8 Touch and massage
Touch and massage
Massage begins with touch, which all of us need; it conveys a feeling of warmth, relaxation and security – all beneficial to good health. There are many empirical examples of massage therapy effects, including reduction of pain during childbirth and lower back pain (Field 2000 p. 45), even without essential oils. The addition of essential oils with analgesic properties enhances the relief obtained by massage alone.
Massaging babies and infants can reduce pain associated with teething, constipation and colic, as well as inducing sleep (Auckett 1981). Studies carried out on preterm infants showed without doubt that massage was beneficial to their growth and development (Field et al. 1987). The babies were massaged for 15 minutes three times a day for 10 days in an incubator. Compared with the control group, 47% of the treated infants gained more weight and were hospitalized for 6 days less.
Patient benefits
Whether the causes of ill-health are biomechanical, psychosocial, biochemical or a combination of these, massage seems to be able to exert a beneficial influence (Chaitow 2000). Touch itself is a basic human behavioural need (Sanderson, Harrison & Price 1991) and ‘may be the only therapy which is instinctive; we hold and caress those we wish to comfort; when we hurt ourselves, our first reaction is to touch and rub the painful part’ (Vickers 1996).
As research and scientific developments in the efficacy of drugs forged ahead, close patient contact diminished and by the 1960s massage had more or less lost its therapeutic status in medical care. However, in the late 1980s and 1990s there was renewed interest by nurses in the value of touch, and now many hospitals and hospices are using massage to benefit their patients; during this time massage has been enhanced by the addition of essential oils, transforming the treatment into aromatherapy (Buckle 1997) (see Box 8.1). The benefits are further enhanced by the choice of essential oils used (Wilkinson 1995) – increased energy levels, reduced side effects from drugs, symptoms not treated by the hospital relieved and emotional problems eased. The effects can last longer than those of massage alone, owing to the therapeutic action of the essential oil components (see Chs 10–15).
Barlow and Cullen (2002) instigated a touch therapy programme aiming to enhance parents’ perceptions of closeness with their children and provide them with an alternative to verbal communication to promote the latter. Parents of children with autism were taught simple massage techniques over 8 weeks. Having practised massage with their children, parents reported that the children tolerated the massage and not only were routine tasks such as dressing tolerated more easily, but the children appeared generally more relaxed. Parents reported feeling closer to their children and that touch therapy had opened a communication channel between them.
Patients can benefit from a massage (simple or involved) given by any of the following:
• a physical therapist – without essential oils
• a physical therapist using essential oils ready blended by an aromatherapist
• a nurse with no professional massage experience, but with a sound knowledge of essential oils
• a nurse using essential oils under the direction of an aromatherapist
• a nurse using touch and gentle non-manipulative massage movements, without essential oils (see Introducing massage, below).
The most important thing to remember is that nothing can replace hands-on, when the giver (whether or not a qualified masseur/se) is caring and works within his/her capabilities, combining gentle touch with a loving attitude. With the right approach, beginning with a small non-intrusive movement, both the giver and the receiver can come to enjoy the care they are sharing, making it easier for the receiver to open up and become more relaxed in body and happier in mind (Worrell 1997). Authors agree that it is not necessary to spend an hour on a massage for it to be effective – people also benefit from a short period of dedicated time.
Massage and aromatherapy – therapies in their own right
Professional massage
Case study 8.1 Anxiety
Intervention
• 3 drops Chamamaelum nobile [Roman chamomile] – antispasmodic, calming, sedative
• 1 drop Rosa damascena [rose otto] – neurotonic
• 3 drops Origanum majorana [sweet marjoram] – analgesic, calming, neurotonic, respiratory tonic
1 mL Valeriana officinalis [valerian] – sedative, tranquillizing
1 mL Chamaemelum nobile – properties as above
2 mL Lavandula angustifolia [lavender] – analgesic, balancing, calming and sedative, tonic
2 mL Origanum majorana – properties as above
3 mL Cananga odorata [ylang ylang] – balancing, calming, sedative
the therapist must know anatomy and physiology, understand the relationship between the structure and function of the tissues being treated, and be knowledgeable in pathology, as well as being skilled in the proper manipulation of tissues (Beard & Wood 1964 p.1).
Massage and aromatherapy
It would prevent misunderstanding of the word aromatherapy if the qualification in massage were totally separate from that of essential oil knowledge. As Vickers (1996 p. 15) so rightly says, ‘massage and aromatherapy should be judged on their own merits’. This ‘combined’ situation arose because aromatherapy was originally aimed at and studied by beauty therapists only, and massage is part of their training.
