I was contacted by an associate editor of MASSAGE Magazine yesterday as an "expert" in the area of cryotherapy and thermotherapy.  This is my response to her.  Hope you enjoy and so you can call them out if they don't acknowledge me!  LOL
                
                First let me thank you for considering my input on this subject.  I have studied the uses of hot and cold therapy and feel that it is therapy that works, as it has over the ages when people did not have anything else to use.  I feel that the best ways of using both cryotherapy and thermotherapy are still some of those original ways also – Ice and heat in their natural forms.  That does not however keep me from using some Tiger Balm or Polar Lotion on occasion.
 
                So, let me answer your questions and give a little background on why to use these things.  The main reason for using any hydrotherapy method is to take the body momentarily away from homeostasis to let the body respond by stimulating the system to heal itself.  And obviously cryotherapy will take the body further away from homeostasis than thermotherapy when we look at the base body temperature of 98.6F.  Both applications have a physiological and circulatory effect on the body by causing vasoconstriction/vasodilation thereby causing either a decrease or increase in both circulation and metabolism.  But that is the science of hydrotherapy.
 
                The benefits of cryotherapy and thermotherapy are therefore based on this science.  And the benefits of each will depend on the duration of the treatment – short or long application.  An ice pack left on for 10 minutes will be totally different from an ice bath used by athletes.  Likewise a hot pack applied on a sore muscle for 10 minutes will have a different effect than an hour long hot stone massage.
 
                The benefits of cryotherapy include:

• An analgesic – pain relief can be a counter-irritant to the stimulation of sensory nerves in the affected area.
• An anesthetic – used to numb an area
• A stimulant – used in a short application, cold can stimulate the body by taking it away from homeostasis
• Burn management – especially useful in the case of sunburns/minor burns to minimize blistering
• Tonic – causes muscle to contract to increase muscle tone
                  I use cold stones for facial massage for migraine or headache relief.  I also use cold stones for muscle overuse especially using a marble neck pillow for clients who work at computers.  Additionally, I use cold after treatment of trigger points.
                  Reasons to use cryotherapy include: sprains or strains, inflammation, pain relief, swelling, headaches, muscle spasms, and any stage of injury.
   
                  The benefits of thermotherapy include:
• An analgesic – as mentioned above both cold and hot can be a counter-irritant
• Diaphoretic – heat can cause sweating which is excellent for opening and cleansing pores which is why heat/steam is used in many facial applications
• Sedative – moderate heat will induce relaxation of muscle
• A stimulant – just like cold when heat is used in a short application it can be to stimulate the body. Short applications of both hot or cold can be perceived by the body as a threat and therefore the body reacts to this stimulation physiologically
                  I use heat to help warm up tissue prior to working tense or sore muscles.  I do this using the heating pad on the table or having heated stones available.  I also do full body hot stone massage as a relaxation technique; however, I advise the client that the effects of this treatment will last longer than the hour they spend on the table due to the body’s physiologic response to the treatment.  The body will take longer to come back to its normal homeostasis after a longer treatment of either hot or cold.
                  Reasons to use thermotherapy include: muscle stiffness or guarding, joint pain and stiffness, stress relief, relaxation, pre-stretching or pre-massage.
   
                  My experience has been that clients see a bigger response when I use hot/cold in their massage sessions.   And if you are asking what is the most helpful in regards to how to use hot and cold I would have to say my stones have been the most helpful in using cryotherapy and thermotherapy in my practice.  But that doesn’t mean I don’t have a “tin” of Tiger Balm or a container of Biotone’s Polar Lotion by my table.  Additionally, I will use specific essential oils mixed with my lotion to create heating or cooling to a muscle area.
   
                 
  

The question of what is Medical Massage has become the million dollar question in massage circles.  And the question I just received is this "Is there a difference between medical massage and clinical massage?"  For the first part of my answer I will defer to James Waslaski, a leader in the massage field, and a quote from his article in Massage Today from June 2004!

