In her talk on massage therapy and lupus, Ms. Kirkbride began by reminding members that it is extremely important to always consult with your doctor before starting any integrative therapies such as massage therapy. Integrative therapies are often called “alternative” or “complimentary” therapies. These types of therapies are intended to be an addition to your regular treatment and not as a replacement.
Often times our pets will roll on their backs or rub up against our legs to get our attention. Many times they are not just asking for food, they are asking to be touched. Touch is not only important to animals, it is also extremely important to humans.
The importance of touch to human development was noted in studies performed by Harry Harlow in the late 1960’s. Harlow performed a series of studies using Rhesus monkeys in an attempt to evaluate the impact of social isolation and deprivation on baby monkeys. In one experiment, Harlow placed a baby monkey in a cage with two surrogate mothers. One of the mothers was made of wire and wood with a food bottle attached to it. The other was made of wire and cloth with no food attached. The baby monkeys clung to the wire and cloth mother and only visited the wire and wood mother for food intake. The results of this study are said to indicate how important contact was for the monkey. The baby monkey needed contact and comfort and chose to spend more time with the surrogate monkey that more closely resembled an actual monkey than the bare boned surrogate containing food. (Suomi, Van der Horst & Van der Veer, 2008).
Evidence of the importance of touch was further observed in the Romanian Orphan Study. This study came about in the early 1990’s after the fall of Ceauşescu. During Ceauşescu’s reign many children were placed in orphanages. The conditions in the orphanages were dismal. Orphan babies received no human or social contact. Only the children’s biological and medical needs were met. The results of this treatment were dire. The children were severely stunted physically, cognitively, and psychologically with many failing to thrive. The Romanian Orphan Study could not ethically be created or recreated, but it provided researchers with a unique insight into the detrimental impact that lack of touch and social isolation can have on human children. (Calrson & Earles, 1997)
Many people have heard of “Eastern Massage/Bodywork” or “Western Massage/Bodywork,” but what does that mean? There are basic differences between Eastern and Western modalities (or types) of massage.
Eastern massage is rooted in Traditional Asian Medicine dating back 2500 to 4000 years ago. Eastern massage is based on the concept of “Life Force.” This is defined as, “…the element that creates and binds together all things and phenomena existing in the Universe” (Salvo, 2007). Many cultures have different names for this concept. In Japan it is referred to as, “Ki.” In China it is referred to as, “Qi, ch’i or chi.” And in India it is referred to as, “Prana.”
Eastern massage is based on a holistic concept of the body in which the body is viewed as one unified system made up of body, mind and spirit. Eastern massage is centered on the idea that energy flows throughout the body and the purpose of massage is to find and address imbalances in the flow of that energy. Eastern modalities use techniques that stimulate and smooth points along energy channels throughout the body. These techniques are said to impact the whole body system as well as the points themselves. These modalities are often a more rigorous form of massage.
Western massage is based on anatomy, pathology and physiology. In Western massage the practitioner addresses specific areas of pain or discomfort. The purpose of Western modalities is to realign and restore the body by focusing on different systems of the body such as the muscular system. Western modalities often use techniques such as broad strokes and circular motions to promote relaxation.
Here is an example of how a Western practitioner may approach a client differently than an Eastern practitioner. A client approaches the practitioner with pain running down the back of the leg. An Eastern practitioner may surmise that there is an energy channel out of balance which may be associated with other body parts such as a major organ. On the other hand a Western practitioner may surmise that a muscle deep within the buttock area is impinging the sciatic nerve that runs from the pelvic area down the back of the leg.
There are over seventy-five different massage therapy modalities currently in existence. This talk provided only a few examples intended to demonstrate some of what is available to consumers as well as illustrate what lupus patients should be aware of when seeking massage therapy services.
Examples of Eastern Modalities
Shiatsu is Japanese for “finger” (shi) “pressure” (atsu). This modality is generally performed on a mat on the floor with a fully clothed client. Shiatsu focuses on “meridians,” or energy channels, throughout the body. Each meridian is associated with a different organ. For example there is the Lung Meridian or the Large Intestine Meridian. There are points along each meridian that are referred to as “tsubos.” Pressure is applied to tsubos to create balance in the energy along the meridians. Practitioners may use their fingers, elbows, knees and feet to perform Shiatsu.
