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PATHOLOGY PERSPECTIVES symptoms, but this is something that should be explored by an educated practitioner who elicits appropriate input from the client. MINIMIzE ENvIRONMENTAl TRIggERS: THE lUBRICANT Many people with aspects of atopy, especially eczema and asthma, report some sensitivity to standard massage lotions and creams. This is probably related to allergy-promoting chemicals found in some oils. It is a good idea to keep some hypoallergenic lubricant available for these clients. Sometimes symptoms like respiratory distress or itchiness don't emerge until several hours after exposure to a trigger. This is a good reason to make a follow-up call the next day to see how the client responds to your work and professional products. MINIMIzE POSTURAl DISCOMfORT: THE fACE CRADlE Clients with hay fever may experience congestion or excessive runny nose (or both) when lying prone. Clients whose symptoms are extreme on the day of their appointment may welcome alternatives to being face- down with pressure on their sinuses for prolonged periods. This may require some imaginative positioning, but it is a good investment of time and energy, since it is diffi cult to relax when your nose never stops dripping. MINIMIzE INfECTION RISK: THE SKIN The typical presentation of eczema involves rough, dry, fl aky, itchy skin. This situation doesn't preclude massage; indeed, the application of a hypoallergenic lotion may be extremely soothing and supportive, as long as itching isn't exacerbated. But if the skin Medscape. Available at http:// emedicine.medscape.com/article/137911- overview (accessed March 2010). ghaff ar, A. 2009. Hypersensitivity Resources Cole, S. Indoor aeroallergens. reactions. The Board of Trustees of the University of South Carolina. Available at http://pathmicro.med.sc.edu/ghaff ar/ hyper00.htm (accessed March 2010). Kelly, J. Allergic and environmental is compromised and shows any signs of bleeding, scabbing, or oozing, this is a potential portal of entry for pathogens and is a local contraindication. asthma. Medscape. Available at http:// emedicine.medscape.com/article/137501- overview (accessed March 2010). lam, J. and S. friedlander. 2008. Atopic dermatitis: a review of recent advances in the fi eld. Pediatric health 2, no. 6:733–47. Available at www. medscape.com/viewarticle/586561 (accessed March 2010). Norton, A. 2009. Acupuncture may ease the itch of eczema. Reuters Health Information. Available at www. medscape.com/viewarticle/714235 (accessed March 2010). Werner, R. 2009. A massage MAXIMIzE yOUR SKIllS: RESPIRATORy MUSClES Clients who struggle with airfl ow often develop hypertonicity in their breathing muscles. Bodywork that focuses on reducing tension in the intercostals, scalenes, and diaphragm can make an enormous difference in the amount of effort it takes to breathe. MAXIMIzE yOUR SKIllS: SINUSES Massage that affects tension and fl uid fl ow over the facial bones can make a wonderful difference for a person who lives with congestion and sinus infl ammation. That magical moment when the sinuses clear is reason enough to book another session. Clients with eczema, hay fever, and therapist's guide to pathology. Baltimore: lippincott Williams & Wilkins. asthma can have a tough time. They live in a world full of triggers that may exacerbate their symptoms. Massage provides a chance to experience quiet appreciation of our physical being. And for people who spend so much effort just to get through the day, what a valuable gift this can be. 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 massage schools worldwide. Her new book, Disease Handbook for Massage Therapists, is now available. Werner can be reached at www.ruthwerner. com or wernerworkshops@ruthwerner.com. Ruth Werner is president of the Massage connect with your colleagues on massageprofessionals.com 101