Welcome to Lindsey’s Therapeutic Massage

ProfileMassage provides relief to people of all ages - from infants to seniors - and from all walks of life - the weekend or competitive athlete to the home gardener or overstressed, overworked executive.

Massage offers a drug-free, non-invasive and humanistic approach based on the body's natural ability to heal itself. Massage has many physiological effects, such as:

* Increasing circulation, allowing the body to pump more oxygen and nutrients into tissues and vital organs.
* Stimulating the lymph system, the body's natural defense, against toxic invaders. For example, in breast cancer patients, massage has been shown to increase the cells that fight cancer.
* Relaxing and softening injured and overused muscles.
* Reducing spasms and cramping.
* Increasing joint flexibility.
* Reducing recovery time for strenuous workouts and eliminating subsequent pains of the athlete at any level.
* Releasing endorphins, the body's natural painkiller. For this reason, massage is being incorporated into treatment for chronic illness, injury and recovery from surgery to control and relieve pain.
* Reducing post-surgery adhesions and edema and reducing and realigning scar tissue after healing has occurred.
* Improving range of motion and decreasing discomfort for patients with low back pain.
* Relieving pain for migraine sufferers and decreasing the need for medication.
* Providing exercise and stretching for atrophied muscles and reducing shortening of the muscles for those with restricted range of motion.
* Contributing to shorter labor and reduced tearing for expectant mothers, as well as lessening the need for medication, minimizing depression and anxiety, and shortening hospital stays. .

Swedish Massage

Types of Massage

What is a Swedish Massage?
The term “Swedish Massage” refers to a variety of techniques specifically designed to relax muscles by applying pressure to them against deeper muscles and bones, and rubbing in the same direction as the flow of blood returning to the heart.
Swedish massage was developed in the 1700’s by a Swedish doctor named Per Henrik Ling.
Purpose of Swedish Massage?
The main purpose of Swedish massage is to increase the oxygen flow in the blood and release toxins from the muscles.
Swedish massage shortens recovery time from muscular strain by flushing the tissues of lactic acid, uric acid, and other metabolic wastes. It increases circulation without increasing heart load. It stretches the ligaments and tendons keeping them supple and pliable. Swedish massage also stimulates the skin and nervous system and soothes the nerves themselves at the same time. It reduces stress, both emotional and physical, and is suggested in a regular program for stress management. It also has many specific medical uses.
Swedish Massage Techniques?
Swedish massage techniques include: long strokes, kneading, friction, tapping, percussion, vibration, effleurage, and shaking motions. The usually sequence of techniques are:
1. Effleurage: Gliding strokes with the palms, thumbs and/or fingertips
2. Petrissage: Kneading movements with the hands, thumbs and/or fingers
3. Friction: Circular pressures with the palms of hands, thumbs and/or fingers
4. Vibration: Oscillatory movements that shake or vibrate the body
5. Percussion: Brisk hacking or tapping
6. Passive and active movements: Bending and stretching
Benefits of Swedish Massage?
Swedish massage feels good, is relaxing and invigorating. It affects the nerves, muscles, glands, and circulation, while promoting health and well being.


Types of Massage

What Is Reflexology?
By Anitra Brown, About.com

Reflexology is a treatment where the therapist works primarily on your feet. The theory behind reflexology is that there are “reflex points” in the feet, hands and ears that relate to specific organs and glands in the body. Practitioners believe that stimulating those reflex points promotes health in that organ via the body’s energetic pathways.
When done by a skilled practitioner, reflexology is deeply relaxing treatment with benefits that can be felt throughout the body. (If they’re less skilled, you’ll just feel like you’ve had a very long foot massage.) Reflexology can be a good treatment choice for people who want to keep their clothes on during a massage. It is also a good choice if you are pressed for time and don’t want to get oil on your body or in your hair.
Reflexology was first developed in the United States in the early 20th century, and was called “zonal therapy”in its earliest incarnations. It is based on the theory that the body is divided into ten zones running longitudinally from head to toe — five on each side of the body. Practitioners believe that pressure on reflex points on the foot or hand will affect body organs in the same zone.
In recent years, reflexologists have begun to incorporate the acupressure techniques of Traditional Chinese Medicine (T.C.M.) into their work. Although reflexology is based on the theory of “zones” instead of T.C.M.’s theory of “meridians” or energy pathways, both treatments are based on the principle that working on specific points can bring about a therapeutic effect in other parts of the body.

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What is Reflexology?
From Cathy Wong, for About.com
Updated: April 7, 2006
About.com Health’s Disease and Condition content is reviewed by our Medical Review Board

What is reflexology?
Reflexology is a form of bodywork that focuses primarily on the feet.

How does reflexology work?
The underlying theory behind reflexology is that there are “reflex” areas on the feet and hands that correspond to specific organs, glands, and other parts of the body. For example:
-the tips of the toes reflect the head
-the heart and chest are around the ball of the foot
-the liver, pancreas and kidney are in the arch of the foot low back and intestines are towards the heel
He believed that certain areas on the feet and hands were linked to other areas and organs of the body. This concept was furthered by physiotherapist Eunice Ingham into the modern practice of reflexology.

Practitioners believe that applying pressure to these reflex areas can promote health in the corresponding organs through energetic pathways.

Dr. William H. Fitzgerald, an ear, nose, and throat doctor, introduced this concept of “zone therapy” in 1915. American physiotherapist Eunice Ingram further developed this zone theory in the 1930’s into what is now knows as reflexology.

A scientific explanation is that the pressure may send signals that balance the nervous system or release chemicals such as endorphins that reduce pain and stress.
What will I feel?
Most people find reflexology for the most part to be very relaxing.

Reflexology shouldn’t be painful. If you feel discomfort, be sure to tell the reflexologist. He or she should work within your comfort zone.

Some areas may be tender or sore, and the reflexologist may spend extra time on these points. The soreness should decrease with pressure.

If you’re ticklish, not to worry. The reflexologist applies firm pressure to the feet.

Why do people get reflexology?
Stress and stress-related conditions
Tension headaches
Digestive disorders
Hormonal imbalances
Sports injuries
Menstrual disorders, such as premenstrual syndrome (PMS)
Digestive problems, such as constipation
Back pain

Reflexology is a popular alternative therapy. It promotes relaxation, improves circulation, reduces pain, soothes tired feet, and encourages overall healing.

Reflexology is also used for post-operative or palliative care. A study in the American Cancer Society journal found that one-third of cancer patients used reflexology as a complementary therapy.

Reflexology is recommended as a complementary therapy and should not replace medical treatment.

What is a typical reflexology treatment like?
A typical treatment is 45 minutes to 60 minutes long and begins with a consultation about your health and lifestyle.

