What are common conditions treated by massage and related therapies?

Whiplash
Most commonly, whiplash affects the neck and is a common injury following a motor vehicle accident. Soft tissue injuries to the neck muscles are referred to as sprains (ligament injury) and strains (muscle/tendon injury). Soft tissue injuries are not seen on X-rays and are often overlooked but can cause severe and debilitating pain. If left untreated, soft tissue injuries can lead to chronic pain and postural dysfunction. In severe cases there may be disc or nerve damage as well.

The inflammatory process and production of scar tissue is the body’s way of healing the damaged tissue but these same processes also weaken muscles, making them less elastic and prone to re-injury and pain. Massage can be crucial for full muscular recovery. Gentle massage, manual lymph drainage and cold hydrotherapy are used initially to decrease edema and muscle spasm. As healing progresses, hot hydrotherapy is used to decrease any excess muscle tone. Your therapist may also use gentle friction techniques and stretching to reduce scar tissue and allow for proper strengthening of the neck muscles using a specific remedial exercise program.

Healing time for whiplash may vary from days to months depending on the severity of injury and a person’s compliancy to the proposed treatment and homecare regimen.

Disc Herniation
A disc, a thick spongy piece of cartilage, separates each vertebra in your spine. The center of the disc contains a fluid filled sac which may protrude or even rupture. This leads to irritation and compression of the nerves around the spine.

A herniation may occur abruptly from a traumatic injury or develop gradually following years of arthritic changes in the spine and degeneration, or wearing down, of the disc itself (degenerative disc disease).

Massage focuses on indirect methods to reduce the herniation and relieve pain symptoms. These methods include pillowing and positioning, pain-free active exercises such as pelvic tilts. Gentle Swedish massage, manual lymph drainage, hydrotherapy and light myofascial techniques help to decrease inflammation, pain, muscle spasm and stress related to pain and sleep disturbances. In the later stages, postural education, proper lifting protocol and strengthening of weak muscles are endorsed to provide protection to the injured joint(s).

At times, surgery is required to repair damage caused by a herniated disc. After this surgery, massage can help decrease healing time, restore muscle health and promote flexibility of the scar tissue to avoid pain that may result from tissue restrictions.

Headaches
Tension, sinus and migraine headaches have different causes but similar treatments from a massage perspective. All will involve the release of the muscle and connective tissues of the head, neck, chest and shoulders through massage, fascial release, stretching and trigger point therapy to eliminate referred muscle pain. Depending on associated symptoms such as swelling other modalities (i.e. MLD) may be used. After balance is restored to the tissues, homecare stretching and hydrotherapy is recommended as well as a maintenance treatment every 4-8 weeks. These conditions are aggravated by stress.

Temporomandibular Joint Dysfunction (TMJD)
This is a group of symptoms affecting the jaw joints caused by traumatic injury, arthritis, an uneven bite (malocclusion) or poor postural habits. Signs of this condition include grinding your teeth, tinnitus (ringing in the ears), headaches, dizziness and pain in the jaw, neck and back. This condition is aggravated by stress. Massage will treat the soft tissues around the TMJ from the outside (extra-orally) and inside (intra-orally). The latter portion of the treatment is paramount to mobilize the TMJ and reach the muscles involved in its movement. The Myofascial restrictions of the neck and shoulders will also be addressed to reduce headaches and improve circulation and range of motion, all of which may make it easier for your dentist to treat your jaw with a necessary appliance.

Perinatal Massage
This term refers to massage during and after pregnancy. A woman’s body undergoes many changes as she nurtures her unborn child and many of these can cause discomfort, pain and swelling, especially in the later stages of pregnancy. Massage can aid in stress reduction and relaxation during this period of change and adaptation and help reduce fatigue, physical pains and emotional tension. Massage can help you learn to know when you are holding tension in the body and then consciously release it, thus preparing you for the birthing process. It is also fun to learn to massage your abdomen and feel your baby move in response to your touch. Breathing and relaxation techniques can also be practiced during massage to increase confidence and control during labour. Pillowing stretches and feedback on your posture may be given to increase comfort at home. Massage during labour can help you relax between contractions, provide emotional support, and reduce pain. Ask your therapist about teaching you and your support person labour massage about one month prior to your due date. After the baby comes, it is important to have Myofascial imbalances addressed and core strength improved. Reducing fatigue and stress levels post-partum can also aid in milk production and letdown for nursing moms and reduce the possibility of post-partum depression. Breast massage may also be recommended.