"The best short definition I gathered from medical massage therapists is: "Medical massage is performed with the intent of improving conditions or pathologies that have been diagnosed by a physician; a wide variety of modalities or procedures are utilized to focus the treatment based on the diagnosed condition." I was determined to prove that advanced disciplines, such as neuromuscular therapy, CranioSacral Therapy (CST), myofascial release, lymphatic drainage, massage for cancer patients, orthopedic massage, etc., fall under medical massage disciplines, and certification in many of these disciplines usually requires a minimum of 100 hours of training."    http://www.massagetoday.com/archives/2004/06/03.html

Waslaski teaches an Orthopedic Massage class and has a book from Elsevier called Clinical Massage Therapy: A Structural Approach to Pain Management.  I do not have this particular book but any other book from Elsevier is in the form of a textbook.  Elsevier is a company that I dealt with when I was the Massage Therapy Chairperson at a private school in Florida.  More about books in a bit.

So now that I have muddied the waters, let me address the Clinical Massage Therapist part of the question.  I found the following quote:

While a massage therapist can work with clients who have tension, stress and pain, "more serious issues are often treated by a clinical massage therapist. This practitioner uses techniques specifically designed to help injuries heal, improve range of motion, and increase muscle function. Also known as medical massage, therapists who perform this work generally do so by prescription from a doctor."        http://work.chron.com/clinical-massage-therapist-16412.html  Please note that this person is NOT a massage therapist, but that does not make her remarks any less true.

About 10 years ago, I was lucky to attend a seminar at the Florida Chiropractic Convention in Orlando.  This convention has in the past, and I would assume still does, hosted a Massage Therapist track as part of their training classes.  At this particular convention I attended a CE Class about Medical Massage by Sandy Fritz.  For those who do not know, Sandy is the main author of two textbooks by Elsevier/Mosby:  Fundamental of and Science of Therapeutic Massage.  In her lecture she feels the ALL massage is basically medical or clinical.  Her reasoning for this is that all massage has some sort of "medical" benefit to the client regardless of why they are on the table. 

But of course the massage industry as any other profession likes "labels".  It makes for great marketing and sales for massage schools and  continuing education providers.  Don't get me wrong, I do believe there is such a thing as Medical Massage but contrary to some advertisments it is not a required "certification" to do that type of massage.  (Disclaimer - My opinion and I do have a Medical Massage Certificate!)

The standard definition for Medical Massage is that it is an outcome-based, results-oriented specific treatment to a targeted area or problem.  The treatment is by diagnosis and prescription of a physician and may follow their specific instructions after a thorough assessment or evaluation of the problem.  It is also generally billable to insurance.  Be aware that not all states allow billing to insurance companies by massage therapists, licensed or not.  For more information about Insurance Billing for Massage Therapists please look up Vivian Madison Mahoney at www.massageinsurancebilling.com.  I was fortunate enough to take her class and received great documentation on the insurance billing process.  She does have an insurance billing seminar on DVD and if you take a class with Premier Continuing Education you can receive free CE hours from her.  (Shameless Plug)  www.premiercontinuingeducation.com

My personal opinion is that networking with a physician or chiropractor would be the best way to get into this type of massage.  Advertisment and marketing to a specific client base would be another way.  But first you need to have the training to do this type of work.  Clinical-based massage is much more specific and requires the therapist to have more specific training and understanding of the mechanics of the human body.  Back to that Anatomy and Physiology that you learned in school. 

My recommendation and that of James Waslaski in his article mentioned above is to have training in as many advanced disciplines as possible.  Recommendations include (but are not limited to):  Myofascial Release, Neuro-muscular Therapy (NMT), Trigger Point Therapy, Cranio-sacral Therapy and Sports Massage/Stretching.  Additionally more specialized Hydrotherapy applications, including Hot/Cold Stone and other more structurally-based modalities such as certain types of Lomi Lomi and Structural Integration techniques.  You also need to know how to explain why/what you are doing to your clients.