You are then asked to remove your shoes and socks and sit comfortably in a reclining chair or on a massage table. Otherwise you remain fully clothed.
The reflexologist will assess the feet and then stimulates various points to identify areas of tenderness or tension.

The reflexologist then uses brisk movements to warm the feet up. Then pressure is applied from the toes to the heel according to your comfort.

Lotion or oil may be used.

How will I feel after?
Most people feel calm and relaxed after a treatment. They may even feel sleepy.

Occasionally, people feel nauseous, anxious, or tearful, but this is only temporary and is considered to be part of the healing process.

If you’re pregnant, talk with your doctor first and let the reflexologist know.

Be sure to give the reflexologist a complete and accurate health history.

If you have foot ulcers, injury, or blood vessel disease such as blood clots, consult your doctor before having reflexology.
©2008 About.com, Inc., a part of The New York Times Company. All rights reserved.


Medical Issues

Getting Past the Pain

By Dan Rutz

Originally published in Body Sense magazine, Autumn/ Winter 2003.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.

Living with fibromyalgia requires a whole new approach to “living.” Those stricken with the unrelenting pain and fatigue that are hallmarks of this affliction cannot always count on doctors to supply a cure or even an effective treatment. In fact, they are sometimes ignored or unheard by the medical community. Sufferers are, instead, challenged to take control over their condition. The judicious use of medicine, seeking out and researching complementary services and remedies, and an intelligent blend of listening to the body without becoming self-absorbed can both liberate and empower.

Find Your Approach
We don’t tend to hold rigid views about what works and what doesn’t.” Those words from Carol Burckhardt, Ph.D., a nurse and researcher at Oregon Health Sciences University, reflect an enlightened attitude among scientists specializing in fibromyalgia. Burckhardt advises patients to “take a positive approach, take a holistic approach and take an inquiring approach to any and all treatments you might use.”

Judy Hayes credits one doctor for helping her find the way back from pain. Hayes, 59, describes her fibromyalgia like “having the flu all the time.” Because symptoms — including tight muscles, body aches, severe fatigue, headache, nausea and difficulty sleeping — are so commonplace, doctors may not know where to start. What’s more, most fibromyalgia occurs in women, whose medical complaints, are not always taken seriously. Hayes was no exception, when 19 years ago doctors made it clear she was just another “crazy female.” After shuttling from doctor to doctor, she finally found one who paid attention. Stephen Balch, M.D. listened to her description, read her list of symptoms and immediately became suspicious it was fibromyalgia. When he correctly predicted the location of painful trigger points, Hayes grew confident a diagnosis was finally at hand.

Balch, who specializes in chronic conditions, reminds all his patients of their respective roles in what he calls PDSM, or physician-directed self-management. Under PDSM, the doctor provides education and sometimes offers medications to deal with specific symptoms. Yet, it is up to the patient to deal with the illness day-in and day-out. It is, he believes, the best formula for success with chronic conditions like fibromyalgia.

Hayes’ commitment to the PDSM philosophy begins by being aware of how she’s doing throughout the day. She takes a muscle relaxant and mild pain medication most evenings, but avoids relying on strong drugs to remain functional. She prefers to manage her condition with a combination of nutritious foods, casual exercise and pacing herself to avoid stress and conflict. This is her way of reclaiming the life she had before the sudden onset of fibromyalgia after an auto accident nearly two decades earlier. Tailoring medical advice requires a high level of trust from both physician and patient. As Balch puts it, “Patients know a lot more about their bodies than doctors do, and doctors know more about medicine than patients do. By sharing their knowledge, the wisest decisions can be made and the best outcomes achieved.”

Controlling the Illness
Hayes is delighted to find that taking Balch’s broader view helps her maintain the upper hand over her disorder. “It used to be that the illness had me,” she explains, “but now I control the illness.”

Hayes finds great relief from physical therapy and massage, stressing “it’s important the therapist knows what he or she is doing.” The worst fear for people with fibromyalgia is a sudden flare-up, and Hayes said bodywork applied improperly for the condition “can set it off.” Implemented appropriately, massage can make the disorder more tolerable.

Massage soothes aches, relieves muscle tension and provides a comforting respite from distress. In a scientific study, The Touch Research Institute at the University of Miami School of Medicine found “those who got 30 minutes of massage two times a week for five weeks had less anxiety and depression and lower levels of stress hormones.” Other benefits shown in the study include less pain and stiffness, less fatigue and less trouble sleeping.

In her experience with patients at Oregon Health Sciences University, researcher Burckhardt is impressed by how effective massage can be. “If the massage therapist listens to the patient and the patient listens to her body it can be a very good match,” she says. Burckhardt favors “easy-does-it” massage techniques. She cites the work of Milton Trager, finding his philosophy of encouraging gentle, free and rocking movement to be especially suitable in managing clients with fibromyalgia. Trager avoids painful areas, Burckhardt explains, just as the sports massage therapist seeks them out. Clearly with fibromyalgia, the former approach is essential, and the latter, detrimental.

Hayes says her therapist helps her gently explore a fuller range of motion. She finds that emphasis to be especially helpful in controlling painful hamstring flare-ups, which can otherwise slow her down considerably.

Detective Work
Fibromyalgia is not a disease in the classic sense, but rather a syndrome, or collection of symptoms. Diagnosis involves detective work, especially since the usual medical tests — X-rays and blood work — show no measurable signs of disease. And although joints may be extremely sore, there is no obvious inflammation. While baffled as to a cause or mechanism, experts recognize fibromyalgia as a neurosomatic disorder (affecting both the nervous system and body). At least part of the problem, doctors believe, centers on how the brain accepts and acts on pain messages. The most consistent finding is a pattern of tenderness in at least 11 of 18 specific points on the body, extending from the neck, shoulders and arms, to the hips, thighs and knee areas. Presence of widespread pain for at least three months generally clinches the diagnosis. Fibromyalgia is neither a muscular-skeletal disorder, nor a psychiatric condition. Minimizing disability, however, requires persistence and a lot of mental discipline, qualities Hayes relies on every day of her life.

Maintaining Balance
Hayes describes herself as “a fighter,” but she is also a realist. Maintaining balance in her life, she has learned to avoid the peaks and valleys of over-exuberance on the good days, and frank misery on the bad. “It takes every bit of energy I have to get out of bed,” Hayes says, in reference to the “good” days. The challenge of getting up is heightened by feelings of fatigue from perpetually fretful nights and the pain of movement after a night of relative inactivity. Reminding herself that morning is the toughest part of the day, she forces herself to start with a calming cup of hot tea.

