Why MLD (Manual Lymphatic Drainage)?

The inspiration for this post came from a client who recently asked, "Why do I treat the lymphatic system? What do you see that inspires you to recommend it?"

Simple questions with a longer answer than I thought. While responding, it occurred to me that a very basic understanding of the lymphatic system is necessary.

The lymphatic system is involved in most (I can't think of any where it's not a major player, but there may be some?) cellular interactions and body functions. It can largely be thought of as a transport system within the body that has 2 main responsibilities:

• deliver nutrients and purification agents to body areas 
• collect and cleanse fluid

Manual Lymphatic Drainage (MLD) is comprised mainly of 2 techniques:

• Strokes to focus on lymph nodes 
• Strokes that focus on vessels and fluid movement 

And
The Lymphatic system does not have a dedicated pump, like the heart, to move body fluids. Instead, it relies on the skeletal muscle movement to generate flow. Movement is essential! I smell a future post...

Here are my reasons for my recommendation:

MLD is useful for anything that has an inflammatory component, words that end in "itis", or any auto-immune condition. It cleans the skin and body tissues and is useful 48 hours before surgery to help provide a clean area for the incision. Also, MLD can be safely used hours after your surgery to remove cellular wastes, speed healing, and promote healthy scar regeneration. It's a great complimentary bodywork to go along with any detox or cleanse and when clients mention suffering from allergies, sinus congestion, puffy eyes or face; MLD is often my initial thought.

When I see any swelling or edema, lymphatic work is extremely useful. MLD along with compression bandaging/garments (CDT), is the gold standard treatment for lymphedema management. Breast cancer survivors and others who've had lymph nodes removed may either have impaired lymphatic movement or swelling. If not experiencing these symptoms now, lymph node removal predisposes the survivor and can set up future impairment. In these cases rerouting normal drainage becomes necessary.

If one arm or leg is bigger than the other, this is another case to consider MLD. When someone comes in and asks me to work on trigger points, scars, or fascial restriction, different techniques treat those concerns. However, once those are addressed, because tissue stiffness will also reduce fluid movement, I'll use MLD to help restore lymphatic flow. This also flushes fluid through the area to remove any cellular debris or nociceptive (pain signaling receptors) substances that have collected because of tissue stiffness.

Lastly, When there's a nerve impingement or entrapment, the nerve becomes irritated and causes neuroinflammation. After treating restrictions and tissues along the nerve's pathway, I'll use MLD to pacify this inflammation. When MLD is applied to the full body it provides a relaxation stimulus to the entire nervous system. So when someone's session goal is relaxation, one of my first thoughts is MLD because of its calming effect.

If you use MLD, please let me know why you use it.

Enjoy,

Joe

NCTMB board certified, CLT
myelitemt.com

Therapeutic Interventions: home based strategies

It's been a while, but here's a great subject to break that cycle: therapeutic interventions.

These are things that are done to break a cycle in your body in the attempt to return it to its "normal" function.

When I work with someone in pain, often I ask if they did anything to help change their situation, if so what and was it helpful?  This is a list to give ideas of at home strategies for physical pain that you can try by yourself to make a therapeutic intervention.

Temperature Apps (applications)- these tend to have a shorter effectiveness, but can be very helpful in trying to figure out your pain.

• Ice or cold application- a natural analgesic that helps slow down nociceptor interaction (pain receptor).  This strategy is usually helpful for the first few hours after acute injuries and nerve and trigger points tend to respond well to cold stimulus.  If you tend to tolerate or favor cold outside of an acute injury, this may indicate trigger point or nerve involvement.
• Heat application or hot shower or soak- muscles and fascia typically respond well to heat and this is a great strategy for stiffness.

Mindfulness- beneficial for overall health and especially chronic pain.

• 10-20 minutes of meditation
• 5-10 minutes visualization-  see yourself returning to pain free normal activity 
• puzzles, reading or coloring
• observe well performed activity- activate mirror neurons in the brain and try to feel the motion as though it was a memory
• spend time enjoying music or art

Movement based strategies-  A good way to try to free up stiffness and restriction, keep it gentle.

