Treatment Room

In This Treatment Room, It’s Your Show

Picture this: It’s your first time sitting down for an intake interview with a massage therapist you’ve never seen before. You may even be about to have your first massage ever. The treatment room is unfamiliar, not to mention the person sitting across from you and asking you pretty personal questions about your body, your medical history. Sure, there are pillows and towels and calming artwork around, soft music is playing, you know you’re supposed to be relaxed, or at least on your way there, but right now it just feels…weird. You’re answering the practitioner’s questions, but you can hear that part of your brain rapid-firing its own questions: “What is this person going to be doing to me? What if I don’t like it? Is it going to hurt? Is she going to touch my feet, because GOD, I hate having my feet touched.”

The short answer is: You’re in charge.

Let’s zoom into that picture a little more: You’re going through treatment for BRCA2 breast cancer. You’ve already had a lumpectomy and 18 weeks of chemotherapy, which is what your medical team recommended as the best course of action. You still have your chemo port in place, just under your collarbone, and during your massage intake, you’re thinking, “Is she going to want me to lie on my stomach? Ugh, I really don’t want to do that—it’s not going to be comfortable for me. Do I say something?”

Yes, say something. And no, you don’t have to lie on your stomach. Your comfort is the top priority.

Now that chemo is finished, you’re in the middle of external beam radiation therapy and, once that’s over, you’re told you will need a double mastectomy and a hysterectomy, because BRCA2 is an aggressive cancer, and the doctors don’t want to take any chances. You feel like you’ve been doing what your medical team has been telling you to do for quite a while now. You really like and trust your doctors and nurses, you know they are drawing up and executing your treatment plan because they feel it’s the best plan of action, the highest chance of success. You show up to the hospital or the treatment center, they tell you where to go, what to wear, where to sit or lie down. They administer the injection, turn on the beam, and, well, you do as they say.

Not so in the massage treatment room.

Whether you’ve been traveling a complex medical road and having a lot of decisions about what happens to your body being made for you, or whether you have a history of good health and just hate having your face touched…YOU get to call the shots during your session.

In my own practice, I tout this often, and with pride. I love asking, “What can I do for you today?” and many times I’ve seen a look pass over someone’s face when I do. Perhaps it’s relief, or a feeling of empowerment. Clients have heard me say many times: “This is your show.” Don’t want to lay face-down? You don’t have to – we’ll get you comfortable with pillows and towels lying on your side, and I can still work on your back that way. Sound good? Having your feet rubbed makes you feel instantly relaxed? Guess what—that’s on the menu.

And this your-show concept applies to every client, every session, not just the first time. Yes, you come in every week for lymphatic drainage for the lymphedema in your arm, but today can we add in 5 or 10 minutes of work on your neck because you slept on it funny? Done. You got it.

The massage treatment room gets to be your space for the time that you are in it. Sometimes there is quiet, sometimes there is sleep. Sometimes there are kvetch sessions, belly laughs, or excited last-night’s-football-game discussions. Sometimes there are tears. The space is what you need it to be, the treatment tailored for you, as you are that day, for those moments. Your voice is heard, you are listened to, you are honored, you are supported.

Lymphatic Drainage – It Ain’t Just for Lymphedema

Anyone who knows me knows that I absolutely love manual lymph drainage (MLD), and, well, sometimes I have to gush about it. (Fluid pun intended. Lymph nerds can’t help it.) The sessions are gentle, painless, non-clinical, relaxing, and over the years that I have been applying this work in my practice, I’ve learned that it’s not just for treating lymphedema, by far.

Post-surgical swelling is a biggie, and that can be from a major surgery like a hip replacement down to a simpler procedure with much smaller incisions, such as liposuction. While some edema is part of the healing process, MLD can help redirect any unnecessarily stagnant fluid (as surgery can sometimes do a number on lymphatic vessels), and this can help alleviate swelling, inflammation, and it can support and possibly even accelerate the healing process. On top of that, MLD also has a calming, analgesic effect, so it can help with post-surgical pain. Which, think about it…maybe less pain meds? Less anxiety? And the benefits can go beyond just where the surgery itself occurred.