Recommendations for books include (but are definitely not limited to):  Anatomy Trains by Tom Myers, Kinesiology by Joseph E. Muscolino, A Massage Therapist's Guide to Pathology by Ruth Werner (who by the way will be teaching some classes at Sage Continuing Education in Lancaster, PA this fall! - www.sagecontinuinged.com), any of the textbooks by Sandy Fritz, Trail Guide to the Body by Andrew Biel, Basic Clinical Massage Therapy: Integrating Anatomy and Treatment by Clay and Pounds (an LWW textbook), and Fascial Release for Structural Balance by James Earls & Thomas Myers.  I am currently taking the online course by Niel Asher on Trigger Points that I highly recommend (NAT) and any of the books by Clair Davies on Trigger Points.

I hope this addresses the question posed by my Facebook reader this morning.  Obviously the best place to start is in the beginning and being a licensed massage therapist is that first step!  Having the desire to "make a difference in the pain and posture of the body" is the next step.  I hope this points you in the right direction.  Please feel free to comment here.

References used:  www.medicalmassage.com, www.massagetoday.com, www.mmpa.us

When I first started teaching pathology to massage therapists about 12 years ago I had to do my research on Fibromyalgia before I could talk about it.  I really didn't know that much about it but I knew that people were being diagnosed with it.  And then I found out that possibly some people were being misdiagnosed with it.  Let me tell you what I found out back then.

Fibromyalgia Syndrome (FMS) a chronic pain syndrome involving sleep disorders and a predictable pattern of tender points in muscle and other soft tissue.  It is diagnosed after all other diseases are ruled out and when 11 active tender points are found disributed among all quadrants of the body.  Nine pairs of tender points in total have been identified on the body. 

Fibromyalgia often overlaps with Chronic Fatigue Syndrome and during my initial research there was the possible association with Epstein-Barr virus as this is associated with mononucleosis, a disease noted for it characteristic symptom of tiredness.   FMS also may include Irritable Bowl Syndrome (IBS), hypothyroidism, TMJ problems and myofascial pain syndrome.  The pain is "invisible" with no outward signs.

At that time I also found that FMS sufferers may have the following:

• Type A personalities
• Be stressed over the limit
• May have been dominared or in a position of high stress or hig responsibility - real or perceived.

I also found some things that at that time FMS was NOT:

• Not an autoimmune mistake
• Not a virus, bacterial or fungal infection
• Not a result of direct injury

What is was however was a combination of related sleep disorders, endocrine and neuro-transmitter imbalances and the emotional state of the patient.

In my original notes I have the following:  May eventually be reclassed as a CNS disorder because of the presence of increased levels of 2 neurotransmitters in CSF of patients which may initiate nerve activity and lead to the pain.

I have always taught that massage is indicated but do not overtreat as clients are sensitive to pain.  I also have always noted that clients may have been misdiagnosed in the past.  I have experienced clients that would tell me that they have been diagnosed with FMS but want deep tissue work.  I say (not to the client) that is NOT fibromyalgia.

Fast forward to the Winter 2015 issue of Massage Therapy Journal from AMTA.  (Hey, I'm getting things out of boxes and so I found it!)  The Right Touch - "With recent research suggesting fibromyalgia may be a central nervous system disorder, can massage therapy still help?  The answer is - Yes."  I feel vindicated in my research from years ago!

Have you ever googled or binged (I don't think I'm making up those verbs) the benefits of massage?

I'm sure there are thousands of pages out there about the benefits of massage and why you should have one.  They are mostly the stuff of myth and legend! 

I know that many of the people that know me are shaking their heads right now and many will not agree with what I am about to expound on, however what I am about to tell you is true.  Even if when you were in my classes I told you some of these things.  Believe me, I'm sorry.  These were things that I was taught in massage school also and therefore was passing on to you as fact.  It is time to change our beliefs about what massage is (and isn't)!

There are currently 5 generic claims about massage that you will find everywhere on the internet and quite possibly in your massage textbooks.  They are as follows:

• Massage increases endorphins
  
• Massage boosts immunity
• Massage decreases cortisol levels
• Massage increases blood circulation
• Massage releases toxins

These claims start in massage school and are perpetuated by our instructors.  I have already admitted to spreading them myself in my classes.  Before I really start to sort of debunk these claims, I need to give you a little background on my information.  I have been reading about these things not being totally true for quite some time now and recently as I have been cleaning and unpacking some things in my office at the new house I came across an article in Massage Today by Tracy Walton.  She is a leader in the massage world when it comes to Oncology Massage and I have attended one of her classes on massage for cancer and the research on it.  When I was in school cancer was a total contraindication for massage.  The myth at that time was that massage spreads cancer cells.  Research tells us that is not true.  Therefore massage for cancer patients  helps them fight pain, nausea, fatigue, anxiety and depression.  Easing pain and improving mood for them is due to growing research support for these options.

