8 Touch and massage
In certain countries the word ‘massage’ cannot be used by aromatherapists unless a massage certificate recognized by that country is held. In France and America a different name – ‘therapeutic touch’ – is often used which allows those not sanctioned by the government to carry out massage under a different name. The intention of the therapist is the same: to relieve tension and enable a beneficial result to take place.
Most aromatherapy schools teach their own specialized massage (or therapeutic touch); nevertheless, patients and clients can still benefit greatly from touch from an inexperienced or non-qualified person. Some massage movements are illustrated in this chapter for the benefit of those already qualified in aromatherapy and/or massage, and to encourage other nurses with a desire to use the simpler methods described. For the lay person or the busy nurse, knowledge of a few of the simpler techniques is an extremely valuable asset which can bring benefit to those needing care.
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.
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.
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 increases the circulation of both blood and lymph, helping in the elimination of toxins from the body; it slows down the pulse rate, lowers blood pressure, releases muscle tension, tones underworked or weak muscles and relieves cramp.
Although these are perhaps not so easy to evaluate, they are significant and play their part in the holistic healing effect: relaxing an apprehensive mind, uplifting depression and despair, relieving panic or anger and, importantly, giving a person the feeling that someone cares enough to spend time giving the specialized contact brought by touch and massage.
Several colleges run short courses that are not sufficiently comprehensive to confer a recognized massage qualification. To meet professional standards and be competent to give a full, professional massage,
Case study 8.1 Anxiety
Kay, a 42-year-old woman working in a family business, was referred for treatment by her GP, with severe anxiety and stress. Over the past 3 weeks, owing to business problems, she had become increasingly withdrawn and anxious. She was experiencing panic attacks (which left her clammy and freezing) in crowded places and also at night, which was disturbing her sleep pattern, thus she found it hard to wake up in the morning. She had extreme tension in her neck and shoulders, suffering headaches as a consequence. Her breathing tended to be shallow and rapid, and she had lost more than a stone in weight over the 3 weeks, partly due to lack of appetite.
Kay opted for treatment twice a week and after the first treatment said she felt much calmer and more relaxed. She was standing upright rather than being bent over with the shoulder tension, and said that her head felt much clearer.
On her next visit Kay reported that she found inhaling the oils when particularly anxious had relieved the hyperventilation and helped her to relax; she had also started to incorporate breathing exercises into her routine.
After six treatments over 3 weeks, Kay felt sufficiently confident to go shopping without anxiety. She had also been able to resolve some of the problems at work. She was beginning to put weight back on and her appetite had returned to normal.
She therefore decided to reduce her treatments to once a week, and after 3 more weeks she felt able to resume some of her work duties, when she reduced her treatments to once a month. She had not ceased taking her medication during her aromatherapy treatment time, but 6 months after first commencing aromatherapy, her doctor felt he could reduce her medication over the next 3 months.
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).
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).
• 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)
These combined benefits not only result in increased body awareness, but also produce better overall health. Studies carried out in hospitals and private practice have shown that massage with essential oils greatly enhances and prolongs the health-giving effects.
• 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’.
Case study 8.2 Depression
Shortly after her return from hospital she stopped taking her medication. She was advised against this, as it is possible for a relapse to occur, but she was adamant as she said it was making her feel worse. She also suffered from lower back pain through sitting for long periods at her knitting machine – an improved posture for knitting was suggested, although Miss L had not felt able to do any since leaving hospital. She used to do aerobics, but again, not since leaving hospital. She was not sleeping well and had PMS before her periods.
After the second one her back felt much better – she was able to move more freely, although her sleeping pattern was not back to normal. It was therefore decided to give Miss L the same essential oils to use at home, in two blends:
• 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.
Effleurage is the basis of all good massage. It can be used on its own, at the beginning and ending of a massage and also in between other types of movement. It consists of two types of stroking, using the whole hand or hands, which should mould themselves to the shape of the part of the body being massaged. The strokes are either deep (i.e. with pressure) or superficial (without pressure). Sometimes only part of the hand is used – perhaps only two fingers on a small area or on a baby.
Deep stroking with both hands is accomplished by moving up the part of the body being massaged with pressure towards the heart; its purpose is to assist the venous and lymphatic circulation by physical effect on the tissues.
Superficial stroking is effected without pressure and in any direction (the pressure is so light that the circulation is not directly affected). The perfection of this technique can require skill and long practice. In simple massage, superficial effleurage is mostly used as the return movement of deep effleurage, moving away from the heart back to the starting position.
Effleurage is used mainly to relax the recipient both mentally and physically and to improve the vascular and lymphatic circulation. Many different types of strokes come under this heading, but all should follow the basic principles above.
Frictions are another form of compression massage, or kneading. They may be performed with the whole or the proximal part of the palm of the hand or with the thumb and fingers to carry out circular movements over a restricted area. There are two types of 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.
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.
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).
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.
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.
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).
Most massage is carried out to relax both mind and body, so the movements themselves (and the changeover from one movement to another) should be smooth and unnoticeable to the recipient. The whole area receiving massage should be covered without a break in continuity, contact or rhythm (except when carrying out percussion).
The duration of a massage session depends on how much of the body is to be massaged, the age of the individual, the size of the body and the enjoyment level of the recipient. Massage sequences suggested in this book last between 5 and 15 minutes depending on the area to be massaged. Ten minutes of massage normally provides sufficient relaxation to induce a good night’s sleep.
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).
Whole-body massage is not taught in this book and is contraindicated in the situations described below, but specific area massage (e.g. shoulders, hands and arms, feet and lower legs, face and scalp) is acceptable in most instances.
• 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:
• 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.
• 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.
These two conditions are often believed to be unsuitable for massage. In fact, both can be alleviated by essential oils used in light effleurage. Special care is needed in the execution of the massage, and only gentle, almost superficial, upward effleurage strokes should be used.
• 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).