resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Saying No to Medicine
An interesting article recently appeared in Men's Journal titled "When to Say No to Your Doctor." The article begins with the summary statement above and effectively arms readers with information that will help them "take more responsibility for your own health care, because you can't be sure anyone else is.
The X Factor in Clinical Research: The Patient
It was the great baseball legend, former New York Yankees catcher Yogi Berra – he of countless aphorisms, each with a mind-bending twist – who once declared, "You can observe a lot by watching."
Talking to Patients About Healthy Aging
I've noticed that a particular category of patients seems to make up more and more of my practice – they work out, but still experience lots of degenerative joint disease (DJD) issues.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Calcium Helps Prevent Colorectal Cancer
Over the past 25 to 30 years, studies have suggested calcium may confer protection against colorectal cancer.
Help Patients Achieve Optimal Vitamin D Levels
Much research has been done on vitamin D levels and their impact on health; optimal levels have been correlated with a reduced risk of developing numerous conditions.
Blaming the Gluteus Medius, Overlooking the Deltoid
The gluteus medius (Gmed) is commonly written about, strengthened and blamed for many conditions, and rightfully so. After all, the Gmed plays a role in pelvic stability, hip motor control and lower-quarter dynamic movements.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Understanding and Identifying Pediatric Growth-Plate Fractures
In general, fractures in children heal well with little intervention as long as the alignment is good. Fractures involving the growth plate, however, are a different issue. In fact, growth-plate injuries are the primary reason for the subspecialty of pediatric orthopedics.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
5 Ways to Occupy Occupational Health
Despite the progress that has been made to better protect workers, occupational health and safety remains a priority area for many national governmental organizations due to the widespread problem of occupationally related morbidity and mortality.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Web Marketing: Content Is King
Google's sweeping updates to its search algorithms over the past few years have brought a paradigm shift in how you can optimize your chiropractic website to gain maximum marketing leverage.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
March, 2009, Vol. 09, Issue 03
Prenatal Massage and Pre-Treatment Evaluations
By Elaine Stillerman, LMT
In addition to learning what to do to support your pregnant/postpartum clients and relieve their common discomforts, part of the prenatal professional training must include how to recognize when a massage should not be provided. And part of the dialogue that you have to establish with your clients is that when you feel a massage should be postponed until after they have been checked by their care providers, you mean it and stand behind your decision. It is not easy to tell a deserving client that her much-coveted massage is not going to happen, but if your pretreatment evaluations are positive, that is the only safe and responsible choice you can make.
But upon what standards or guidelines do you base your decision? The answer comes from understanding prenatal and postpartum anatomy and physiology. By the end of the pregnancy, most women have an increase of up to 40 percent more interstitial fluid. This excess fluid generally pools in her extremities, especially the legs and feet. In most cases, this "gravity" edema can be treated effectively with manual lymphatic drainage (MLD) and elevation of her legs. And although the swelling can be extensive due to poor posture, poor diet, excessive sodium in the foods she eats, standing a great deal during the day, weather conditions, and restrictive clothing to name a few contributing factors, it poses no health risk. Appropriate massage (MLD) will reduce the swelling by enhancing lymph absorption.
Assessing Serious Conditions
There are times, however, when the swelling is a symptom of a more serious condition - preeclampsia. This hypertensive condition is extremely dangerous for mother and her baby. Preeclampsia is a condition characterized by swelling of the face, hands, and feet, elevated blood pressure, excessive fluid retention, and protein in the urine. It is sometimes accompanied by severe headaches (or migranes) with or without optical "floaters." If preeclampsia is suspected or confirmed, all massage must be avoided until her blood pressure stabilizes and her care provider affirms that she and her baby are out of danger.
In order to test for the presence of this potentially life-threatening illness, we assess the swelling by pressing on the lowest part of each leg, just above the ankle. Press for a count of 5. If the indentation does not fill, or remains pitting, and the ischemic region does not appear red again within 10-30 seconds, massage is contraindicated and the client must see her care provider immediately. Some women develop preeclampsia during postpartum recovery, so the test for pitting edema must continue for the first six weeks, or during the puerperium recovery.