In the article and in her e-book "5 Myths and Truths About Massage Therapy", Tracy Walton looks at the 5 generic claims mentioned above and also talks about the difference between the clinical vs. mechanistic outcomes in any type of therapy, treatment or drug program.  Clinical outcomes are those things that create a change in the signs and symptoms of the client or patients problem.  Did massage help or work?  Examples are a change in their stress level, or pain level or with their range of motion.  Mechanistic outcomes create a change in a biological substance.  The examples here are changes in hormone levels, blood sugar, endorphins, cortisol, etc.  These changes must be measured in saliva, blood, urine or tissues. 

As you have probably figured out by now the 5 claims above are more mechanistic outcomes that none of us as therapists are trained to report.  Also, clients are coming to us as massage therapists for clinical outcomes;  they want to reduce stress, decrease pain and soreness or just be relaxed.  The fact that massage may reduce stress  DOES NOT equate to massage lowers cortisol.  To paraphrase Tracy, "massage works, just not the way we were taught".  Clients DO NOT come to us for mechanistic outcomes.

So what is the research and what about those 5 generic claims?  I will summarize Tracy's book.

Massage increases endorphins - studies are inconclusive.  Massage does reduce pain and makes the client feel better and relaxed but is not proven to increase endorphin levels.

Massage boosts immunity - this is hard to prove.  The immune system is very complex and massage could influence immunity over time but mainly massage promotes relaxation and reduces stress.

Massage decreases cortisol (just one of the stress hormones, but the one with the most press) - again, this has not been proven and in fact was disproved in one study!  Decreasing stress and increasing well being is still what we do as massage therapists.

Massage increases blood circulation - the questions here are where, how deep, arterial or venous, for how long and does it matter?  Results in studies are inconclusive as to this issue.  We do know that hyperemia is present locally with certain strokes thus promoting tissue health in that area.  But the lowering of blood pressure or increasing the actual circulation systemically is that proven.

Massage releases toxins - just what are these toxins of which we speak?  I have always hated the word toxins - there are by-products of the metabolic process, but sometimes these are good by-products that go out in the blood stream to affect another part of the body.  Even lactic acid has it's uses.  Lactic acid becomes a fuel when oxygen levels are low in athletes and dissipates in the body with normal breathing.   We could just as easily say that breathing releases toxins in the body.  Either way there is absolutely NO RESEARCH to suggest that this happens more during a massage.  And blood or urine would have to be measured to test this.  (Oh, and water after a massage DOES NOT flush out these "toxins" either!)

Not enough overall studies have been done to prove many of the claims that massage therapists and educators have made over the years.  The thing that I think would also be hard to do with any massage study would be measuring the effects of the massage because every massage measured must be exactly the same.  And we all know how hard that is to do!

So please don't start a rant on me here ( or go ahead - it will increase my blog traffic - LOL) but these are the actual facts based on research or lack thereof.  For more information go to www.tracywalton.com or Google (or Bing) 5 Myths and Truths About Massage Therapy.  It is a pdf download so you can read it at your leisure.  There are some other links within the ebook that you may find quite interesting also.

You read it here!  Massage is good for you regardless of any research.

This was the question I posed to my students in the last 3 classes that I taught.

After some thought I got answers of the back and the legs.  My response was that they are both. 

Technically they are transitional between the trunk and the lower extremities.  Anatomically they are generally referred to as part of the trunk.  Functionally, because of their actions, they are part of the lower extermities.

So just what do the gluteal muscles do?  Their main actions are extension of the hip as in standing or walking, especially in climbing or stairs.  They also help to perform lateral rotation of the hip (maximus), abductions and medial rotation of the hip (medius & minimus).   Their major synergists (helpers) are the hamstrings and piriformis along with tensor fascia latae. 

