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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.

Breathing and Neck Pain

Have been seeing a few clients lately with neck pain with trigger points present in their scalenes muscles. These muscles are side of the neck (more towards the front than the back) and they are used to tilt the neck and also stabilise the ribs when breathing.

Typically this arises when the person is what is known as paradoxically breathing or thoracic breathing when we should be diaphramatically breathing.

Some people can diaphragmatically breathe in one position but not in another. For example, many of us fail when we are sitting typing on a computer. Yet, We should be able to breathe correctly whether standing, sitting or lying.

One technique that is often used to train our breathing patterns is to put your right hand on your chest and left hand on your stomach. With your eyes closed then breathe in through the nose to a count of around 4 and then exhale via the mouth. This exhalation is also performed to the count of four. Whilst this exhalation is taking place then the abdomen should be returning to the original position.

This exercise should be practiced for around 60 seconds at any one time and should be repeat during the day whilst standing, sitting and lying down.

A demonstration of breathing exercises is shown in the video below.

  

Do you cheat when you stretch your quads?

Many people “cheat” when they stretch their quads. The standard stretch for the quads that you will see many people doing is to stand on one leg and bring their foot to your butt.

However, the chances are that their alignment is such that they are not actually stretching the quads at all, but merely compensating by hip or trunk rotation.

(If you can cope with the sound of young children) The following video explains how best to perform a genuine quad stretch.

Free Massages – How Not to Give Them

When you are a student massage therapist then providing a free massage for Sydney family members and friends is considered part of the training. In return for you giving them a massage then you get the chance to practice strokes and techniques that you may have learnt in class. In addition, you can solicit feedback from the recipient of the free massage.

It is a win-win situation.

However, once you have qualified and start working as a massage therapist then this synergistic situation changes. You are confident of your skills and how your bodywork is received by clients and client feedback is less important for you.

If you have been working hard at a clinic, doing mobile massage or at a spa then the last thing you want to be doing when you get home is to give away a freebie.

free massage in SydneyUnfortunately from the therapists point of view though friends and family don’t necessarily see it this way and many therapists are frequently asked to give them a few minutes of time to massage their stiff neck or sore shoulder.

A question that is often posed is how can I, as a therapist, politely decline to work on them?

On a recent Facebook posting, therapists gave suggestions on how to deal with this issue. The most common response was along the lines of handing the person your business card and asking them to call to make a booking.

Here of some of the other answers.

I say in a funny sarcastic yet friendly way, “I have all my free massages when I was in school for two years. I have to pay off my student loans before giving anymore free massages.”

I’m just honest. I tell them that I don’t have the stamina on my days off and they always understand. If I can tell someone is just trying to get a freebie, I tell them they can have a business card. They laugh and say, “Smart answer”.

Tell them you’ll trade if they work on you first

When family and friends come crying to me about what is hurting on them (hinting about wanting me to work on them) I always reply by telling them what is hurting on me. They usually get the hint

It seems that people think that because we are MT’s, that we never hurt. Typically don’t like it when I say… Yeah, my neck and back are killing me too!

Sometimes if my friends say “Oh, my back hurts so badly!” I answer with, “I’m sorry, I wish I knew someone who could help”

Make an appointment, today’s my day off.

“Sure! I’ll trade you. I can always use a massage! 5 minutes for 5 minutes?” “Uhh.. uhh… uhh… “

  
But probably my favourite is

If you know someone who is a mechanic, and says “My back hurts, can you help me?” answer: My car needs brakes, can you help me later tonight?
If you know someone who does daycare and they ask for free massage, ask them in turn to babysit your kids for free when they get off work.
You get the point. If they wouldn’t work for free, why should you?

By Richard Lane

Pain Between Shoulders

Although there are any number of reasons that people call for remedial massage, probably one of the more common is for pain between the shoulder blades. This can be an isolated pain or it can be in conjunction with neck pain and stiffness or headaches. The pain can be persistent and chronic or it can appear acutely after a particular activity or movement.

