Why Has It Been So Long Since the Last Newsletter?

I have been traveling a fair amount this summer already, and have three trips planned for August. (Oh, my!)

In June, I went to Philadelphia to be a Teaching Assistant (TA) for a Lymph Drainage Therapy (LDT) 2 class. I TA LDT classes to help others learn the techniques as well as to hone my skills.

I took two classes in July in Florida: one was learning how to release physical trauma to the brain (see article below) and the other was to renew my certification for Lymphedema Bandaging (my LLCC credential).

In August, two of my trips are for personal/family reasons. The other will be to TA another LDT2 class in Reston, VA.

Treating Brain Trauma

This was the first in a series of four classes on working on the brain. It is only open to advanced students of Lymph Drainage Therapy, CranioSacral Therapy and Visceral Manipulation curricula taught by the Upledger Institute.

What Does This Work Entail?

The technique is very gentle. The pressure should always be comfortable. This work is done with the client fully clothed. The work is done almost exclusively on the head; the final step may involve working on the spinal cord, which can be done over the clothing.

Who's a Candidate for This Work?

Anyone who has suffered some type of trauma to the head: This can be birth trauma, a concussion, hitting your head when you fall, being hit in the head or face by an object, or surgery.

Since the brain controls all of our functions, this work is beneficial for many disorders: balance, vision, hearing, sleep, memory, body temperature control problems, to mention just a few.

I personally experienced an improvement in my ability to balance on one foot while taking this class. One student worked on someone with early onset Alzheimer's on a weekly basis. That client experienced an improvement in short term memory.

What is Lymph Drainage Therapy?

Lymph Drainage Therapy (LDT) is one of a variety of similar techniques that work the Lymphatic System of the body. It is characterized by very light touch, rhythmic strokes which stretch the skin rather than gliding over the skin, and a release of the streched skin. Each stroke consists of two parts: the stretch and the release. Each storke part lasts the same amount of time. The strokes vary in length from 1 second, 6 seconds, 10 seconds, 20 seconds and even longer, depending on the purpose of the stroke.

The other major lymph drainage techniques used in the United States are the Dr. Vodder Manual Lymph Drainage technique or Vodder technique. (The difference between these two is that the Dr. Vodder technique is taught by the direct-line school created by Dr. Vodder; the Vodder technique is taught by schools that have made some changes to the Dr. Vodder technique, so are no longer in the direct line.)

What Benefits Can I Expect From a Lymph Drainage Therapy Session?

Because if the rhythmic nature of the technique and the very light touch, people find it extremely relaxing. In fact, I often have my clients fall asleep when I am doing LDT on them, more so than all the other massages I give.

But, not only is it relaxing, it is very therapeutic. It is an excellent technique to relieve pain and soreness in joints and in muscles, reduce fluid retention (edema), improve range of motion where there is a restriction, improve the immune system, detoxify the body, decrease wrinkles, help relieve the symptoms of chronic fatigue and fibromyalgia. In conjunction with bandaging, lymph drainage is the gold star treatment for Lymphedema. It can be helpful in treating many other conditions, too numerous to mention here.

One additional use would be to have a session or two a couple of days before and after surgery. The benefit of having some LDT prior to surgery would be to reduce the amount of fluid within the tissues. This can result in a "cleaner" incision and less fluid leakage into the surgical area. The benefit of having sessions after surgery is to help the body rid itself of the edema (swelling) around the surgical area. This helps the incision to heal more quickly and also to help reduce the possibilty of infection.

What Is The Lymphatic System?

The Lymphatic System is a component of the circulatory system and consists of lymphatic vessels (similar to blood vessels), lymph nodes, lymph fluid. The circulatory system has one pathway for blood to leave the heart (arteries) and two ways for it (blood and components of the blood) to return to the heart (veins and lymph vessels). Many of the lymph vessels parallel the arteries and veins.

Lymph fluid is that portion of the interstitial fluid between cells of tissues (muscles, organs, etc.) that is pulled into the lymph vessels. The veins also carry away a large portion of this interstitial fluid. Lymph consists of water, proteins, fats, minerals (such as calcium, zinc, sodium, etc.), a variety of free cells (variety of blood cell types and immune cells), various hormones and a variety of waste products.

