Pharmacology and Massage Therapy: Beta-Blockers

One of the most frequently prescribed class of drugs in the United States are the drugs commonly known as beta blockers. They are prescribed for a great variety of conditions that are approved by the FDA and are used "off label" for any number of other conditions.
Some common beta blockers that you may see on your client's medication list include: propranolol (Inderal), metoprolol (Lopressor) and atenolol (Tenormin).
The drugs block the effects of the Sympathetic Nervous System (SNS) by stopping the effect of epinephrine/norepinephrine at the beta receptors in the heart and sometimes also in the lungs and adrenal glands. The SNS is part of the Autonomic Nervous System that regulates the functions of our bodies in response to internal and external factors. The SNS is the branch that stimulates the body to action and when overstimulated is the source of stress effects on the body. By blocking the effects of the SNS at the receptor sites the drugs decrease blood pressure, decrease the force of heart contractions, slow electrical impulse conduction through the heart, decrease heart output and oxygen demand. In those that affect the lungs, constriction of the broncioles can occur.
Side effects that are related to the blocking of the SNS include fatigue, sleepiness, low blood pressure, slow heart rate, fainting, fluid retention, wheezing, irregular heartbeat, edema, Raynaud's syndrome, gas, and nausea and vomiting.
Beta blockers are generally used to treat high blood pressure, irregular heart rhythms and long-term prevention of angina (chest pain) and heart attack. They are also used for such diverse conditions as migraines, anxiety, essential tremors, glaucoma, PMS and perimenopausal symptoms.
As a massage therapist recognize that the body may relax more quickly and deeply for the client taking these meds and that gentle stimulation at the end of the massage may be needed. A drop in blood pressure can also occur with massage, so care in getting the client on and off the table is needed. Other changes to how massage is applied may be required related to the client condition, severity of cardiac disease etc.
References: http://www.mayoclinic.com/health/beta-blockers/HI00059 , http://www.medicinenet.com/beta_blockers/article.htm
Jean Wible, RN, BSN, LMT, NCTMB, HTCP Author of "Pharmacology for Massage Therapy" and "Drug Handbook for Massage Therapists"

Pathology and Massage: Scleroderma by Jean Wible

Scleroderma is an autoimmune disease that affects women 4 times more than men. While its cause is unclear, its symptoms are due to an overproduction of collogen and hardening (sclerosis) of the tissues of the body. Scleroderma can manifest in many ways. It can be local or systemic. It can affect the skin, blood vessels and organs. The most common symptom is changes in the color of the skin and tightening and thickening of the skin.
In localized scleroderma two types of lesions can occur; morphea, which shows as oval patches on the trunk, face and extremities that start as dry, thickened skin and progress to pale centers with purple edges, or linear, where a discolored line or band on arms, legs or forehead appear resembling a scar from a long cut. Localized scleroderma is usually self-limiting and may resolve over time.
Systemic scleroderma is a more serious form of the disease that can involve skin, blood vessels, and organs especially the heart, kidneys, lungs and digestive tract. There are 3 forms; limited systemic scleroderma which has a slow onset and progression but can eventually affect the organs, diffuse scleroderma which has a sudden onset and more rapidly involves the organs, and sine scleroderma which only involves the organs and doesn't manifest in the skin at all.
CREST is the acronym for the common symptoms of scleroderma and stands for Calcinosis, calcium deposits in the skin especially in the fingers, Raynaud's phenomenon, impaired circulation and vascular spasm in the extremities, Esophageal dysmotility or sluggish digestion with reflux, Sclerodactyly, which is hardening of the fingers, and Telangiectasia or discoloration of the skin.
Systemic scleroderma can cause major health problems as it progresses. Ulcerations of the skin can lead to infection and gangrene while fibrosis of lungs, kidney and heart can lead to failure of these organs. While most often a long term, chronic disease systemic scleroderma can be fatal.
Treatment is supportive with immunosuppressant drugs, corticosteroids, pain relievers, and other drugs depending on the symptoms. Physical and occupational therapy are also utilized to help maintain movement and flexibility of the joints as long as possible.
Massage therapy will need to be adjusted depending on the type of scleroderma, the individual symptoms and the severity of the disease. Myofascial techniques will generally be ineffective due to changes in the tissue itself. Deep tissue may be cautioned or contraindicated if skin hardening is severe and circulation compromised. Gentle relaxation massage that is firm and rhythmic can help improve circulation and be soothing to tight tissues as well as help the client to deal with the stress and pain of a chronic disease. Passive and active movement of the joints can also be of help but should be gentle and never forced beyond the physiologic barriers. Energy work and breath work are some of the other modalities that may be used even when massage may be contraindicated.
Further information on this topic can be found at http://www.mayoclinic.com/health/scleroderma/DS00362 , http://www.scleroderma.org/ , or http://www.niams.nih.gov/Health_Info/Scleroderma/default.asp
Jean Wible is a Registerd Nurse, Nationally Certified and Licensed Massage Therapist and Healing Touch Certified Practitioner. Author of "Pharmacology for Massage Therapy" and "Drug Handbook for Massage Therapists" and faculty at the Associate Degree Program in Massage Therapy at The Community College of Baltimore County.