Many people will believe that the root cause of the problem lies in the muscles between the shoulders blades, namely the rhomboids. If they book in for a massage then they will expect that the therapist pays particular attention to these muscles and the muscles around the area to reduce the tightness and tension.

MHowever, often the problem is not associated with tightness in the area but weakness. Tightness in other muscles is causing the muscles such as the rhomboids to become irritated because they are over-stretched not because they are overly tight. A massage therapist that tries to eliminate the tightness by stretching and adding length to the muscles may even be adding to the problem.

Often postural professionals will refer this condition with terms such as forward head posture or upper cross syndrome. The pain between the shoulders actually results from the complex interaction of the muscles around the shoulder girdle. It comes about from an increase in tightness in the muscles at the front of the neck and upper chest and weakness with the upper back and back of the neck (technically muscles such as the levator scapula, pectoralis major, suboccipitals, SCM and upper trapezius tend to be tight whereas the lower trapezius and rhomboid muscles tend to be weak).

Typically when you have your posture checked, a therapist would notice that the shoulder blades (the scapulae) are depressed lower than they should be and they are spread apart towards the sides of the body. When the shoulder blades are in this position, the traps and the rhomboids are stretched to their maximum and they struggle to hold the weight of the arms. The force of gravity leads to a constant pulling on the muscles and nerves in the area. The results is pain in and around the neck, between the shoulder blades and even down the arms.

Postural awareness is the first starting point for reducing the impact of upper crossed syndrome or forward head posture. Left untreated it can lead to degenerative changes in the upper back and result in constant neck pain, back pain and contributes to the formation of the Dowager’s Hump and be implicated in TMJ dysfunction.

  
Being mindful of when you are performing repeated tasks with you arms extended in front of you (such as typing on computers or driving) is a good starting point. However, restoring the balance between the muscles of the shoulder girdle is of prime importance and this can often be quite a challenge as normal movement patterns may have been compromised by persistant pain.

Massage can help to address some of the issues associated with these problems, in particular by releasing those muscles that are pulling the shoulders blades forward and down. Your therapist can also suggest stretching exercises for the upper chest and strengthening exercises for the upper back.

When Massage is not Perfect

Most massage devotees know the benefits that massage brings to them in their life which may be physical, emotional or spiritual (or a combination thereof). Once people find a therapist that they are happy with then they will generally stick with that therapist so that they know that they will get a great bodywork experience each time. They have a good dialogue with their therapist who knows what they do and do not like for their massage session.

However, there are times when circumstances dictate that you may need to see a different masseur such as you are in a different town or your normal therapist is not able to fit you in.

when massage goes wrongNow you are probably comfortable to accept that the massage will probably not be as good as the one you are used to but there are a number of reasons why it may not be the experience you are looking for. For me, these include:

(1) The therapist performs a “cookie-cutter” massage. They just do the massage they normal do and there is no attempt to customise the massage to any requirements you may have let the therapist know. This approach may be ok if you are just having a relaxation massage in a day spa but if you are after any type of remedial massage then there is nothing more annoying than the therapist spending minimal time on parts of the body that you really want to be massaged.

(2) When an hour’s massage includes the time to discuss your requirements and your undressing/dressing time. If you are paying for a massage but end up only getting 45 minutes of hands-on time then you will feel cheated and any relaxation that the massage achieves can dissipate instantly.

(3) Being basted with oil. I really do not like excessive oil and it’s a turn off if the therapist is constantly reaching for the bottle of lubricant to apply more and more oil or lotion. Less is more when it comes to massage, in my view. How can a massage therapist feel the soft tissues and muscles when their hands are skidding over the skin like a skater on ice?