The lymph vessels connect to a succession of lymph nodes. The lymph nodes filter out excess water and harmful substances, and forms some white blood cells (which fight infection).

The lymphoid organs consist of the Thymus, the tonsils, and the spleen. These, along with the lymph nodes, play an important role in the immune system of the body. They either make or mature the cells that fight infection. So, a healthy, well functioning lymph system will enable your body to fight off infections and diseases more quickly and keep you healthier.

The lymph vessels join together until one lymph vessel on each side of the body connects to the veins close to the heart, thereby returning all the substances in the lymph fluid to the general circulation to later be processed by other systems of the body.
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Sources:

1. Chikly, Bruno, M.D., D.O. (Honorary). Silent Waves: Theory and Practice of Lymph Drainage Therapy, First Edition, Revised. I.H.H. Publishing, Scottsdale, Arizona. 2002.

2. Thibodeau, Gary and Patton, Kevin. The Human Body in Health and Disease, Fourth Edition. Elsevier Mosby, St. Louis, MO. 2006.

3. Chikly, Bruno, M.D., D.O. (Honorary). Study Guides for LDT1,LDT2, LDT3, and LDT Advanced1. Upledger Institute, Palm Beach Gardens, FL. Various years.

Questions from Clients Regarding LDT

What Causes My Lymph Vessels and/or Nodes to become congested?

There are several reasons for the lymphatic system to become clogged: the primary ones are trauma and inflamation and the concentration of their effects within the lymphatic system.

What Can I Do At Home to Prevent My Lymph Vessels and Lymph Nodes Open and Prevent them from Becoming Congesting?

Wearing tight clothing (such as jeans, tight bras, and tight elasticized banding at legs and waist of underpants, belts) compresses the lymph vessels and nodes, not allowing the fluid to move through them. So, loosen those belts and waistbands; wear looser clothing; and for the ladies, be fitted for a better size bra.

Deep breathing helps to keep the lymph fluid flowing, especially through the chest and abdominal areas. The Lymph System has no pump to move the lymph (such as the heart for the circulatory system); it relies heavily upon the contraction of muscles around it to force the fluid to move. When you breath deeply, filling your lungs from top to bottom, you are using many muscles: the diaphragm, muscles between the ribs, as well as the abdominal muscles. This then "pumps" the lymph fluid through its vessels in the abdominal cavity and the in the chest.

Exercise also moves the lymph, for the same reason as deep breathing: the contraction of muscles.

Another technique to keep the lymph fluid from becoming congested is dry brushing. Using a natural bristle body brush, you want to brush the skin in the direction of the lymph flow: generally in the direction of the heart. You want to use a dry brush; however, if it scratches/hurts too much, you can wet it slightly; but, only wet the brush until you can tolerate the dry brushing. This dry brushing is good for detoxing and for the skin.

Let the Lymph Flow!

What is the Feasability/Effectiveness of LDT Without Bandaging for treating Lymphedema?

If the client is unwilling to be wrapped to reduce the degree of Lymphedema, then the manual treatment (the LDT) becomes less effective in reducing the size of the limb. The LDT then is more for the client's comfort.

What is Myofascial Release Massage?

Massage incorporating myofascial release techniques works on muscles as well a connective tissue. "Myofascial" comes from the Latin words for muscle ("myo") and elastic band ("fascia "). Connective tissue is called fascia as it has an elastic nature, as do muscles. This elasticity allows muscles and fascia to stretch, much like a rubber band. Myofascial Release is gentle, and consists of light stretching and massage.

What Exactly is Fascia?

According to Stedman's Medical Dictionary, fascia is "a sheet of fibrous tissue that envelops the body beneath the skin; it also encloses muscles and groups of muscles, and separates their several layers or groups." So, fascia is what connects everything to everything else! It surrounds every muscle (actually within the muscle joining muscle fibers and bundles together), group of muscles, organ, bone, nerve, blood vessel in the body. And it extends to the cell level. It is a complex web that extends from head to foot, from the skin to the innermost level of the body.