The attachements of these 3 muscles, maximus, medius and minimus are on the illium along the crest and then along the body of the illium moving inferiorly.  The distal attachments are into the IT Band and the greater trochanter of the femur thus the hip movements which each of these muscles.  The gluteals are stretched by their antagonists, theilipsoas, tensor fascia latae, the adductors and themselves in some cases.

So how does this affect your clients?  Think of what they do for a living.  How do they use their bodies?  Or even what do they do occasionally that may affect their muscles?  Of course anyone who walks or stands at all during the day will be using these muscles and/or overusing them.   Conversely if they are not using them they could also be affected. 

Low back pain may be associated with gluteals as well as any of the other muscles that attach to the illium at the iliac crest.  Piriformis syndrome or sciatica may also be related to tight gluteal muscles since they sit superficial to piriformis.  Skiers, runners as well as truck drivers and couch potatoes all may end up in your office with gluteal issues.  Don't ever let them tell you that they don't use their glutes!  Work them!  They can be worked over the sheet without any embarrassment to your client!

I was contacted recently by a current student (not one of mine) with some Lomi Lomi questions so here they are and here are my answers.

Q. How often do you perform Lomi Lomi massage or how often do clients request that service?  What type of clients typically see you for Lomi Lomi massage (specific issues or more spiritual or do they just find it relaxings)?  Is Lomi Lomi massage more stressful on your body than Swedish massage?  Do you typically perform this massage at a client's home or in an office space?  What about Temple Lomi draping?  What kind of draping do you use for Lomi Lomi massage?  And finally what are any common misconceptions about Lomi Lomi massage?

A.  Whew!

In answer to how often I perform Lomi Lomi, I would say every day.  After I learned Lomi Lomi it became a part of every massage that I do.  I may not do an entire Lomi protocol at every session but every client gets some part of Lomi as part of my regular massage now.  It is not necessarily a requested service but I have had clients call me specifically for Lomi when they find out that I do that type of massage.  I would say that the ones that do call me for Lomi are looking for a different type of massage experience outside the standard Swedish relaxation massage experience or even the deep tissue massage experience.  Most people have seen the videos online or have had someone come back for Hawaii and tell them of their experience of having a Lomi massage.  Not everyone however understands that there are as many variations of Lomi as there are of Swedish massage.

I must say that I do not do Temple-style Lomi which is a more modern take on Lomi and not necessarily what would have actually been practiced by the Kahunas and Kapunas of old.  The Lomi practitioner of the Islands would have been skilled in more than just the manual manipulation of tissue but also would have been knowledgable of herbs and the skillful manipulation of joints and other areas of healing.  My tradition of Lomi comes from Aunty Margaret lineage as my original instructor studied directly with her on the Big Island - Hawaii.  The Lomi protocol that I do is not more stressful on my body than Swedish massage or any of the other modalities that I know.  In fact, I would say that it is probably less stressful based on the movements and body mechanics I have learned to use with the Lomi that I have learned over the years.

I do work out of an office or my own home and rarely do out-calls any more.  And my method of draping is pretty much the same as any standard Swedish massage.  I modestly drape and always use a bottom sheet for my Lomi massage.  As I said before I do not practice Temple Lomi.   I have had students come to my classes expecting Temple Lomi but have not gone away disappointed with what they have learned.

I think that the most common misconception about Lomi Lomi massage is that it is ALL Temple Lomi since that is what they see most on the Internet and You Tube.  I have had my class cancelled at a spa because that is what they thought it was going to be and would not even give me a chance to do a practical demonstration!  There are many books available to you and many versions of Lomi, if you are interested then take some classes.  In fact I would love to come to Michigan and show you my version of Lomi!

Please come back to my website as I am currently in the process of creating some videos of my Aunty Margaret style Pololei Lomi and would love for you to see them.  I love Lomi Lomi and the results that I get with clients - both relaxation wise and structurally.  I hope that you give it a try in a variety of its different styles.

And thanks for the question!