(4) The therapist being a poor time keeper. If you are having (and even enjoying) a “cookie-cutter” massage you realise that the routine the therapist is performing is being curtailed and rushed on one side of the body compared with the other. It may be that your right leg gets 10 minutes of care and attention but, as the clock ticks on, the left side only ends up with a cursory couple of strokes.

(5) A distracted therapist. Answering the phone or door or talking to any other therapist is a no-no for me. I’m paying for you to massage me not plan later appointments (or even worse your social life). Also just going through the motions with the massage and not using your hands to listen to what my body is telling you.

(6) Bad breath.

(7) Incidental contact with other parts of your body other than the massage tools you intend to use. Your stomach bracing against my head as you stroke down my back or your boobs in my face whilst you are working on my chest or stomach is not professional.

(8) Lack of thought with music. I don’t like the radio on during a massage and I don’t like Adele.

  
This is not meant as a critique of the massage profession in general but more a whimsical depiction of some of the more negative experiences I have had during massages and some of the things I specifically do not like. It is not to decry the positive energy I normally get from massage.

However, feel free to add any others you may have in the comments section below…..

By Richard Lane

Swearing and Pain Relief

Many massage therapists will tell you that massage should not be painful and “no pain – no gain” should not apply to bodywork. If they are causing you pain then you should let them know so that they can back off their pressure or change the massage “tool” they are using or work elsewhere to try to achieve their objective.

However, there are occasions when the therapist does need to cause a little (or significant) pain to release a restriction or tight muscle through deep tissue techniques. Sometimes you have to go one step back to go two steps forward and this is approach is often employed physiotherapists who do soft tissue work.

pain relief during massageThe pain can be intense albeit often only for a short time whilst the therapist is doing their stuff. (Am speaking from recent experience for a hamstring problem which has had my therapist well and truly getting stuck into my glutes which is only good when he finishes).

Makes you feel like letting fly with words and expletives that you wouldn’t normally use in public.

Well, researchers have found that swearing can have a positive impact on pain tolerance so long as swearing is not part of your everyday vocabulary (1).

In the study, participants were asked to place their hand into room temperature water for three minutes to act as a baseline. They then had to place it in water at 5°C for as long as possible whilst repeating either a specific swear word or a specific non-swear word.

The results from the research were that people who did not swear very often in daily life could keep their hands in the cold water for about 140 seconds when they were permitted to swear. This was about as twice as long as the time when they used the specific non-swear word.

However, for those people who stated that swearing was part of their daily speech, they could only keep their hands in the cold water for about 120 seconds when they used the allowed swear word.

  
The researchers concluded from the study that swearing can be an effective form of short term pain reliever if used in moderation by providing a type of “stress-induced analgesia”. If swearing is part of your normal vernacular though this can water down their emotional benefits.

So the next time your therapist is getting well and truly stuck into some soft tissues and it hurts, don’t be shy. Feel free to let fly with the words you wouldn’t be using in polite company and give yourself some natural and free pain relief with no side-effects (other than maybe a little post-massage embarrassment).

Will you feel better for it? ******* oath you will!

(1) R. Stephens, C. Umland. “Swearing as a Response to Pain – Effect of Daily Swearing Frequency”. The Journal of Pain. Vol 12 Issue 12. Pages 1274-1281. Dec 2011

By Richard Lane

Sports Massage Does Work!

In recent years there seems to be have a move towards more evidence based practise for a range of practitioners. This is not a bad thing for the massage industry as many of the more spurious claims that are made can be challenged and dismissed. However, one of the problems that massage faces is that there is a dearth of quality research available.

There are a number of reasons why this is the case which include a lack of money when compared with the amount of funds available for pharmaceutical trials and also a fundamental problem with much of the research in the natural therapies domain in that designing standard treatment protocols is extremely difficult when most therapists’ practice is based on tailoring a treatment to an individual client’s needs at the time.

A 2012 study into the benefits of sports massage has attempted to redress the issue of quality massage research with findings that are encouraging for the industry.