I had a client come in who had had knee replacement surgery a few months ago. There was still some swelling around his knee, but he also felt like “he was puffy and swollen everywhere,” including his chest, shoulders, and abdomen. “I don’t know why, but I feel like something about the surgery, the anaesthesia or something is ‘stuck’ in there and needs help getting out.” We did a full lymphatic drainage session, stimulating the major collections of lymph nodes and working on all the extremities with special attention to the knee. During the session, he said he could feel a sort of “bubbling, draining sensation” near his collarbone, and the next day, he felt like not only was his knee less swollen, but that puffy feeling in his torso was less noticeable as well.

Another wonderful benefit of MLD, especially during cold and allergy seasons, is that it can help drain the sinuses. By directing strokes along the face and head toward the collections of lymph nodes in the neck, the jaw, and around the ears, then downward toward the collarbone (the region where the lymphatic system “ends” and joins up with the cardiovascular system where it deposits its fluid), that junky sinus congestion can give way to some relief and easier breathing.

Besides post-surgical MLD and MLD for sinuses, both of which I use a lot in my practice, a few other conditions have shown positive client results with the application of lymphatic drainage, whether in my treatment room or in my colleagues’ work:

• Headaches/Migraines
• Post-trauma, such as whiplash or sprains
• Fibromyalgia
• Rheumatoid Arthritis
• Chronic Fatigue Syndrome
• Scleroderma
• Pain Control/General Relaxation

While everyone’s body responds differently, and at different times, Manual Lymph Drainage is such gentle yet such versatile and often effective work. I often say that the lymphatic system is an unsung hero in our bodies, doing its thing all quietly awesome and responsible for more than we sometimes know or give it credit for. In doing this work, I get to celebrate and help support this fluid-balance and immune-response powerhouse, and hopefully end up with the picture I love the most: more people feeling better in their bodies. And if that ain’t worth gushing about, I don’t know what is.

Touch of Kindness Presents a Poster at the S4OM Oncology Massage Summit

I was honored to be asked to present a poster for Touch of Kindness at the 4th Oncology Massage Healing Summit, 2016, sponsored by the Society for Oncology Massage (S4OM), at Northwestern Health Sciences University in Bloomington, Minnesota. The summit abounded with classes and workshops for oncology massage therapists, and there was plenty of rich discussion about oncology massage education, research, and funding, both in private practice and in hospital settings. I was grateful to have so many conversations with therapists from not only around the country, but around the globe.

Many massage therapists said they have felt in the same pickle that I have – wanting to find a way to ease the financial barriers to oncology massage but still needing to bring in enough income to make a living and stay in business. Having the poster at the summit was a fun, visual, conversation-starting way to present the pay-it-forward model as one possible solution to this problem, and the comments were great:

“Huh. This is so EASY!”

“What a great idea! So simple, but it seems like a win-win-win.”

“I feel like I’m always apologizing that I don’t take insurance. But then if I could offer something like THIS…”

And my favorite: “Oh my gosh, I cannot WAIT to get back home and do this in my own practice!”

Look for an upcoming column in Massage Today magazine on Touch of Kindness as well. Word is spreading!

Touch of Kindness was proud to present at poster at the 2016 Society for Oncology Massage summit in Minneapolis.

Touch of Kindness was proud to present at poster at the 2016 Society for Oncology Massage summit in Minneapolis. Photo by Nanci Newton.

Post-Mastectomy Care and Massage

A client once told me that right after her double mastectomy, she felt like she was tossed into the ocean without a lifeboat or any direction. The surgery was a success, but no one warned her of the extent of pain and tightness she would feel as the scars began to form across her chest. About how she wouldn’t be able to lift her arm high enough to take a glass from the shelf, let alone brush her own hair.

This tightness and limited range of motion in the shoulder and trunk following mastectomy surgery is normal, but there’s also something that can be done to help aid the healing process during those early weeks after the procedure, and your surgeon may not tell you, not because they don’t want to help, but because maybe it’s out of their range of care or they aren’t sure where to refer out to.

