Tuesday, 8 October 2013

The Benefits of Massage for Relieving Arthritic Pain

The Benefits of Massage for Relieving Arthritic Pain

By Paula Ng and Gill Tree
Joint pain is nothing new. Arthritis, in its many guises, was described by ancient Egyptian medical texts, Hippocrates (the father of western medicine) and an Ayurvedic medicine text from 123 AD respectively. 
Today, more than 10 million adults in the UK, (6 million women and 4 million men), consult their GP each year with arthritis and related conditions, and 7.5 million working days were lost in 2011/2012 due to musculoskeletal conditions. 

What is arthritis?
Arthritis is inflammation of the joints. There are well over 100 types of arthritis, the two most common being osteoarthritis and rheumatoid arthritis.
Until recently, osteoarthritis was considered a primarily degenerative disorder caused by general wear and tear. It is now believed to be far more complex with genetics and nutrition, particularly, Vitamin D deficiency, playing a part.
Rheumatoid arthritis is an auto-immune disease that results in joint inflammation. There is no cure for this condition so management is by symptomatic control.
The physical signs of inflammation for most sufferers are:
  • pain
  • redness
  • swelling
  • stiffness and decreased movement
  • warmth to the touch.
The pain, in particular, contributes to the £442 million that the NHS spent on painkillers in 2010-2011. Arthritis Research UK, a leading UK charity raising awareness and funds for the fight against arthritis, recently launched new initiatives to address the underestimated problem of chronic pain from the condition. 
"Pain relief is essential but, as well as drugs, people with arthritis can help themselves by keeping active and mobile, keeping their weight down, and benefiting from physiotherapy and other non-drug treatments,"
Massage can certainly be viewed as one such ‘non-drug treatment’.

How massage can help - 
Patients are frequently concerned about side effects associated with prescribed drugs. Different people tolerate the side effects of conventional treatments in different ways and it can be a hard, frustrating search to find effective relief. For many, symptoms can restrict simple daily activities to such an extent that health deteriorates further due to stress and tension. These symptoms can have such a debilitating effect that arthritis is the most common condition for which people receive Disability Living Allowance (DLA). 
Massage can help sufferers take control by managing their symptoms in a positive, nurturing forum, either with or without other treatment methods.

The effects of massage - 
The holistic approach of massage therapy is ideally suited to conditions such as arthritis. The entire body is massaged, not just the site of pain, ensuring that both mind and body can welcome the healing touches of the ‘relaxation response’ and the mechanical response.
The ‘relaxation response’, as first defined by Dr Herbert Benson is physiologically different from sleep or simply resting. It is ‘a state of deep relaxation in which the heart rate, blood pressure and breathing rate decrease. Muscle tension relaxes, stress hormone levels fall, and the mind becomes tranquil’.
The mechanical response refers to the two major physical effects of massage, namely increase in blood and lymph circulation and normalisation of the soft tissue.

Relaxation Response - 
Massage has the ability to relax the body, but also to soothe and quiet the mind. In a relaxed state, the perception of pain is altered, often alleviated, and a person may feel more empowered to cope with their pain and address the anxiety caused by the frustration of their situation.
Massage has a powerful effect on the endocrine system. It increases levels of the neurotransmitters serotonin, dopamine and oxytocin. In a study on massage therapy by the Touch Research Institute at the University Of Miami School Of Medicine, serotonin levels in the test subjects increased by 28 percent, dopamine by 31 percent. 
Serotonin – This hormone positively affects emotions and thoughts. It is a neurotransmitter that has a calming effect on the brain and body functions, producing a general sense of well-being. The ‘happy hormone’.
Dopamine – This neurotransmitter helps regulate mood, attention, learning and sleep and is vital in the body’s control of movement. It is also believed to release endorphins, chemicals that allow us to feel pleasure. The ‘feel good hormone’.
Oxytocin – This has been dubbed the "hugging hormone," as it produces feelings of calm and contentment. The initial feeling of well-being from a massage is produced by the release of oxytocin from the posterior pituitary. Oxytocin imparts a feeling of being ‘unstressed’, loved and loving.
Whilst massage causes an increase in these neurotransmitters, it also decreases the levels of less desirable chemicals; cortisol (9) and substance P.
Cortisol - Stress affects the brain by releasing cortisol, often referred to as "the stress hormone", which negatively affects many systems throughout the body. It is secreted into the bloodstream during the body’s ‘fight or flight’ response to stressful situations. Long term exposure to cortisol can result in sleep problems, depression, increased heart rate, affecting heart, lungs, circulatory and digestive systems and is also associated with a weakened immune system.
Substance P - This is a protein found in the brain and spinal cord that transmits pain signals from sensory nerve ending to the central nervous system, i.e. its function is to cause pain. It has been implicated in inflammatory conditions and is believed to be involved in the regulation of pain, stress and anxiety. Massage has been shown to decrease substance P levels (10), contributing to pain relief.

