Christy, a 40 year old mother of two, had just returned to the workforce as her children were now in high school. She was excited about the challenge to renew her career as a high school math teacher. On her first day back at work she was given an overwhelming number of requests from her principal including lesson plans, supply lists, and unexpected homeroom and hall duties.

Christy had always prided herself on having everything as close to perfect as possible and completed on time. She worked on lesson plans until midnight and went to bed only to wake up two hours later feeling like she couldn't breathe with extreme pressure and pain in her chest. She was rushed to the ER by her husband where she had an EKG. The doctor said her heart was okay but she was suffering from an anxiety attack. She was given medication and kept for observation until she felt she could breathe again, and the pain in her chest had diminished.

Treating Anxiety Without Pharmaceuticals

She was referred to a psychotherapist and given a diagnosis of anxiety disorder. The psychotherapist saw her for 10 sessions and she appeared to be doing fine while still on the medication. When her medication ran out the psychotherapist suggested she discontinue it and practice her new stress relieving techniques. One week later she awoke again in the middle of the night unable to breathe normally with pain in her chest - the very symptoms of her first anxiety attack.

Christy came to my office seeking a solution that was not pharmaceutical or psychological since she experienced her anxiety attack as physical. Christy's condition is typical of a great number of potential clients who experience anxiety attacks.

The physical symptoms of an anxiety attack include dizziness, heart palpation, trembling, sweating, shortness of breath, chest pressure or pain, burning skin, pins and needles, hot and cold flushes, numbness and tingling sensation, tight stomach, nausea, pounding / racing heart, choking sensation, throat closing. Psychological symptoms include fear, panic and feeling overwhelmed. As you can see the physical symptoms outweigh the psychological, and the autonomic nervous system is out of balance.

Breathing plays a major role. Chest pressure or pain, shortness of breath, trembling, pins and needles, numbness and tingling sensation, choking and throat tightness, and knot in the stomach are all directly related to breathing. Anxiety attacks at their most intense usually include hyperventilation, which intensifies the physical sensations listed above. This presents incredible opportunities for the application of massage techniques.

Tension and contraction of muscles involved in the breathing process are directly associated with the onset of an anxiety attack. These include the muscles of the abdomen and diaphragm, the muscles surrounding the rib cage, the intercostal muscles between the ribs, the muscles of the throat and neck, and the muscles of the face/mouth/and jaw. Contraction of these muscles distorts the body and can be easily recognized through structural evaluation with the client standing.

Structural Evaluation

When doing a structural evaluation, first notice if the upper body is pulled down and forward – this is usually a major indication that the muscles are contracting as part of the anxiety. Next look at the muscles of the abdomen – are they moving freely or do they seem to hardly move with each breath. If they are not moving freely they can be part of the anxiety.

Also, look to see if there are any creases in the abdomen that are indications of a major blocking or contractions that pull the client forward and down restricting the breathing. Now, have the client take deep breaths and notice whether the ribs are moving evenly in inhalation and exhalation, or are the tightened contracted muscles restricting their movement.

It is important to look at the front, back and sides when evaluating the expansion of the ribs during breath. Next notice if the shoulders are medially rotated which indicates that the pectoralis muscles are contracting and restricting breathing. Then, look at the structure of the neck - are the muscles contracted and rigid, are there creases across the neck, both can be signs of restricted breathing associated with anxiety. Finally, look at the face and jaw to see if they are being rigidly held. If so they can restrict the ability to breathe fully and are part of the physical manifestation of anxiety.

The Treatment Plan

Observing anxiety symptoms in a structural evaluation can facilitate devising a treatment plan specific to your client. I find starting with the abdomen paying attention to the psoas and diaphragm, working up through the front of the rib cage, shoulders and neck, and then the sides and down the back is very effective. Applying a 3-step approach will allow you to work deeply even in the first session.

1. Apply superficial strokes to release the surface tension and some of the ischemia, swelling, inflammation and some of the trigger points.
2. Apply directed myofascial unwinding strokes, which are deeper and release the tissue in the direction of structural improvement.
3. Work specific individual fibers and muscles to release the muscles, connective tissue, fascia, scar tissue and adhesions at a deeper level.

Using Cranial/Structural therapy before applying soft tissue treatments will improve the structure, and help maintain the changes. Cranial/Structural Decompression techniques will also help balance the autonomic nervous system and bring the body into homeostasis. Breath release therapy is another tool to open and release blocks of breathing, but should only be applied by a massage therapist who has been properly trained.

Christy received a combination of Cranial/Structural therapy and Cranial/Structural Decompression, specialized soft tissue protocols, and breath release therapy. After six sessions her physical symptoms of anxiety disappeared and she reported that her overall level of fear and need to be in control also diminished. Christy was no longer having anxiety attacks and felt she was able to successfully adjust to the pressures at school.

References

1. McCann D. Relief from Carpal Tunnel Pain and Other Nerve Entrapment Syndromes. Tampa: A&A Printing, 2000; pp. 35-38.
2. McCann D. The Integration of Cranial/Structural and Soft Tissue. Massage Today, February 2014.
3. McCann D. Make A Difference in Clients Who Suffer from Traumatic Brain Injury. Massage Today, March 2016.