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There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Atypical Femoral Fractures and Bisphosphonate Use: What to Watch For
Bisphosphonates (BP) are popular drugs, with more than 8 billion in sales in 2008; however, profits have declined as patents began expiring. Nonetheless, BP remain the most commonly prescribed drugs for patients at risk of osteoporotic fractures, with several million prescriptions written every year.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
B Vitamins Improve Memory, Prevent Brain Atrophy
The 2010 OPTIMA study showed that the accelerated rate of brain atrophy in elderly with mild cognitive impairment could be slowed via supplementation with homocysteine-lowering B vitamins, which included folic acid, vitamin B12 and vitamin B6.
Interpersonal Skills 101: Enhancing the Value of Our Patient Interactions
Recently, I read an interesting article in our local newspaper titled "The Value of Human Interaction." The article presented comments from a senior editor for Fortune magazine who discussed "Civility in the Business World."
Primary Spine Care: Addressing Concerns & Criticisms
The Dec. 1, 2013 issue of Dynamic Chiropractic included an article describing the implementation of a training program for primary spine practitioners (PSP) within a metropolitan region and supported by a large BC/BS plan.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
A Reality Check – and a Chance to Educate
Imagine working in the public relations department of nutrition retailer General Nutrition Corporation (GNC) and reading the The New York Times announce...
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
Avoid Random Treatment of Trigger Points (Part 2)
We must acknowledge that the fascia, which surrounds literally everything in our bodies, including every muscle fiber, is more than just a covering.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
Expanding Access, Branch by Branch
The big news coming from Capitol Hill isn't merely the recent introduction of a pair of bills designed to expand chiropractic services in the Veterans Affairs and military health care systems; after all, similar legislation has made its way through Congress before, never reaching the Oval Office for presidential signature.
Impacting Chiropractic's Future With Technology
When it comes to electronic health records (EHR), Robert Moberg and Dr. Steven Kraus are two of the leading industry experts on the topic.
Low Back Pain: Posture and Movement Analysis
When performing static and dynamic movement analysis of the lumbopelvic hip area, begin with standing visual posture analysis of the pelvis, and then perform lumbar range of motion and assess what you might see during normal versus abnormal lumbar flexion motion.
Help Update the LBP Practice Guideline
The Council on Chiropractic Guidelines and Practice Parameters has announced the release of an updated Clinical Practice Guideline for Chiropractic Management of Low Back Pain for stakeholder review and comment.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
April, 2009, Vol. 09, Issue 04
Incorporating Lymphatic Drainage in Facelift Massage
By Rita Woods, LMT
More and more therapists are performing facial massage as a stand alone session such as a facelift massage. Women in their 60s, the typical age group treated in my practice, present with specific issues that should be taken into consideration. First, if they do not receive regular massage and do not have an active lifestyle, they may have sluggish circulatory/lymphatic systems. Second, they may have health and medication issues that impact how, and if, you can proceed with the session. In this column, I'll discuss what you need to know and how to approach the facial lymphatic system in a basic and uncomplicated session.
Areas of Caution
First, some words of caution. If your client suffers from an active infection such as sinusitis, strep throat, tooth abscess or any skin infection, do not proceed. Active head/face infection is your number one contraindication for this work. If, however, they have been taking antibiotics for at least three days, it is generally safe to proceed. Next, if your client has facial swelling of unknown origin, do not proceed. Remember this is for a typical session with a healthy client and no extenuating circumstances. While it is possible to use this work to address blunt force trauma and post-facial surgery, that requires advanced training. Standard massage contraindications also apply even when working on the face alone.
Facial Lymphatic System
Now, onto the treatment itself. You remember from your massage school curriculum that massage increases circulation; it also increases lymphatic flow. That is, massage also increases the release and flow of lymphatic waste. As with any "waste disposal," some form of clearing should be done before adding more waste to the system. (For example, if there is mud stuck in the end of a garden hose, the mud must be cleared out before the water can flow effectively. The same holds true in the body's waste removal systems.)
Unlike the blood circulation in the face which drains in a variety of directions before ending up back at the heart, the facial lymphatic system follows a very exacting drainage path. The right side of the face flows to the right and the left side to the left - with both sides ultimately flowing into submandibular lymph nodes. While there are other locations housing lymph nodes involved with head/face "cleaning," such as under the occiput, the main ones for facelift style work are the submandibular ones. Lymph nodes vary in size from small - about the size of a pin head - to large, about the size of an olive. The ones under the mandible are about the size of a pea.
During a regular full body massage, muscles are warmed and circulation increases. When performing a stand alone face session, muscles must also be "prewarmed" in order to gain the necessary effects. As importantly, submandibular lymph nodes must be stimulated (rubbed) in order to open and enhance circulatory and lymphatic flow. Failure to do so could result in edema and puffiness especially under the eyes, an area prone to sluggish lymph flow.
If your client suffers from bags under the eyes or obvious fluid retention in the face, you may choose to focus more time on lymphatic work until some of the fluid and puffiness has decreased, possibly in one or two sessions. Although it is not possible or practical to teach a facial lymphatic protocol in this format, we can follow some basic steps that will surely help your client. Do not mix muscle work and lymphatic work. The lymph vessels are just under the surface of the skin on the face and are easily flattened by pressing too deeply. While they recover quickly, they need time to do so. A muscle technique to break up adhesions should not immediately be followed by a lymphatic stroke.
Two Key Areas
Two key areas to focus your attention are the submandibular nodes and the terminus. The terminus is where the lymph vessels dump into the circulatory system just before entering the heart. Unlike the rest of the body, the lymph vessels of the face have a straight shot down the neck and into the heart. You want to stimulate this area to prepare it to receive more lymph. This stimulation, while gentle, is more aggressive than work on the actual vessels. The same is true of the submandibular nodes. You will exert a steady and firm pressure, almost in a milking/pumping action, to these nodes. Done correctly, your client will be able to breathe, swallow and speak while you affect the nodes. The tips of your fingers apply pumping pressure on the underside of mandible and your fingers must remain in constant contact with the inner edge of the jaw line. The nodes are tucked up under the inside edge and in some cases can be palpated. Keeping your fingers on the bone will also ensure that you are not encroaching on arteries or veins in the neck.
Steps of Treatment
A typical session would be as follows: 1)Warm the facial muscles using any gentle, non-invasive technique; 2)Gently stimulate the lymphatic terminus which is found below the clavicles and on either side of the manubrium; 3) Stimulate the submandibular lymph nodes by using digital pressure up underneath the mandible bone; then 4) Proceed with your facelift session protocol. Upon completion of the facelift protocol, allow 5-10 minutes for stimulating the lymph flow through the lymphatic vessels. These vessels respond well to light stroking that is almost featherlike. Starting with the region closest to the nodes, apply a light stretch to the skin then follow the movement with a featherlike trailing toward the nodes. Your stroke will look like a 7 or an L. Work your strokes up to the middle of the face with the featherlike trailing toward the nodes. You may encounter some drag if there is lubricant on the face. If so, you can use a cotton ball for the trailing stroke. Cotton balls work well on and around the eyelids.
The combination of the proper facial and/or facelift massage and lymphatic drainage of the face can multiply the effects of facial work. Some of my happiest clients are those who finally get rid of the bag-gage.
I want to thank Charlotte Versagi, lymphatic massage instructor extraordinaire for sharing her knowledge and experience in the writing of this article.
Click here for more information about Rita Woods, LMT.
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