Issue link: https://www.massageandbodyworkdigital.com/i/1358392
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 37 therapists who apply vibrating machines to improve alveolar function, devices that help knock mucus into airways so it can be more easily expelled, and several others. But look over that list of pulmonary rehabilitation interventions again: Can you see opportunities for the integration of massage therapy in this setting? If medications and rehabilitation are not sufficient, then PF patients may consider a lung transplant. Between 2,000 and 3,000 patients receive donated lungs each year in this country. Improved techniques and strategies for postsurgical care mean the prognosis for survival is good: About 50 percent of transplant recipients live for more than five years after their surgery—and some live for much longer. WHERE DOES MASSAGE THERAPY FIT? The intersection between massage therapy and PF is unexplored terrain. There is no published research on how massage might help or hurt people with PF, so we must use our critical-thinking skills to explore the possibilities. In this situation, we can consider what living with breathing problems means for people with PF—specifically about the vicious circle between chronic shortness of breath and anxiety that exacerbates dyspnea, which worsens anxiety, ad infinitum. Breathlessness can be an emotionally frightening and disabling symptom affecting mobility and quality of life. —Somogyi Dyspnea, even in its mildest forms, can induce a fear of suffocation and the anticipation of a worsening of symptoms, including acute respiratory distress syndrome (ARDS) and its most feared outcomes (i.e., hospitalization in intensive care units, intubation, and death). This, in turn, might heighten fear response, false alarms, and exacerbate vigilance towards respiratory symptoms both in affected and unaffected individuals. —Javelot et al. We have some information on massage therapy for other lung problems, especially COPD and asthma. Not surprisingly, people with those conditions have positive responses to massage, with reports of reduced anxiety and less resistance in their breathing. Massage therapy, with its muscle alignment techniques, and trigger point treatment for relaxation applied to the accessory muscles of respiration contributed to muscles length improvement, and by consequence, its force, considering that until then this group of muscles were overloaded by increased respiratory work, and COPD's exacerbation. —de Alvarenga et al. The experience of anxiety about breathing is inextricable with any reduction in respiratory function. Because unrestricted breathing is so central to our experience of feeling safe and healthy, it is not surprising people with breathing disorders don't have an accurate sense of interoception—the ability to gauge our own internal condition—so the cycles continue. Specifically, when anxious individuals receive body signals, they cannot easily differentiate between those which are associated with potential aversive (or pleasant) consequences versus those which are part of constantly ongoing and fluctuating interoceptive afferents. As a consequence, these individuals imbue afferent interoceptive stimuli with motivational significance, specifically, an internal body signal, e.g., an inspiratory breathing sensation, is associated with negative valence and linked to belief-based processes, e.g., "I am not getting enough air," which results in an increased "fight/ flight" response and potential withdrawal or avoidance behaviors. —Paulus et al. Wouldn't it be amazing if it were possible to interrupt the self-fulfilling cycle of anxiety and breathing problems? Maybe with loving, educated, soothing touch? And indeed, the research supports this idea. Interoceptive awareness facilitates regulation and an integrated sense of self, and thus contributes to health and well-being. —Price et al. We have research about massage therapy and anxiety. We have research about massage therapy and improved breathing. And we have research about massage therapy and an enriched sense of interoception and self-efficacy. To my knowledge, no one has put these elements together to create treatment plans that include massage therapy for patients with PF, but it doesn't seem like a stretch. This idea particularly resonates when we see factors in pulmonary rehabilitation protocols include attention to posture, stretching, breathing exercises, and manual therapy. PF is often a progressive, irreversible, and ultimately fatal disease. It can be controlled and slowed, but not reversed. Massage therapy won't change that. But I am eager to explore ways that skilled massage therapy, with an emphasis on breathwork, calmness, and imbuing a sense of peace, might integrate with respiratory therapy to add to the precious quality of life for those who face this challenge. 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 booksofdiscovery. com), now in its seventh edition, which is used in massage schools worldwide and is the host of the podcast I Have a Client Who . . . on The ABMP Podcast Network. Werner is available at ruthwerner.com or wernerworkshops@ruthwerner.com.¦ PATHOLOGY PERSPECTIVES