Mechanical response - 
In fundamental terms, massage is physical manipulation of soft tissue which positively affects the circulatory system and the state of soft tissues.
It is believed that massage can enhance oxygen and nutrient delivery to cells by improving blood and lymph circulation.  As tissues begin to function more efficiently, more waste products are removed, excess fluid absorption may increase and thus reduce swelling; a central part of arthritis care.
Many arthritis sufferers complain of painful muscle contractions and spasms. These may be caused by a number of factors, but anxiety and tension are certainly contributing factors. Massage relaxes muscle tissue, tendons and ligaments, reducing muscle contractions, and lessening nerve compression. Even though deep tissues cannot be directly massaged, the release of superficial muscular tension will assist in deep muscle realignment and improve mobility.

The significance of pressure
For massage to have a symptom-relieving effect, moderate pressure appears to be vital. Tiffany Field of the Touch Research Institute in Miami highlighted in a study that what matters most is level of pressure used in a massage. The study demonstrated that pressure receptors under the skin’s surface need to be stimulated with moderate pressure in order to convey pain-reducing signals to the brain. (11)
 “The critical thing is using moderate pressure,” says Field. “Light pressure, just touching the surface of the skin or brushing it superficially, is not getting at those pressure receptors. Light pressure can be stimulating, not relaxing.”

Specific research - 
One key study carried by Tiffany Field and her associates, documenting the reduction of hand arthritis pain by massage therapy. The massage therapy group was massaged on the affected wrist/hand once a week for a 4-week period and, highly significantly, were also taught self-massage on the wrist/hand that was to be done daily at home. This element of self- help reinforces the holistic approach that can be so empowering.
The results were very encouraging – ‘The massage therapy group versus the control group had lower anxiety and depressed mood scores after the first and last sessions, and that group reported less pain and greater grip strength after their sessions. The massage therapy group showed greater improvement than the control group on all of these measures across the study period’ (12).
Arthritis Research UK wrote a report on complementary therapies and after considering the results of several trials concluded that “while there’s only a little evidence that massage is effective in osteoarthritis, there’s consistent evidence from a number of trials to suggest that it’s effective in treating some of the symptoms of fibromyalgia and low back pain. 13)
Contraindications - 
Whilst massage can greatly benefit the symptoms of arthritis, deep pressure or compression to the arthritic joints would be contraindicated. Physical manipulation of soft tissue may aggravate the condition and increase discomfort. It is wise to avoid massaging a sufferer of rheumatoid arthritis during a flare up as the condition may be aggravated causing further distress.
Arthritic joints can be very sensitive so it is critical to communicate well with a client to establish levels of tolerance.
What does the future hold?
Many sufferers and healthcare professionals would welcome a more holistic approach to the management of arthritis. Currently, enough research has been carried out to substantiate the potential impact of massage on pain management and specialised units now do exist in hospitals, clinics and home care schemes to offer massage.
It may be that massage becomes the non-pharmacological treatment of choice or indeed it may prove to be most effective when used in combination with other treatment methods. Nonetheless, more clinical research is clearly needed if the positive contribution of massage in the management of arthritis is to be widely accepted.
“Our prime purpose in this life is to help others. And if you can't help them, at least don't hurt them.”
Dalai Lama 