Some people liken fascia to a knitted sweater or a spider's web due to its interconnectivity. When I explain fascia, I tell people that when they lift the skin away from a raw chicken breast, it is that filmy-like tissue that joins the skin to the meat (actually muscle). John Barnes, a leading proponent and developer of myofascial techniques, says, "The most interesting aspect of the fascial system is that it is not just a system of separate coverings. It is actually one structure that exists from head to foot without interruption. In this way you can begin to see that each part of the entire body is connected to every other part by the fascia, like the yarn in a sweater."

This reminds me of the song Dem Bones (also called Dry Bones or Dem Dry Bones) I remember singing and hearing as a child. See separate article Dem Bones Song.

Why Have Myofascial Release?

When the fascia is normal and healthy, it is relaxed and has the ability to stretch and move easily; there are no restrictions. However, once our bodies experience some physical trauma (injury, inflammation, scarring, poor posture, etc.), the fascia can become tight, losing its ability to stretch, and becomes restricted. When the this occurs, the fascia then puts pressure on the other tissues it surrounds, causing pain, limiting motion, decreasing flexibility and/or affecting stability. Due to the fascia's interconnectivity, this tension/pain sometimes can extend throughout the body.

Some typical syndromes or injuries for which myofascial release is indicated include, but are not limited to the following:

* Injured, stiff, sore muscles
* Chronic Back Pain
* Chronic Fatigue Syndrome
* Poor posture
* Tension, Anxiety
* Repetitive Stress Injuries such as Carpal Tunnel Syndrome Fibromyalgia
* Frozen Shoulder
* Sports Injuries (e.g., Tennis or Golfer's Elbow)
* Cerebral Palsy
* Scoliosis
* A variety of pains: migraine headaches, menstrual cramps, arthritis, whiplash, sprains, etc.

What Happens During a Myofascial Session?

Myofascial Release is gentle and uses a mix of stretching and massage. The massage therapist (MT) will open with either light massage (Swedish massage, see my article from March 2007 archived on my Blog, see below on how to access the Blog) or extended stretches to the tissue in order to warm the muscles and the fascia. By extended stretches, I mean stretches that last 2 minutes (or even longer). This releases tension (caused by scar tissue or adhesions resulting from injuries) in the muscles or fascia, and even bones, nerves and joints.

Next the MT will use very slow strokes in the direction of the fibers. The strokes can be either long straight strokes or twisting strokes to apply the appropriate pressure to the tissues. This stretches, loosens, softens and lengthens the muscle tissues, thereby allowing it to relax and return to its normal state, thereby relieving the pain. These stretching strokes may be repeated several times until the muscles is fully relaxed and released. Some MTs will have the client move the muscle being worked on by bending and straightening the nearby joint the muscle goes over.

The MT might finish the session with some smoothing Swedish strokes.

The normal session is an hour long. Due to its slow nature, a Myofascial Release session will generally cover one or two areas of the body. However, the effect may be over the whole body. Depending upon the condition being treated and its duration, multiple sessions may be required.
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Sources:

1. Myofascial Release, http://www.massagetherapy101.com/massage-techniques/myofascial-release.aspx, massagetherapy101.com.
2. Stedman's On-line Medical Dictionary, http://www.stedmans.com/section.cfm/45
3. Myofascial Release, John Barnes Webpage, http://www.myofascialrelease.com/mfr/mfr.asp?wss=FF61694AB9B84ABB84A2B98CAE71001C
4. What is Myofascial Release? John Barnes webpage, http://www.myofascialrelease.com/mfr/mfr_what.asp?wss=FF61694AB9B84ABB84A2B98CAE71001C
5. Myofascial Release, Holistic Junction webpage, http://www.holisticjunction.com/categories/HAD/myofascial-release.htm
6. "Myofascial Release Therapy, Body Wisdom Massage Therapy School, http://www.bodywisdomschool.com/myofacial_therapy.htm

Dem Bones Song

This song show hows all the bones are interconnected. Similarly, all the muscles and other tissues in the body are interconnected. And the fascia is the glue that binds them all together. By the way, there are several variations on this song.


(Chorus) Oh those bones, oh those bones,
oh those skeleton bones.
Oh those bones, oh those bones,
oh those skeleton bones.
Oh those bones, oh those bones,
oh those skeleton bones.
Oh mercy how they scare!

