Massage & Bodywork

September/October 2009

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environmental toxins, especially lead, some pesticides, radiation, and other substances, may lead to miscarriage and subsequent scarring. Extreme thinness, which can suppress ovulation, and being significantly overweight are also obstacles to fertility. Perhaps the behavioral factor that is most frustrating to couples trying to conceive is the role that stress plays in this process. The link between stress hormones and reproductive hormones has not been extensively studied, but it is certainly anecdotally true that when some couples finally acknowledge that this event may never happen for them, they then find themselves unexpectedly (and joyfully) pregnant. BODYWORK INTERVENTIONS Massage and bodywork modalities from all over the world have an ancient tradition of working to promote healthy female fertility. Recently, some protocols addressing the pelvic environment have been developed. Some combine massage and aspects of physical therapy, and small-scale studies show some success in increasing both tubal patency (the ability for sperm cells to travel through the uterine tube) and pregnancy rates.7 According to Marty Ryan, a massage therapist who specializes in addressing abdominal and pelvic issues, the exact mechanism for how these techniques work isn't clear. In his words, "Externally manipulating, stretching, and creating slack in the fallopian tubes is not so difficult if you can find the appropriate landmarks. Improving the general connective tissue quality in terms of arterial blood, venous and lymph return, mobility, elasticity, and overall slide and glide is of course a great thing."8 The benefits of using bodywork as an intervention to improve fertility seem self-evident: this approach doesn't involve knives, needles, lasers, or chemicals; it is physically and emotionally supportive during a time of great stress; and it harnesses the natural processes of the body to create an avenue for a happy outcome. However, it is important to point out that pelvic massage for a client who struggles with fertility is not a risk-free undertaking. Without adequate education and information, a therapist could be dabbling in an environment that is poorly understood. Risks include rupturing a cyst, working around unresolved abscesses, manipulating a fibroid tumor, or in a worst-case scenario, working with undiagnosed ovarian cancer that is spread most efficiently through peritoneal fluid.9 These possibilities must all be addressed when working with a client who might benefit from deep-pelvic massage, which is why working as part of a healthcare team and getting a thorough health history are absolutely critical in this setting. IN CONCLUSION I must confess to entering into my exploration of the use of deep pelvic massage for infertility with a certain level of skepticism. Because my interest is in pathophysiology, I tend to look at situations from that perspective, and I was concerned about people making overstated claims about what massage can do in a situation where a client has every reason to cling to every hint of a hopeful conclusion. Further, I worry about ill-prepared therapists making mistakes and causing physical harm. I have been on the scene when a student learning psoas work ruptured an ovarian cyst in her partner, leading to a trip to the emergency room. But as I learned more about how well- trained therapists can differentiate between healthy and unhealthy tissue, and began to understand some ideas about how fascial restrictions can cause problems, and how manipulation can ease them, I have become convinced that this is a field that holds enormous promise and potential for our clients who struggle with this issue. teaches several courses at the Myotherapy College of Utah and is approved by the NCBTMB as a 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. Werner is available at www.ruthwerner.com or wernerworkshops@ruthwerner.com. Ruth Werner is a writer and educator who NOTES 1. What Causes Female Infertility? Stanford University, 2009. Available at www.stanford. edu/class/siw198q/websites/reprotech/ New%20Ways%20of%20Making%20Babies/ Causefem.htm (accessed August 2009). 2. M. P. McCarthy, RN, CNS, PhD, "Women's Lived Experience of Infertility After Medical Intervention," Journal of Midwifery & Women's Health 53, no. 4 (2008): 319–24. Available at www.medscape.com/ viewarticle/577014 (accessed August 2009). 3. Shirley Vanderbilt, "Soft Tissue Massage: Infertility Treatment of the New Millennium?" Massage & Bodywork 14, no. 6 (2000): 56–8. Available at www.massagetherapy.com/articles/index.php/ article_id/282 (accessed August 2009). 4. Although they have traditionally been called fallopian tubes after the 16th-century anatomist Gabriele Fallopio, a movement toward substituting functional names for personal names has led to the use of uterine tube or oviduct for these structures. 5. P. Kovacs, MD, PhD, "Endometriosis and Primary Infertility," Medscape Ob/Gyn & Women's Health 10, no. 2 (2005). Available at www.medscape.com/ viewarticle/511725 (accessed August 2009). 6. What Causes Female Infertility? 7. Belinda F. Wurn, PT et al., "Treating Female Infertility and Improving IVF Pregnancy Rates With a Manual Physical Therapy Technique," Medscape General Medicine 6, no. 2 (2004): 51. Available at www.medscape.com/ viewarticle/480429 (accessed August 2009). 8. Marty Ryan, e-mail correspondence (July 2009). 9. Ruth Werner, A Massage Therapist's Guide to Pathology, fourth edition (Lippincott Williams & Wilkins, 2009), 635. connect with your colleagues on massageprofessionals.com 113

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