Breast Massage
Menstrual cycles, pregnancy, lactation and menopause all affect the female hormones and soft tissues of the breast. Any woman may experience breast congestion and tenderness as a result of this. Trauma or surgical procedures to the breast and surrounding lymph tissue can also result in these symptoms. Massage, MLD and hydrotherapy are effective and gentle ways to treat these symptoms and improve circulation to and from the breast and surrounding tissue. Your therapist’s palpation skills can also alert you to any lumps found in the breast tissue. Breast massage is recommended for:

• Any congestion and swelling of the breast
• Painful or engorged breasts during pregnancy, breastfeeding or weaning
• Pain and swelling following partial or radical mastectomies and lumpectomies (this will also include treatment of scar tissue from surgery and/or radiation)
• Discomfort and/or pain associated with premenstrual or menopausal cycles
• Congestion and/or engorgement of breasts following miscarriage or stillbirth
• Enhancing body awareness and body image

Instruction can also be given on how you or someone you are close to can perform breast massage at home.

Stress Management
Stress is a complex “organism” that seems to have a mind of its’ own, often harming us in silence, over time. In our fast-paced lives, we rarely stop to think about how many sources of stress we are faced with or how stress affects our body’s response to its’ presence. Not all stress is harmful; there are positive stressors that encourage us to move forward and achieve goals; those that advance our lives and provide us with a sense of accomplishment. But frequently these positive stresses become overwhelmed by the negative stresses of over-booked schedules and deadlines. When this hectic lifestyle is combined with the inevitable ups and downs of life, such as illness in the family or finances, the stress can be very destructive. The body’s fight or flight response goes on autopilot and there is little room for our rest and digest functions. Thus, our body produces chronically high levels of stress hormones (like cortisol) that interfere with the delicate hormonal balance of our body systems. This results in sleep disturbances, stomach upset, constipation or diarrhoea, headaches, moodiness or irritability and fatigue. In situations where persons experience high levels of unhealthy stress for long periods, our immune function decreases and chronic pain patterns, depression, anxiety and insomnia can develop. We will always have stress in our lives; learning to manage it effectively is the key to preventing many health related concerns associated with its’ presence.

Massage, aromatherapy, Reiki and meditation are all useful modalities to treat stress. Relaxation is the primary treatment goal and will be difficult for many people to achieve at first. It can be challenging to take your body off alert. Music, breathing and progressive relaxation exercises may also be added to improve body awareness, reduce heart rate and blood pressure, slow the breath and identify areas of tension. Massage can release muscle tension, increase circulation, improve sleep patterns and provide emotional support. Your therapist can also provide you with contacts of other healthcare professional that treat stress and stress-related conditions.

Sport Massage
Massage is used as both a preventative and rehabilitative treatment for athletes and sport related injury. It is used generally to treat any muscle imbalances and fascial restrictions, to improve blood and lymph circulation and to reduce stress. Specific techniques can be applied to treat an injury and reduce swelling, bruising, pain and improve healing time. The therapist can also monitor the healing tissue and assess when return to sport is possible and if any precautions are necessary (i.e. taping). Pre-event massage uses fast, invigorating techniques to stimulate the muscles and blood flow. It is done for 20 minutes prior to an event and is generally done through the clothing. Many athletes use this time to relax and visualize success. Post-event massage is done after you have cooled down. It is slower and focuses on eliminating metabolite build-up in muscle tissue, reducing any pain or swelling and may include the use of hydrotherapy (cold or hot applications). This should be done within the first few hours following the event to prevent delayed onset muscle soreness (DOMS). Sea salt baths or contrast hydrotherapies are often recommended as methods of self-care after sporting events or training.

Please see the hydrotherapy discussion for details.

