Issue link: https://www.massageandbodyworkdigital.com/i/720675
that separates instructors from therapists, but the movements are generally subtle and slow, are intended to support health and address health conditions, and are not commonly used for strength and conditioning. When selecting a tai chi/qigong instructor, or when there is no access to a certified yoga therapist, consider not only years of experience, but experience in treating chronic pain disorders. Additionally, the client should inquire about ways the therapy might be modified to accommodate their condition. Mindfulness and Awareness Many massage therapists work with the breath, incorporate visualization techniques, and use rhythmic, soft-vocal instructions to create a calm environment for healing. We often place our hands on painful areas of the client's body to facilitate the client's ability to focus attention on their inner experience of the pain. We might ask them to describe what they feel and guide them to access internal experiences of discomfort with gentle curiosity, helping them to differentiate the boundaries of the pain—size, shape, textures—and discover where there is ease. Once out of the soothing environment of a massage session, it may be difficult for the client to recreate that same sense of peace and internal connection with their experience of pain and comfort when at home or at work. Support your client by teaching breathing, meditation, or visualization techniques to enhance self-care between sessions. Cynthia Price, PhD, LMT, does extensive research on body- mind interventions, focusing on mindful awareness and presence during and between hands-on sessions. In June 2016, Price was appointed to the National Advisory Counsel for the National Institutes of Health, National Center for Complementary and Integrative Health. Massage therapy can play a unique role in teaching body awareness and can facilitate our clients' engagement with dimensions of body awareness that are linked to regulation, self- care, and stages of acceptance and change in relationship to both the experience of pain and the experience of self. 21 She recommends that we ask our clients to spend time every day engaged in a body awareness practice, something that is easily achieved, such as attending to an area of discomfort by placing their hand on the area and breathing into it while being present to what they notice internally. This can be done every few hours for just a minute or two, or before going to sleep at night. Mindfulness meditation, with its emphasis on nonjudgmental, curious observation of emotions, sensations, and thoughts, offers another practical approach to the self-management and relief of chronic pain. Meditation can teach clients to observe maladaptive cognitive, emotional, and physical habits that escalate pain with acceptance, curiosity, and friendliness. This helps clients learn to make new choices that reduce pain and improve mood and physical function. 22 An at-home practice of mindful awareness or meditation can be cultivated through sitting or walking in meditation, practicing a mindful body scan, and using breathing techniques to keep 94 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 6 one's attention focused on inner sensations rather than distractions of the mind. This also helps clients find pain-free areas and control muscle tension that is often a reaction to pain. In addition, body awareness and mindful meditation can enable clients to better pace activities, adjust posture and body position, and prevent pain and tension escalation. 23 Carolyn McManus, a physical therapist who teaches mindfulness practices to pain patients at a hospital in Seattle, discusses the difference between the sensation of pain and reactions to the sensation using the equation: pain = sensation + your reaction. This can be an invitation for clients to try techniques to manage their reactions to pain. Here are three at- home strategies McManus teaches: