Massage & Bodywork

MAY | JUNE 2019

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PATHOLOGY PERSPECTIVES Resources Dukowicz, Andrew C., Brian E. Lacy, and Gary M. Levine. "Small Intestinal Bacterial Overgrowth." Gastroenterology & Hepatology 3, no. 2 (February 2007): 112–22. Francino, M. P. "Antibiotics and the Human Gut Microbiome: Dysbioses and Accumulation of Resistances." Frontiers in Microbiology 6 (January 12, 2016). Accessed February 2019. https://doi.org/10.3389/fmicb.2015.01543. Healthline. "Why the Gut Microbiome Is Crucial for Your Health." June 27, 2017. Access February 2019. www.healthline.com/nutrition/ gut-microbiome-and-health. Quigley, Eamonn, and Ahmed Abu-Shanab. "Small Intestinal Bacterial Overgrowth." Infectious Disease Clinics of North America 24 (2010): 943– 59. Rezaie, Ali et al. "Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus." The American Journal of Gastroenterology 112, no. 5 (May 2017): 775–84. Accessed February 2019. https://doi.org/10.1038/ajg.2017.46. "Small Intestinal Bacterial Overgrowth: Clinical Manifestations and Diagnosis UpToDate." Accessed February 2019. www.uptodate.com/contents/ smallintestinalbacterial-overgrowth-clinical-manifestations-and-diagnosis?topicRef=4783&source=see_link. "Small Intestinal Bacterial Overgrowth: Etiology and Pathogenesis—UpToDate." Accessed February 2019. www.uptodate.com/contents/ small-intestinal-bacterial-overgrowth-etiology-and-pathogenesis?search=sibo&source=search_result&selectedTitle=3~144&usage_ type=default&display_rank=3. Tuddenham, Susan and Cynthia L. Sears. "The Intestinal Microbiome and Health." Current Opinion in Infectious Diseases 28, no. 5 (October 2015): 464–70. Accessed February 2019. https://doi.org/10.1097/QCO.0000000000000196. The chronic pain, gas, and diarrhea seen with SIBO are signs that this is a situation that needs to be pursued with a primary care provider. SIBO itself can be a serious disorder, and other conditions that look like it—celiac disease, small intestinal diverticulitis, Crohn's disease, and so on—can also make people very ill. It is not within our scope of practice to determine whether someone's persistent and repeating stomachache is dangerous or not, and in this situation it is important to refer out. If a client has been diagnosed with SIBO and wants to receive massage, then some special accommodations may be necessary. It would be irresponsible to suggest that massage therapy can help treat this condition, but we may be able to make living with it less stressful. Gentle work to the abdomen, offering positioning adjustments like side-lying, and simply putting a warm hand on the belly may be very soothing and calming to a person with chronic digestive pain. Of course, we must also anticipate the need for a sudden and urgent trip to the bathroom. Therapists who have advanced education in visceral manipulation may be able to offer work that promotes intestinal motility to help move materials through the system more efficiently. But this is not something to do for clients with diagnosed GI tract disorders unless the therapist has extensive training. Clients whose conditions are severe may find rigorous massage uncomfortable and overwhelming. Further, long-term nutritional deficiencies may create substantial health problems that impact decisions about massage therapy. Examples include bone brittleness and muscle spasms related to low calcium absorption, skin rashes related to a lack of selenium and essential fatty acids, and easy bruising related to a shortage of vitamin K. Are you likely to have clients who have SIBO? At this point, it's hard to know, because the medical community's diagnostic capacity for this condition is so limited. But many massage therapists have clients whose digestive systems do not operate at optimal levels. Let's be sensitive and sensible about how we structure our work with these clients, and let's be sure to give them ethical and responsible advice for their self-care. Ruth Werner is a former massage therapist, a writer and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology (available at www. booksofdiscovery.com), now in its sixth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com or wernerworkshops@ruthwerner.com. Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 39

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