Massage & Bodywork

May/June 2011

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pathology perspectives BY RUTH WERNER THE MANY FACES OF BOTOX Where Does Massage Fit? Consider this scenario: You work in a spa, and your client has come for a day of pampering that you are pleased to be part of. There's a catch—this morning she had Botox injections to her forehead. Do you know what kinds of adjustments you need to make to keep her healthy and happy? Or this one: You work in a clinic. A new client has a condition you've never heard of, called cervical dystonia. It causes painful and uncontrolled muscle spasms of the neck. His neurologist has recently given him injections of Botox, and now he would like to receive massage. Are you sure that's a good idea? The chances are, typical massage therapists know little or nothing about how best to help their clients who use Botox for therapeutic or cosmetic purposes. Indeed, little research has been published about the interface between these two interventions. But these clients come to us for care and depend on us to work for their best interests. In this article, we will try to map out enough information for readers to be able to ask the right questions when clients who use Botox come their way. ANATOMY REVIEW—MUSCLE CONTRACTIONS Readers will probably remember that muscle contractions begin with a signal in the movement centers of the brain. The signal travels down the descending tracts of the spinal cord. A synapse links the impulse to the motor neurons that form the outgoing section of the spinal nerves at the correct levels. Ultimately, peripheral motor neurons deliver the stimulus to the targeted muscle cells at the motor end plate—the connection site between the myofiber membrane and the motor neuron. The electrochemical signal jumps from motor neuron to muscle cell with the help of acetylcholine, the neurotransmitter that tells muscle cells to begin the process of ratcheting actin and myosin molecules together. Then, the muscle cell contracts. Obviously, this happens in hundreds or thousands of locations simultaneously in order for muscles to do the work we ask of them, and the coordinated movement that results can be a thing of beauty. Sometimes glitches occur, though—muscles contract more often or for longer periods than we would like, or stray neurological signals cause them to contract painfully and involuntarily. Alternatively, a central nervous system disruption, like stroke or cerebral palsy, can cause some muscles to stay in permanent contraction—this is spasticity that can be painful and even debilitating. If somehow the secretion of acetylcholine at the motor end plates could be stopped, the muscle would no longer be able to contract. Could this be a solution to some muscle contraction problems? BOTULISM—A BRIEF HISTORY The first recorded case of botulism was in 1735, when a German physician documented an outbreak of dangerous, even deadly, paralysis that accompanied the consumption of a particular batch of contaminated sausages. He named this phenomenon, which turned out to be related to a bacterial infection, from the Latin botulus, which means "sausage." Clostridium botulinum is a rod- shaped bacterium that doesn't need oxygen to thrive, and it creates an environment-resistant shell called a spore. This allows it to be dormant for prolonged periods until it finds a friendly growth medium. These earn CE hours at your convenience: abmp's online education center, 103

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