Moderation has become Hayes’ byword as she builds a routine around both a schedule and personal limitations. “I don’t want to be known as a person who is sick,” she says, while in the same breath points out, “you can’t do what you used to do.” After two decades of living with fibromyalgia, Hayes likes to remind herself, “I’m a human being, not a human doing.”

Dan Rutz is an independent health communications specialist currently involved with bioterrorism preparedness and infectious disease prevention.

Treating Fibromyalgia
Massage Therapy as a Beneficial Tool

By Ross Turchaninov and Boris Prilutsky

Illustrations courtesy of the authors.

Originally published in Massage & Bodywork magazine, February/March 2004.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.

Most massage therapists and bodyworkers have seen the effects of fibromyalgia on at least some of their clients’ bodies and minds. Often unable to find help elsewhere, fibromyalgia sufferers have been known to seek out alternative methods to find lasting pain relief. Understanding the disorder more comprehensively and discovering how massage can be applied to a particular client may benefit all who suffer from it.

A Fibromyalgia Primer
Fibromyalgia (FM) is a chronic musculoskeletal condition expressed in widespread pain over the entire body. FM patients (a higher percentage of whom are women than men) also suffer from tension headaches, fatigue, stiffness and sleep disorders. It is estimated that 7 million Americans are afflicted with fibromyalgia — their pain and fatigue in some cases being so severe that the individual spends entire days in bed.

As recently as 18 years ago, the U.S. medical community recognized FM largely as a psychosomatic disorder, not a physical condition. Physicians would conduct lab tests and X-rays to find evidence of rheumatoid arthritis, osteoarthritis and other pathologies that produce pain in muscles and tendons. Of course, with FM the ultimate culprit, these tests showed nothing. In most cases, the patient appeared to be physically normal, hence the psychosomatic diagnosis.

Today, FM is diagnosed in most cases of fatigue, insomnia and other sleep disorders, regardless if “algia” (pain) is present or not. Even though the last 18 years of scientific research has added a wealth of information to the discussion of FM diagnosis, it has not clarified an already existing confusion — what causes FM onset?

There is an evolving theory that attempts to explain a chain of pathological events responsible for the development of FM. This theory (the supporters of which believe it is not an abnormality of the muscular system) states that the concentrations and activities of neurotransmitters are changed as a result of an unknown trigger such as trauma, sleep disorders, hormonal changes, stress, chemical exposure, etc. These changes mark the first step in the development of FM. Numerous studies have confirmed that FM patients show a decrease in their serotonin concentrations. From this point of view, only one reasonable approach is recommended: serotonin reuptake inhibiting medications (Prozac, Paxil, etc.), sedative medications, muscular relaxants and exercises to increase natural endorphin production. Years of such treatment, however, have failed many individuals. FM has now reached pandemic proportions and patients caught in this web sooner or later may find their lives ruined.

Point by point: Throughout this feature, body maps detail the direction of connective tissue massage on different parts of the body. The base of the arrow shows the initial position of the fingers. The tip of the arrow shows the direction of pull and end of application. The arrow numbers are recommendations on where to start.
We believe that FM is actually a fibromyositic pathology. Fibromyositis is a chronic, low-grade inflammatory condition of the muscle, fascia and other connective tissue. The main cause of fibromyositis is the accumulation of pathological hypertonus in muscles over a prolonged period of time. This can be triggered by post-traumatic phenomena, stress, sleep disorders, hormonal changes (thereby explaining the high incidence of women), toxic chemical exposure and other factors.

Finding a New Theory
In order to better understand how massage can help in cases of FM, a short discussion of anatomy and pathology is appropriate. As we all know, muscles are surrounded by fascia. This connective tissue plays an important role in the determination of the extent of muscle stretch and contraction. It is very important to understand that fascia also provides pathways for nerves and blood vessels. In cases of FM, due to the prolonged pathological hypertonus in muscles, fascia becomes tense causing compression of muscle fibers, nerve tissue and blood vessels. This kind of irritation first initiates, and later brings about the development of, fibromyositis. The condition of constant muscle tension in FM cases creates an overload (strain) on muscles and tendons. Strain always leads to the development of inflammation.

The persistence of this inflammatory condition prompts calcium deposits in muscles and tendon attachments to the periosteum — in other words, fibromyositis. A chronic inflammatory condition of the skeleto-muscular system causes secondary changes in neurotransmitter levels and activities in the central nervous system. The changes appear after the patient starts to experience chronic pain. In such a case, the initial trigger is in the skeletal muscles where local, pathological abnormalities were developed.

Authors of many studies have detected significant depletions of adenosine tri-phosphate (ATP) concentration, as well as other high-energy phosphates in the skeletal muscles of FM patients (Bengtsson et al., 1986, Larsson et al., 1988, Bennett, 1991, Park et al., 1998). ATP is a major energy source for muscular contraction. When a nervous command arrives through a motor neuron to a skeletal muscle to produce a contraction, ATP molecules are used. This energy causes the actin and myosin to attach to, and slide past, one another during muscular contractions. When a muscle needs to relax, it again uses ATP molecules to detach myosin from actin. It is important to remember that constant (chronic) muscular hypertonus uses and exhausts the stores of ATP.

Imagine a situation where the concentration of ATP is decreased. The motor commands arrive from the central nervous system to the muscles, and muscular contraction is achieved using available ATP. However, when the muscle needs to relax, ATP is in short supply, as most of it has been used in the contraction. In such a case, some of the muscle fibers remain in the contracted state, even during periods of relaxation. New nervous commands arrive, and again, all available ATP is used to produce a contraction. This is how tension starts to build. The more tension builds up in skeletal muscles, the more tension we can find in the fascia, aponeurosis and other soft tissues. Tension causes a decrease in elasticity, and it starts to affect microcirculation. A mismatch between motor nervous commands and insufficient arterial blood supply initiates changes in the local pH, followed by the activation of pain receptors. It’s at this time the patient starts to feel pain.

After several weeks or months (depending on the individual) of such bombardment of the central nervous system with chronic pain, changes in neurotransmitter activities and concentrations become apparent. The level of substance P (a neurotransmitter responsible for the slow or chronic pain conduction through the spinal cord) increases and the level of serotonin decreases. Serotonin is a very important neurotransmitter, mediating basic bodily functions such as smooth muscle contraction (especially digestive system musculature) and blood coagulation. Additionally, serotonin acts as a neurotransmitter in the brain. It is responsible for our wakeful state and excitement. Patients with clinical depression, which frequently accompanies FM, show a significant decrease in the concentration of serotonin in the brain. All examined FM patients exhibit an increase in the concentration of substance P in the spinal cord, which in most cases is the result of a decreased pH level in muscles.

