resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
Assessing Core Stability and ROM: 5 Basic Checks
One of the first steps in addressing core stability is assessing static posture, ranges of motion, and motion of the pelvic bones, sacrum, femurs, lumbar spine and thoracic spine.
Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
End of an Era Looms at NYCC
New York Chiropractic College recently announced that Dr. Frank Nicchi will retire in August 2017 after 36 years with the college, the past 17 as president.
All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
6 Steps to Make 2017 Your Best Year Yet
People often ask me what defines success. Success, for me, is simple: doing exactly what you want to do in life. Whether it's the kind of practice you run, your life at home, your hobbies or something else, it's achieving anything you put your mind to.
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
A Q & A About Updated Codes
Yes, indeed there was an update to ICD-10 on Oct.1, 2016. This is a regular update to the diagnosis coding system and this type of update will occur every Oct. 1, just as it did when the ICD-9 system was in place.
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
Dedicated to Defending Chiropractic
Whether you're a veteran DC or a first-trimester student, the name George McAndrews should be part and parcel of your professional vernacular, as familiar as the word chiropractic.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
June, 2012, Vol. 12, Issue 06
What You Should Know About Corticosteroids
By Rita Woods, LMT
Corticosteroids are steroid hormones made naturally by the body and are classified as either mineral corticoids or glucocorticoids. Artificial corticosteroids are used as medications. You might be familiar with the most commonly prescribed synthetic steroids which are triamcinolone, cortisone, prednisone, dexamethasone and methylprednisolone.Many of our clients may be undergoing some treatment which includes the use of steroids. (The common term 'steroids' used here should not be confused with the male hormone related steroid compounds that are used predominantly to build muscle mass.)
It is very important to do a thorough medication/medical intake evaluation. It is also important for you to be proactive in reading about and researching your client's conditions and medications so that you can customize the massage sessions appropriately. An excellent website for researching medications is www.drugs.com. Other websites that provide easy to understand information and offer insight are the Cleveland Clinic at my.clevelandclinic.org and the Mayo Clinic at www.mayoclinic.com and www.webmd.com. These are excellent sites to recommend to your clients to research their own conditions and medications. You can also find some great complimentary sites that are packed with helpful knowledge. In my practice, I have found that the more familiar a client is with their condition and medications, the more effectively they communicate with their healthcare providers.
Steroids are used to treat a variety of conditions and manage pain. Steroids work by decreasing inflammation and reducing the activity of the immune system. More specifically, steroids reduce the production of inflammatory chemicals in order to minimize tissue damage. Steroids also reduce the activity of the immune system by affecting the function of white blood cells. Another common use of steroids is in conjunction with chemotherapy. The primary benefits when used in cancer treatment include: reduced nausea associated with chemotherapy and radiation, kills some cancer cells and shrinks tumors as part of chemotherapy, and decreases swelling and reduces allergic reactions (before transfusions, for example). And since one of the side effects of steroid use is increased appetite and weight gain, this can also benefit the client undergoing traditional treatment for cancer. Additionally, they can excite the system so they can be effective fatigue fighters.
Let's take a look at some of the side effects and see how they might impact your massage session. Keep in mind that not all patients will develop side effects and the side effects will be different for each individual. The occurrence of side effects depends on the dose, the type of steroid given and the length of treatment. The following list includes the more common side effects of systemic steroid use given either through pill form or IV administration. These circulate through the blood stream. This is only a partial list. As already mentioned, the client may be experiencing wakefulness or agitation, nervousness or restlessness and increased appetite and weight gain. They may bruise easily, the skin may become thin, and they may develop streaks or red spots. They may experience changes in body fat distribution, water retention and swelling. Steroid use can also cause or worsen diabetes, increased blood pressure, cause cataracts or glaucoma, and blurred vision. Of particular interest to massage is possible muscle weakness, corticosteroid induced myopathy, and osteoporosis/osteonecrosis. We'll look at bone loss and muscle weakness in a minute.