When scars form, they can sometimes lay down collagen fibers in crazy, mish-mash directions. I like to personify the body, and I imagine a crew of construction workers with very good intentions, but their work isn’t always the neatest. Instead they’re shouting, “Fill the hole! As quickly as possible!” The body wants to heal quickly by nature. In fact, if you puncture the skin with a needle, it takes just one second after that puncture for fibrin (a wound-healing protein) to start forming, ready to fill the hole.

But those hastily-laid collagen fibers can cause lumpiness, pulling, and puckering in the superficial tissues. Adhesions can form, “webbing” in the armpit (called “axillary cording”) can occur, and scar tissue likes to attract more scar tissue, which only exacerbates the sensations of pain and tightness.

Massage can help encourage the construction crew to lay fibers down in a more organized manner, keeping the tissue pliable as it is forming, which can reduce pull on the incision and the surrounding tissues. Massage can also help create space and alignment in surrounding muscle tissue, such as in the upper chest and shoulders, which may be very tight after surgery. And lymphatic drainage massage can aid in keeping lymph circulation flowing, which can help reduce swelling.

I’ve been lucky to see some incredible results in my treatment room with a combination of very gentle scar work (which can be incorporated as soon as the incisions have closed up), lymphatic drainage massage, and non-aggressive myofascial techniques to help mobilize the shoulder joint and trunk. This can happen as soon as 2-3 weeks post-surgery. In fact, earlier on is great. As scar tissue forms, it’s a little like concrete setting. The longer you wait, the more difficult it can be to encourage the tissue toward greater pliability, so you can really benefit from the work in those critical first few weeks after surgery.

The work is painless and relaxing and is really just about kindly “nudging” the body toward smoother recovery. People are able to get back to their daily activities sooner. They can drive. They can blow-dry their own hair. Recently a client of mine walked into my office after we’d been working together for a few weeks, raised her hands above her head, and cried tears of joy at regaining her range of motion.

Though some post-mastectomy patients can feel lost, there is direction. There is massage, there is physical therapy, and there is a body that wants to heal. You don’t have to be lost at sea, and with your range of motion back, you can swim to shore.

“I found my way to Megan’s massage therapy practice two weeks after my surgery for cancer. Although the surgery was very successful, I was feeling tense and uncertain about what to expect as I healed, and how best to support the healing process of muscles and skin impacted by the surgery. From the moment I walked into Megan’s peaceful treatment room, I was put at ease—treatment was always gentle, attuned, and ultimately very effective in preventing scar tissue as well as increasing range of motion. I feel grateful to have had this skilled care and support during what otherwise would have been a much more stressful period of my recovery.”
~ J. L., Middlesex County

Lymphedema – Are You or Someone You Know At Risk?

Lymphedema is a largely underdiagnosed condition, and anyone who’s had any type of mastectomy, lumpectomy, radiation treatment, lymph node removal, node biopsy, or even surgeries or trauma to the limbs should absolutely know what it is, ways that you may be able to reduce your risk of developing it, and early signs.

Education about this is so very important, and we’ve got to spread the word.

So let’s jump in and talk broad brush strokes about what lymphedema is, how signs and symptoms often appear, and about some risk reduction practices.

The lymphatic system and lymphedema

Your lymphatic system is largely responsible for the fluid balance in your body, and it also plays a role in immune function. You can think of the lymphatic system like a kind of plumbing system. The tiny vessels pull excess fluid from your tissues and with that, they collect things like dead cells, bacteria, and waste products, transporting them to the lymph nodes to be broken down. This is all then sent to the cardiovascular system and then eventually your urinary system takes care of what excess fluid and waste products need to be eliminated.

When there is damage to the lymphatic system, this circulation can’t happen, and the result is a backup of this protein-rich fluid that instead of being exported to your venous system is now accumulating in the tissues. This can cause swelling and thickening of the skin.

Primary lymphedema occurs when the lymphatic system is malformed at birth, even though symptoms may not show up until puberty, during pregnancy, or even later. This can be hereditary or spontaneous. Secondary lymphedema occurs as a result of an external factor, the most common causes being mastectomies, lumpectomies with radiation and/or removal of lymph nodes that may cause damage to the lymphatic system.

