How to Choose a Therapist

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You’ve just had the most stressful week of your life to date, or every muscle in your body aches from the workout at the gym, or you just want to relax and escape from reality (or the kids) for an hour. Wouldn’t a massage be an answer to all of the above? Of course it would, but where do you go? How do you choose a Massage Therapist?

With the ever growing popularity of massage, there are a number of salons and spas offering all types of massages and bodywork. There is also an increasing number of individuals advertising de-stressing, relaxing, “healing” treatments. The first thing you need to know is what the difference is between “hands-on” full body massages and energy work. Massage has been around since the beginning of time. Each culture has developed their own style, each with it’s own unique approach, but still based on the same principles and desired outcome. Overall health and balancing of the body and it’s many systems. The most common types of massage can be broken down into two categories: European/Swedish style and Oriental.

The European or Swedish style focuses on the manipulation of the body’s soft tissue including muscles, tendons, ligaments and connective tissues. It generally involves the use of oils or creams applied through gliding and squeezing strokes that affect the musculo-skeletal, circulatory, and lymphatic systems of the body. The therapeutic benefits are release of chronic tension and pain in muscles, improves circulation, increases flexibility in the joints and reduction of mental and physical fatigue. There are many different forms of therapy styles, Thai, Structural Integration, Trigger Point Therapy, Myofascial Release etc.  Please make sure you fully understand what the treatment entails before you get on the table.

There are numerous types of Oriental massages. The most common styles being the Japanese Shiatsu and the Chinese Amma. Both are ancient healing therapies which combine oriental medical principals and the understanding of the energy channels or meridians that run through the body, in order to restore, promote and maintain optimum health through treatment of the physical body. There are no oils involved, however there may be use of lineaments on specific areas. Gentle manipulations and the use of acupressure (not acupuncture, which requires the use of needles and an Oriental Medical Doctor’s Degree) points to restore, balance and facilitate the flow of energy through out the body. The benefits are numerous including relief from stress and tension and muscle ache, however these therapies are excellent for medical aliments such as respiratory infections, TMJ, digestive disorders, arthritis and many more.

Both types of massage are excellent and have many things in common including the fact that they must be given only by a qualified therapist. Some states require licensing others certification. Either one means that the therapist has gone to school and received the proper training to administer the treatment. You should never allow anyone to perform any type of physical manipulation on your body unless they have provided proper qualifications.

This brings me to the definition of energy work. Along with the new appreciation for massage and its benefits there has also been a rising interest in “energy healers”. Reiki and Chi Kung are currently two of the most popular forms of energy work. These types of therapies are wonderful and can be just as therapeutic as a full body massage, but they do not require hands-on manipulation of the body (sometimes hands are placed lightly on specific areas but no manipulations) and most importantly they are not regulated by the state. The practitioner concentrates on balancing the body through it’s energy fields. There are three levels to Reiki, the last resulting in Master ship, however the training for each level is only two days each. Now without regulation you can see how one can be taken in by a person claiming to be a healer. Unfortunately, the greedy ones ruin it for those who are true practitioners. So please make sure that you thoroughly check out the person before you go to them. No honest practitioner would be insulted if you asked for references.

I recommend that for your first massage you should try the European/Swedish style and then if you are comfortable with that and receptive to the idea of energy balancing you should then try the Oriental style. Be sure to try as many different styles as you never know which one will really “speak” to you.

Before you can consider which type of massage you would like you have to choose a therapist. The best way to pick a therapist is through referral. Your friends, family and your doctor can be a great source. As mentioned earlier, massage can be found at local spas, hair salons and chiropractor’s offices. There are therapists who have there own private practices with their own treatment rooms and/or will make out-calls to your home.  Here are a few things to remember when you are choosing a Massage Therapist:

• Make sure that the therapist is qualified and has presented proper certifications.
• You must be comfortable with the therapist. There is no point in getting a massage if you’re going to be on edge the whole time.
• Make sure that the therapist takes a complete medical history before starting the treatment. Certain conditions are considered contraindications for the European massage (i.e. high blood pressure).
• Understand that while you are usually required to disrobe, you may leave your underwear on and you should be properly draped (covered with towel or sheet) at all times. Only the area being worked on should be exposed.
• If you are uncomfortable with certain areas being touched or the therapist’s touch is too hard/soft for you, tell this to the therapist. Communication is essential, you need to work together.
• You may be a little sore after your first massage, however if you are in major pain then the therapist worked you too hard, so make sure to tell her the next time.
• If you did not like the massage or the therapist do not let that stop you from going to someone else. Finding the right therapist is like finding the right doctor. You need to feel secure with and have confidence in him or her.