There are modern variations on Shiatsus such as “Watsu” which is a form of hydrotherapy in which Shiatsu is performed in a warm pool of water. This can provide an additional level of relaxation to the Shiatsu experience.
Thai massage is generally performed on a mat on the floor with the client fully clothed. Thai massage focuses on “sen,” or energy channels, throughout the body. Thai massage is also referred to as “Thai yoga” as it involves the use of extensive stretching as well as rhythmic compression and rocking. Traditional Thai massage can last over two hours however Thai massages found in the United States are generally 60 to 90 minute sessions.
Tui Na is a form of “external” Traditional Chinese Medicine (TCM). Tui Na is performed on a mat on the floor or on a massage table with the client fully clothed. This modality can be performed in a variety of ways from extremely rigorous with active stretching and firm pressure to relaxing with soft manipulation of acupressure points. Acupressure points are energy points. Practitioners utilize a number of techniques including compression, rocking, kneading, rolling, as well as pressing and rubbing of muscle tissue and between joints.
Reiki is a form of bodywork that was developed in 1922 in Japan. It involves little to no contact with the body. With Reiki the practitioner uses their palms to balance the “ki” or life force energy throughout the body.
Examples of Western Modalities
Swedish massage is defined as, “…a systemic and scientific manipulation of the soft tissues of the body for the purpose of establishing or maintaining good health, (Salvo, 2007).” The founding father of Swedish massage was Pehr Henrik Ling (1779-1839). He was a Swedish physiologist and gymnastics instructor. He is also known as the father of physical therapy.
Swedish massage utilizes a variety of strokes that promote relaxation. Practitioners generally use oil or lotions. Techniques for Swedish massage include: circular strokes, kneading, friction, percussive strokes, rocking, jostling, stretching, joint mobilization (moving a joint through its normal range of motion) and more. Swedish massage is performed on a massage table. Clients are generally unclothed and should be properly draped with a sheet throughout the massage. The practitioner will undrape an area when working and will re-drape as they move onto the next area. For example, a practitioner will uncover a leg and properly drape the sheet to protect private areas from exposure. They will massage this leg, re-drape and move on to the next leg.
Always let your practitioner know if you are feeling uncomfortable and/or exposed with the draping or if you feel more comfortable leaving undergarments on during the massage.
Deep Tissue Massage
In a spa environment “deep tissue” often refers to deeper pressure. The true intention of deep tissue massage is a deeper manipulation of the muscle tissue through the use of friction, deep pressure, and active/passive motion techniques. Deep tissue massage is also known as “clinical massage” and uses techniques intended to deal with specific injuries or painful musculature. These techniques are often used by physical therapists to address areas of pain or injury.
Craniosacral was created by osteopath John Upledger in the late 1970’s and early 1980’s. Cranio signifies the “cranium” and sacral refers to the “sacrum.” This modality is performed on a fully clothed client on a massage table. It involves extremely light touch intended to release restrictions in the craniosacral system. The craniosacral system is made up of the membranes and cranial spinal fluid that surround and protect the brain and spinal cord. Practitioners use five grams or less of pressure when performing craniosacral on a client.
Research on massage therapy is ongoing. Current research indicates that massage therapy (using at least a moderate pressure) may:
Current research on massage therapy has been conducted on a variety of chronic illnesses; there is, however, a gap in research on autoimmune disease and lupus. Reductions in cortisol levels and increases in dopamine and serotonin levels are some common positive results of massage therapy found in many research studies. However, these results may not extend to those with autoimmune diseases or lupus. It is important to note that research results are specific to the population being studied and may or may not extend to other conditions.
Contraindications are a situation or a time when massage therapy is not recommended. Massage therapy is not recommended:
**It is VERY IMPORTANT to speak with your doctor if you are receiving infusion therapy and considering massage therapy. Medications delivered by infusion impact your body’s ability to heal. Check with your doctor to be sure it is ok for you to receive a massage.**
According to the American Massage Therapy Association (AMTA) those with lupus should avoid massage modalities that increase inflammation. This includes Deep Tissue Massage and any “hot” therapies such as Hot Stone Massage.