In its very early stages, lymphedema can spontaneously resolve on its own, but the chance of it returning is always present. In later stages, lymphedema can be managed with tools such as manual lymphatic drainage (MLD), bandaging, compression garments, and diligent skin care, but there is no cure. Lymphedema is a life-long, chronic condition. Life-long .This is often not an easy thing to hear.

What are some of the signs?

Symptoms can come on a few weeks after a procedure, or years later, or not at all. The onset of lymphedema can be gradual (which is most common), or it can sometimes come on quickly. Some symptoms may be felt before any swelling is ever actually visible, such as feelings of “heaviness” or “achiness” in the limbs. In the arms, it often starts in the forearm; and in the legs, it often starts in the foot or ankle area. It is also possible to develop lymphedema in the head, neck, or genital areas, though arms and legs are most common.

If swelling starts to become visible or noticeable (like suddenly your wedding rings stop fitting and you had a mastectomy on your left side), indentations that do not immediately disappear when you press in with your fingers (also called “pitting edema”) may be another sign, but this can vary as well.

If you believe you may be experiencing symptoms, contact your doctor for an evaluation and ask questions. A lot of questions, and don’t stop until you feel you are getting answers. I encourage you to ask lymphedema therapists in your area questions that you may be able to bring back to your doctor for clarification or ideas.

I’ve had a mastectomy/lumpectomy/radiation/node removal. How can I reduce my risk of developing secondary lymphedema?

Below are just a few of the risk reduction practices outlined by the National Lymphedema Network, reworded by me. For a full list sanctioned by the NLN, click here: http://www.lymphnet.org/pdfDocs/nlnriskreduction_summary.pdf

1. Your Skin

  • Keep your skin protected to reduce the risk of infection. Keep the at-risk extremity clean and dry, and apply moisturizer daily.
  • Avoid blood draws and injections on the at-risk limb.
  • Wear gloves while doing activities that may cause injury to the skin. If you do get a scratch or puncture, wash it well with soap and water and watch closely for any signs of infection.

2. Exercise/Lifestyle

  • Gradually build up the duration and intensity of any activity or exercise, and take frequent rest periods during activity to allow the at-risk limb to recover. For a position paper on exercise from the NLN, click here: http://www.lymphnet.org/pdfDocs/nlnexercise.pdf

3. Avoid Limb Constriction

  • Avoid having blood pressure taken on the at-risk extremity , and wear loose-fitting clothing and jewelry.

4. Compression Garments

  • Consider wearing a well-fitting compression garment for air travel. The decrease in cabin pressure puts stress on both the lymphatic and circulatory systems, and this can increase swelling.

5. Avoid Extreme Temperatures

  • Avoid exposure to extreme cold, which can cause rebound swelling as well as chapping of the skin. Avoid prolonged exposure (more than 15 minutes) to heat, such as hot tubs or saunas.

The bottom line: Education is power. Spread the word about lymphedema . Mention it to your friends, your family, that woman in your dance class who just had a double mastectomy. Even though many people who have undergone things like surgery, radiation, or lymph node dissection will never develop it, it pays to know the ways to reduce your risk and the signs that can lead to early detection. Listen to your body, treat it with utmost care, and keep an open dialogue with your healthcare team.

Thank you for being an advocate for your health and for the health of those you care about.

Resources for further information:

National Lymphedema Network http://www.lymphnet.org/
Lymphedema Awareness Foundation http://www.lymphaware.org/
Step Up Speak Out (specific to breast cancer-related lymphedema) http://www.stepup-speakout.org/

Are You a Computer Slave? How Massage Therapy Can Benefit You

Your computer may be hurting your posture and body

Even if you love your desk job, working at a computer all day can be a pain in the neck…and back, shoulders, hips, head….

If you’re like most folks, when you sit at your computer, your shoulders are slumped and rounded forward, your head is held forward as if you can WILL the computer screen to come closer to your face, your feet may be tucked under your chair or you may cross one leg over the other. And by the end of the day, or when you’re getting out of bed the next morning, or—if you’re lucky—maybe months or YEARS down the road, it hits ya. Pain, stiffness, headaches, maybe even chronic digestion problems. All thanks to being a computer slave.

