Massage

I find there is a misconception in the public sphere that prenatal massage is just a luxury, a nice treat for wealthy women who need to relax during pregnancy.  This actually couldn’t be further from the truth.  Of course, relaxing the nervous system has many benefits for mother and baby, but there is so much more a therapist can do.  A knowledgeable, nurturing prenatal massage therapist can really round out any pregnant woman’s wellness team, as we address the pains specific to pregnancy, provide a crucial increase in body awareness, balance the ligaments and muscles in the pelvis, provide postural alignment and comfort tips for everyday, and support a woman’s confidence in her inner wisdom – ALL of which make for an easier pregnancy AND, most of the time, an easier labor.  I love partnering with my pregnant clients, serving as a support for them throughout the duration of their pregnancy and beyond.  I deliberately keep my prices reasonable, so that women on almost any budget can afford to come for an hour once a month.  I also volunteer my services through a non-profit organization for those who otherwise really wouldn’t have access to massage.  I am passionate about this work because I see what a difference it can make. As I have said many times, “It’s not just rubbing oil!”

Most trained prenatal massage therapists are proficient in deep tissue techniques to ease the specific complaints of pregnancy.  Most of my clients experience low back pain and hip pain as their pregnancy progresses.  Many also have tightness in the outer calf, discomfort in the neck and shoulders, and occasionally in the head and jaw.  Regular massage can help alleviate all of these aches.  For the uncomfortable swelling in the legs and feet, manual lymphatic drainage massage helps to bring some welcome relief.  The increase in body awareness is a wonderful collateral benefit to touch, as many women are not aware of how much tension they hold and where exactly in the body they hold it.  Labor becomes much more comfortable if a woman is already practiced in recognizing where she is holding tension unnecessarily and has learned how to let it go.

Besides the hands-on time we have together, I love to show clients little things to make them more comfortable at home and during daily living.  The right pillow propping so that the belly and legs are properly supported can make all the difference in a night’s sleep. Learning how to fill the lungs with air when there is a baby pushing up against them makes it easier to avoid shallow breathing.  Postural education can be so helpful as the center of gravity starts to shift forward.  Doula training has given me some excellent tools to teach my clients and their partners, and many of them can be used during labor to give baby a little more wiggle room if there is a stall.  Some of my favorites involve the use of the rebozo, a brilliant contribution to birth learned from Mexican midwives.  Partners can use the rebozo in a “sifting” motion, to give mama temporary relief from the baby weight and allow the abdominal muscles to relax.  The rebozo also takes the strain off of the uterine ligaments.  With repetition, this can serve to decrease imbalances in the body which can cause hiccups in labor.  It also just feels great!

Pregnant women need support – LOTS of it.  (Postpartum women need even more, but that is for another post.)  Along with a great doctor or midwife, birth education provider and doula, a caring prenatal massage therapist adds much benefit to a woman’s pregnancy team.

My last few blog posts have focused on the relationship between body and mind.  Most massage therapists are very interested in how one informs the other.  In keeping with that theme, I recently read a fascinating book about Post Traumatic Stress Disorder, “The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma” by Bessel Van Der Kolk, M.D.  In it, Van Der Kolk explores the physiological changes in the body and minds of people who have experienced traumatic situations, essentially providing a more scientific explanation for the visceral and very physical reactions to emotional triggers exhibited by sufferers of trauma.  These reactions in the body can keep us trapped in a feedback loop of defensive or non-productive behavior, hindering our capacity to heal emotionally.  Van Der Kolk convincingly argues that since the nervous system after trauma is altered, we can utilize the nervous system in order to remap the brain and heal from past experience.  In very simplified terms, we can use the body to reprogram our minds.

Van Der Kolk bases much of his book on his work with war veterans and survivors of childhood abuse.  These extreme definitions of trauma provide very vivid examples of how the body and mind can react to shocking and stressful situations.  However, for my purposes I would like to expand the breadth of how we talk about trauma.  Fear or hurt in reaction to almost anything can leave dramatic marks on our psyches, resulting in traumatic effects. A “traumatic incident” can encompass a wide spectrum, from a car accident to a teacher’s harsh reprimand.  Shame around sexual desire or sexual rejection can cause trauma.  Even a tired father absentmindedly refusing a hug during childhood can leave a scar.  A situation that appears benign to one participant can leave a painful impression for a lifetime on another participant, if not dealt with.