Stetka, B., Wei, N., 2013. Arthritis, Then and Now, Medscape Rheumatology.
Health & Safety Executive Report, Health and Safety Statistics 2011/2012.
Sun BH, Wu CW, Kalunian KC. New developments in osteoarthritis. Rheum Dis Clin North Am. 2007;33:135-148
McAlindon T, LaValley M, Schneider E, et al. Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis: a randomized controlled trial JAMA. 2013;309:155-162.
Department for work and pensions. Disability Living Allowance - cases in payment Caseload (Thousands): Main Disabling Condition by Gender of claimant. [Date accessed: 1-5-2008].
Dr Herbert Benson, MD and Miriam Z. Klipper.  The Relaxation Response, HarperCollins 2009.
Field T, Hernandez-Reif M, Diego M, Schanberg S, Kuhn C. Cortisol decreases and serotonin and dopamine increase following massage therapy.
 International Journal of  Neuroscience. 2005 Oct;115(10):1397-413. 
Touch Research Institutes, University of Miami School of Medicine, Miami, Florida 33101, USA. tfield@med.miami.edu
Journal of Bodywork & Movement Therapy. 2011 Jan;15(1):3-14. doi: 10.1016/j.jbmt.2010.06.001. Epub 2010 Jul 2. Does massage therapy reduce cortisol? A comprehensive quantitative review. Moyer CA, Seefeldt L, Mann ES, Jackley LM.
Touch Research Institute. Authors: Tiffany Field, Ph.D., Miguel Diego, Christy Cullen, Maria Hernandez-Reif, Ph.D., William Sunshine and Steven Douglas. Originally published in the Journal of Clinical Rheumatology, April 2002, Vol. 8, No. 2, pp. 72-76. 
Tiffany Field; Miguel Diego; Maria Hernandez-Reif (Profiled Authors: Miguel Angel Diego; Tiffany M. Field) International Journal of Neuroscience. 2010;120(5):381-385. Moderate Pressure is Essential for Massage Therapy Effects. May 2010, Vol. 120, No. 5 , Pages 381-385
 Field, T., Diego, M., Hernandez-Reif, M., Shea, J. (2007). Hand arthritis pain reduced by massage therapy. Journal of Bodywork and Movement Therapies, 2, 21-24.
Arthritis Research UK; Practitioner-based complementary and alternative therapies for the treatment of rheumatoid arthritis, osteoarthritis, fibromyalgia and low back pain, Pages 32-33

Wednesday, 26 June 2013

Hands – the tools of your trade

As a massage therapist, your hands often say more than your words; greeting a new client with a warm handshake, adding expression with gestures, the gentle placing of towels and linen and, of course, the giving of a massage. As tools, they work hard for you.
With a little care and commitment every day, these tools will see you through many years as a professional massage therapist.

Second only to your smile, your hands will be the feature your clients focus on to form an initial impression of you. It may seem obvious, but ensure your hands and nails are always scrupulously clean, with nails cut short. Wash hands in warm, not hot, water and a non-drying soap.

Endless washing can strip hands of natural oils so it is important to moisturise regularly. There is nothing quite as uncomfortable as a massage from a therapist with dry, cracked and rough skin on their hands. An instant softening treatment for hands can easily be made at home. Mix together a teaspoonful of oats, a little olive oil and one drop of lemon essential oil. Massage well into dry hands and rinse. Use this as a gentle exfoliant on hands twice a week.
An added bonus of using a high quality, cold-pressed oil for your massages is that it will keep your hands well-nourished and smooth. Top this up with regular use of a hand cream containing natural, skin softening ingredients and an SPF to help prevent signs of premature skin ageing.