Osteoarthritis (OA)
In the early stages of OA, massage provides preventative care by decreasing pain and muscle spasm, maintaining range of motion of the affected joint(s) and promoting circulation. Remedial exercises may be modified to strengthen the muscles surrounding the affected joint, providing a stabilizing force for the joint.
In the later stages, hydrotherapy and manual lymph drainage can help manage inflammatory episodes, and gentle massage and manual muscle stretching can maintain circulation to the affected area and reduce pain. Massage can help prevent losing muscle tone due to disuse by assisting with range of motion and other strengthening exercises that do not stress the affected joint. Paraffin wax treatments are found to be beneficial for this condition between flare-ups. With this treatment, the affected joints (i.e. hand) is dipped into the melted wax several times and removed. The wax solidifies quickly but remains pliable. The wax-covered area is then covered in saran wrap and/or a towel and left for 10-15 minutes. The result is a deep penetrating heat that promotes healthy circulation and waste removal.
A compress of castor oil often helps with the joint and muscle pain of osteoarthritis:

1. Empty one small bottle of castor oil onto a cotton or flannel cloth.
2. Place the saturated cloth over the affected joint and wrap loosely in plastic wrap.
3. You may leave this on over night OR apply heat on top of it and remove after 20 minutes.
4. NOTE: heat should not be used if there is any inflammation present.
   

Rheumatoid Arthritis (RA)
This arthritide may occur on its own in children and adults or secondary to another condition such as HIV/AIDS and multiple sclerosis. It is always associated with inflammation. Massage and hydrotherapy can aid in the management of flare-ups, decrease pain and swelling, increase muscle strength to provide support to the affected joints and may prevent/inhibit joint deformity and muscle contractures by using gentle range of motion and stretching techniques. Paraffin treatments are also useful in treating RA between flare-ups.

Central Nervous System (CNS) Disorders
CNS disorders affect the nerves of the brain and spinal cord. Damage here can affect motor skills, sensation, reflexes and/or cognition (thinking/memory).

Multiple sclerosis (MS) is a neurological condition affecting the functioning of the brain and spinal cord (the central nervous system). It is a condition that is characterized by periods of remission from symptoms as the body attempts to heal itself, and periods of heightened symptoms when the damage becomes too much for the body to handle.

Massage for a person with MS focuses on calming the sympathetic nervous system, the part responsible for stress responses. This aids in decreasing muscle spasticity and fatigue. Therapeutic massage can improve and maintain tissue health, limit muscle contractures, provide pain management, increase/maintain range of motion and joint health. Your therapist can also assist you with posture and body awareness. It has been found that regular massage treatment is very beneficial in the management of the symptoms associated with multiple sclerosis. The response is also favourable by MS patients receiving Reiki.

Parkinson’s disease is a progressive, degenerative disease of the CNS primarily affecting motor skills. Massage treatment for Parkinson’s disease is beneficial as it encourages an integrative approach to body awareness. Therapeutic massage can:

• Decrease the muscle soreness associated with tremors and, in some cases, the frequency and intensity of the tremors as well.
• Maintain tissue health with ample circulation.
• Prevent postural changes and muscle imbalances in early stages of the disease.
• Limit contractures of muscles and fascia
• Decrease constipation associated with postural changes
• Encourage healthy breathing patterns through breathing exercises and treatment of the diaphragm.

Cerebral Palsy (CP) is a CNS disorder that occurs at birth. It can be mildly or severely debilitating, often resulting in paraplegia or quadriplegia. Massage focuses on limiting muscle and fascial contractures, decreasing pain and maintaining tissue health. The percussive actions of tapotement are often beneficial here in decreasing mucous congestion in the lungs and upper respiratory tract that can occur with CP.

Peripheral Nerve Disorders/Injury
Peripheral nerves start at the spinal cord and travel out into the body’s organs and tissues to supply them with neurological information from the brain and spinal cord. When damaged, the tissues the nerve is in are directly affected and cease to function or do so with complications such as weakness and pain.

Sciatica: True sciatica results from injury or compression to the sciatic nerve roots where they exit the spine. This may result from injury to the spine or disc or an injury to the nerve itself. Massage can decrease associated muscle spasm and burning pain sensations. It increases circulation to the area and can reduce inflammation that may be present. Maintaining tissue health, muscle tone and joint range of motion become important goals in the treatment of sciatica. Postural education and associated muscle imbalances are also addressed.

