Online massage booking        Find us on Facebook    Google+    twitter RSS

Massage Swaps

There are very few people who do not benefit from massages and massage therapists are no exception. In fact, given the physical nature of the work often with suboptimal postural position, massage therapists probably need more massage than some other professions.

There are often debates on social networks about the merits of fellow massage therapists trading massages.

Massage exchangeIt can be a great way for students to practise their strokes and receive constructive criticisms about their bodyworking style in a non-threatening environment. They can learn and discuss new techniques. They can ‘talk shop’ about the massage industry, their ideas and their business plans.

However, professional therapists who trade massages in Sydney tend to be the exception rather than the rule.

In theory it should seem logical that therapists work on each other. However, in practice, even though most therapists try it at some stage in their career, most end up deciding that paying for massages works better for them.

There are a number of reasons for why professional do not tend to swap massages.

– They struggle to find someone that they want to receive regular bodywork from who also wishes to trade.
– They struggle to find suitable times that work for both parties.
– Very few therapists like to do a mutual swap within the same session. It is always very hard to get up from a massage table and then have to give your trade partner a massage straightaway.
– If they do find a massage swap partner who they do like, it is very rare that the bartering relationship is completely reciprocal. As often occurs in any relationship, one party tends to feel that they are investing more than the other. Eg one therapist may cancel or put paying clients ahead of their trade partner.

  
Most therapists tend to find swap partners when they are studying and it may well be that they only swap whilst they are learning new modalities or techniques. There are massage exchange websites where therapists can check out other massage practitioners who they may wish to consider swapping with. However, as a word of caution, many those with register with these sites may be after a sensual massage swap.

Even therapists who find that they are compatible with respect to swapping massages often drift away over time and what might start out as a weekly or fortnightly swap, ends up being just an occasional massage. In the end most experienced therapists end up preferring to become just another paying customer with therapists they enjoy receiving bodywork from.

By Richard Lane

Stretching and Injury Prevention

Does Stretching Prior to Exercise Reduce the Risk of Injury?

We are all told that we should stretch before undertaking vigorous exercise but does scientific research support this. Pre-workout stretching seems to be a logical thing to do as tight muscles/tendons probably have a greater susceptibility to strain during exercise (when compared with relaxed-flexible soft tissues). However if we stretch are we less likely to get injured? The research evidence is contradictory.

Some studies have found support for the hypothesis, others no difference (and some that stretching prior to a work-out can actually increase the prevalence to injury!). For example in a study of 1543 athletes who ran in the Honolulu Marathon, 47% of all male runners who stretched regularly were injured during a one-year period while only 33% of male runners who didn’t stretch were hurt (1).

ExerciseEven when the research accounted for the fact that the strongest predictor of a future injury is a past injury and excluded runners who had taken up stretching after a previous injury, the stretchers had a 33% greater risk of injury. The stretchers did not run any more miles than the non-stretched individuals.

However, this study also concluded that stretching after workouts reduced the risk of injury. The conclusion was made that stretching must be carried out when muscles are warm (and thus less resistant to being stretched out) to be protective.
In a similar stduy (2) 159 runners were instructed how to warm up, cool down and stretch effectively while a second group of 167 similar runners received no instruction at all. Over a few months, the injury rates of the two groups were identical so the instructed warm-up, cool-down and stretching provided no protective benefit.

However, other studies have found that stretching may be beneficial. A study of military recruits who practised a series of static stretches before and after training were compared to a control group who performed no stretches (3). The stretching group demonstrated a significantly lower rate of muscle-related injuries but no difference in the rate of bone or joint injuries.

In a review of the literature, Thacker et al (4) stated that “There is not sufficient evidence to endorse of discontinue routine stretching before or after exercise to prevent injury among competitive or recreational athletes”.

  
(1) Lally D. ‘New Study Links Stretching with Higher Injury Rates’, Running Research News, Vol. 10(3), pp. 5-6, 1994
(2) van Mechelen W, Hlobil H, Kemper HCG, et al. Prevention of running injuries by warm-up, cool-down, and stretching exercises. Am J Sports Med 1993;21:711-19.
(3) Amoko et al. “Effect of static stretching on prevention of injuries for military recruits.”
(4) Thacker et al. “The Impact of Stretching on Sports Injury Risk: A Systematic Review of the Literature”. Medicine & Science in Sports & Exercise. 36(3):371-378, March 2004.

Massage and Physiotherapy

Often when people ring to enquire about the nature of the Sydney remedial massage services that we offer there is some confusion and misunderstanding about what the differences between physiotherapists and remedial massage therapists. Some people believe that we offer similar services but this is not the case. Whilst there is a degree of overlap between the two professions, there is significantly more that is different.