Sports massage SydneyAfter a water skiing injury a researcher at McMaster University, Canada, Mark Tarnopolsky, found that massage therapy provided a significant amount of pain relief and he decided that he wanted to understand the underlying mechanism whereby massage aided his recovery.

Along with some colleagues, Tarnolpolsky decided to investigate why massage can reduce pain and the results (for massage therapists and for sports people) were encouraging (1).

For the study, 11 males were exercised to such an extent that they were affected by exercise-induced muscle damage after working out on an upright bicycle. One of their legs was then massaged for 10 minutes. The researchers took muscle biopsy samples from the participants’ vastus lateralis muscles at various times:
– at baseline
– immediately after the massage
– after 2.5 hours of recovery.

The results were extremely encouraging. There is strong support for the hypothesis that exercise can activate the genes which are associated with repair and inflammation and it was no surprise that the researchers observed there was significantly more indicators of cell repair and also inflammation in the biopsy samples post-exercise when compared with the pre-exercise measurements.

However, there was a clear distinction between the study participants’ legs that had been massaged and had not been.

They found that the legs which had received the 10 minutes of sports massage had:
– reduced the amount of exercise induced muscle inflammation by diminishing the activity of a protein, NF-kB
– increased by about 30% a gene that helps muscle cells build mitochondria, PGC-1
– modified levels of other proteins with similar roles in the body.

  
Although this is only one study and the massage protocol may not be relevant for all sports people, it does provide evidence supporting the use of massage therapy to reduce pain and encourage muscle repair. Further work would need to be carried out to assess the optimum pressure, length of massage and the commencement time after exercise.

But there are few who would argue that getting a massage to reduce pain from sport is a preferable alternative to anti-inflammatory medications.

(1) J. D. Crane, D. I Ogborn et al “Massage Therapy Attenuates Inflammatory Signalling After Exercise-Induced Muscle Damage”. Science Translational Medicine 4, 119ra13 (2012).

By Richard Lane

Dry Needling

If you have been a regular recipient of remedial massage over the years then there is a reasonable chance then at some stage you would have been offered the opportunity to try dry needling. More and more massage (and for that matter physiotherapists) in Sydney have been trained to provide dry needling. Some of the therapists who work with Inner West Mobile Massage are trained to provide dry needling treatments.

But what is dry needling, is it different to acupuncture and is it effective?
Deactivation of trigger points through use of dry needles in SydneyA technicial definition is that dry needling uses a variety of needling techniques to initiate change in soft tissue dysfunction which are the results of physiological loading causing inflammation or irritation of the soft tissue. A more normal description is that dry needling is used to de-activate trigger points in the muscles (for information regarding trigger points then there is more information here). The insertion of a needle is considered as being an effective way of relieving the pain and discomfort which may be attributable to the trigger point.

For a dry needling treatment, then a thin needle is inserted into the trigger point (which the therapist has identified through palpation). If the needle is positioned correctly then there will normally be a local twitch response, an involuntary reflex as the muscle fibres of the taut band of the trigger point contract.

As with any bodywork modality, the effectiveness of a dry needling treatment is directly related to the skill of the practitioner. Obviously just sticking needles into the muscles and hoping is not likely to provide good results. The therapists palpation skills and knowledge of anatomy are critical to the success of the therapy.

Dry Needling and Acupuncture
Although both modalities use needles to initiate healing for the body there is a distinct difference regarding the philosophy behind dry needling and acupuncture. Dry needling aims to reduce pain through the de-activation of trigger points. The needles are inserted into the trigger point but they are not left in the muscles for much more than a few seconds.
Acupuncture uses needles to enhance energy and chi flow through the meridians of the body. An acupunturist would normally leave the needles in the meridian points for an extended period of time.

Now whilst there is a huge underlying difference in the intent of the two modalities, there is also a significant area of commonality. It is often reported that there is an overlap of somewhere between 70-90% for trigger points and the meridian points used by acupunturists.