The relationship between therapist and patient is one of confidentiality and trust. You work together to relieve the tension, aches and pains while balancing the body’s systems to maintain a healthy and happy life. Massage is one of the best ways to combat the daily stresses of our all to hectic lives. It is not asking a lot, even though you may feel like it is, to take time out for yourself. Your health and piece of mind are worth an hour of your time!

All Parts are Equal or are They?

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When a person has back surgery or has had a limb amputated, it is standard for them to go through a rehabilitation process, including physical therapy or massage therapy to be prescribed. However, if a woman has breast surgery, rehabilitation (massage or physical therapy) is not automatically ordered and often not even suggested.
When a woman chooses to have her breasts removed, reconstructed, increased or reduced, it’s important that she understands not only the benefits of the procedures, but the risks as well. Chronic pain and postural problems can appear years later if rehabilitation is not completed following breast surgery.

Breasts are composed of mammary glands, connective tissue, blood vessels, nerves, and lymph vessels. Breast tissue can extend from the border of the breastbone near the center of the chest all the way to the armpit, and overlies the second to sixth ribs. The breast has an axillary tail, which is a tail of tissue that extends up into the armpit region. The breast lies on top of the pectoralis major muscle.
Breast tissue is part of the fascial web of connective tissue, which runs continuously throughout the body from head to foot and superficial to deep without interruption. Any alteration, even the slightest damage to the fascial network has major ramifications.
The body’s balance and symmetry can be significantly altered after a mastectomy, augmentation or reduction. This is something many women aren’t informed of or prepared for. Scar tissue is also a very important fact which women need to be aware of and prepared for. Unpredictable development of scar tissue is quite common after any surgery and can have long-term effects on the body.
Early intervention following breast surgery by a massage or physical therapist can play a pivotal roll in helping women heal and regain full function.
After mastectomy surgery a woman may experience tightness or pulling originating from her incision, which spreads across her body. This is caused by scar tissue, which is the body’s way of healing from surgery. The result can be very dense tissue under the incision, which is painful and which can restrict the arm’s range of motion (ROM). The restricted ROM puts women at risk for a painful condition known as frozen shoulder. Scars can range in size after a breast-conserving lumpectomy or a mastectomy procedure that removes the entire breast. Either way, most breast cancer patients are left with some sort of surgical scar as a by-product of their quest to heal.
In order to rebuild the breast, tissue is taken from another area of the body. It can be taken from several different locations. One host area is the Latissimus Dorsi. In the picture below you can see how much of the body is affected by this location.
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The TUG procedure uses skin and fat from the inner portion of the upper thigh; the incision scar will be hidden near the crease of the groin. The flap is named for the transverse upper gracilis muscle to which the skin and fat are connected. Muscle may be removed as part of the TUG flap.

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Radiation treatment for Breast Cancer has its own list of complications. This type of therapy not only changes tissue characteristics by making it more susceptible to breakdown, it continues to make tissues tighter for 2 to 5 years following treatment.

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It can also lead to:
Skin tightening;
Limited arm and shoulder mobility;
Chest expansion limitations;
Restrictions in and around the area of treatment.
Breast reduction surgery is still largely considered to be a cosmetic surgical procedure. However, it is most often performed to relieve significant physical and emotional problems resulting from overly large and/or heavy breasts. Surgeries are classified as “cosmetic” if it is an elective procedure that insurance does not cover. If it is a procedure that is restoring form or function, it’s referred to as “reconstructive”. Reconstructive procedures are often covered by insurance. The same procedure may be classified as cosmetic or reconstructive depending on how it impacts an individual. Public opinion still sees it as cosmetic but 9.5 times out of ten it is being performed to reduce pain or to alter the overall structure.

 

According to the American Society of Aesthetic Plastic Surgery, 112,964 breast reductions were performed in 2011. Breast reduction surgery leaves permanent scarring.

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The operation using the anchor technique leaves three scars:
One around the nipple (areola);
One from the nipple to the crease below the breast (this is the worst scar as it takes the most tension);
One from the breast bone to the armpit along the crease below the breast.