Historically there are suggestions that the first chartered society of physiotherapists formed from remedial massages so there is a degree of commonality between them. However, since that time physiotherapists and physical therapists have moved away from this background and offer distinctly different treatments and therapies from remedial massage therapists who have largely stayed constant with their approach. Remedial massage therapists still rely on the same touch and palpation skills to provide the same benefits for their clients and there is no reason why the effectiveness of the application of these skills will have changed over the years.

Massage Therapy
physiotherapy and massageMassage therapists rely on touch to deliver remedial bodywork to their clients. There are many different massage modalities available such as deep tissue, sports, Swedish, Thai, trigger point therapy etc and they all work on the soft tissues of the body (mainly muscles but also tendons, ligaments and connective tissue/fascia). Massage therapists do not do any manipulation and, most importantly as a means of distinction from physiotherapists, they do not have sufficient training to be considered as diagnostic practitioners. If you are after a firm diagnosis of any condition you are faced with then you will need to see someone other than a massage therapist (although your masseur should be able to advise who to see for diagnosis).

People will most commonly see remedial massage therapists when they are suffering from muscular and soft tissue complaints. Sessions will typically last around an hour (or longer) and the therapist will use their hands, fingers, knuckles, elbows and forearms to provide the manipulation to the soft tissues. Although most remedial massage sessions have a direct therapeutic objective, for many people an added benefit is that, whilst the massage itself may be a little painful and intense, it will always provide a degree of relaxation for the massage recipient.

Physiotherapy
Physiotherapists will treat people who are suffering from injury or physical condition using a range of different techniques. Whilst hands on bodywork may be incorporated within this treatment, typically it is only a small component of any session. A typical physical therapy session will involve some assessment, some bodywork (if appropriate), application of ice, ultra-sound or tens machines and some corrective exercise therapy (which will normally involve exercises that the patient may do away from the clinic).

Typical injuries that may be treated by physiotherapists are both acute and chronic in nature. It is not uncommon for a physiotherapist to be seeing two or three patients simultaneously and so you may experience times during your session as the physiotherapists when you are not actually being formally treated by the therapist.

===============

If you are not sure who you should be seeing then it is always advisable to talk to any potential practitioner about your requirements prior to booking. You have the right to expect an honest answer regarding their suitability and appropriateness (although sometimes it can be a little tricky to make complete assessment over the phone). You should ask them about the nature of the treatment that you can expect.

As a rule of thumb, if you are suffering from an acute injury or require a firm diagnosis of your condition then it is probably preferable that your first port of call be a physiotherapist. It may be that after a few sessions then massage therapy may become more relevant for your treatment (generally in our view most people would sooner experience a massage assuming that their treatment goals are met).

  
If your condition is more general and chronic in nature, such as stiff neck or ongoing sore shoulder then massage therapy may be appropriate. This is particularly the case if you wish to have a more general approach with the therapist devoting their time solely to your body rather than a session that is totally dedicated to dealing with the soreness in your left forearm, for example.

Regardless of the therapy you receive, then it is suggested that you talk to your therapist about goals and milestones with the treatment program. If you do not feel you are progressing at the rate you would like then it may be an idea to consider alternative treatments (although it is also recommended that you give a therapist a fair opportunity to make progress and not just chop and change after one or two sessions).

Baby Massage

Babies like massage. It helps them sleep better and to relax. Many traditional cultures have used massage as part of baby care, and research indicates that it can have many benefits. Infant massage allows you to understand and respond to your baby’s body language. It is also a fantastic way to let your baby feel safe and secure.

Infant massage should be a wonderful experience for both the parent and the child, and whilst it does not necessarily come naturally to parents, it is need not be difficult and it can be learned from others practicing or from specially designed infant massage classes.

The Benefits of Baby Massage
Baby massage1. Provides relief from discomfort
Oxytocin and endorphins can be released through massage and these assist in relieving discomfort from teething, congestion and colic. For example a very gentle daily abdomen massage (a specific sequence provided by a trained practitioner) can assist in moving and releasing small amounts of gas trapped in the colon. If the small amounts of gas are consistently being eliminated then it may be possible to prevent the build up of gas and reduce impact of baby colic.

2. Speeds development of the brain and nervous system
Skin stimulation can speed the process of myelination of the brain and nervous system which improves the body-brain communication.

3. Relaxation and enhancement of neurological development
During a baby massage the child can experience both stress and relaxation stimulae. Increased circulation, cool air on the skin, the stimulation of stroking, may be stressful to a newborn, yet if these are balanced with the reassuring the parental voice and touch, then the baby will undergo a learning experience.