Steroids can be administered locally in a variety of ways. Inhaled corticosteroids are often prescribed for asthma. They are used in lower doses to reduce inflammation in the airways. Corticosteroid nasal sprays are sometimes used to relieve allergy symptoms. Topical corticosteroids are rubbed on the skin, where they help relieve the itch and redness of inflammatory skin conditions such as eczema. Injected corticosteroids can be given to reduce or relieve the symptoms of rheumatoid arthritis, joint pain, plantar fasciitis and such. Typically, these cause fewer side effects than oral corticosteroids. When reviewing your client's list of medications, keep this in mind and think through the process. So, let's go back and look at some specific musculoskeletal issues that you need to be aware of.
"High-dose cortisone is the second most common cause of osteoporosis, and we currently have no real treatment for this serious side effect," says senior author Steven L. Teitelbaum, MD, Messing Professor of Pathology and Immunology. "Given how frequently these drugs are used to treat many different conditions, that's a major clinical problem." The femoral head is the most commonly affected area. Common sense tells you that if your client fits into this category, you must never use the deep pressure during the massage. One study, published in The Lancet medical journal in 2000, stated that high doses of inhaled steroids used by asthma patients caused significant loss in bone density. The key here is high dose versus low dose and the length of treatment. The study used patients on high doses for at least six years. Think it through. Look it up. Talk to your client.
Corticosteroids inhibit intestinal calcium absorption and increase urinary calcium excretion leading to bone resorption and bone loss. People taking oral steroids also double their risk for severe vitamin D deficiency, which can lead to further bone disease or muscle weakness. Researchers at Albert Einstein College of Medicine of Yeshiva University, in New York City, said in September 2011, steroids might increase levels of an enzyme that inactivates the vitamin, resulting in osteomalacia (softening of the bones), rickets (softening of bones in children) or clinical myopathy (muscle weakness). They recommended that physicians monitor vitamin D levels of patients being treated with oral steroids.
Corticosteroid induced myopathy is damage to the muscle fibers caused by treatment with corticosteroids, such as prednisone, cortisone, dexamethasone and fludrocortisone or overproduction of steroids associated with Cushing's disease. Myopathy causes changes in muscle fibers, including atrophy (shrinkage), lipid (fatty) deposits, necrotic (dead) areas and increased interstitial (connective) tissue between fibers. You may have severe damage to the muscles while the muscles appear normal in size. This happens because the connective tissue increases in the space surrounding the muscle fibers so no noticeable difference in the anatomy is obvious. Everything "looks" normal. However, these clients will experience increasing intolerance to exercise because the muscles start to weaken with use and pain increases. The muscles most affected are those in the arms and legs and the pelvis (hips). Weakness usually starts in the proximal (upper) portion of the muscle and progresses to the distal (bottom) portion. You may have increased difficulty standing, walking up stairs and reaching upward.
The potential impact on bone, muscle and skin with high dose steroid use should send up a red flag in your massage therapy brain. Additionally, because of the possible fluid changes in the body, the circulatory system could be overloaded so try to minimize the movement of fluids with gentle work unless you are trained to specifically work with this. Refer them to a massage specialist or get permission (in writing) from their doctor.
In summary, I think it's safe to say that gentle work is the best way to go with clients on steroids. The exception to this may be in working on the feet. The feet are made to take a pounding like nothing else in the body. The small muscles in a tendon rich environment are designed to withstand pressure that our larger muscles are not designed to do. So, even if your client is undergoing chemotherapy and suffering with chemotherapy induced peripheral neuropathy, the deeper work on the feet to address this issue is generally acceptable. Another (and additional) option for these clients might be stretching. One therapist I spoke with suggests beginning Tai Chi to all of her oncology clients. I think that's a great suggestion. Keep up the good work!
Click here for previous articles by Rita Woods, LMT.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.