Massage & Bodywork

September | October 2014

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42 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 4 PATHOLOGY PERSPECTIVES Stress, anxiety, and depression are often significant problems for people with PCS, and massage therapy may offer important benefits for these complications as well, as long as our clients can be comfortable while they receive our work. One of the big challenges in caring for clients with PCS is positioning. Problems with balance, dizziness, and vertigo can be exacerbated by lying flat or turning over on a massage table. Practitioners must sometimes be imaginative in how they manage these logistics. Further, some massage therapists find that deep, specific work, especially on the neck, can exacerbate symptoms: it seems to overwhelm the sensory system and can be hard for clients with PCS to process. Bodywork modalities that seem to be well received include most techniques that are designed to focus on inducing and strengthening a parasympathetic response. Many craniosacral therapists find that this modality produces good results for dizziness, headaches, and stress. Lymphatic drainage techniques for the face and head are also perceived as deeply relaxing. One therapist recommends massaging the whole head, including the facial muscles and the scalp, yet many patients find that caregivers are reluctant to touch them in these areas that need special attention. It is not only the patients in the PCS community who could benefit from massage and bodywork: their partners and caregivers are likewise under an enormous amount of stress as their loved ones go through major changes. TREATMENT Treatment for PCS takes a symptom-by-symptom approach, beginning with rest and cessation of any activities that might cause another impact. Psychotherapy and cognitive rehabilitation help restore intellectual function and manage the mood changes that these injuries often bring about. Biofeedback and other stress management strategies are recommended as well: it is important for these patients not to get caught in a cycle of sympathetic reactions that then trigger more sympathetic reactions. Problems with balance, dizziness, and vertigo are addressed with a process called vestibular rehabilitation. Other symptoms, such as depression, headaches, sleep disorders, and so on, are treated pharmacologically. LIVING WITH PCS Jay Fraga, founder of a concussion advocacy group called The Knockout Project, is the survivor of multiple head traumas, beginning with a life-threatening wreck at age 19, through several crashes as a BMX racer, and culminating with a minor head bump from his 3-year-old child. He struggles with concentration and memory, migraines, sleeplessness, and vertigo that can only be managed with the discipline of a trained athlete. Vertigo was a serious problem after one of Fraga's incidents. He went through vestibular rehabilitation—a process which he describes as "the seventh circle of hell." This is a series of eye and balance exercises developed to help people with a variety of conditions related to vestibular nerve damage, including benign paroxysmal positional vertigo, discussed in Massage & Bodywork, July/ August 2010, page 98 (www.massageandbodyworkdigital.com/i/68175/100). At the same time, he consulted a chiropractor specializing in upper-neck issues and found—like many PCS patients—his atlas was subluxated. When that issue was resolved, his vestibular problems were much improved. Unlike many PCS patients, Fraga was able to continue working throughout his rehabilitation. He still struggles with symptoms that may be with him for the rest of his life, but he is not completely debilitated by them. Fraga finds that acupuncture is a powerful therapy for him, putting him into a deeply relaxed state. "After my acupuncture treatment they have to sort of pour me into the car," he says. MASSAGE FOR CLIENTS WITH PCS The role of massage therapy for clients living with PCS is limited, but helpful. The initial trauma, be it a sports injury, the result of a violent attack, or a motor vehicle accident, is likely to create other problems connected with a high- velocity event. Temporomandibular joint dysfunction and whiplash are likely, for instance. Injuries to noncentral nervous system structures can respond well to massage therapy, as we work to relieve unnecessary muscular guarding, minimize constricting scar tissue, and promote a healthy and effective healing process.

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