4. Sleep
Some babies sleep for longer periods following infant massage and also appear to have longer periods of deep sleep. However it should be noted that a course of action that is effective with one baby does not necessarily apply to the next. There are cases where the problematic sleep pattern of babies is not improved by infant massage.

Other benefits include:

  • Enhances the bonding process
  • Helps muscle tone and assists growth
  • Strengthens the immune system
  • Increases Circulation
  • Improves sensory awareness

Baby massage provides quality time between parent and baby and enables parents to feel more confident in their role and provides parents with a great tool for aiding their child to relax during stressful times.

Tips for a Great Baby Massage
To begin with then choose a time in which you and your child are relaxed and calm eg 30 minutes after the baby has eaten may be a great time. Do not massage infants under 5 months of age in conjunction with bath time. This is over-stimulating. For young infants, massage and bath time need to be separated by a nap or night- time sleep as they are both quite stimulating.

  • Place the baby on a soft surface and your baby will feel comfortable and secure.
  • The room needs to be warm enough for your baby to be comfortable without any clothing.
  • Don’t not apply cold cream or lotion directly onto your baby but warm it first by putting the cream onto your hands and rubbing them together.
  • Always begin with massaging the legs. This is an unobtrusive way to begin a massage as the legs are touched constantly while changing nappies. To place your hands directly on the infant’s chest or abdomen to begin massaging can be intrusive, and unacceptable to many infants.
  • Use long firm (but tender) strokes. Light, feathery massage tend to irritate babies infants, as it does most adults.
  • During the massage then feel free to look at your baby tenderly. This will stimulate all the senses of the baby and establish a more intense visual and tactile communication. Speaking to your baby during the massage will also add to the experience.
  •   

  • If the baby wants to change position let them do so. Do not force your baby to keep a position, you can go back to these areas later on. Never watch the clock while massaging your baby. Simply go by what your child is indicating they want. If your baby wants more massage, and you are willing to continue then keep going. If you can see that your child has had enough – stop, regardless of how much massage you managed to get through.
  • Never massage your baby while they are is crying. (The only exception for this may be with colic, and painful gas). Any arm movements going in and out from the chest indicate that you should stop the massage.

Remember that your touches should be tender and consider being flexible and not keeping to a rigid routine.

The Benefits of Abdominal Massage

Many massage therapists will spend the vast majority of session working on the back of the client. They will give great bodywork to the back, shoulders, neck and the back of the legs but then only give cursory attention to the front of the body. Now it is true that most of us have significant issues with the back of our bodies but to neglect the muscles and soft tissues at the front of the body is to provide an incomplete session. Only a few therapists would routinely incorporate an abdominal massage within a full body massage, yet there is little doubt that bodywork through the stomach area can offer many health benefits.

Abdominal massageMost people who do request an abdominal massage would likely do so because of digestive issues although there is also significant musculature in the area that may require release to assist with physical problems. For example, a tight and contracted rectus abdominis muscle will impact on the stability and movement of the lower part of the body or lead to us slouching forward setting up postural imperfection through the lower back.

In total there are at least four layers of muscles in the abdomen and these can impact on your core strength (both your physical and emotional core). Trigger points are not uncommon in the abdominal muscles and the pain referral patterns can include the lower back. Simons and Travell (1) observed that

An active trigger point high in the rectus abdominis muscle on either side can refer to the mid-back bilaterally, which is described by the patient as running horizontally across the back on both sides at the thoracolumbar level … In the lowest part of the rectus abdominis, trigger points may refer pain bilaterally to the sacroiliac and low back regions.

Regardless of the requirement for remedial massage and trigger point techniques for hypertonic muscles in the abdomen, the vast majority of abdominal massage will be for digestive issues. Most therapists consider that massage to the stomach areas will improve the capability of the digestive system and will potentially benefit some of the organs that are contained within the abdominal cavity (such as liver, pancreas, gall bladder, small intestine and colon). A recent review of research has confirmed that there are likely to be benefits for performing abdominal massage to treat chronic constipation. Sinclair (2) concluded “studies have demonstrated that abdominal massage can stimulate peristalsis, decrease colonic transit time, increase the frequency of bowel movements in constipated patients, and decrease the feelings of discomfort and pain that accompany it. There is also good evidence that massage can stimulate peristalsis in patients with post-surgical ileus.”

Routine for Abdominal Massage
In order to give an abdominal massage then the stomach needs to be exposed and it is usually recommended that there be some bolstering under the knees to slightly relax the abdominal region. Normal massage lubricatants are fine to use.

