This column will examine the practice of aromatherapy to increase reader knowledge about the use of essential oils in the practice of massage in therapeutic and spa settings, and for a range of client issues. I have taught continuing education classes in aromatherapy for over 10 years in Florida and across the U.S. Many massage therapists who take the introductory class have had little formal training in aromatherapy.

They are excited to learn that essential oils are not just for relaxation and that there are a large number of essences they can use to enhance their practices. They discover they don't need to rely on a few blends purchased from a supplier; with some knowledge, awareness and good intent, they can create blends more directly suited to a particular client's immediate needs.

Practice Issues: Appropriateness, Contraindications and Technique

Diagnosing and prescribing is not in our current scope of practice, but at this time there is no regulation on using essential oils in massage oils or air diffusions. It is common practice for spas to offer clients a choice of relaxing, cleansing, stimulating, or pain relieving aromatherapy blends. Some go further and have the client fill out an intake form that narrows down the complaint and helps the therapist select essences for an individual blend. I doubt you will have much to consider in this respect when using aromatherapy as part of your practice, though you might avoid sentences like "It sounds like you have a cold. I will make a blend of Eucalyptus, Lavender and Tea Tree for you." A way to deal with a scope of practice issue, should it arise, is to educate.

If you have a book like Aromatherapy, an A-Z by Patricia Davis (or any other standard text in the field), you can look up a condition and show your client what an author says. The client can then choose to follow the author's advice. Or you can use a personal example like: "When my Aunt Martha had this, she found relief from using..." Again, the client can choose to follow Aunt Martha's example or not. These approaches fall under the heading of "education," which we are all free to do.

The issue of contraindication is a bit controversial in the aromatherapy community today. Aromatherapists like Sylla Sheppard-Hanger (author of Aromatherapy Practitioner Manual, Vols. I and II) list the contraindications for certain essences and specific conditions, such as pregnancy or high blood pressure. Others, like Australian Aromatherapist Ron Guba, follow the French medical model that believes any danger from essential oils comes from the ingestion of fairly large amounts. If you read current trade publications like The Aromatherapy Journal or Aromatherapy Today, you will see articles from both sides. My own belief falls somewhere between the two. I feel that it is always best to trust your instincts about using some of the more powerful essences, like sage, thyme or oregano.

Because the most direct and effective method for aromatherapy is inhalation, as you give a treatment, you, too, receive a treatment. As a therapist, you have more exposure to the essences than your clients. Essences can remain in the body for up to 24 hours, and are eliminated in our usual ways of elimination. With daily use, essences can build up in the system, so it makes sense to vary the oils you use and reserve the stronger ones for situations that truly require them.

Most aromatherapists would agree that essential oils, with the notable exception of lavender, should not be used "neat," or undiluted, on the skin. Essential oils are highly concentrated and applying one directly to the skin can cause mild to severe irritation, depending on the essence and a person's sensitivity. Eucalyptus, peppermint, ginger, cinnamon, sweet orange, juniper, oregano, sage, black pepper, thyme, clove, and sweet birch are some of the more commonly used oils that are known irritants and should be used in high dilution (only a drop or two in an ounce of carrier oil) and not on sensitive tissue areas.

Some people can have allergic reactions to essential oils. If a person is allergic to pollen, you might avoid using essential oils that come from various pollen producers: flowering plants, trees and grasses. Likewise, some people are allergic to fruits. It's a good idea to clear those issues on your intake sheet before you blend. What does an allergic reaction to an essential oil look like?

Take heart, there are no reported cases of death due to anaphylactic shock in the extensive medical literature on essential oils (a great deal of research has been done by the food and cosmetic industries who use most of the essential oils produced.) An allergic response can include headache, sneezing, upset stomach and skin rash. The good news is that the reaction is not usually long lasting.

Phototoxicity means that the skin cell membrane is weakened, making it more permeable to ultra violet (UV) light. Some essential oils are considered phototoxic. Expressed bergamot, cedarwood, cinnamon, ginger, grapefruit, expressed lime, mandarin, expressed orange, and patchouli should be avoided prior to prolonged exposure to strong sunlight. The distilled oils of lime, orange and essence of bergamot that have had the furocoumarins (FCF) removed are not considered phototoxic. This is important to remember if you practice in a resort area or anywhere people sunbathe and partake in outdoor sports and activities.

Making a Blend

To make a treatment blend, use a cold pressed nut, seed or vegetable oil as your carrier. Choose something with no other ingredients or fragrances added. Never use mineral oil. Some kind of oil, fat or emulsifying agent must be present in your carrier to absorb the essential oils. I recommend fractionated coconut oil, which has had the solid white, smells-like-coconut component removed. This is a light, colorless and odorless oil that does not oxidize. And because it consists of saturated fatty acids - the closest substance to human subcutaneous fat - you have almost complete skin penetration.

While there are no hard and fast rules, generally speaking, for regular massage you would use up to seven drops of up to five different essences in one ounce of carrier oil. This number can vary due to the essences used and with need. For example, a blend for muscle ache might contain three drops of lavender, two drops of geranium, one drop of Roman chamomile, and one drop of Clary sage. You might double this recipe if the pain is chronic or severe. But if a blend for muscle pain included two drops of spike lavender, one drop of peppermint, one drop of helichrysum, and one drop of thyme linalool, you might increase the spike lavender, and maybe add one more drop of peppermint, but the intensity of thyme and helichrysum would limit them to one drop each. The intensity of the essence will be very clear to you from its smell.

I base my blends on information about properties and from information about inhalation. In this area of work, "the nose knows" is a true saying. When you inhale essential oils, the volatile molecules are carried via the olfactory nerve to the limbic region of the brain where the properties are recognized. The response of pleasure - yes, attraction - is an indication that the properties will be useful and helpful. A response of dislike, like nose wrinkling, would indicate that you shouldn't use that essence at this time. You get information for yourself and for others this way. Try it and see. Some of the best-laid blend ideas can be undone when inhalation is the judge.