Aromatherapy schools in the 1970s taught their own specialized massage to beauty therapists; many placed too much emphasis on the massage and barely any on the essential oils. This situation has been regulated to a certain degree by the Aromatherapy Council (AC), which stipulates the number of hours to be spent on massage, anatomy and physiology and on essential oil knowledge in order for an aromatherapy course to be accredited by them (see Ch. 17).
Because the aromatherapy and massage are linked, neither is taken to its full potential: the massage training of aromatherapists is not as thorough as that of a physical therapist and the essential oil training is not as deep as that of an aromatologist (therapist qualified in aromatic medicine) and member of the Institute of Aromatic Medicine (see Ch. 9).
Beneficial effects of massage
Massage is widely recognized as providing the following benefits; it:
• induces deep relaxation, relieving both mental and physical fatigue
• releases chronic neck and shoulder tension and backache
• improves circulation to the muscles, reducing inflammation and pain
• relieves neuralgic, arthritic and rheumatic conditions
• helps sprains, fractures; breaks and dislocations heal more readily
• promotes correct posture and helps improve mobility
• improves, directly or indirectly, the function of every internal organ
• improves digestion, assimilation and elimination
• increases the ability of the kidneys to function efficiently
• flushes the lymphatic system by the mechanical elimination of harmful substances (especially toxins due to bacteria) and waste matter
• helps to disperse many types of headache (or migraine) originating from the gallbladder, liver, stomach and large intestine, and also those of emotional origin (including premenstrual syndrome or PMS)
• stimulates both body and mind without negative side effects
• helps to release suppressed feelings, which can be shared in a safe, confidential setting
• is a form of passive exercise, partially compensating for lack of active exercise.
Simple massage skills
The most easily acquired massage skills are:
• Stroking, which comes under the heading of effleurage movements (perhaps the most important for hospital use), for which the whole of both hands from fingertips to wrist should be used. Stroking is simply an extension of touch and, as well as being one of the simplest, is one of the most important movements in massage.
• Frictions, which come under the heading of petrissage (a deeper and more energetic series of movements than effleurage), and in which either the thumb or one or more fingers are employed. ‘Rubbing it better’ is a simple friction movement. The Hippocratic writings (from the Hippocratic collection 460–357 BC) remarks that ‘the physician must be experienced in many things, but assuredly also in rubbing, for rubbing can bind a joint that is too loose and loosen a joint that is too hard’.
• Kneading (a form of petrissage), involving use of the palm, the palmar surface of the fingers, the thumb, or thumb and fingers working together, is a squeezing and ‘pulling’ movement, often used on the shoulders and the thighs.
• Percussion, where the outside of the hands and fingers continually make and break contact with the body in a definite rhythm, is not normally used in aromatherapy.
• Lymph drainage is only briefly covered in an aromatherapy training programme. It is fully covered on a Vodder technique course.
Frictions
1. Fixed frictions move the superficial tissues over the underlying structures, i.e. the part of the hand used is ‘stuck’ firmly to the client’s skin, which is moved over the tissues beneath by making circles.
2. Gliding frictions move over a small area of the skin surface and may also progress along a specific path.
Other factors
Learning the different movements is only part of massage training. Equally important is the way in which these movements are performed. Essential factors to consider are contact, the direction of movement, the amount of pressure, the rate and rhythm of the movements, the medium used, the position of both patient and therapist, and the duration and frequency of the treatment (Beard & Wood 1964 pp. 37–40). Further factors include the need for full contact with the patient and complete relaxation of the masseur’s own hands and arms because hard, tense hands transfer tension (and possibly pain) to the recipient. The mind should be cleared of any intruding, disruptive thoughts: the wellbeing of the client and how he/she can benefit must be uppermost.
The following principles need to be absorbed at the same time as the actual movements are learned.
Contact
No part of the human body is flat; nevertheless, when using effleurage (stroking movements) there should be full hand contact with every part of any large area to be massaged (Price 1999). Nothing breaks the relaxing effect of massage more than the repeated lifting off and replacing of hands. Fully relaxed hands and fingers maintain this contact by following the body’s contours closely, draping themselves over the body like silk. The hands should remain in contact with the body for both outward and return journeys of all movements made in sequence: lifting off disrupts the flow of the massage as a whole (Price 2000 p. 203).