– Place your hands gently on the stomach and palpate. The stomach should feel soft and relaxed

– Always be aware of the breathing of the client and work with the breathe, not against it.

– Sink in through the diaphragm region with the breathe of the client

– Lightly work along the lower border of the rib-cage with fingers and thumbs.

– Gently effleurage the area with light circular strokes. Always work in the direction of the digestive system which means working clockwise around the stomach.

– Place your hands over the rectus abdominis and gently palpate for areas of tenderness and restriction. Work the edges of the muscles with static compression (asking the client to tense the muscle by have them start to sit up) with sufficient pressure to be therapeutic but not too much that it causes pain. Release attachments at the xyphoid process (obviously without ever putting direct pressure on the vulnerable process itself). Release the attachments at the upper border of the pubic bone (mindful of the sensitive nature of this area – if client has any concerns then you can get them to use their own hand to achieve this release or alternatively work through a drape).

– Work deeper under the ribcage on both sides of the body (be aware of working too deeply directly into the liver which is on the right side of the body). Cross friction at any tender points.

– Pull through the sides of the body with relaxed hands, reaching around the body as far as possible, working and stretching the fascia.

– Work the ascending colon (right side) and descending colon (left). Make sure you connect with sufficient pressure through colon although not too much so that it causes pain. Some therapists recommended clearing the descending colon first too “make room”.

– Finish with a calming connective touch to the abdomen.

  
Normal massage contraindications would apply for abdominal bodywork and if the massage is to be performed for a specific health objective then it is recommended that it be discussed with suitable doctor prior to treatment. Also be aware that many people may have emotional sensitivity and instinctively be highly protective of this so any bodywork needs to be mindful and respectful

1. Simons DG, Travell JG. Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1, Upper Half of Body, 2nd Edition. Lippincott, Williams and Wilkins, 1999:943.
2. Sinclair M. The use of abdominal massage to treat chronic constipation. J Bodyw Mov Ther 2011; 15:436-445.

============
Update – a 2011 review of the effect of abdominal massage in chronic constipation found that abdominal massage can stimulate peristalsis, decrease colonic transit time, increase the frequency of bowel movements in constipated patients, and decrease the feelings of discomfort and pain that accompany it.

“The use of abdominal massage to treat chronic constipation.” Sinclair M.
J Bodyw Mov Ther. 2011 Oct;15(4):436-45. doi: 10.1016/j.jbmt.2010.07.007. Epub 2010 Aug 25.
============

By Richard Lane

PNF Stretching

PNF stretching is considered to be the most effective way to increase static flexibility and is a combination of static passive stretching and isometric stretching. PNF stands for Proprioceptive Neuromuscular Facilitation and was first developed as a treatment for paralysis patients.

PNF stretching is usually carried out with a partner who provides the resistance for the isometric contraction although it can be done without a partner (but generally will be less effective). If using a partner, then it is important that the partner be attentive and focused.

Pnf StretchingThe most commonly used PNF technique is the “Hold-Relax” which is sometimes referred to as the “Contract-Relax”. The muscle is stretched passively towards the limit of its range of motion and then the muscle being stretched is isometrically contracted for 5-15 seconds after which the muscle is relaxed for a couple of seconds before being subjected to a passive stretch which should be greater than the initial passive stretch. This stretch is held for around 10-15 seconds before repeating the PNF stretch one or two more times.

PNF Stretching Examples: Hamstring Stretch
For an example of a PNF stretch, then the person being stretched lies flat on their back with one leg bent at 45 degrees and the other leg extended straight. The partner lifts the straight leg until a comfortable stretch is felt through the hamstring (nb partner just supports the stretched leg and does not push). This stretch is held for 15 seconds.

The stretchee should then isometrically contract the hamstring against partner’s resistance for 5-15 seconds, relaxes and the partner gently guides the hamstring to a deeper stretch. This is repeated a few more times until there is no further increase in range of motion.

Brief PNF Physiology of Stretching
Muscles spindles cells located within the muscles, protect the muscle from injury. They sense how far and fast a muscle is being stretched and when activated produce a stretch reflex. This reflex causes the muscles to contract to prevent overstretching the muscle.

Located within the muscle tendon is another sensor called the golgi tendon which senses how much tension is being put upon the tendon. When the golgi tendon is activated then it relaxes the muscles (unlike the muscle spindle).