The severity of scarring largely depends on the individual. Most women are completely unaware of how the scar tissue is affecting them.

 

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Kelly Bowers, a massage therapist from Washington, DC states:
“I had breast reduction surgery in 1992. By 2012 I rarely thought of it and certainly didn’t think the scars were an issue any more. They were barely visible! Then I had scar release work. I was stunned at how far I felt the effects of the work. I felt it from my shoulder to my hip! I’m delighted I had a chance to experience this work and finally take care of these scars as they deserved to be taken care of.”
The American Society for Aesthetic Plastic Surgery also reported that breast augmentation is the most popular surgical cosmetic procedure for women, with more than 316,000 procedures performed in 2011. Yes, augmentation is an elective cosmetic surgery, but it is still a surgery that alters the body. Rehabilitative therapy is necessary after any surgery.

Women who have breast augmentation frequently experience:
Limited upper extremity mobility (range of motion);
Arm weakness and swelling;
Fatigue;
Shoulder dysfunction;
Back pain;
Chest pain.

 
Scar tissue can occur at any time after the augmentation has been performed, not just within the first few months. Capsular contracture is the term used to describe scar tissue that can form around breast implants which may cause the breasts to harden, look or feel different, and may cause some discomfort from the tightening of the capsule. Capsular contracture is an unpredictable complication, but it is also the most common complication following breast augmentation.

 
Scars left by breast augmentation surgery are usually hidden in the crease beneath the breast (inframammary fold incision), around the nipple (peri-areolar incision) or in the armpit (transaxillary incision). Rehabilitation/therapy and physical activity are integral to recovery and to reduce post-breast surgery side effects such as:
Scar tissue/soft tissue immobility;
Flexibility limitations;
Limited range of motion;
Decreased strength.

 
Even if a woman does not actually develop pain or limited function directly after the procedure, at some point pain and disability will become present if scar tissue is not addressed in a timely and proper fashion.

Forget Me Knot

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What do all of the following have in common?

Caesarean “C” Section

Breast reduction

Breast implant

Appendectomy

Laparoscopy

Arthroscopy

 

Well that is easy right?  They are all surgeries. But would it surprise you to know that 6 out of 10 women who walk into my office do not consider C- Sections or breast work surgeries? Yes, you did read that correctly.

There is an alarm gong off in my head.  At first it was a small ding and as the years have gone by it has been getting louder and louder. These days it is going off like an air raid siren.  When a new client comes to see me I, as with all health professionals, I have them fill out a medical history intake form. It is very common for people to “forget” about past injuries, illness and yes even a minor surgery.  It has always amazes me none the less, I mean really how does one forget they broke an arm or an ankle?

Here are some of the many conversations/comments that have resulted from the “Please list all surgeries” section on the form:

“Surgery? No..not really… Well…I had a c-section but I do not consider that surgery.” 

“Why is that?”

“Well..it wasn’t  planned it was an emergency.”

 

“No surgery…I just had my breasts done but that doesn’t count.”

 

” I did have my toe chopped off but they sewed it back on and  that was so long ago it doesn’t matter.”

 

No.. No surgeries ..just had some work done on my mouth twice.” 

“Do you mean you had Oral surgery?”

“Yes”

 

“Well I did have my uterus taken out. But they did that through my belly button- barely even see the scar..so no, no surgery.”

During a session I will observe a scar and inquire as to its origin. The client inevitably says “What scar? where?  Oh right?  …That’s from when I wiped out on my motorcycle…yeah I ruptured my spleen and they had to do surgery”  and this one on your leg? “Oh that?  I was dragged by the bike on asphalt pretty narlly huh?!”  

Scar tissue therapy is generally overlooked by health professionals because the extent of physiological effects scars can have on the body have never really been acknowledged. If the Doctors are ignoring the effects then what hope does the patient have of ever understanding the that the slightest restriction, in the elaborate matrix of fascia, can have major repercussions from one end of the body to the other.

During the course of my career I’ve treated many patients whose problems could be traced back to a scar they had forgotten they even had. Almost everyone has a scar. While not every scar presents a problem, often they can.

I never know what amazes me more the body’s ability to respond so quickly to the release of adhered tissues or the shock on the patient’s face when their body is freed from it’s restrictions and pain due to that scar they forgot they even had.  But the one thing I do know is that ignorance is not bliss.  The time has come for the public to be made aware of  effects of scar tissue and adhesions.