Pressure
In effleurage on a large area pressure should always be concentrated on the palm of the hand (Price 2000 p. 201). The fingers should be kept completely relaxed because pressure from fingers is not relaxing – finger pressure should be used in friction movements only. Normally, palm pressure should be applied only when moving towards the heart, with none on the return journey. One of the aims of massage is to stimulate the circulation (the return of venous blood is not easily accomplished by the heart – pressure towards the heart increases the rate of circulation. The lymphatic flow is also increased, ridding the body more quickly of any harmful substances.
Speed
This depends to a certain extent on the effects to be achieved. Generally speaking, massage is given to relax the recipient, and a rate of approximately 15 strokes a minute for a long stroke (e.g. hand to shoulder) is considered correct (Mennell 1945) or 18 cm (7 inches) per second (Beard & Wood 1964 p. 38). Anything faster than this is used only if the massage is intended to be stimulating.
Rhythm
Uneven or jerky movements are not conducive to relaxation and care should be taken to maintain a smooth, unbroken rhythm (Price 2000 p. 203). While massaging, relaxing music with a gentle rhythm can be of great help in sustaining continuous, fluent and flowing effleurage movements. Frictions also should be performed rhythmically (Beard & Wood 1964 pp. 10–11).
Frequency
The frequency of massage treatment depends to a great extent on the pathological condition of the patient, as does the type of massage given. ‘It is generally believed that massage is most effective daily, although some investigators have suggested that it is more beneficial when administered more frequently and for a shorter duration’ (Beard & Wood 1964 p. 39).
Contraindications to massage
Illness
• Infection. The advice of the microbiologist or the infection control nurse should be sought.
• Pyrexia. If the client feels well enough an appropriate specific area could be massaged gently, using oils to give a cooling effect (e.g. include 0.5–1% peppermint in the blend).
• Severe heart conditions. Permission from the doctor or specialist must be obtained for whole-body massage.
• Medication. If the patients is on strong (and/or many types of) medication, specific-area massage only should be used.
• Cancer. There is some controversy regarding massage, and aromatherapists report that consultants can give conflicting advice. Some say that it is not advisable to encourage movement of the lymph as this may promote migration of the cancer to another area of the body; others say that moving the lymph and thereby encouraging the elimination of toxins (possibly some of the cancer cells also) could be beneficial (see Ch. 15). It is the opinion of Horrigan (1991) that, although surface massage will not cure cancer by natural means, it will not:
Localized damage
• Inoculations. The site of an inoculation given within the previous 24 hours should not be massaged.
• Recent fractures and recent scar tissue. The healing of scar tissue can be hastened by the gentle application of essential oils in a carrier oil or lotion, or spraying them in a water carrier on to the site if touch cannot be tolerated.
• Bruises, broken skin, boils and cuts. If small, these can be covered with thin transparent tape before proceeding with the massage.
Normal physiology
• Hunger. If 6 hours or more have passed since any food intake, or if the patient feels hungry, fainting may occur with whole-body massage.
• Digestion. Immediately following a heavy meal, the digestive system is working full time and whole-body massage could cause either nausea or fainting.
• Alcohol. After recent alcohol intake, full body massage and certain essential oils can intensify the effects of alcohol, possibly causing dizziness, or a floating feeling. Specific-area massage does not have this effect and the amount of any essential oil used (in the recommended dilution) would be too small to contraindicate their use.
• Perspiring. Immediately after exertion, sport, a long hot bath or sauna, the body is excreting sweat and heat and absorbs essential oils with difficulty. It is advisable to wait 20–30 minutes before whole-body massage, although a 10–15-minute wait is adequate for specific-area massage.
• Menstruation. During the first 2 days of menstruation bleeding could be increased by whole-body massage. However, specific-area massage can help to relieve congestion and soothe any pain or discomfort.
Varicose veins and oedema
• Varices. The area above the damaged valve should be cleared first with deep, firm, upward effleurage strokes, before commencing the light upward strokes on the affected area itself.
• Oedema. This condition must be treated by a precise technique. When present in an ankle the massage should begin with the upper leg, because it is important to clear this area first before attempting to relieve the oedema. Treatment of the lower leg should then be carried out, returning to the upper leg at intervals during the massage and to finish. The affected part must be elevated while giving the massage (Beard & Wood 1964 pp. 38, 60, 104).