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A B M P m e m b e r s ea r n F R E E C E h o u r s by rea d i n g t h i s i s s u e ! 59 IMPROVE YOUR CLIENTS' LIVES Massage therapy can prove to be one of the best treatments for older clients with diabetes. When administered properly, the protocol is an integral part of ongoing care, producing results that improve quality of life dramatically. Note 1. The DayBreak Geriatric Massage Institute's NIDDM protocol for clients with diabetes was developed by Dietrich Miesler and is taught as part of the DayBreak curriculum. For more information, visit daybreak-massage.com. Dawn Castiglione has been a licensed massage therapist since 2010. She became geriatric massage certified in 2011 after training under Dr. Sharon Puszko, DayBreak's previous owner. Working mainly in retirement communities, assisted-living facilities, and memory-care units, Castiglione has enjoyed a career in massage therapy with her focus on seniors and those with degenerative conditions. After teaching for DayBreak for nearly a decade, she became owner, director, and principal educator of DayBreak in 2022. She enjoys guest speaking at support groups and major events for Alzheimer's and Parkinson's, and looks forward to helping massage therapists everywhere take their skill and passion to the next level, helping them to embrace the geriatric specialty in massage therapy. the calf, from ankle to popliteal space, using a squeeze-and-release motion. Recognizing that petrissage is often too much pressure for this muscle group in seniors and knowing that eff leurage is simply not enough to accomplish the intended goal, perform this stroke that combines both techniques simultaneously to safely achieve the desired result. The goals of the f luffing technique include decreasing swelling by gently moving accumulated f luids, assisting in the return of venous blood f low back toward the heart, moving lymph f luid, and enhancing the continued effects of EDRF produced during the foot-pumping technique mentioned earlier. The f luffing technique is always performed with hands moving toward the heart. The squeeze-and-release motion is performed with the palm of the therapist's hands, along with the four fingers on their same hand. Avoid applying too much pressure with the thumb, which can cause bruising. Remember, the f luffing technique is considered more of a lymphatic stroke, so the pressure should be light. As your hands glide up the back of the lower leg, approximately five or six squeeze- and-release moves will be executed (while gliding) before reaching the popliteal space behind the knee. Each squeeze is generally performed one second apart. However, depending on the condition of the client's skin, tissue, muscle mass, and swelling, squeeze can be increased to twice per second, covering less surface area between squeezes. Make three or four passes from ankle to knee. More time can certainly be tolerated by, and even warranted for, the client, since you will often spend the entire half- hour session on the client's feet and legs exclusively. For more information on EDRF and working with elderly clients with diabetes, read about Dietrich Miesler's early work at massagetherapy.com/ articles/what-world-edrf. Fluffing overload their system. Massage can lower blood pressure and blood sugar levels, so a longer session could be detrimental. And if a client with diabetes is prescribed insulin, wait until about two hours after their injection before proceeding with massage. FOOT PUMPING The foot-pumping maneuver mimics the muscle activity that happens when walking. Simply pumping the client's foot back and forth helps activate muscles that are now more sedentary, which can vastly improve blood circulation and muscle health. Work the full range of motion from dorsif lexion to plantar f lexion, without force, for a minimum of one minute. The rhythmic movement produces a release of endothelium-derived relaxing factor (EDRF), a hormone-like substance that's an exceptionally powerful vasodilator released by the endothelium, which relaxes and opens narrowed blood vessels. This is one of the first techniques used within the DayBreak NIDDM sequence, as it sets up the body for increased benefit from all the subsequent strokes. FLUFFING Fluffing is a hybrid stroke composed of a gliding and pulsing motion performed over an area of the body. For example, when treating the back of the lower leg, gently glide your palms up the back of