Important findings supporting this theory are pathological changes found in the muscle cell mitochondria (Bennett, 1991), as well as a decrease in magnesium concentration (Abrahams and Flechas, 1992). Mitochondria are the power plants of the cell, synthesizing ATP (magnesium is a mediator in ATP synthesis). Numerous mitochondria are found within each cell. When ATP is depleted in the skeletal muscles of FM patients, an “energy crisis” (Eisenger, 1992) is created, triggering the entire clinical picture.

Comparing Fibromyalgia and Myofascial Pain
As you see, this concept has a completely opposing approach to the pathogenesis and the treatment of FM that is currently practiced. The key is in the skeletal muscles that have developed pathological abnormalities. The abundant clinical picture of FM is a secondary reaction, triggered by chronic pain followed by changes in the neurotransmitters. From this point of view, the initial target of the treatment is skeletal muscles, fascia and other connective tissue. Very frequently, myofascial pain syndrome (MPS) is misdiagnosed as FM. Therefore, it is important for the massage practitioner to understand the difference between these abnormalities.

The clinical picture of MPS is usually much more acute. In the areas of the trigger points, the pain is more intense with a radiating pattern along the same muscle or muscle group. The patient complains of a decrease in the range of motion, as well as a significant weakness in muscles containing active trigger points. The patient feels better when the muscle is at rest, and the intensity of the pain increases as soon as the affected muscle starts to contract. One of the main clinical differences between FM and MPS is the distribution of pain. In MPS, the pain has local character and if it radiates, the patient feels it along the same segment. MPS affects all age groups and both genders. There are no accompanying syndromes. Please note that sharper levels of pain do not bring about a decrease in serotonin level. Rather, a low-grade persistent pain such as in FM, is the causative factor in serotonin level decrease.

The clinical picture of FM is much more complicated. The intensity of the pain in FM is much lower, but it is persistent. Pain is present regardless of contraction or relaxation of affected muscles. Low-grade, persistent, psychologically-exhausting pain is one of the main symptoms of FM. Another difference is poor localization of pain, which seems to affect other soft tissues as well (e.g., skin, fascia and periosteum). Finally, the FM patient may exhibit pain either over the entire body or have patchy localizations of pain. In the case of the latter, affected areas are separated by unaffected areas. For example, the patient will complain of headaches, pain in the lower back and gluteal areas, and in the plantar fascia of the feet.

Contrary to MPS, FM carries a very strong psychological component. The patient is usually depressed, suffers from mood swings, easily bursts into tears, has significant sleep disturbances, and is mentally and physically fatigued. Additionally, the patient may have many related physical complaints: migraines, bruxism (teeth grinding), TMJ problems, irritable bowel syndrome, pelvic pain, tachycardia (increased cardiac rate), Raynauld’s phenomenon and chronic rhinitis.

The pain-causing physical expressions of chronic inflammation consist of mild swelling of the soft tissue, tension in fascia, pathological hypertonus of muscles, significant decrease in blood supply and calcium depositing in the soft tissue.

FM Treatment
Because poly-fibromyositis is a chronic condition, one must remember that the first three to four treatments can possibly aggravate the clinical picture. For an unclear reason, only 10 percent of FM clients react with aggravation of pain. In any case, we recommend that the FM client be informed of the possibility of reaction. The reason for this aggravation of pain is the intense stimulation of oxygen supply to the “hungry” cells and the excessive release of toxic waste products from the tissues into the circulatory system. Usually, however, during the first 10 to 15 correct massage therapy treatments, the client can, in fact, notice clear, significant positive changes. One must keep in mind, however, that the healing process requires time.

We recommend beginning the first 10 massage therapy treatments on a two procedures per week basis. Remember that FM clients complain of sharper levels of pain in certain regions (such as neck and upper back, or lower back, including the buttocks regions, etc.). We believe that in such cases, massage therapists must focus on those regions. However, the full-body massage treatment should be considered after the first three to four treatments. Also keep in mind that lying on the stomach for more than 12 minutes at a time is not recommended for the FM client, because the pressure on the rib cage transmitting to the rib attachments can cause additional tension in the muscles. Therefore, consider treating the neck and upper back region in a side-lying position, with a towel placed between the neck and pillow. When the client is prone, we recommend placing one pillow under the stomach and two pillows under the chest. Do not treat FM clients using a massage chair.

We also maintain that exercise is very beneficial for FM clients. It is important to keep in mind, however, that the exercise program should not begin prior to the first 10 sessions of massage therapy. Many clients have severe reactions to exercise if not prepared for active movements by a series of massage procedures.

After the first 10 treatments, the client has to begin a combination of exercise (at least two to three times a week), with special massage therapy for FM (five additional treatments). After a two-week break from massage therapy (keep in mind that the exercise program does not get a break), it is important to come back for a series of 15 massage therapy procedures (at least twice a week) and continue the exercise program (at least four times a week at this point). Usually, after the first 30 massage therapy procedures and continued exercise, FM symptoms (such as pain all over the body, sleeplessness, tension headaches, chronic fatigue) become much less severe. Even though the client may think that she feels better, she must still continue to receive treatments and maintain her exercise program. After a three-week break from massage therapy, the client must return to at least one massage therapy procedure every week and, of course, still continue to exercise at least four times a week. This is the only way to prevent re-accumulation of tension in muscles.

Some experts have recommended that FM clients employ various types of aerobic and stretching exercises for their condition. From our knowledge and experience, we can say that the most beneficial exercise program for FM clients revolves around rehabilitative exercise routines (making sure that the neck, shoulders, upper back, lower back, hips and knees are exercised separately). Clients should be advised not to force any movements when they exercise. If, for example, a left head rotation produces even the slightest pain, the movement must stop, and the head must be turned toward the center. It is also important to advise the client to perform the exercises slowly, as any aggressive exercise may aggravate the symptoms significantly.

History’s Lessons
In 1968, in Dnepropetrovsk, Ukraine, in the former Soviet Union, workers of a large industrial complex started developing fibromyalgia symptoms in epidemic proportions. The Soviet government assigned a group of scientists to find the causes of this epidemic. It was clear to everyone that psychosomatic disorders should be ruled out.

The group of scientists eventually found that an adjacent lake, heavily contaminated with toxic waste, was causing muscular tension. Over time, this led to the development of fibromyalgia. What these scientists learned was that individuals suffering from myofascial pain syndrome have a higher risk of developing fibromyalgia. But those who develop fibromyalgia are almost guaranteed to develop chronic fatigue syndrome.

During a study and clinical treatments, these scientists concluded that the development of fibromyalgia and chronic fatigue syndrome can be prevented by medical massage treatments (for more on medical massage, see Boris Prilutsky’s medical massage article in Massage & Bodywork, August/September 2003). As we mentioned here, the persistence of low-grade pain bombards the central nervous system and causes a decrease in serotonin level. Restoration of ATP, neuromuscular function and stabilization of metabolism will decrease the pain sensation. The elimination of low-grade pain will allow the central nervous system to restore the level of serotonin and chronic fatigue syndrome development will be prevented.

The Way Forward
In our decades of practical experience, we have treated many cases of classic fibromyalgia. We can report that in most cases, symptoms such as fatigue, general body pains, headaches, stiffness and sleeplessness were significantly reduced following a series of massage therapy sessions. We strongly believe that a correctly formulated medical massage protocol is the main tool in effective control and elimination of FM symptoms. Proper nutritional support, exercise, psychological assistance and other types of therapy are equally important components. But they should be employed later when the pain sensation and stiffness are significantly reduced.

It was almost three decades ago in the former Soviet Union that scientists researched and established the theory of fibromyositis development as a main cause of FM. They also developed a method of massage therapy treatment that we’ve described here. The main goal of this article is to share with practitioners the optimal protocol of medical massage in treating fibromyalgia cases and to enable massage therapists to share this concept with other healthcare practitioners.

Medical Massage Techniques
(with lubrication)

Figure 1: Client lies on her side. Place a folded towel between the neck and pillow. Place fingers around the occipital bone at the insertion of neck muscles to the skull. Gradually massage the region, while increasing pressure, for three minutes.

Figure 2: Stand in front of client, place both hands on the neck. Perform petrissage No. 1 on the lateral part of the neck and upper trapezius. This petrissage is a kneading technique where the thumbs act as barriers for soft tissue movement, and the four fingers mobilize soft tissue in the direction of the thumbs. Both hands perform the same action simultaneously. Do not massage the carotid artery.

Figure 3: If possible, place the arm of the client behind her back. Place a hand on the anterior part of the shoulder joint for support. With the top of the fingers of the other hand, massage under the scapula area. If it is difficult or impossible for the client to place her arm behind the back, perform the sub-scapular mobilization in a normal position.

Figure 4: Perform petrissage No. 2 on the lateral part of the neck and upper trapezius. Petrissage No. 2 is a kneading technique where the thumbs act as barriers for soft tissue movement and four fingers mobilize soft tissue in the direction of the thumbs. This technique is not simultaneous — each hand follows the other.

Figure 5: Place both thumbs on the lateral part of the neck as close as possible to the occipital bone. Thumb after thumb, massage the entire lateral side of the neck.

Figure 6: The client lies on her stomach. Place your right palm on the lower back region. Place your left hand on top of the right hand. With application of initial pressure, perform ironing techniques from the bottom up on all areas of the back. Upon reaching the upper part of the back, disconnect the hands and return to the lower part without contact.

Figure 7: Place the back of the fingers on the lower part of the back and, with initial pressure from the bottom up, massage the entire area of the back. Upon reaching the upper part of the back, disconnect the hands and return to the lower part without contact.

Figure 8: Place the hands on the lateral parts of the back. Under initial pressure, massage the entire back, hand against hand in a manner of cross-fiber friction.

Figure 9: Perform petrissage No. 1 and No. 2 on the entire area of the back.

Figure 10: Connective tissue massage can release tension in myofascial tissue.

Ross Turchaninov, M.D., graduated with honors from the Odessa Medical School in Ukraine and was selected for advanced studies at the Kiev Orthopedic Institute for Scientific Research. He graduated with specialization in trauma surgery and post-traumatic rehabilitation. He served as the chief supervisor of the rehabilitation program at the Ministry of Public Health in Ukraine. Turchaninov is a graduate of the Chiropractic and Medical Massage program for physicians in the Kiev Orthopedic Institute. He is the author of 25 articles, two patents and two textbooks on medical massage, and teaches medical massage seminars at the Institute of Professional Practical Therapy in Los Angeles, Calif., as well as nationally. He can be reached at 602/404-1583.

Boris Prilutsky, M.A., is the founding director and senior instructor at the Institute of Professional Practical Therapy (IPPT) in Los Angeles, Calif. He graduated from the Pedagogic Institute of Higher Education in Vinnitsa, Ukraine, with a degree in physical education, and from Medical College in Ramat-Gan, Israel, with a major in chiropractic medicine. He has practiced and taught medical massage for more than 30 years. Prilutsky has published extensively on various topics of physical medicine and rehabilitation, and has been involved with numerous collaborative research studies. He can be reached at 310/836-8811.

1 Abraham, G.E., and J.D. Flechas. Management of Fibromyalgia: Rationale for the use of Magnesium and Malic Acid. Journal of Nutritional Research, 3:39-59, 1992.
2 Bengtsson, A., F. G. Henrikson, and J. Larsson. Reduced High-Energy Phosphate Levels in the Painful Muscles of Patients With Primary Fibromyalgia. Arth Rheum, 29:817-821, 1986.
3 Bennett, R.M. Myofascial Pain Syndromes and the Fibromyalgia Syndrome: A Comparative Analysis. J Manual Med, 6:34-45, 1991.
4 Bland, J.S. Fibromyalgia and Myofascial Pain. Applying New Essentials in Nutritional Medicine, HealthComm Intern, 1995.
5 Eisinger, J., K. Mechtouf, and A. Platamura. Anomalities Biologiques Au Cours Des Fibromyalgies: I. Lactacidemie et Pyruvicemie. Lyon Mediterranee Med, 28:851-854, 1992.
6 Goldberg, D. Fibromyalgia Syndrome: An Emerging but Controversial Condition. Journal of the American Medical Association. 257(20):2782-2787, 1987.
7 Goldberg, D. Fibromyalgia and Its Relationship to Chronic Fatigue Syndrome, Viral Illness and Immune Abnormalities. J Rheum, 16 (Sup19):92, 1989.
8 Larsson, S.E., A. Bengtsson, and L. Bodegard. Muscle Changes in Work-Related Chronic Myalgia. Acta Orthop Scand, 59:74-78, 1988.
9 Moldofsky, H., P. Sasskin, and L. Salem. Sleep and Symptoms of Postinfectious Neuromyastenia and Fibrositis Syndrome. Sleep Res, 16:492, 1987.
10 Park, J.H., P. Phothiamat, C. T. Oates, M. Hernans-Schulman, and N. J.Olsen. Use of P-31 Magnetic Resonance Spectroscopy to Detect Metabolic Abnormalities in Muscles of Patients with Fibromyalgia. Arth Rheum, 41(3):406-413, 1998.

Medical Massage Protocol for Fibromyalgia
How can massage therapy help clients suffering from fibromyalgia? Simply by eliminating the causes of pain. Here is a medical massage protocol for you to try that has been especially designed for fibromyalgia (FM) cases.

1. Every massage therapy session has to start in the inhibitory regime, use the same techniques, stroke speed, pressure and direction of application, and must include paravertebral zones massage — massage of the paravertebral muscles, as well as the skin and connective tissue associated with these muscles. The best combination of massage therapy techniques for the inhibitory regime starts with effleurage and later switches to gentle kneading of soft tissue. The main goal of an effleurage introduction is to restore the threshold of activating pain receptors in the soft tissue. When working on specific regions affected most intensely by fibromyalgia (often the lower back, upper back and neck), the work should not exceed 7-10 minutes per area.

2. Using connective tissue massage, we can release tension in myofascial tissue, as well as reduce muscle tension to some degree. Be aware that the threshold of pain in FM clients is very low. Therefore, perform connective tissue massage techniques slowly, with attention given to the client’s communication about the sharpness of pain and protective muscular contraction reflex. When applying myofascial tissue release techniques, we recommend using the top of your second and third fingers, bent at a 90-degree angle. Touch the skin, lightly catching a fold of tissue and slowly, using short strokes, pull toward yourself. Do not use lubrication in connective tissue massage.

We see great importance in myofascial tissue release techniques, as there is release in both fascia and muscles, thereby allowing a release of tension. Therefore, throughout this article, we offer you maps of the direction of connective tissue massage on different parts of the body. The base of the arrow shows the initial position of the fingers and folding of the skin. The tip of the arrow shows the direction of pull and end of the application. The arrow numbers are recommendations as to where to start connective tissue massage.

3. By removing venous blood using squeezing techniques, we significantly increase arterial blood supply to the tissue (which means increased supply of oxygen, nutrients, etc.). This process helps FM clients tremendously. All strokes must be directed only toward the heart. By restoring normal metabolism in skeletal muscles and connective tissue, we increase the ATP production and concentration, which in turn, restores the pH level. Consequently, the amount of substance P (the neurotransmitter responsible for the slow or chronic pain conductance through the spinal cord) is reduced and serotonin level is increased. Clinically, the client will report decreased pain levels and an increased wakefulness.

4. Calcifications in soft tissues have a consistency similar to that of an egg shell. These deposits are made up of polymolecular structures — waste products that can’t pass through capillary pores and therefore can’t be absorbed into the circulatory system. We can break down pathological accumulations of calcium by gradually increasing pressure during cross-fiber massage. This way we initiate the breakdown of these polymolecular structures into individual molecules, facilitating their removal. This process helps tremendously to restore the elasticity and length of muscles, which is a necessary condition for normal metabolism and muscular function.

5. Using mostly kneading techniques, we stimulate numerous types of receptors in the skin, muscle tissues, vessels, tendons and ligaments. This stimulation generates a tremendous amount of impulses. Stimulating the nervous system this way helps improve innervation (restoring neurological pathways), a necessary factor in stabilizing the metabolism. The multiple reflexes to the massage stimuli bring about muscle relaxation, increased arterial blood supply to the tissues, elimination of insomnia and an improvement in the quality of sleep. This is an expression of the balance of activities between the sympathetic and parasympathetic divisions of the nervous system.

6. FM patients have “tender points” in the affected muscles and in their insertion areas into bones. The intensity of the pain in the tender points is lower compared to the trigger points. According to the recommendations of the American College of Rheumatology, a FM patient has a unique localization pattern of 18 tender points on the body. When at least 11 of the 18 are present, a physician may establish the FM diagnosis. In our opinion, there is one very important question to be answered — are tender points different pathological abnormalities than trigger points?

According to the traditional view, they are. However, some authors (Bland, 1995) and our clinical experience suggest that tender points are more likely latent trigger points that once were active. This is why when an FM patient has a flare-up, the pain intensity in the tender points increases dramatically. Tender point therapy has the same goal as trigger point therapy — application of ischemic compression. However, the technical rules are different. In trigger point therapy, the practitioner uses enough pressure to reach the client’s threshold of pain and go slightly beyond it. In case of tender point therapy, the practitioner should apply enough pressure to detect the client’s threshold of pain in a particular point, and then slightly reduce the amount of applied pressure. Thus, in the case of FM, the pressure of ischemic compression has to be maintained just below the threshold of pain (i.e., on the sub-threshold level).

Another difference is the actual application of pressure. In trigger point therapy, the practitioner should remain still while applying ischemic compression to prevent unnecessary activation of the pain-analyzing system. In tender point therapy there is no initial activation of the pain-analyzing system. However, the application of pressure on the sub-threshold level alone is not enough to quickly and efficiently eliminate a tender point. In applying tender point therapy, the practitioner should combine the application of direct pressure with circular and longitudinal friction to the area of the tender point. The only similarity between trigger point therapy and tender point therapy is the termination of ischemic compression. In both cases, the practitioner should withdraw pressure very quickly to reinforce reflex vasodilation. Each tender point compression should be maintained for 30 seconds. We strongly believe that the 18 trigger points cannot be considered the only means of discovery and therapy of trigger points. In fact, trigger points in FM clients could be detected and must be eliminated in a typical trigger point localization, such as in the belly of a muscle, periosteal trigger point, etc.

7. Post-isometric muscular relaxation (PIR) is an important final component of each session. Be sure that the client uses no more than 15 percent to 20 percent of maximal muscular strength while contracting muscles against the resistance. Also be very gradual with the application of passive stretching. Usually skeletal muscles affected by FM are much shorter and their passive stretching may cause additional uncomfortable sensations. Please be aware that if the client voluntarily or involuntarily contracts a muscle during the PIR, do not apply PIR at all. Consider PIR in later stages of treatment when the above-mentioned phenomena are not present.

8. Periosteal massage — Usually clients with FM have abundant degenerative changes in the periosteum. However, areas of periosteal trigger points are very sensitive. This is why periosteal massage should be incorporated into the protocol late, during the last five sessions.


Medical Issues

Massage Therapy as a Lupus Treatment Tool
By Jeri Jewett-Tennant, MPH, About.com
Updated: April 9, 2008

About.com Health’s Disease and Condition content is reviewed by our Medical Review Board

Where one method of treating systemic lupus erythematosus1 will work for one individual, it may have little affect on another. Thus it is common for someone suffering from lupus to explore various ways to treat the symptoms of the disease, notably pain caused by inflammation, a hallmark of the disease.

Some methods, like massage therapy, are considered complementary and alternative medicines2 (CAM), defined as a group of diverse medical and health care systems, practices and products that are not presently considered a part of conventional medicine. These approaches come as novel to some and completely familiar to others. Massage therapy, for example, is a time-honored method of pain and stress relief.

It is important to note, however, that the Lupus Foundation of America3 does not recommend medications, products or methods not approved by the U.S. Food and Drug Administration4 or the American College of Rheumatology5, further stating on its web site, “remedies that have not undergone the scrutiny of scientific investigation, lack the crucial information and data necessary to enable physicians to make sound recommendations regarding substances.”

Before exploring any new treatment option, then, it is best to talk with your healthcare provider.

Massage Therapy
The use of massage therapy6 as pain management tool continues to gain popularity in the United States. One survey found that 5 percent of 31,000 participants had used massage therapy in the previous year and nearly 10 percent had engaged in therapy at least once in their life. And, increasingly, healthcare providers are discussing massage therapy with their patients as a way to complement their conventional medical treatment (another survey found that 63 percent of massage therapist7s received referrals from healthcare professionals).

There are dozens of massage therapy methods, but all follow the same basic principles and practices: pressing, rubbing, and manipulating the body’s muscles and soft tissues, in an effort to relax the patient and decrease his or her physical pain. This is achieved by increasing the flow of blood and oxygen to the massaged areas, warming and relaxing them.

Massage therapy is performed by a licensed therapist who may use a number of different techniques. Long strokes and friction on the muscles is the hallmark of a therapist who prefers Swedish massage. Patterns and deep pressure applied by individual fingers to the knotted muscles and muscle layers is part of a therapist’s deep tissue arsenal. And a therapist who applies varying, rhythmic pressure from the fingers to zones on the body corresponding with the body’s vital flow of energy is engaging in shiatsu massage.

The Role of the Massage Therapist
Professionals who provide massages to patients are called massage therapists8. They work in a variety of settings, from office locations to house calls and workplace visits.

If you are considering massage therapy, chose a licensed and trained practitioner. Your healthcare provider should be able to refer one to you. And in some cases, conventional medical professionals might also be licensed to perform massage therapy.

Most therapists attend a school or training program and, as stated, a fair number of massage therapists also practice medicine in another capacity, such as a nurse. Study typically covers subjects such as anatomy and physiology, kinesiology, therapeutic evaluation, massage techniques, first aid, legal issues, and hands-on practice.

Treatment, Benefits and Risk
A standard massage therapy session typically lasts a half hour to an hour, but can be shorter or longer. The atmosphere should be relaxed and the patient comfortable.

The therapist may use oil or powder to reduce friction on the skin and employ ice, heat and fragrances as part of the therapy. You should feel free to discuss the techniques he or she will use prior to the therapy session.

And while there are few risks and side effects associated with massage therapy – temporary discomfort, bruising, swelling or an allergic reaction to massage oils are the most common – there are some people who should not receive massage therapy, emphasizing the need to talk to your healthcare professional prior to starting any regime. Those that should not receive massage therapy – or should consult their doctor before getting massage therapy – include:

Those with deep vein thrombosis9, a blood clot in a deep vein, usually in the legs
A bleeding disorder or taking blood-thinning drugs such as warfarin10
Damaged blood vessels
Weakened bones from osteoporosis11, a recent fracture, or cancer
A fever
Fragile skin
Heart problems14

Massage Therapy As CAM16. National Center for Complementary and Alternative Medicine, National Institutes of Health. March 2008.
Massage Therapy Industry Fact Sheet17 American Massage Therapy Association. March 2008.


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Deep Tissue

Types of Massage

Deep Tissue Massage
From Cathy Wong, for About.com
Updated: April 11, 2006
About.com Health’s Disease and Condition content is reviewed by our Medical Review Board

What is deep tissue massage?
Deep tissue massage is a type of massage therapy that focuses on realigning deeper layers of muscles and connective tissue.

It is especially helpful for chronically tense and contracted areas such as stiff necks, low back tightness, and sore shoulders.

Some of the same strokes are used as classic massage therapy1, but the movement is slower and the pressure is deeper and concentrated on areas of tension and pain.

How does deep tissue massage work?
When there is chronic muscle tension or injury, there are usually adhesions (bands of painful, rigid tissue) in muscles, tendons, and ligaments.

Adhesions can block circulation and cause pain, limited movement, and inflammation.

Deep tissue massage works by physically breaking down these adhesions to relieve pain and restore normal movement. To do this, the massage therapist often uses direct deep pressure or friction applied across the grain of the muscles.

Will deep tissue massage hurt?
At certain points during the massage, most people find there is usually some discomfort and pain.

It is important to tell the massage therapist when things hurt and if any soreness or pain you experience is outside your comfort range.

There is usually some stiffness or pain after a deep tissue massage, but it should subside within a day or so. The massage therapist may recommend applying ice to the area after the massage.

What conditions is deep tissue massage used for?
Unlike classic massage therapy, which is used for relaxation, deep tissue massage usually focuses on a specific problem, such as:
Chronic pain
Limited mobility
Recovery from injuries (e.g. whiplash, falls, sports injury)
Repetitive strain injury, such as carpal tunnel syndrome
Postural problems
Ostearthritis pain
Muscle tension or spasm
According to the August 2005 issue of Consumer Reports2 magazine, 34,000 people ranked deep tissue massage more effective in relieving osteoarthritis pain than physical therapy, exercise, prescription medications, chiropractic, acupuncture, diet, glucosamine and over-the-counter drugs.

Deep tissue massage also received a top ranking for fibromyalgia pain.

People often notice improved range of motion immediately after a deep tissue massage.

What can I expect during my visit?
Massage therapists may use fingertips, knuckles, hands, elbows, and forearms during the deep tissue massage.

You may be asked to breathe deeply as the massage therapist works on certain tense areas.
It is important to drink plenty of water as you can after the massage to flush metabolic waste from the tissues.

Massage is not recommended for certain people:
-infectious skin disease, rash, or open wounds
-immediately after surgery
-immediately after chemotherapy or radiation, unless recommended by your doctor
-people with osteoporosis should consult their doctor before getting a massage
-prone to blood clots. There is a risk of blood clots being dislodged. If you have heart disease, check with your doctor before having a massage
-pregnant women should check with their doctor first if they are considering getting a massage. Massage in pregnant women should be done by massage therapists who are certified in pregnancy massage.

-massage should not be done directly over bruises, inflamed skin, unhealed wounds, tumors, abdominal hernia, or areas of recent fractures.
-Additional tips
don’t eat a heavy meal before the massage
-if it’s your first time at the clinic or spa, arrive at least 10 minutes early to complete the necessary forms. Otherwise, arrive 5 minutes early so you can have a few minutes to rest and relax before starting the massage.