Multiple studies show that trauma produces physiological changes in the brain (please refer to the aforementioned book for specifics – it is dense and full of research articles and case studies).  Trauma activates the right-brain, which is responsible for emotion and creativity, and deactivates the left-brain, which governs rational thought, language and historical sequencing.  This shutting down of the left-brain activity explains why when faced with an emotional trigger, we may not be able to put into words what we are feeling or experiencing.  Rational thought escapes us, the lines between past and present become blurred and we are incapable of understanding that we are not in actual danger in the present moment, as we were back when we initially suffered the traumatic event.  There is an accompanying increase in stress hormone activity, or a recalibration of the brain’s “alarm system”, which becomes chronic, keeping us in a constant state of sympathetic nervous system activity, or “fight or flight”.  Here is a basic idea of how this works:  the thalamus in the brain combines our perceptive input into a coherent picture of what is actually happening.  This can take two pathways in the brain.  The first is what neuroscientist Joseph LeDoux calls “the low road”, down to the amygdala in the limbic brain.  Van Der Kolk refers to the amygdala as our smoke detector, as one of its main functions is to determine whether input is relevant for our survival or not.  This function is quick and automatic, and if danger is sensed, the amygdala can instantly trigger the release of the stress hormones cortisol and adrenaline and recruit the nervous system to produce a whole-body response.  The second pathway, “the high road”, is much slower than the first.  The input here is directed up to the frontal cortex, for a conscious interpretation of the situation.  We can then judge whether the threat is real through conscious assessment: we observe what is happening, predict what might happen in various scenarios and then make a choice to act.  The problem is that the low road gets first dibs on interpreting the incoming information, so we can ostensibly get into nervous system activation before we can consciously assess whether there is real danger or not.  Trauma increases the risk of misinterpreting the signals and thalamus processing can break down, so those with PTSD have a much harder time making sense of the input, often over-reacting to innocuous comments or facial expressions.  In addition, the medial prefrontal cortex of trauma victims is often shut down.  This affects our sense of being fully alive and the sense of who we are.  For this reason, trauma sufferers often feel “dead inside” or feel like they “are not themselves” after the trauma.

The topic of trauma is incredibly complex and I have obviously simplified things for the purposes of this blog.  The vagus nerve plays an important role, and that will be the subject of another post.  However, I hope I have begun to make clear that trauma sufferers often repeat behaviors not out of a lack of willpower but due to actual changes in the brain.  This is why talk therapy alone is often not enough to resolve the problem.  If the emotional brain is wreaking havoc on the nervous system, no amount of insight and understanding will silence our “danger signals”.  Naming a trauma and connecting with another person can be an important part of healing the sense of isolation often felt by victims. However, adjunctive therapies are almost always necessary.  Trauma involves constant sensory overload and makes us feel chronically unsafe in our own bodies.  In order to recover we need to become familiar with and befriend our bodily sensations again; we need to feel IN our bodies and in the present moment.  Developing our sense of interoception, the awareness of our subtle body-based feelings, can help us change our relationship to our bodily sensations and learn to identify past versus present.  Van Der Kolk suggests going about this in two ways:  recalibrating both the low and high roads.  We can regulate the nervous system activation through breath, movement and touch.  We can also strengthen the capacity of the frontal lobes to monitor body sensations through mindfulness meditation or yoga.  Our perceptual and emotional map is nurtured and shaped by our experiences.  In other words, “neurons that fire together, wire together”; this is the neuroplasticity of the brain.  We can use the concept of neuroplasticity to remap our brains and regain our agency after traumatic experiences.

In summary, after trauma we experience the world through a different nervous system.  However, we can rewire our brains in order to regain a sense of normalcy.  In the next post, I will elaborate on some effective ways to accomplish this, including how massage therapy comes into play.  Massage therapy by itself will not resolve trauma, nor is it the most effective adjunctive therapy for all conditions.  However, it can be an incredibly powerful tool to develop body awareness, ground us in the present moment and reestablish boundaries and a sense of safety in touch.