Please Note: There are forms of deep massage that may be used by your physical therapist as prescribed by your doctor. This is different from a fully body deep tissue massage at a spa or massage therapy clinic/studio. Physical therapists work in conjunction with your doctor and are aware of your condition. They use deep tissue massage on specific areas of injury or pain and generally do not work on the whole body.
LICENSED! Your massage therapist should be licensed! This means that they will use the letters, “LMT” to stand for “Licensed Massage Therapist.” Each state has different licensure requirements based on hours of training and practice. For example the state of Texas requires 500 hours, Arizona requires 750 hours and New York requires 1000 hours. New York requires that licensed massage therapists are exposed to a variety of different modalities including Eastern modalities such as Shiatsu or Thai Massage.
Be sure to check your massage therapist’s New York license. You can do so by clicking on this link: http://www.op.nysed.gov/opsearches.htm
Please Note: Some Eastern modalities are performed by unlicensed bodyworkers. It is possible to take trainings in Shiatsu and Thai Massage and other forms of bodywork without receiving a license from the state. These practitioners should not be working on clients. Make sure you check that your practitioner is licensed!
In addition to being licensed you will want to be sure that your massage therapist has knowledge of lupus and a history of working with chronic illnesses, especially autoimmune diseases. You will want an LMT who listens and acknowledges that you are the expert on your body, your symptoms and your experiences. And you want to find an LMT you feel comfortable with and one who never works past your point of comfort. Watch out for LMTs who say they know how to “fix” or “cure” you! If you are inexperienced with massage therapy, you want to find an LMT who will explain what they are doing and with whom you feel comfortable asking questions. Comfort is the key!
Communicating with your LMT
Your first session with a new LMT should begin with an interview. Most LMT’s will allot 15-20 minutes of the first session to get to know you. (This may be much shorter if you are going to a spa.) Some LMTs will have you fill out paperwork and others will listen and make notes later. This is your opportunity to tell your LMT about yourself, your lupus and your experiences. It is also the time to ask them any questions that you may have.
There is important information that you will want to tell your LMT.
You will want to tell them all of your important health history, this includes:
You will also want to tell your LMT if this is the first time you have had a massage or how often you receive massages. If this is your first time, you may want to start with a 30 or 60 minutes appointment until your body gets used to massage and you are familiar with how your body reacts. You will also want to tell your LMT if there are any areas of pain or discomfort and whether these are chronic or acute issues. This information will impact how your LMT works on the area. Often if it is an acute pain or injury the LMT will avoid the area if there is swelling and inflammation. They will not want to aggravate an injury and will wait until the injury has moved past the acute phase. Make sure to tell your LMT the areas that you want them to focus on as well as any areas you would like them to avoid. Areas that you want them to avoid may be sensitive areas or areas you don’t like touched (for example, many people do not want their face touched).
In addition, you will want to be sure to tell your LMT if you have any allergies. This includes allergies to laundry detergents or fabric softeners. Most LMTs use “free” detergents and fabric softeners but you may be allergic or sensitive to a particular brand, you will want to be sure your LMT is aware. Also let them know if you have any sensitivities or allergies to oils or lotions. Find out what kind of lotion or oil your LMT uses; they should have a hypoallergenic/non-scented option. It is also important to let your LMT know if you are sensitive or allergic to any smells, especially scents like lavender which is often used as an essential oil for relaxation. Ask your LMT if they light scented candles in the room and request that they do not light them if you are sensitive to the smell. You should also mention if you are allergic to any animals such as dogs or cats. Your LMT may own an animal and should take extra precautions.
How do I find a qualified LMT?
There is no absolute way to find the best LMT for you. You may have to try a few different ones until you find the right fit. But you can start by asking your friends, especially those who have lupus or other chronic illnesses. You can also visit the AMTA website. Members of the AMTA can register on the site and will include their credentials, the forms of massage they are trained in, the populations they work with and any certifications they may have. The AMTA and the SLE Lupus Foundation have teamed up to create The Lupus Project. This is a group of LMTs who are members of the AMTA and work with people with lupus on a sliding scale. You can check the AMTA website to find LMTs who participate with the Lupus Project.
Don’t be afraid to call and “interview” an LMT. You might ask them a series of questions like:
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Learn more information about the SLE Workshop at HSS, a free support and education group held monthly for people with lupus, their families, and friends.
Summary by Gwyneth Kirkbride, Social Work Intern, Department of Social Work Programs