related changes can result in bony spurs and narrowed disc space in the cervical vertebrae. Joints with arthritis are more prone to inflammation from repeated movements or sustained positions than healthy joints.

Another etiology of cervical pain is emotional stress. Stress is known to precede apical breathing patterns. Together, stress and shallow, apical breathing cause neck muscles to tense. If this tension is sustained, a compressive force is exerted on the cervical vertebrae.

Waking with a stiff neck or having intensifying neck discomfort can be very painful. Thankfully, a long list of massage therapy techniques can help release hypertonic neck muscles, activate blood circulation and increase range of motion. However, a healer’s intentions go far beyond providing immediate pain relief. Sending clients with neck pain home with a flyer full of suggestions – or at least a verbal recitation of them – can go a long way in helping them deal with this nuisance or even prevent it from happening again.

Seven self-care strategies to empower clients with neck pain are:

1. Stress Relief – While stress will aggravate neck pain, relaxation can ease it. Suggestions for accomplishing this feat include deep abdominal breathing, meditation, visualization and other relaxation techniques.

2. Frequent Breaks – Even though sustained positions foster muscle tightness, this practice is deeply ingrained in our culture. If driving long distances or working long hours in one position, make sure to take frequent breaks. Breaks are best used to stretch, breathe deeply, take a sip of water and return to proper posture.

3. Exercises and Stretches – While some must be prescribed by a physical therapist, a massage therapist can suggest exercises and stretches for the neck as long as they don’t cause pain. Exercises and stretches help reduce pain by restoring muscle function, optimizing posture to prevent overload of muscle and increasing the strength and endurance of the neck muscles. These can include shoulder blade rolls/squeezes/shrugs, cervical extension/flexion, rotation, stretching the front wall chest muscles, strengthening the shoulder muscles and isometric exercises.

4. Hot and Cold Therapy – Most practitioners suggest alternating heat and cold to help a stiff, painful neck. Reduce inflammation by applying a cold pack for up to 20 minutes several times a day. Alternate this approach with heat, either a warm shower or a hot pack, for up to 20 minutes. Heat can help relax sore muscles, but it can aggravate inflammation if the area is red, warm and swollen.

5. Evaluate Ergonomics – Adjusting home or workplace conditions to relieve unnecessary neck stress can go a long way in preventing cervical discomfort. This includes proper positioning of a desk, chair, computer and phone so the screen is at eye level, knees are slightly lower than hips, arms rest comfortably on armrests and the neck is in a relaxed neutral position while on the phone.

6. Sleep Deliberately – Since a lot of neck pain can arise from poor positioning during sleep, deliberately planning a sleep position can prevent a painful neck. Avoid sleeping on the stomach and use a pillow that supports the natural curve of the neck. Back sleepers are advised to use a rounded pillow (neck roll) under the curve of the neck, with a flatter pillow cushioning the head. Side sleepers should keep their spine straight by using a pillow that is higher under the neck than the head. The goal is to prevent overnight neck flexion.

7. Sock and Tennis Balls – A simple homemade device can be used for self-administered cervical acupressure. Put two tennis balls in a sock and tie off the sock so the balls are stationary. Place the tennis balls under the occiput so they are pressing on the hollows under the skull on either side of the spine (Gallbladder 20) for about 10 minutes. Lying on this device can help relax taut, posterior neck muscles.

With today’s fast-paced society, stress and muscle tension are significant sources of neck pain. In fact, a person who has suffered from neck pain in the past is four times more likely to end up with a recurrence of this problem. Although, if armed with these seven strategies, massage therapists can empower their clients to overcome neck pain – and prevent its  return