Massage & Bodywork

March/April 2010

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PATHOLOGY PERSPECTIVES Resources Fatty liver. american Liver Foundation. available at www. liverfoundation.org/education/info/ fattyliver (accessed January 2010). Feldstein, a. and M. Kay. 2009. Fatty liver disease. american college of gastroenterology. available at www.gi.org/patients/gihealth/fld. asp (accessed January 2010). Lee, D. and J. Marks. 2009. body fat, the silent killer. Medicinenet, Inc. available at www.medicinenet.com/ script/main/art.asp?articlekey=4658 (accessed January 2010). Mayo clinic Staff. nonalcoholic fatty liver disease. Mayo Foundation for Medical education and research (MFMer). available at www.mayoclinic.com/ health/nonalcoholic-fatty-liver-disease/ DS00577 (accessed January 2010). Mendler, M. 2009. Fatty liver: nonalcoholic fatty liver disease (naFLD) and nonalcoholic steatohepatitis (naSh). Medicinenet, Inc. available at www.medicinenet.com/ script/main/art.asp?articlekey=1909 (accessed January 2010). Sears, D. Fatty liver. Medscape. available at http://emedicine. medscape.com/article/175472- overview (accessed January 2010). may also involve ascites—the accumulation of fluid in the peritoneal cavity because the liver is too congested to process all the blood that is delivered through the hepatic and portal vessels. TREATMENT OPTIONS FOR NAFLD Although NAFLD and the accompanying risk of NASH is an increasingly common problem with our aging and overweight population, the best ways to treat or reverse it have not been investigated thoroughly. If it is caught early (and because it is silent—it typically isn't), the liver changes may be reversed with healthy changes in diet and exercise—both of which can stabilize blood glucose and reduce triglycerides. Aggressive treatment with diabetes management drugs and cholesterol lowering medications are frequently recommended, but their efficacy in reversing the NAFLD or preventing progression to NASH is not fully established. MASSAGE FOR NAFLD If a massage therapist has clients who are significantly overweight, the chances are excellent that many of them would test positive for low-grade liver damage. If any signs of more extreme liver problems are present, and especially if a client needs to curtail his or her activity levels because of illness, rigorous bodywork that focuses on fluid movement may be outside the capacity of that client to adapt. Here, as in many cases, the practitioner must assess what normal daily activities a client can do easily and keep the adaptive demands of the massage within those parameters. The good news is that the act of receiving massage, even gentle non- circulatory based modalities, tends to inspire clients to take better care of themselves. In massage, we offer a self-indulgent treat that is also a health- promoting health-care intervention, and it increases our clients' sense of value and self-worth. Because NAFLD is best controlled through positive changes in diet and exercise, any intervention that advances the idea that good self-care is a worthwhile investment of time, energy, and sacrifice can have benefits that far outlast the immediate relaxation that we associate with a brilliant massage. approved provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2009), now in its fourth edition, which is used in massage schools worldwide. Her book Disease Handbook for Massage Therapists is also now available from Lippincott Williams & Wilkins. Werner can be reached at www.ruthwerner.com or wernerworkshops@ruthwerner.com. Ruth Werner is a writer and NCBTMB- connect with your colleagues on massageprofessionals.com 101

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