And let’s be honest, I feel your pain, because I hold this cruddy posture too. I’m doing it as I’m writing this (hel-LO crossed legs!) and have to consciously force myself to put my feet flat on the floor and straighten my spine and shoulders. Because when you sit this way, certain back, neck, and chest muscles become overly contracted and shortened from having to support your head and spine in this position, while other muscles become overly weakened and lengthened. This imbalance gives you that pain, stiffness, and tension. You’re also essentially smooshing your blood vessels, reducing blood supply to your muscles, resulting in more pain, plus an increased risk of fatigue and a higher chance of injury, not to mention less oxygen to your brain. Not pretty.

Okay, enough blah blah blah about how the computer is wrecking my body. I ain’t giving up my PC anytime soon, so what can we do about it?

The beauty of massage for us computer slaves is that your therapist can identify which of those neck, back, shoulder, or hip muscles are in that shortened or lengthened pattern and manually help coax them back to their intended state. Through both superficial and deep work with those muscles’ fibers and the surrounding fascia (the “Saran Wrap” that covers everything in our bodies and has recently been shown to play a major role in posture), massage therapy can relax and create length in those overly contracted bits and “wake up” and create breadth in those poor stretched-out and weakened muscles (like that spot between your shoulder blades. You know the one I’m talking about). Between the work that your massage therapist does during your sessions plus the stretches and posture tweaks that they’ll show you how to do at home, your body starts to get a sense of “Oh, right, THIS is how I’m supposed to carry myself.” The next time you’re at your desk, maybe you’re more aware of those shoulders creeping forward and you take a deep breath and slowly bring them back and down away from your ears, maybe you pull your head up straight and take notice how—even though it’s not your “normal”—it feels…right. Suddenly you’re one step further away from that chronic pain and tension, one step closer to feeling better, not just after your massage, but every day.

Study Shows How Massage Heals Deep

I love me some science.

It is sometimes a struggle for me in my career to not always have scientific evidence to back up what massage therapists do. I like being able to tell my clients what has been proven to work and even more importantly, why it does. Of course there is validity and benefit in the countless good things that therapeutic touch does for our bodies and minds that simply cannot be studied. Who can deny the magic of intuition and unspoken communication between therapist and client that can sometimes lead to the most productive, helpful sessions without a word being said? Or what of the quiet mystery of energy work, or those times when a client says: “I don’t know what you just did, but my pain is gone” and, honestly, in that session YOU don’t know precisely what you just did to make that happen either?

Yet when it comes to fostering trust and credibility to this work, for me nothing beats a solid massage study that lays out scientific facts found in a lab. Many massage therapists and instructors at massage schools have been saying for years that massage reduces inflammation and can promote healing, but nobody could come out and say exactly why. In the February 1, 2012 issue of Science Translational Medicine, a study was published showing that massage may play a role in healing injured muscles deep down, all the way down to the cells.

Eleven healthy young men agreed to have both of their thighs biopsied for the study, led by Dr. Mark Tarnopolsky, researcher at McMaster University in Ontario, Canada. Three tissue samples were taken: Once before undergoing strenuous exercise to the point of muscle exhaustion on a stationary bicycle; once again directly after the exercise was completed; and then a third time after just one leg was massaged in each participant.

After tissue study and comparison with the control sample, the research team found that the massage reduced exercise-related inflammation by diminishing activity of a cytokine protein called NF-kB. Massage also seemed to aid in cell recovery by upping amounts of another protein called PGC-1alpha, which spurs production of new mitochondria — tiny yet powerful organelles inside cells that are crucial for muscle energy generation via glucose conversion and for cell function and repair. “The bottom line is that there appears to be a suppression of pathways in inflammation and an increase in mitochondrial biogenesis,” helping the muscle adapt to the demands of increased exercise, said Tarnopolsky.

Dr. Tarnopolsky said that massage works quite differently from Nsaids and other anti-inflammatory drugs, which reduce inflammation and pain but may actually retard healing. Many people, for instance, pop an aspirin or Aleve at the first sign of muscle soreness. “There’s some theoretical concern that there is a maladaptive response in the long run if you’re constantly suppressing inflammation with drugs,” he said. “With massage, you can have your cake and eat it too—massage can suppress inflammation and actually enhance cell recovery.”