A condition known as pseudo-sciatica or Piriformis syndrome may mimic the symptoms of true sciatica. The cause of the pain here is a compression of the sciatic nerve as it passes under, and in some cases, through a piriformis muscle that is tight and shortened in length. It is commonly experienced during pregnancy as the body changes and among office employees who sit for prolonged periods. The massage treatment for this focuses on restoring normal length of the piriformis muscle and other tight muscles in the hip and gluteal area. Range of motion exercises and stretching are performed along with myofascial release and Swedish techniques to reduce the compression of the sciatic nerve.

Carpal Tunnel Syndrome, common in today’s computer age, is the compression of the median nerve at the wrist, usually by fascial adhesions, muscle restrictions and misaligned wrist bones. It causes numbness, tingling sensations and weakness in the thumb and first two fingers. Treatment focuses on Myofascial release, reduction of adhesions, stretching and mobilization of the affected carpal bones. (A similar condition known as Tarsal Tunnel Syndrome can occur in the ankle).

Compartment syndrome occurs when a peripheral nerve is compressed by excessively tight muscles and fascia or excessive edema (swelling) around a nerve reduces its nutrient supply. In both cases, there is an increase of pressure on the nerve that leads to weakness and numbness in the surrounding area. Depending on the cause, treatment goals will vary; if excessive tightness is the problem, Myofascial, deep tissue massage, stretching and range of motion exercises will be used. If swelling is the problem, treatment will focus on lymphatic drainage and range of motion first and then address the soft tissue directly and reduce any adhesion or fascial restriction.

Thoracic outlet syndrome occurs when tight muscles of the neck and/or chest compress the nerve and vascular bundle at the top of the ribcage. It is a common condition, often associated with poor posture that causes numbness, weakness and sometimes pain in the arm and hand. Treatment focuses on Myofascial release, deep tissue massage and stretching of the affected muscles to relieve compression.

Respiratory Conditions
Asthma causes restriction in the muscles of the neck, chest and between the ribs, (the intercostals muscles). Massage and hydrotherapy techniques are used to reduce these areas of tightness and mobilize the rib cage so that the lungs can fully expand. Breathing exercises will also be given to help strengthen the lungs.

Sinusitis is an inflammation of one or more of the sinuses. It can be associated with allergies, headaches and facial pain. Treatment will include MLD to reduce the swelling (provided no infection is present), facial massage, tapotement to help clear fluids from sinus walls and massage and stretching of the neck and shoulder muscles. Contrast hydrotherapy is ofen given as homecare.

Postural Conditions
These are a group of conditions that affect posture and consequently, body alignment and function. They may be asymptomatic (without pain or other problems) or symptomatic (painful, inhibiting joint or muscle function). In some cases, these postural conditions can be secondary to disease processes such as arthritis or Parkinson’s and may even affect the function of the diaphragm and organs. A person may also be born with postural conditions.

Scoliosis is a curvature of the spine that results in muscle spasm on one side of the spine and weakness on the other. There are various presentations and it can range from mild to debilitating.

Hyperkyphosis is an exaggerated forward curve of the spine in the upper back. It results in tightness and restriction in the chest and diaphragm, loss of range of motion of the neck and shoulders and weakness in the spinal muscles. It can also affect the curvatures of the neck and low back, usually increasing the curve of the neck (hyperlordosis) and decreasing that of the low back (hypolordosis)This condition can be caused by poor posture/slouching.

Hyperlordosis is an increase in the natural curvature of the spine at the neck or lower back. This can be secondary to myofascial imbalances, prolonged postures and poor postural habits. It results in spasm of the muscles on either side of the spine around the curve and weakness in the muscles that normally counterbalance the spine for proper posture. When present in the low back, it can result in a decrease in the natural curve of the mid and upper back (hypokyphosis).

Flatback posture is present when all natural spinal curvatures are decreased.

Treatment for all includes massage, hydrotherapy, trigger point therapy, range of motion and myofascial release as well as stretching and strengthening exercises to lessen the curvatures, relieve discomfort and improve joint function.

Serious Illnesses/Palliative care

Cancer
It is important to note here that the main focus of massage here is to provide emotional support and stress reduction during and after medical cancer treatments. Your doctor should be informed that you wish to have massage and when appropriate, your therapist may request permission to open a dialogue with your doctor regarding a proposed treatment plan for massage.

