Massage & Bodywork

September/October 2010

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JOIN RUTH WERNER, JAMES WASLASKI, AND LYNDA SOLIEN-WOLFE FOR THE SEMINAR AT SEA, JANUARY 23–30, 2011, AND EARN CEUS. FOR MORE INFORMATION, VISIT WWW.ORTHOMASSAGE.NET. stress—is also part of many treatment plans; this may help speed the process of angiogenesis to restore circulation to the starved tissues. Until recently, the standard treatment for a recognized case of PAD was to surgically replace the damaged section of artery in what amounts to a type of bypass surgery. However the risk for infection and other complications was significant, and it often didn't lead to a successful outcome. The more current intervention involves balloon angioplasty along with the insertion of a stent to prevent the artery from becoming occluded again. This can be done as a closed surgery and has a high success rate. Consequently, the prospect of dangerous ulcers, infections, and amputation is quite rare for PAD patients today. MASSAGE? Obstructed blood flow in the legs (or anywhere) is a significant red flag for massage therapists and other bodywork practitioners. If the obstruction is in the veins (deep vein thrombosis, or DVT), the risks are quite different than if it is in the arteries. With DVT, if a piece of debris breaks off, then it can flow unobstructed up the leg, into the vena cava, through the right side of the heart, and into the lungs: this is a pulmonary embolism, and it kills about 200,000 people every year.2 a clot or plaque on the arterial side that becomes disrupted by massage or other interventions can rupture, and the movement of debris "downstream" can create a complete blockage in a more distal part of the artery: as discussed, this is an infarction, and it can lead to extensive tissue damage from ischemia. Further, a client who has PAD has a significantly increased vulnerability to both heart attack and stroke. Resources Exercise for PAD. Vascular Disease Foundation. Available at (accessed spring 2010). Khan, A.N. and S. MacDonald. Renal artery stenosis/renovascular hypertension. Medscape. Available at (accessed spring 2010). Watson, L., Ellis, B., and G.C. Leng. 2008. Exercise for intermittent claudication. Cochrane Database of Systematic Reviews 4, no. CD000990. The Cochrane Collaboration. Available at CD000990/frame.html (accessed spring 2010). Mayo clinic staff. Peripheral artery disease (PAD). Mayo Foundation for Medical (accessed spring 2010). Peripheral artery disease (PAD) overview. Cleveland Clinic. Available at http:// Education and Research (MFMER). Available at arterial-disease/DS00537 (accessed spring 2010). Peripheral arterial disease. National Heart Lung and Blood Institute. Available at www. (accessed spring 2010). Stoppler, M.C. 2010. Peripheral vascular disease. MedicineNet, Inc. Available at www. (accessed spring 2010). Werner, R. 2009. A massage therapist's guide to pathology (Baltimore, Maryland: Lippincott Williams & Wilkins), 71–378. However, because the body is so By contrast, adept at growing new pathways for blood to flow, a long-standing and stable obstruction may not be such a dangerous situation. Decisions about bodywork need to be made in the context of what the client can tolerate in terms of exercise and increased load on the circulatory system. After all, careful exercise may actually promote the creation of helpful new arteries. In short, this is an excellent example of a client who needs to compile a health-care team so that all of his or her providers, including a massage therapist, can work together for the best results. Massage Therapy Foundation. She is a writer and NCBTMB-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 Ruth Werner is the president of the massage schools worldwide. Her latest book, Disease Handbook for Massage Therapists (Lippincott Williams & Wilkins, 2009), is also available at Werner can be reached at www.ruthwerner. com or NOTES 1. C. Chahin, B. Rose, and S. Stuhlmiller, "Lower- Extremity Atherosclerotic Arterial Disease," Medscape. Available at article/423649-overview (accessed July 2010). 2. D. Schreiber, "Deep Venous Thrombosis and Thrombophlebitis," Medscape. Available at topic122.htm (accessed spring 2010). connect with your colleagues on 101

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