Massage Therapy Week in the News

Massage Therapy Week at CCBC was a celebration of wellness and an appreciation of how Therapeutic Massage can improve your quality of life. Thanks to everyone who stopped by for a massage or to learn more about the Associate's Degree program in Massage Therapy at the Community College of Baltimore County.

Read the article in The Avenue

Worst Massage Ever!

When I started talking to other Massage Therapists about the worst massage I'd ever received, everyone had a story to tell. "Oh, do you mean the one that was so light and fluffy it was annoying, or the one who left you with bruises?"

Well, yes, those too. The light and fluffy one tells me that poor therapist never learned the first thing about body mechanics and doesn't know how to apply appropriate pressure; it is sooo annoying, like a gnat I just want to swat away. Don't waste my time.

Then there is the steam roller who believes in applying deep pressure at 90 mile an hour - this person is clueless about "listening" to the client and never learned the secret to great deep tissue . . . the sloooow sink, the take all the time in the world, oh yes, that feels good sort of relief that knotted muscles are begging for. Is it any mystery why many people don't like Deep Tissue Massage? Slow down, breath, pay attention. The really bad Deep Tissue massage that I had was even more memorable because this guy worked out of his house . . . okay, nothing wrong with that, but there was the smelly dog, the music that wasn't at all massage music, and the fact that this guy wouldn't shut up and when I asked him to slow down, he told me that I wasn't the first person to tell him that. Well, Duh? And to make matters worse, this therapist had 17 years of experience. How can one have 17 years of experience and be so unskilled?

The worst massage I've had lately is one that I received while attending a National Convention. It was a text book case of all the things not to do in a massage. The room was cluttered and unappealing, the therapist talked too much, he alternated between too deep and too light, really did not appear to be paying attention, and he was really unprofessional with the draping. It seemed that he hadn't heard a word I said when I explained where I was tight and where I wanted him to focus. To add insult to injury he cut the massage short. Well, considering how bad the massage was, he may have done me a favor. My first thought was that this guy was really inexperienced - then on second thought I realized he may have been experienced but was just unskilled! I have had a number of very good massages at our student clinic by student therapists who are inexperienced, but surprisingly skilled.

What was your worst massage experience? And how do you find a good therapist when you are traveling?

The Amazing Human Body

How many times have you been to Body Worlds? This is the most amazing educational opportunity! If you missed it when it was in Baltimore, it now currently back in Philadelphia until February 10, 2010, and is well worth the drive!
http://www2.fi.edu/bodyworlds2/

As a Massage Therapist, understanding the intricacies of the musculoskeletal anatomy is essential. Even after taking the Full Body Dissection Seminar (Kent Health Systems & The University of Southern Florida at Tampa), I never miss an opportunity to view these amazing exhibits. What a great (inexpensive) way to deepen your understanding of the anatomy.

Baltimore's # 1 Massage School - 2 year AAS Degree

Start Now! If you are thinking about entering Massage School in the Spring, Come to the Open house on Wednesday October 28th between 4 - 7 pm to learn more. It isn't too early to begin the enrollment, placement and registration process.

We are located on the Essex Campus of The Community College of Baltimore County, 7201 Rossville Blvd, bldg J, Rm 323, Baltimore, MD 21237.

Pathology for Massage Therapists, a 3 credit course

Pathology for Massage Therapists concentrates on the recognition, assessment and treatment of common musculoskeletal pathologies; it covers assessment and identification of dysfunctions, creation of specific treatment plans, and the ways that massage therapy affects both the diseases themselves and their consequences. This course is a requirement in the CCBC Massage Therapy program, which leads to an Associates Degree in Applied Science.

However, the course may also be taken by experienced Licensed Massage Therapists and Registered Massage Practitioners who want to be better prepared to work with clients who have a variety of health conditions. If you have been practicing for years, you may not have had much training in Pathology, or you may just want a refresher course. You may enroll for credit, or audit this course, with the Program Director's permission.

Product Review: Microwaveable Hot Packs

When hot packs are appropriate, which one is best?
There are two that I particularly like: Elasto-gel, and Therabeads.
They both maintain heat well, and they both will last for years if properly cared for.
The elasto-gel packs are more pliable and conform very nicely to the shape of the body. Therabeads packs are firmer and do not conform as well, but have the advantage of a temperature-sensitive strip that tells you if the pack is too hot or within a safe heat range. I use both Elasto-gel and Therabeads, depending on the specific need. They come in a variety of sizes and shapes. They are available at BMLbasic.com, a massage, spa and physician's office supplier.