No matter what time of year it is in Austin, it seems to be allergy season.  It’s either mold, cedar, pollen or some other grass or allergen.  Right now we seem to be getting a reprieve from the allergies, but with the temperatures varying wildly from 80 to 40 and back to 80 from day to day, half of the population seems to be sick. The point: we are a congested bunch!  One non-chemical way to help your body rid itself of some of this excess fluid is through Manual Lymphatic Drainage of the neck and face.  I offer this as an additional service after a massage, not only to aid in decongestion but also to combat the effects of being face-down in the face cradle during the massage itself.  The best results come from receiving MLD from another practitioner, but I occasionally perform a quick self-MLD on my own face (like after a big cry).  I find it not only effective in relieving my puffiness but also incredibly relaxing.  A slightly abridged version of self-MLD is easy for almost anyone to do and yields great results!

An overview of the lymphatic system and an explanation of Manual Lymphatic Drainage can be found in previous blog posts (click the aforementioned for a more comprehensive refresher).  In a nutshell, the lymphatic vessels absorb interstitial fluid, waste products, dead cells, bacteria, viruses, fats, and proteins from the body’s tissues, while also giving passage to immune cells as they are needed.  The lymph nodes filter this fluid and remove damaging foreign elements, such as bacteria, while then producing additional infection-fighting white blood cells.  The lymphatic system is critical to proper immune function.  The purpose of MLD is to stimulate the lymphatic system to move lymph through the lymphatic vessels and nodes.  (Watch this cool video tracking lymph flow before and after MLD using near-infrared fluorescence imaging!)  For those with edema (post-injury, post-surgery, etc) or lymphedema, MLD is very effective at reducing the swelling.  However, it is also a support for anyone who wants to reinforce immune function.

While the majority of lymph nodes are found in the intestinal tract, there are easily accessible and important nodes in the neck.  Stimulating these nodes and encouraging them to pump any excess fluid out of the head will produce a surprising amount of relief for a puffy face!  Plus the DIY version is quick and easy to do.  However, before getting started it is important to recognize that MLD is not suitable for everyone.  There are just a few but very important contraindications.  If you present with the following conditions, you should NOT receive MLD or perform it on yourself:

1.  Fever or active infection (must wait until out of the acute phase)
2. Untreated congestive heart failure (the lymph fluid ultimately moves back into the circulatory system, so if the heart is not functioning properly it is not a good idea to move MORE fluid into the heart)
3. Acute, untreated DVT (deep vein thrombosis, for fear of dislodging the clot)
4. Acute cellulitis (a potentially serious bacterial infection of the skin, which can spread rapidly through tissues via lymph)
5. Additional contraindications specifically for MLD on the neck:  cardiac arrhythmia and hyperthyroidism

Provided you have none of the above conditions, you can follow along with this video to perform the most basic version of MLD for the head and neck on yourself.  (DISCLOSURE: This is not me in the video.  I am an even bigger dork on camera than I am in real life, so I will spare you from my antics.  This is a massage therapist from Kentucky who has many good videos already on YouTube.)

The version I do starts with these steps, but includes gentle rhythmic strokes along the skin of the face, from midline outward.  Treating the entire face is much more effective but even with this procedure, you will definitely get some relief.  As always with MLD, the emphasis is on gentle movement along the skin not pressure down into the tissues.

A side note: I have heard other therapists say that MLD should not be used for allergies since allergies are caused by a hyperimmune response.  In this theory, the therapist would not want to stimulate the immune system when it is already going haywire.  However, I have been unable to find research or evidence that substantiates this claim.  To the contrary, MLD is commonly used to treat the symptoms of autoimmune disorders.  Personally, I have clinical experience treating clients with fibromyalgia and rheumatoid arthritis with MLD, with great success.

So, the next time your face feels puffy or congested, try this simple DIY lymphatic drainage.  To take advantage of the time to get in some relaxation as well, try it while lying down on your back in a quiet place.