• stretching
• yoga
• swimming or trmpoline/rebounder
• dance
• tai chi
• light weights, light cardio or light exercise

Pressure based strategies-

• self massage- your hands are wonderful tools you take with you everywhere.  They are great, and my number 1 pressure tool, when you can reach the spot.
• tools- balls, foam rollers, theracane, still point inducers...(etc.) this list is endless.  I'd recommend starting with a softer tool held over a stiff or tender spot, for a minute or a few, and letting the tissue soften around the tool.  You can use a towel if your tool is too pointy or increase the tool density over time as necessary.  Tools can easily become a noxious stimulus to your nervous system, when this happens, your work becomes counterproductive.  Back off on the tools density or your pressure (or both) your next try.

This is only meant to give you ideas about home based interventions and is by no means a complete list. Please feel free to add comments below.

Enjoy,

Joe

myelitemt.com

How Massage Therapy is part Art and part Science

Much like Music and Art, Massage therapy is a very broad, highly subjective and ambiguous term.  Massage therapy like the two hemispheres of the brain, is comprised of two parts: it's both an art form and science.  To add to the confusion of creating definitions of what a Massage Therapist is/should be and what makes a good massage great, Therapists have found homes in a wide variety of venues from hospitals and Chiropractor's offices to gyms and spas.  

The artistic side is comprised more of sense of feel and intuition rather than governed by pure logic.  The therapist may not be able to fully explain how or why they do something or work a particular area of the body; and often times the therapist is "lead"or "drawn" to somewhere because of this feeling.  

Typically the artistic side is seen as having more of a sense of flow and has often been compared to the artistry of a dance.  This work relies on the therapists ability to access their humanistic, compassionate awareness and although in many cases this element is an innate quality; through work and intention it can be developed. This type of work can be very helpful in a situation where someone is seeking comfort or relaxation and is most frequently an Event massage.

Whereas the science portion is more oriented in the analytic side of things; the "hows" and "whys" of massage therapy.  It's concerned with the physiologic principals behind the technical strokes and how those techniques impact the body; it's steeped in anatomy, physiology and kinesiology.  

It is in this capacity that the therapist plays the role of detective, assessing what might be involved, why, what not do, and any technical adaptations that may be required for the given situation.  Often this side of therapy is very useful to those suffering from repetitive strain injuries, chronic or acute pain, or pathology: and it is a Process endeavor, usually requiring multiple sessions for optimal results.  

The science side of massage therapy is not an innate quality and is similar to many Martial Arts and Dance forms in this way: while one can reproduce the technical abilities quite well, the understanding of the philosophy behind the technique is more elusive and requires commitment, dedication, study and experience to fully access its enlightenment.

During my time as a Therapist I have been fortunate enough to witness, study, receive and learn from people who are very gifted in both the Artistic side of therapy and its Scientific counterpart.  They are fluent in both sides of massage therapy and fully capable of adapting, blending and weaving between both sides at will and as dictated by the receiver and the situation (something that I look for in my therapist).  

While what makes a good massage great will differ from receiver to receiver and time to time, a common thread elevating a good session to a great one (like in any great art work) is the application of knowledge and intention.  The key is to determine what you're looking for as a receiver and to communicate that need with your therapist.

Thanks and stay well!
http://myelitemassagetherapy.com/

A Need for Contact

Everyday I consider that we (in the US) live and operate in a very touch-deprived society. 

My very next thought is both quite humbling and empowering simultaneously; Massage Therapists have the privilege of addressing this depravity with each session.  

There are so many aspects to writing about the importance of touch, volumes of articles in professional journals and entire books dedicated to this subject.  While I cannot cover all aspects, I did want to share some of the ideas and articles I came across that highlight the gravity of the very basic human need to receive compassionate touch and stimulate our sense of well being.  

This excerpt is taken from the September 1999 AMTA (American Massage Therapy Association http://www.amtamassage.org/index.html) Massage Journal article written by Debra Brooks, titled The Hypermobile Client/Therapist.  

In the article Brooks interviews Author, Scientist (medical and psychological), Clinician, and Teacher: Joan Borysenko, Ph.D. 