During treatment such as chemotherapy or radiation the massage focuses on stress reduction and relaxation. Light Swedish techniques that don’t promote circulation may be used to help reduce muscle tension and pain. Gentle stretching and range of motion exercises may also be applied here.

After a medical treatment is completed, your doctor should approve any changes to a massage treatment plan. Hydrotherapy and manual lymph drainage can help reduce swelling and improve skin health and, once the skin has healed, gentle fascial techniques and stretching can increase scar tissue mobility and decrease fascial restrictions, pain and muscle contractures.

Many family members also find massage useful in reducing stress levels and managing self-care during this time.

Reiki is also a wonderful treatment to aid in relieving the stress and body pains that occur during and after cancer treatment.

HIV/AIDS
Massage benefits persons living with HIV/AIDS by focusing on emotional support and stress reduction to decrease the pain response. It helps eliminate pain-causing toxins from the body by increasing circulation and reducing fatigue and generalized muscle ache. Massage is also useful in managing secondary conditions such as peripheral neuropathies and arthritis. The massage treatment plan is symptom oriented as requested by each individual and your therapist will keep an open dialogue with you regarding changes in your medical treatments, other alternative therapies and medications. You should inform your doctor that you are also receiving massage therapy.

Many family members also find massage useful in reducing stress levels and managing self-care during this time.

Pre- and post-operative care (surgery)

Massage benefits before surgery:

• increases tissue flexibility and pliability
• ensures regulated blood flow to area
• decreases any pre-existing scar tissue
• decreases/eliminates pre-existing fascial restrictions

Massage benefits after surgery:

• increases the rate of healing
• decreases inflammation/edema
• decreases scar tissue and/or increases scar tissue mobility
• restores normal range of motion and muscle strength
• restores normal circulation to area and improves skin health

Insomnia
This is a condition that afflicts many people for a wide variety of reasons. Any combination of massage, hydrotherapy, guided imagery, visualization, aromatherapy and other relaxation techniques may be used to provide a stress reduction treatment.

The goal here is to increase circulation, aid in relaxation and decrease malaise, muscle fatigue and levels of cortisol, a stress hormone.

Your therapist may also suggest homecare regimens including meditation, reading, salt baths, a ‘sleep-time routine’, yoga or other light exercise. In all cases, the cause of the insomnia should be isolated as this will assist in formulating your specific treatment plan.

Fibromyalgia
Although the causes of fibromyalgia are thought to be varied and predominately unknown, massage can benefit those diagnosed with this condition by treating individual symptoms and addressing common musculoskeletal imbalances which may be an additional stress to the body. Tender points associated with fibromyalgia may be treated with gentle massage, myofascial release to surrounding areas, stretching and strain-counter strain methods. Massage aids in reducing restrictions and clumping of the body’s connective tissue, increases circulation, decreases the levels of the stress hormone cortisol, provides pain management and reduces excess muscle tone. Massage also helps to regulate sleep cycles and better sleep allows your body to repair itself more efficiently. Prescribed exercises will help increase energy levels, strengthen the body and prevent symptoms of depression.

Please refer to the chronic pain discussion.

Tendonitis
Usually a result of overuse, tendonitis is the inflammation of a tendon. Tendons attach muscles to bones. A fluid filled sac, called a ‘tendon sheath’, surrounds some tendons. When this sheath is inflamed as well, it is referred to as tenosynovitis.

Tennis elbow and golfer’s elbow are common forms of tendonitis.

A massage treatment for tendonitis uses stretching to restore normal muscle length and strengthening exercises to restore muscle balance. Adhesions and scar tissue are eliminated using a frictioning technique without oils. This breaks downs the scar tissue for realignment with massage and stretching. It is important to rest the area affected by temporarily limiting activities that caused the initial condition, tennis for example. Gentle mobilizations and range of motion exercises help maintain joint health. After a gradual return to activity and several massage sessions, it is recommended that massage be used as a preventative measure to future flare-ups.

Strain/Sprain
A strain results from a tearing of muscle and/or tendon fibres. It may be mild, moderate or severe. A sprain results from tearing of ligament fibres. Massage focuses on eliminating inflammation, residual edema and scar tissue formed during the healing process. The goal then becomes to restore range of motion, muscle length and strength and return to normal activities.