A voluntary contraction during a stretch increases the tension on the muscle, activating the golgi tendon organs more than the stretch alone. So when the voluntary contraction is stopped the muscle is inhibited from contracting against a subsequent stretch. PNF stretches uses this to take advantage of the sudden vulnerability of the muscle and its increased range of motion by using the period immediately following the isometric contraction to train the stretch receptors to get used to this new, increased, muscle length. This is accomplished by the final passive stretch.

Some General Recommendations for PNF Stretching

•Leave 48 hours between PNF stretching routines
•For each muscle group complete 2-5 sets of the chosen exercise
•Each set should consist of one stretch held for 10-15 seconds after the contracting and relaxing phases
•PNF is not recommended for anyone under 18 years old
•A 5-10 minute thorough warm up is recommended before performing PNF stretching as a separate exercise session.

While most of us could obtain benefit from the improvement in flexbility that PNF stretching can bring, there is some conjecture amongst sports professionals about the effective of stretching in general to reduce the risk of injuries and to improve performance. Although there is some conflicting evidence reported, on balance research literature reviews such as reported by Thacker et al (1) support the hypothesis that routine stretching has little impact on reducing total injuries amongst competitive or recreational athletes.

  
However, research has also found that pnf stretching may lead to improvements in running mechanics. Caplan et al (2) concluded from studying rubgy league players that stretch training at the end of regular training is effective in improving running mechanics during high velocity running.

As with all stretches, only take a PNF to the limit of what feels comfortable. Pain is an indication that you are overstretching.

In addition, there are advantages and disadvantages of PNF stretching and it may be worthwhile discussing these with a suitably qualified sports therapist.

(1) Thacker SB, Gilchrist J, Stroup DF, Kimsey CD., Jr. “The impact of stretching on sports injury risk: a systematic review of the literature”. Med Sci Sports Exerc. 2004;36:371-378
(2) Caplan N, Roggers R, Parr MK, Hayes PR. “The effect of proprioceptive neuromuscular facilitation and static stretch training on running mechanics.” J Strength Cond Res, 2009, 23: 1175-1180

By Richard Lane

Therapeutic Breast Massage

Breast massage can be a contentious issue amongst therapists. Some promote that there potential health benefits through lymphatic drainage; others are less enthusiastic about any advantages of performing breast massage. Some are concerned about the personal nature of any Sydney massage that involves touching of breast tissue; others are more relaxed.

However, it must be mentioned that professional associations have policies regarding breast massage. For example, the Australian Association of Massage Therapists offers a policy development document on this issue at http://membership.aamt.com.au/lib/Journals/Summer06/AAMTbreast.pdf.
Within this document they state:

Massage therapists must recognise, accept and respect the right of every individual client to choose whether they wish to decline breast massage …..
Even when agreement with the client for the breasts to be included in a treatment is granted, it is entirely inappropriate and completely unnecessary to provide disproportionately prolonged massage to the area and that that the client is free to revoke that consent during the massage.

AAMT suggest that massage of the breast tissue is currently practiced in modalities of Manual Lymph Drainage, Lymphodema, Lomi Lomi and post surgical breast augmentation and when specifically prescribed by a Medical Practitioner. During a standard remedial or relaxation massage then there is no reason for the breasts to be massaged and the ATMS policy is that mammary glands should not be massaged and only professional techniques should be applied to surrounding tissues.

This last point can cause a little confusion from massage recipients though. For example, the pectoral muscle groups are often indicated when people have tension in their neck and shoulders. Tightness in the upper back muscles is often the result of excessively hypertonic pectoral muscles bringing the shoulders forward. Therapists may often feel that lengthening these muscles of the upper chest is important for improved posture yet to access these muscles then the therapist needs to work close to breast tissue.

Massage for the pectoral musclesThe picture to the right on this page of this page demonstrates a therapist performing a remedial massage technique on the pectoral region. It is easy to image that, on women with a larger bust, performing such a stroke for the pectoralis major and pectoralis minor muscles would be extremely difficult without touching breast tissue.

But this stroke would not be applying massage to the breast itself.

  
Therapists do need to be mindful of such strokes, explaining why they need to work in this area and soliciting permission from the client before commencing. The client also has the right to request the therapist stop should they ever become uncomfortable about the nature of the touch. Some therapists may ask the client to hold their breast to provide a physical barrier between the therapist’s hand and the breast.

As mentioned above breast massage in Sydney is not permitted within a remedial or relaxation massage. I have included the technique (with client permission) during Lomi Lomi massage. Within a traditional Lomi Lomi massage then including massage to the breasts is considered to be a normal part of the routine and whilst there is obviously no muscles within breast tissue, there are claims that it can reduce pain and stress in the chest.


Tweet