Borysenko: I think there are actually three important components of massage therapy that complement all forms of healing.

First is actual physical touch. We know a great deal about physical touch, for example, on the immune system. Physical touch releases growth hormones that will help your immune system recover. Without touch, the immune system cannot recharge. Everybody needs to be touched and although most of the massage research literature on touch deals with babies, the need for massage certainly continues throughout life. I do believe we are a touch-deprived culture.

People are afraid of being sued if they touch. You can't even have a teacher any more touch a crying child. What has happened in our society regarding touch is truly pathetic. So going to a place where it is safe to be touched is very, very important. It is effectual at the most basic hormonal, physiological, and immune system level.

The second component is the specificity of the touch. For example, releasing tension in the muscles, causing relaxation, doing trigger-point work, and doing things of that nature. All of this works very well via the work of massage therapy. The effect that massage therapy can have on healing a deeper injury by releasing tension in the muscle is remarkable.

And the third component is the energetic aspect. The research on energy, medicine, and touch that is therapeutic comes down to one very basic thing: when there is a respectful intention to heal, some kind of energy flows from the healer to the one who is being healed. So when a massage therapist has that kind of respectful care in her hands, then more is happening than just at a physical level. Something is happening at an energetic level, as well. 

To read the article in its entirety:  http://www.amtamassage.org/articles/3/MTJ/detail/1829

This next excerpt is taken from an article co-authored by Trish Dryden, M.Ed, R.M.T. and Pamela Fitch, B.A., R.M.T. titled Recovering Body and Soul from Post-Traumatic Stress Disorder in the March 2000 AMTA Massage Journal.  This section highlights the benefits of touch.

Benefits of Touch

There are no specific physical manipulation techniques for working with trauma clients. Swedish massage can be as effective and enlightening to a client as the most advanced fascial mobilization. No matter the technique, massage therapy can inadvertently trigger traumatic memory, which, as massage therapists know, also can be a powerful tool for healing and growth.¹³ For example, there is ample documentation that touch stimulation is essential for babies to thrive. The results of Tiffany Field's research on preterm infants is most compelling, where each was given 15-minute massages three times a day for 10 days while still in incubators.¹⁴ The treated infants gained 47 percent more weight and were hospitalized for 6 days less. They performed better on the Brazelton Neonatal Behavior Assessment Scale.¹⁵ The babies averaged 12 points higher on the mental scale and 13 points higher on the motor scale than the control group. In another experiment,¹⁶ rat pups were stimulated with tiny wet paintbrushes, a procedure designed to mimic the licking of newborn litters by their mothers. The rat pups which were "licked" with the paintbrushes thrived similarly to those which had received normal care by mothers. Those that received no stimulation became ill, had small growth rates, and failed in many instances to thrive.

To read this article in its entirety: http://www.amtamassage.org/articles/3/MTJ/detail/1817

In the Fall 2004 edition of the AMTA MTJ (Massage Therapy Journal).  Dawn Nelson contributed an article titled The Power Of Human Touch In Alzheimer's Care.

Once again, the demand to embrace our very basic human need for contact is underscored; however, this article focuses on the importance of touch as we venture into our twilight years and particularly for those who are debilitated by Alzheimer's Disease and Dementia.  

In a very thought provoking article Nelson writes,"Throughout the progression of AD, the broad, general benefits of therapeutic massage, when appropriately adapted, are beneficial in improving circulation, softening contracted muscles, relieving minor aches and pains, and promoting relaxation.

Perhaps even more importantly, skilled touch sessions provide significant psychosocial benefits to those with AD in residential facilities, including:

• Focused one-on-one attention;

• Companionship;

• Mental stimulation;

• An opportunity for social interaction;

• Skin-on-skin contact;

• Sensory and tactile stimulation;

• Nonverbal communication;

• Nurturing;

• Pleasure.

Intentional, caring touch helps to:

• Reassure those who are confused;

• Calm those who are agitated;

• Increase body awareness;

• Ground the disoriented person in present time and space;

• Provide a touchstone with physical reality;

• Reinforce verbal communication;

• Redirect energy or shift attention;

• Reduce the need for medication and

physical restraints;

• Alleviate feelings of isolation, loneliness or abandonment."