Interestingly this study also helped further debunk the idea that massage helps “clear away lactic acid after exercise”—a claim that is increasingly going the way of the dodo—as Dr. Tarnopolsky and his team observed no change in lactic acid concentrations after the massage therapy was performed.

Thanks to technological advances in the last decade that now allow scientists to probe these miniscule body structures, we are able to go from relying only on client’s subjective reports of pain relief and increased muscle performance following massage to examining measureable results on a cellular level.

Can I get a nerdy high-five? Because this is terrific news for the field of massage. With scientific evidence growing (though more studies need to be—and increasingly are being—conducted), does this open doors to even more doctor-referred massage therapy sessions, to possible insurance reimbursement for regular massage therapy sessions, to a new outlook on how clients choose to seek treatment for their pain and inflammation? We can only hope.

I know massage works. Clients know massage works. Thanks to studies like this, we can start to have a scientific look into the answers to the question “Why?” Something big is happening during a massage, and sometimes it’s happening at the SMALLEST level.

Celebrating the Power of Relaxation in Massage

Or after a more focused, therapeutic session: “Oh my gosh, I am SO relaxed” (followed by a sheepish look, as if that wasn’t supposed to happen and the client seems almost embarrassed to have let themselves relax).

Why “just” a relaxation massage? Why the chagrin over that fabulous, feel-good loopiness after you rise from the massage table and float out the door? Relaxation is one of the rare gifts that a therapist can give to their clients (how many times have you left, say, the dentist’s office or your primary care doctor’s office feeling that way?), but it is also valuable and beneficial for your body and your mind in ways that go far beyond just that initial “massage head:” euphoric feeling.

When the body is relaxed, when trust between therapist and client has been built, when the parasympathetic nervous system (the “rest and digest” state, as opposed to the highly anxious “fight or flight” sympathetic state) kicks in—this is when real healing begins. All those frenzied, rapid-fire thoughts that swing from one to the next—what Buddhists call your “monkey mind”—slow down to a calming purr. You can feel your muscles let go of some of the tension they have been holding, and this in itself creates benefits that you can feel, but this foundation of relaxation in a more focused, stuctural massage session also allows your therapist to manipulate your soft tissues more effectively and more comfortably for you. Further, it’s believed that relaxation as result of massage increases your systemic circulation, decreases your respiratory rate, that it promotes feelings of well-being and enhances the mind-body connection as well as lifts mood. What’s not to love?

In a recent randomized, controlled trial, both relaxation massage and more specific “structural massage” were studied as treatment for chronic low back pain. Not only did the results demonstrate that massage therapy improved function and decreased pain in participants with low back pain after 10 weeks, it also showed that a course of relaxation massage alone “had effects similar to those of structural massage. Both types of massage were associated with improved function at 26 weeks.” (Cherkin et al, 2011). The study also credited the results with possible nonspecific effects such as “time spent in a relaxing environment, being touched, receiving care from a caring therapist, being given self-care advice, or increased body awareness.” All of these are wonderful components of the work of massage, and, in my opinion, deserve to be celebrated.

It’s easy to think of taking time to relax as “doing nothing.” For some, if their massage therapist isn’t making them hurt for the whole session (“no pain, no gain”), then it’s just a “fluff and buff” and a “waste of time.” It’s okay to appreciate the softer side of massage—to recognize and relish in the specific, tangible results that come from specific, deep, focused work but to also unabashedly languish in those Swedish “dessert strokes” that make you melt. Enjoy the relaxation benefits, and walk out of your therapist’s office wearing your “massage head” with pride.

Source: “A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain.” Daniel C. Cherkin, PhD; Karen J. Sherman, PhD, MPH; Janet Kahn, PhD; Robert Wellman, MS; Andrea J. Cook, PhD; Eric Johnson, MS; Janet Erro, RN, MN; Kristin Delaney, MPH; and Richard A. Deyo, MD, MPH. Annals of Internal Medicine, July 5, 2011, Vol. 155, No. 1, 1-9