In order to protect against hemorrhaging during childbirth, pregnant women produce more blood clots. During the second trimester, there is an increase in the synthesis of plasma fibrinogen (coagulating factors VII, VIII, IX, X, and fibrinogen) that continues throughout the first few months (8-10 weeks) of postpartum. The potential in blood clot formation (thromboembolism) is five to sixfold during pregnancy and up to three months postpartum. These clots primarily appear in the deeper veins of the legs: the femoral, iliac, and saphenous veins. In order to prevent dislodging these clots, the safest and most effective modality to employ is, once again, MLD.
The risk factors for clots during pregnancy include a sedentary lifestyle, being confined to bed rest, a maternal age of 30 or older, being over-weight, having an autoimmune disease like lupus, and being pregnant with the fourth (or more) child. In addition, clots may develop because of the weight of the gravid uterus slowing iliac and femoral circulation, sluggish blood flow, venous stasis, increased blood volume, and higher levels of progesterone relaxing the smooth muscle fibers. (Although many of these changes reverse soon after childbirth, fibrinogenic activity doesn't normalize until 8-10 weeks postpartum.)
Illness and death from venous thromboembolism occur 1 in 1,000 to 1 in 2,000 pregnant and postpartum women. These figures do not reflect deaths which occur after the traditional 6-week recovery period.
Deep venous thrombosis (DVT), which occurs mostly in the left leg and its resultant pulmonary embolism are the leading causes of preventable in-hospital mortality in the United States. In general (not necessarily related to pregnancy and postpartum), the signs of DVT are commensurate with the degree of blockage in the vein and inflammation of the vessel wall. Many people, including those who are pregnant, are asymptomatic, but it is important to evaluate both legs before massaging your pregnant or postpartum mother for the signs that we can assess.
Surgeries, like Cesarean sections, increase the risk of thromboemboli and the sequelae of a pulmonary embolism. After surgery, most clots occur in the left leg, although both legs must be evaluated.
While lightly placing your hand(s) down the back of her leg (you can perform this before she gets on the treatment table or through the sheet with your client lying on her side), palpate for localized unilateral swelling, heat, pain (which occurs only 50 percent of the time), tenderness on the over-lying dermatome (50 percent of the time), muscle contraction, and possible redness. Keep in mind that the edematous leg will feel hot all over; remember that you are feeling for localized symptoms. In addition, her legs will feel hotter around the joints where the fluid tends to aggregate and in areas where the veins are superficial like the backs of her knees or her ankles.
The second test is specifically for the calf muscles and evaluates the presence of clots in the saphenous vein. However, this Homan sign or Homan check is present in less than one-third of patients with confirmed DVT and is positive in more than 50 percent of patients without DVT, so it is nonspecific. Still, it is a relatively fair barometer to use. With her leg extended, flex her knee to about 5 degrees. Dorsiflect (bend or flex backward) her foot. Any sharp pain in her calf may indicate a positive result. If you suspect that a blood clot is present, do not massage and refer her to her care provider immediately.
To effectively use these pretreatment evaluations, let your pregnant (postpartum) clients know that you will be doing them before each treatment. Once you become proficient, they will take less than one minute to do collectively. If you suspect pitting edema or the presence of a blood clot, explain this to your client in a calm manner and suggest that she seek immediate medical confirmation. I usually suggest that these evaluations are not absolute medical diagnoses but rather indicate that caution should be exercised, and massage should not take place. Instead, I offer my clients an opportunity to book another appointment, once the situation has been addressed, "on the house." However, it never fails that my clients return and pay, regardless of my offer.
Make these pretreatment evaluations a part of your prenatal/postpartum practice. You will feel more confident about giving the massage and your clients will be grateful that you are taking appropriate care of them and their babies.
Click here for previous articles by Elaine Stillerman, LMT.
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