After hours practising massage as a student or giving massages from 9-5 as a therapist, your tired hands will benefit greatly from some stretching and strengthening exercises. It is central to your work that you maintain flexibility and dexterity in all the joints of your hands.
Basic stretches that can be incorporated into your day take just a few minutes and can be done anywhere. All stretches should be done at a slow, controlled pace.
Wrist stretch – Place both palms together as in a prayer position. Slowly bring wrists down, keeping palms together. Ease palms apart slowly to feel a stretch in your fingers. Release by moving your wrists upwards.
Fan stretch – Holds hands up, fingers together, palms facing forwards. Fan out your fingers and thumbs, hold for 2 seconds and slowly release.
Finger flexor stretch – Place right hand on a flat surface with fingers relaxed. Using the fingers of your left hand as a ‘scoop’, gently lift the right thumb up and back, supporting with light pressure and hold for two seconds. Release and repeat with each finger. Repeat for the left hand.
Hand exerciser – Similar to a squidgy rubber egg, these can be purchased from any good sports retailer. Simply squeeze the exerciser to improve hand strength or roll between the fingers to increase dexterity.

‘Helping hands with a little self-care’

Monday, 24 June 2013



Make sure your product: you - is of the highest quality. Are your skills really honed? Are the equipment and treatment room of the highest quality? How can we aspire to be the best that we can? Is our appearance immaculat...e and the way we approach people and communicate, warm yet professional, welcoming, reassuring and assertive?

People don’t just buy because of price. Many factors come into the equation, including the client’s confidence in you and what you are able to provide. It is important to see what the competition is charging, but this doesn’t have to be an indication of what to charge. So many people use price, as a measure of quality and to charge too low will therefore be a mistake.

What we offer is a service, often thought of as “intangible”. You can’t see it, smell it or taste it before deciding to buy. It is therefore important to make our service as accessible as possible to the hesitant or nervous potential client. Offer introductory incentives, be available to talk through their questions and concerns and give talks and demonstrations for the public to meet you in person, as often as you can.

Is your clinic accessible, is there parking, it is easy to find, do you give directions to find you readily, is the environment right, does it have the right ambience, do you work during the right time of day, to ensure your supply is meeting demand?

Promotion includes, using the media effectively, advertising, giving presentations, getting referrals and being a self advocate. Advertising can be an expensive and often unproductive way to get more clients. Referrals are by far the best way.
Gill Tree, Managing Director

Monday, 17 June 2013

Massage Benefits

As you lie on the table under crisp, fresh sheets, hushed music draws you into the moment. The smell of sage fills the air and you hear the gentle sound of massage oil being warmed in your therapist's hands. The pains of age, the throbbing from your overstressed muscles, the sheer need to be touched -- all cry out for therapeutic hands to start their work. Once the session gets underway, the problems of the world fade into an oblivious 60 minutes of relief and all you can comprehend right now is not wanting it to end.
But what if that hour of massage did more for you than just take the pressures of the day away? What if that gentle, Swedish massage helped you combat cancer? What if bodywork helped you recover from a strained hamstring in half the time? What if your sleep, digestion and mood all improved with massage and bodywork? What if these weren't just "what ifs"?

Evidence is showing that the more massage you can allow yourself, the better you'll feel. Here's why.

Massage as a healing tool has been around for thousands of years in many cultures. Touching is a natural human reaction to pain and stress, and for conveying compassion and support. Think of the last time you bumped your head or had a sore calf. What did you do? Rubbed it, right? The same was true of our earliest ancestors. Healers throughout time and throughout the world have instinctually and independently developed a wide range of therapeutic techniques using touch. Many are still in use today, and with good reason. We now have scientific proof of the benefits of massage - benefits ranging from treating chronic diseases and injuries to alleviating the growing tensions of our modern lifestyles. Having a massage does more than just relax your body and mind - there are specific physiological and psychological changes which occur, even more so when massage is utilized as a preventative, frequent therapy and not simply mere luxury. Massage not only feels good, but it can cure what ails you.