Effectiveness of Dry Needling
Research on the effectiveness and efficacy of dry needling is fairly limited. Some commentators will argue that many positive findings are based on small sample sized research studies which may or may not have flaws with respect to methodology. One of the major problems is similar to research studies into acupuncture: the skill, training and knowledge of the practitioner is a variable largely out of the control of researchers. Also most practitioners will vary their approach depending on issues that the client presents with and for them, there is no standard treatment.

  
Dry Needling – Inner West Mobile Massage
Whether or not dry needling can be clinically proven to provide pain relief through de-activation of trigger points may be considered as being a mute point anyway. The issue is whether it can work for you.

If you are interested in trying dry needling then a couple of the therapists who work with us are trained and qualified to offer this therapy. Give us a call on 0421 410 057 if you would like more information.

By Richard Lane

Massage and Nausea

Unfortunately an occasional side effect of massage is that you can occasionally feel a little nauseous after the massage. Whilst you will hopefully feel relaxed, looser with less muscle and joint pain, it is possible that you may just feel a little off colour for a while.

For most people, this side effect of massage only last for a relatively short period. Some people will need to have a lie down and sleep. Others will drink plenty of water to feel as though they are giving their system a flush. Regardless, in the vast majority of cases, the nausea is only a transient hindrance.

Dizziness and nausea post massage
There is much discussion regarding the cause of the nausea and dizziness after a massage and it may well be the case that there are a number of different causes. One theory which is discounted by most therapists is that the nausea is caused by toxins that are release by the massage. For a discussion of this fallacy then please check out www.innerwestmassage.com.au/massage-toxins.php.
A recent hypothesis is that “Post Massage Soreness and Malaise” is the result of a mild case of Rhabdomyolysis which occurs when muscle cells are damaged and it interferes with the blood chemistry.

Personally whilst there may be some evidence to support this theory, if you follow this theory then you would agree that the deeper the massage, then the more likely you would be affected. Although this is a personal viewpoint, it doesn’t tally with my experiences.

For me nausea is more likely if I haven’t had a massage for a while and I have never noticed any correlation between the pressure/intensity of the massage and the degree of nausea experienced. I tend to subscribe to the theory of Dr Keith Eric Grant who considers that massage is about returning the body towards homeostasis and that the nausea may be the result of giving the lymphatic system a bit of a kick-along. Other therapists may argue differently to this but regardless this type of nausea post massage is very normal and not a cause for concern.

However, if you start vomiting and feel extremely dizzy post massage then that is a different kettle of fish. This happen whilst I was massaging someone a while ago and we had to stop the massage after about 20 minutes as the client was unable to continue. Although massage had only been carried out to the back, just the act of lying prone was too much for the client. Although she recovered and started to feel better once she rose from the table, this was not a normal state of affairs and seeing her doctor was the next step.

Although uncommon, one possible explanation for the extreme nausea in this case is atlantoaxial instability.

Atlantoaxial instability can be considered as a loose upper spine and is the loss of the integrity of the joint between the top two vertebrae, the atlas and the axis. For some people who may have had a neck injury or trauma, then when they move their head or neck then a bone projection (the “dens”) from the axis may effectively make contact with their brain stem. The result of this can range from mildly unpleasant through to downright dangerous.

  
Whilst massage is not necessarily precluded for people who suffer from atlantoaxial instability, extreme caution would be required. The neck can be considered vulnerable and only relatively gentle strokes should be attempted with the approval of a suitably trained diagnostic therapist. Most doctors would strongly recommend that there be no manipulation such as a chiropractic adjustment.

Although there may not have been a formal diagnosis of the condition then a massage therapist should be alert to the possibility. A client may be particularly tight high in the neck or be very guarded and protective of the way they hold their head. If any alarm bells are rung for the therapist then they back off with the intensity of their work and use the adage “too little is better than too much”.

By Richard Lane


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