With the toe bone connected to the foot bone,
and the foot bone connected to the ankle bone,
and the ankle bone connected to the leg bone.
Oh mercy how they scare!

(Chorus)

With the leg bone connected to the knee bone,
and the knee bone connected to the thigh bone,
and the thigh bone connected to the hip bone.
Oh mercy how they scare!

(Chorus)

With the hip bone connected to the back bone,
and the back bone connected to the neck bone,
and the neck bone connected to the head bone,
Oh mercy how they scare!

(Chorus)

With the finger bone connected to the hand bone,
and the hand bone connected to the arm bone,
and the arm bone connected to the shoulder bone,
Oh mercy how they scare!

(Chorus)

With the shoulder bone connected to the back bone,
and the back bone connected to the neck bone,
and the neck bone connected to the head bone.
Oh mercy how they scare!

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Source:

Dry Bones (or Skeleton Bones), http://www.niehs.nih.gov/kids/lyrics/bones.htm

What is Deep Tissue Massage?

Deep Tissue (DT) Massage works on the muscle deeper within the body as well as the deeper portions of thick muscles that located are more superficial. Deep tissue massage is performed on muscles that are chronically tense, tight, knotty, inflamed, sore, and/or painful. These conditions can affect the blood flow and therefore the amount of oxygen to the muscles; this results in the build-up of toxins in the tissues, causing chronic pain. Muscles affected in this manner are often shortened and can result in distorted postural positions by pulling the bones from their normal position.

Tense tight muscles can be caused by physical work, by over exercising, stress, injury, congenital conditions, among others causes. Deep Tissue is not generally applied to the entire body as Swedish massage is. It is performed only on tense, tight muscles; and may be applied only to one or two body parts in a session, for example:

• The back;
• Runners may have DT done to their thighs and/or lower legs;
• People who use their arms extensively in their work (such as massage therapists [big smile] or construction workers) would have their arms done;
• People who use computers extensively would want DT to their necks and shoulders.

A little bit of Swedish Massage is actually done first: In order to affect the deeper muscles, the muscle layers above them (the superficial muscles) must be relaxed first, allowing the massage therapist access to the deeper muscles. But the deeper muscles are often unaffected by this lighter massage technique.

To work on the deeper muscles, the massage therapist (MT) uses greater pressure and more specificity. One muscle at a time is worked. To work deeper, the massage therapist will use any of the following tools: his/her fingers with hands either side by side or one on top of the other, individual fingers and thumbs, heel of the hand, fist, knuckles, forearm and elbow. The massage table is lower than for a Swedish massage so that the MT has leverage. While some of the same Swedish strokes are used, they are done more slowly and with deeper pressure. Friction is generally faster and deeper and across the grain of the muscle fibers.

How Deep Should Deep Tissue Massage Be?

Since the pressure is deep and the muscles involved are generally tense, tight and sore, there can often be some pain associated with a DT massage. However, and this is a big however, it should not be excruciatingly painful. Massage therapists use a 10-point pain/pressure. Pressure that is a "10" would be the most excruciating pain you could ever image. The lightest touch would be a "1." Pain that hurts but hurts good is generally rated a "7;" once it goes beyond hurting good, it has become an "8" or a "9." Everything below a "7" is generally not painful, but is felt as varying degrees of pressure. Most Swedish massage is done in the 3-5 pressure range: you feel the pressure and it feels good.

In a DT massage, the MT aims to work the muscles at the 6-7 pain/pressure level. If the pressure is at this level, the client should not experience pain afterwards because of the massage. This level of pressure most effectively relaxes muscles by lengthening the muscle fibers (the level of the pressure will also decrease during the process), releases deeply held patterns of tension, and increases the flow of blood which helps to remove toxins in the tissue. It is imperative to drink lots of water after a massage: This flushes the toxins out of the body and helps to eliminate that source of the pain.

Deep Tissue massage requires good communication between the MT and the client. The MT should be checking often with the client on the pain/pressure level, to ensure not exceeding the 7 level. A good MT will also be aware of the client's body language in determining pain/pressure level: a twitch, a jerk, holding the breath, tensing of surrounding muscle groups are all signs that the pressure is too much. But, it is also incumbent upon the client to let the MT know immediately if the pressure reaches and especially exceeds a 7. This two-way communication on pressure helps to ensure that the MT gives the client the best massage possible with the least amount of discomfort from massage-induced pain.