Massage Therapy Continuing Ed for 2010 - More Choices!

More Choices, More Classes, More ways to complete

your CE requirements and make you happy.
Wow are we going to be busy next year!

Look at some of the goodies we have lined up for you:

• Nurturing the Mother (Claire Marie Miller)
• Authentic Thai Massage
• Trager
• Healing Touch
• Orthopedic Massage
• Better Body Mechanics
• Massage Research
• Feldenkrais
• Bodywork for the Dying
• . . . and much, much more!

CCBC - The Place for Massage Therapy Training in Baltimore!

Ccbc Massage-Therapy Now on Facebook!

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Finding a massage therapist

Besides the Yellow Pages, there are other ways to find a therapist. The American Massage Therapy Association maintains a locater service. This service allows you to select by zip code or city name, and by specialty. It also tells you if the therapist you then select on will sell gift certifcates. It also provides their hours and more details about where they work and the type of work they do.

Word of mouth is one of the best ways, seek out recommendations from friends. Use the newspaper, Craigslist and online searches carefully. Be sure that the advertising says "Licensed Massage Therapist" or "Registered Massage Practitioner". If they don't say this, then the therapist may not be trained in Swedish, Deep Tissue or other legitimate massage therapy modalities (methods).

Use this opportunity to post a comment to ask us for articles about specific topics that you may be interested in.

Gift Certificates - Buying Smart

Since it's the time of year for gift giving, and you don't know what to buy, consider purchasing gift certificates for Massage Therapy.

Our clinic at CCBC also offers gift certificates. Not only do you save money on these, but you are purchasing time with students who have received the very latest in training and technique, and are quite concerned about doing your massage very properly. Call us at 443-840-1598 and leave a message for more information.

Gift Certificates purchased in Maryland since 2006 have some additional protections. Effective in October of 2006, a new gift card/gift certificate law went into effect in Maryland. This new law applies to all gift cards and certificates except those that can be used at many different places, such as Master Card or Discover gift cards. Any gift card or certificate in Maryland that is for a specific business now must be good for a minimum of four years. During this period, no changes to the conditions may be made unless they benefit the consumer. Do beware, there are still businesses that sell gift certificates that say they expire in 90 days. You can fight this, but it could take some time and require contacting the Consumer Protection office.

To buy a gift certificate from a massage therapist, simply call them. See also, our article on finding a massage therapist. You may also be able to receive a discount if you purchase multiple gift certificates at one time.

Encourage your recipient to use the certificate sooner, rather than later. They may find that Massage Therapy is more helpful than expected at feeling better, more alert and/or relaxed.

Doug

What is Chair Massage?

Chair Massage is a quick way to seek relief for the high-tension areas of the neck, shoulders and upper back. Chair Massage is usually given to people on a massage chair. This special-purpose equipment has a seat, leg pad, arm pad, chest pad and face pad. As you sit in this chair, your entire body is supported so that you can let you muscles totally relax. The massage is normally 15 minutes in length, but may be longer or shorter depending on the circumstances. These types of massage may be found for "free" at events therapists and school programs use to meet the public. They may also be available for a small fee. The fee is normally $1 per minute, so the 15 minute massage would be $15.

One may casually find these at the state fair, civic events or trade shows, such as the home show at the fairgrounds. They are also available by appointment from many therapists. Some therapists will even book in to your home spa party. The therapist should always ask you a few questions to be sure that the massage would be healthful for you. There are conditions where massage can do more harm than good, so the therapist will want to "screen" you for these. They may ask about medications you are taking, if you've had any recent injury or surgery and if you have any skin issues. They may also ask you if there are particular trouble spots you want them to work on. During the massage, the client is in charge; you can say if it is too hard, or doesn't feel good, and the therapist will adjust their work.

Chair Massage is an easy and inexpensive way to experience massage therapy, loosen tight shoulders, backs and necks and learn more about this wonderful way to help take care of your body. It is taught in our MASS101 and MASS210 courses.

Doug Wittich, Adjunct Instructor
Maryland State Licensed Massage Therapist
8913 Clement Ave (In Chiropractic Wellness Associates), Parkville, Md 21234
443-794-0735

Public Presentation

We will provide a speaker to the Cedmont Community Association meeting on Thursday, November 13th at 7:30 PM. The Cedmont Community Association is open to the public and serves communities in the Northeast Baltimore area, approximately south of Belair Rd, east of White Avenue, north of I-95.

The meeting will be at Epiphany Lutheran Church (http://www.god-is-love.org/), 4301 Raspe Ave, Baltimore MD 21206.

The presentation will be an introduction to Massage Therapy, including the benefits of massage and what to expect during a massage session.