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Medical Issues

More info

Pregnancy Massage

Types of Massage

Pregnancy Massage
Touch for the Mom-To-Be

By Shirley Vanderbilt

Originally published in Body Sense magazine, Fall 2002.
Associated Bodywork and Massage Professionals. All rights reserved.

Pregnancy is a beautiful and natural condition — nine transformative months full of excitement, planning and peering at the awesome unfolding of life. But this transformation also brings inevitable side effects, sometimes making a woman feel like her body has been taken over by an alien force. In the early months, there are mood swings from ecstasy to unpredictable crying, in later months, there are aches and pains more common to the domain of the elderly. Physical changes, such as nausea, back pain, heartburn, raging hormones, breast pain, and swollen legs and ankles affect many women during this time. But you don’t have to suffer in silence. The gentle, noninvasive approach of pregnancy massage can ease your discomfort, help you prepare for labor and give you the emotional support of a caring practitioner. Massage sessions can also bring back a sense of body-mind integration, putting you into a state of relaxation and calm acceptance of your continually evolving physical form.

According to Lynne Daize, with the National Association of Pregnancy Massage Therapy, training for this specialty includes learning specific techniques for each trimester, as well as those required for labor and postpartum massage. A certified pregnancy massage therapist is well-acquainted with the physical and hormonal effects of pregnancy and has the skills to counterbalance these changes. You’ll find the therapist uses a lighter touch and concentrates on those areas most vulnerable to changes in your body. She will also give you deep breathing exercises and tips on how to improve your posture to adjust to the added weight and shifting center of gravity.

Massage has many scientifically proven health benefits such as stimulating the blood and lymph systems, thereby increasing immunity and removal of toxins, stabilizing hormonal levels, and adding tone and flexibility to muscles — all of which enhance the health of both you and your baby. As pregnancy progresses, your body adjusts to a changing alignment caused by the baby’s increasing weight. This puts strain on your back and legs and increases stress on weight-bearing joints. Massage increases flexibility, enhancing the ability to carry this extra weight while also relieving aches and pains, leg cramps and muscle spasms. The effects of relaxation and tension release add to improvement in the physical state of muscles and joints, and assist in balancing emotions.

Recent studies from the Touch Research Institute (TRI) in Miami, Fla., indicates that pregnancy massage provides more than just symptom relief for the mother. A group of 26 pregnant women were given either massage or relaxation therapy during a five-week study. In addition to experiencing a reduction in symptoms of anxiety, stress, sleep problems and back pain, the massage group had fewer complications in their delivery. Their newborns also had fewer postnatal complications. Another TRI study reported massage during labor resulted in shorter labor times for the mothers, shorter hospital stays and less postpartum depression.

Obstetrician Bonita Kolrud of Westside Women’s Care in Wheat Ridge, Colo., is an avid proponent of bodywork, although she cautions women to make sure their therapist is experienced with pregnancy massage. Kolrud praises the physical benefits of massage, noting it relieves tension and pain caused by changes in body alignment. “The biggest thing is so many women still look at massage as a luxury. But it has so many physical health benefits and is more of a necessity for some patients. Emotionally, it’s really beneficial for women to be touched when they’re pregnant. I think a lot of pregnant women don’t necessarily get as much physical touching as they would like. It’s a very nurturing thing having someone taking care of you, and it’s a great bonding experience with the baby when you’re both receiving massage.”

What to Expect When Expecting
During the first trimester of pregnancy, a primary goal of massage is to provide relaxation and increase flow of the circulation systems. Stimulating the blood system pumps more energy-giving oxygen and nutrients into your cells and increases blood flow to the placenta. Muscle tension can slow down lymph flow, leaving you fatigued and at risk of toxemia. By stimulating this system, massage speeds up elimination of toxins and excess fluid, boosting your immunity and energy level.

And when it comes to morning sickness, Daize indicates that while bodywork won’t completely relieve nausea, it can certainly diminish the queasiness.

In the second trimester, increasing weight of the baby can cause muscle soreness. “The mother starts going through more changes,” says Daize, “so massage is used to relieve muscle spasms and ease structural changes.” The therapist works to loosen joints, keeping them aligned, and soften the connective tissues, relieving backaches and leg cramps.

As pregnancy progresses and the abdomen enlarges, special positioning is required during massage. Up to the 24th week of pregnancy it is acceptable, according to Daize, for moms to be on their back with the right hip tilted up, taking pressure off the nerves and arteries. Pressure on the arteries in the back, she notes, will diminish blood flow and oxygen to the fetus. Another position that decreases stress on the back is side-lying, with the belly supported by a small wedge pillow.

During the final trimester’s “home stretch,” the baby begins to gain weight more rapidly, pressing against inner organs and shifting them about. Discomfort increases and the impending due date can cause added stress and anxiety. At this stage, Daize says, the therapist focuses on trigger points to relieve pain while continuing to elicit relaxation throughout the body. Generally, during the last two weeks before mom’s due date the therapist concentrates her techniques on preparing the mother’s body for delivery.

Before initiating massage, consult your obstetrician, especially if you are high-risk. While massage is a safe treatment, there are certain conditions that require your physician’s approval and careful monitoring by the therapist. Notify your therapist immediately of any changes in your physical health, and consult your obstetrician about continuing the treatments should complications arise. Some physicians may be unaware of the benefits of pregnancy massage and hesitant to recommend it. In these cases, the therapist can help by providing information that explains her specialized training and experience.

Spouses and partners can be included in the massage experience as well. As your due date nears, you can bring your labor coach into your session to learn basic massage techniques. Kolrud notes that massage during labor is especially beneficial if the woman “prefers to do it as naturally as possible.” You might consider hiring a doula or massage therapy birth assistant to comfort and guide you through the entire labor and delivery process. These professionals are trained to provide both physical and emotional support. They act as a liaison with medical staff and as the mother’s caregiver, using their expertise to create a stress-free and positive environment. By giving massage, suggesting alternative positions for labor and tending to minor details, they relieve fathers and family members of much of the pressure and responsibility in the labor room.

Special Delivery
Once your baby has arrived, massage can continue to be an important part of good health for you and your new infant. Postpartum massage can relieve the stress and tension of your new responsibilities and provide nurturing and relaxation to help you in adjusting to motherhood. By increasing circulation, massage enhances the post-birth healing process and has a significant effect on realigning the body when the center of gravity shifts back to normal. You can also share this pleasurable experience with your newborn. Infant massage is one of the best ways to bond with your baby and provide a secure, comforting welcome into the world. Ask your therapist about infant massage instruction, or call Johnson & Johnson (877/565-5465) to order their video, Parent Guide to Infant Massage.

Shirley Vanderbilt is a staff writer for Body Sense magazine.