It is also important to understand that the level of pressure felt is relative to the client. Everybody has different tolerance of pain/pressure. What is a 5 to one person could a 3 to another and a 7 to a third person. Also, with the MT exerting the same amount of pressure to different body parts or muscles on the same client can be perceived at different pain/pressure levels. Whether the MT's touch is considered pleasurable or painful depends on multiple factors: Amount of tension in the tissues; condition of the muscles (healthy or injured); client's perception of the touch, ability to relax and accept deeper pressure, confidence in the MT.

What Results (Benefits) Can I Expect From a Deep Tissue Massage?

As I stated earlier, the muscles will relax, releasing toxins, and the soreness and tension will be decreased, and hopefully gone. (The improvement in pain will depend upon how long the muscles have been tight, sore and achy. The longer the condition has existed, the more likely it is that multiple massage sessions will be needed for total relief.) Where there has been postural distortion, posture will become more normal and balanced as the relaxed muscles permit the bones to return to their normal position. This results in improving structural and functional integrity for the client, including improved range of motion. Pain caused by inflammation (such as from arthritis and tendinitis) will be reduced.

Sometimes after the massage, the muscles hurt more before they get better. This is called a "healing crisis." Muscles that have been neglected for some time can respond with varying amounts of pain. Sometimes it may take a day or two for these muscles to react to the massage. Then the pain will decrease and the client should feel better.

Sources:

1. Everything You Want to Know About Massage, About Massage.com, http://rs6.net/tn.jsp?t=pryej4bab.0.0.hcxxg5bab.0&ts=S0240&p=http%3A%2F%2Fwww.aboutmassage.com%2Ftechniques.htm&id=preview
2. Deep Tissue Massage and Therapy: Getting to the Root of the Problem, Amy Mullen, http://rs6.net/tn.jsp?t=pryej4bab.0.0.hcxxg5bab.0&ts=S0240&p=http%3A%2F%2Fwww.associatedcontent.com%2Farticle%2F20229%2Fdeep_tissue_massage_and_therapy.html&id=preview
3. Top Ten Massage Techniques: More Natural Therapies Solutions. Adapted from New Choices in Natural Healing, edited by Bill Gottlieb, Editor-in-Chief, Prevention Magazine Health Bookds. http://rs6.net/tn.jsp?t=pryej4bab.0.0.hcxxg5bab.0&ts=S0240&p=http%3A%2F%2Fwww.care2.com%2Fchannels%2Fsolutions%2Fself%2F385&id=preview
4. Therapeutic Massage Techniques: Deep Tissue Massage. © 2006 Therapeutic Kneads, Ltd., Highland Park, IL. http://rs6.net/tn.jsp?t=pryej4bab.0.0.hcxxg5bab.0&ts=S0240&p=http%3A%2F%2Fwww.wekneadyou.com%2Fpages%2Ftechniques.htm&id=preview
5. What Is Deep Tissue Massage? From Anitra Brown, Your Guide to Spas. http://rs6.net/tn.jsp?t=pryej4bab.0.0.hcxxg5bab.0&ts=S0240&p=http%3A%2F%2Fspas.about.com%2Fod%2Fmassag1%2Fa%2Fdeeptissue.htmGlossary&id=preview
6. Glossary. MassageTherapy.com. http://rs6.net/tn.jsp?t=pryej4bab.0.0.hcxxg5bab.0&ts=S0240&p=http%3A%2F%2Fwww.massagetherapy.com%2Fglossary%2Findex.php%23D&id=preview
7. What is Deep Tissue Massage? Mama'sHealth.com. http://rs6.net/tn.jsp?t=pryej4bab.0.0.hcxxg5bab.0&ts=S0240&p=http%3A%2F%2Fwww.mamashealth.com%2Fmassage%2Fdtissue.asp&id=preview
8. Scheumann, Donald W. The Balanced Body: A Guide to Deep Tissue and Neuromuscular Therapy, 2nd edition. Philadelphia, PA: Lippincott Williams & Watkins, 2002