Originally published in Body Sense magazine, Fall 2001.
Copyright 2001. Associated Bodywork and Massage Professionals. All rights reserved.

Friday, 14 June 2013

Feeling Stressed? A Natural Remedy

The next time stress has you hankering for a high-fat, creamy treat, skip the ice cream and try some homemade guacamole – the thick, rich texture can satisfy your craving and reduce those frantic feelings. Plus, the green wonders’ double wh...ammy of monounsaturated fat and potassium can lower blood pressure.

One of the best ways to reduce high blood pressure, according to the National Heart, Lung, and Blood Institute, is to get enough potassium — and just half an avocado offers 487 milligrams, more than you’ll get from a medium-size banana. To whip up your own avocado salad dressing, puree a medium avocado with 2 tablespoons of lemon juice and a dash of cayenne.
Posted on Essentials for Health Facebook Page

Tuesday, 11 June 2013

Giving Presentations and Teaching Your Therapy

Teaching massage is to me joyous work that not only gives your participants wonderful skills that they can use on friends and family, it develops and enhances you as a therapist and acts as a ...great marketing tool. When I first started Essentials for Health I taught many massage workshops all over London and got a lot of faithful massage clients as a result.

I am also a huge advocate for giving presentations about your work and believe them to be one of your best marketing tools. In a previous article I spoke about how giving the service of a massage is intangible - it can’t be sampled in the same way a car can be test driven or a perfume smelled. By going out and speaking to your public, you will build rapport and gain their confidence. If people like you and feel comfortable why wouldn’t they book with you?

It is often quoted that people would rather die than talk to a group of people. This reaction seems a little extreme particularly when to my knowledge no one has actually died from speaking in public!!

In actual fact, public speaking can believe it or not be an enjoyable experience especially once we realise that we can make friends with those terrible nerves that cause our hands to shake, voice to wobble and those butterflies to feel more like Kamikaze pilots!!

So this article will cover some guidelines for both teaching and presenting.

Over time I have come to love speaking in public, when it finally dawned on me that the only way to give presentations was my way.
To be me, with a few golden rules thrown in for good measure.

So, what are the “golden rules” of presenting?

KISS - keep it short and simple
Ensure there is a beginning, middle and end, and make sure the beginning and ending have impact. Command attention at the beginning and go out with a big bang
Know your subject
Know how to use props and visual aids
Have simple, clear messages
Wherever possible, give examples and anecdotes
Get to know the audience
Organise the presentation logically and time it
Use prompt cards
Rehearse and practice
Learn to laugh at yourself, you'll need to!
Use humour, particularly when you make a mistake!
Be enthusiastic
Involve the audience
Keep jargon out
Act and look confident, even if you're not
Scan the room and include everyone, even if they look like they're asleep!
Be prepared for the emergency; no flip chart paper, no powerpoint, only a few in the audience
Be visual, summon up any acting skills
Gill Tree, Managing Director

Monday, 3 June 2013

Touch Foundation

I started Essentials for Health to change the world though the healing power of touch. My experience in social work had led me to working with some of the most vulnerable in our society including people who were alcohol and drug dependent, the homeless, those with physical and learning disabilities and the acutely ill. It was no surprise that my massage clients were often those that other touch th...erapists felt under confident to work with, the dying, the sexually abused and those with HIV and aids.

Early in the company’s history we had strong links with the local community in east London where EfH was born and many of my students through EfH were able to work with similarly vulnerable groups, sometimes paid and often voluntary.

I always wanted to continue this service and have always dreamed of having our own charity to facilitate this and am extremely proud to announce that the Touch Foundation has been born! To start with we want to offer our massage e-course to clients of charities such as Relate, the British Heart Foundation and Scope.
Do you have any contacts? The Foundation will be instrumental in offering massage training to professional care givers and those in the medical profession as well as being a link between charities and those therapists who wish to volunteer. Pledge your time and interest now!
Gill Tree - Managing Director