To read this article in its entirety: 

http://www.amtamassage.org/uploads/cms/documents/powerofhumantouchalzheimers.pdf

This was just a slight glimpse into a broad subject I am in awe of, and I wished to share with you.  Feel free to comment on this blog, especially if you feel that I neglected anything important.
Thanks and stay well!
http://myelitemassagetherapy.com/

Heat Pads vs Cold Compressions

Many I've worked with have said that they never know which to use: heat or ice?
Knowing how this impacts the body physiologically can shed light on any confusion out there.   Be prepared for some 10 cent biological terms...ok, ok 5 cent.

Heat acts as a vasodilator, it widens the blood vessels by relaxing the smooth muscles cells within the cell walls.  This allows blood to flow with less vascular resistance.  (Thank you Wikipedia!)
Generally speaking remember: muscles, particularly stiff and rigid ones, love heat and typically respond very well to it.  In fact, muscles that are more chronically rigid and stiff often suffer from impeded blood flow (ischemia) and heat pads can be a very beneficial intervention.  Although, reduced blood flow is usually more of a result of something else and less of a perpetuating or causative factor.

If you decide to break out your heating pad to address your next stiff area, do not exceed 20 minute applications.  Generally, 20 minutes on and 20 minutes off is the most accepted cycle.  I use 10-15 minutes on and the same amount of off-time for my cycles.  Once heated (vasodilated) having a brief time-off allows the tissue to "normalize" (return to a homeostatic state).  When this on-off cycle is repeated it can pump blood through the area, thusly removing debris that could have developed in the ischemic, rigid tissue.
Like I said, remember: stiff muscles love heat.

Ice or cold compresses act as a vasoconstrictor, it narrows the blood vessels by contracting the muscular wall of the vessels.  Blood flow is restricted, thus retaining body heat and increasing vascular resistance (Thanks again Wikipedia!)
In addition, the cold application also slows the signals being sent to the central nervous system particularly the nociceptors (specialized receptor cells that transmit information about pain).  For this last reason, cold compresses act as a natural analgesic and are very helpful interventions for acute pain.

Our bodies are very adept at producing inflammation.  Once the inflammatory response is triggered, the body can easily become overzealous in its production.  Because of its vasoconstrictive properties, cold compresses can help corral and contain the inflammation to the tissues that are in need of its services.  The next time you twist your ankle and it swells up and becomes very painful, you may want to use a cold compress.  Follow the same general rules for time applications as heat, don't apply for longer than 20 minutes at a time and cycle as desired.  Also know that the inflammation stage for most acute injuries is the 48-72 hours period following the injury.  During this time, stay with cold applications; heat is not recommended (you want to contain the inflammation) and if the inflammation stage lasts longer than 72 hours, seek medical intervention.
So remember: if the pain is acute and there's inflammation or swelling, use a cold compress.

Keep in mind, these are physiologic generalities, your case may be different, there are always exceptions.  Both temperature applications are not long standing interventions; they address a more immediate concern and not the perpetuating factor.
Be well and stay healthy!
http://myelitemassagetherapy.com/

Tips: Getting the Most from your Massage Appointments

   Knowing what your goals are for receiving a massage and sharing those goals with your therapist will allow for a more successful session.

There are a wide variety of techniques and approaches Therapists can utilize during a session, each with subtly different results.  The more information you can relay about what you're looking for, the better able the Therapist to shape the session to address your needs.  

The reasons many seek a massage largely fall into two categories: Stress Management or Pain Management.  Both deserve individual approaches.  Decide which one you're after. Now consider, Do you see your massage session as more of an Event or a Process experience?

Some Event experiences include: Birthday present, Anniversary, Race or Sporting Events, Vacation, Mother's Day, Valentines Day; any singular occurrence.

For more recurring, chronic concerns massage therapy delivers best results with frequency, over a period of time, as a Process experience.  Much like going to the gym, learning a foreign language, or dancing; the body retains more information the more often it's exposed to the stimulation.

In summation, it's all about you and your goals.
Thanks and stay well!
http://myelitemassagetherapy.com/