SCI Forum - Complementary and Alternative Medicine
Therapeutic Massage | Naturopathy | Acupuncture | Resources
June 14, 2005 - Complementary and alternative medicine ( CAM) includes a variety of health care treatment modalities that are not part of conventional medical practice. These include acupuncture, chiropractic, herbal treatments, therapeutic massage, meditation and naturopathy as well as many other types of care. This evening's SCI Forum speakers were local practitioners of three CAM modalities: therapeutic massage, naturopathy and acupuncture.
Therapeutic Massage
Valerie Martin and Ann Primous are both nurses on the inpatient rehab unit at the University of Washington Medical Center who decided to enhance their ability to help rehab patients by becoming licensed massage therapists.
Martin began with a definition: "Therapeutic massage is a mechanical, physical manipulation of soft tissue that involves movements of stroking, touching, compressing, jostling (rocking motion of body), tapping, percussion, kneading, range of motion (ROM) and stretching."
Regulations surrounding licensure vary from state to state. "In Washington State, licensed massage therapists have gone through an accredited program of usually one year. Some programs are now expanding to two years. In other states it might only be three months."
One of the advantages of massage therapy is its portability. It can be done in an office or home, in a chair or bed. Costs vary among therapists, and some insurance companies will cover it, Martin said. "But not all therapists will bill insurance."
"Why to people go for massage?" Martin asked. "Primarily for treatment for chronic and acute injury, for pain, and for relaxation. It helps increase circulation, helps with venous return, and helps increase or maintain ROM."
"Any kind of chronic condition can be treated with massage," Primous added. "Massage increases your ability to take oxygen into the tissues."
"A very skilled therapist who can work in the upper thoracic region and in the chest wall can actually increase lung function," she continued. "If you're sitting in a wheelchair, the higher your injury, the more compressed the ribcage can become because there isn't enough enervation to those nerves to allow for full and rich expansion to the ribcage. A really skilled therapist who can work in the ribcage can help minimize dysfunction from the injury."
This in turn "helps with respiration, so people can breath deeper," Martin said.. "Good therapists will incorporate breathing into the massage."
Massage is helpful for many SCI-related problems. In treating overuse (repetitive motion) injuries, such as those due to pushing a wheelchair, massage breaks down adhesions by warming up and compressing connective tissue,. Massage can help with problems that come from the asymmetry of having one side weaker than the other. It also gives clients feedback about their bodies, increasing body awareness. It can help both increase muscle tone in unused muscles and decrease spasticity if the patient has hypertonicity in the muscle. And by working carefully in the abdomen, it can improve constipation, another common problem in SCI.
Some massage therapists report that clients with disabilities often have improvement in mild depression after massage treatments, Martin said. "Being on a table and incorporating touch seems to allow people a safe environment to do some talking if they feel like it, or just basically be more in tune with what's going on inside them."
"Bodies are made to be touched and our touch sense is very powerful and meaningful," Primous added. "People with SCI can have varying levels of isolation and may not have the same level of safe appropriate touch that they might have had without injury. That's a really critical piece of people's experience (with massage), that people have the opportunity to have touch that is safe, soothing, appropriate. It brings very much of a healing quality into the life of the person receiving massage."
There are some situations and conditions for which massage should be avoided. First, "No Rolfing!" Martin warned. "It's a deep-tissue technique and fine in areas where you can feel, but in areas where you don't have sensation I don't think it would be a good idea. That also goes too for any hot or cold treatment-heat or ice where you don't have sensation" is not recommended.
"Having a UTI, fever, DVT (blood clot) or other medical condition might warrant a physician's okay before getting a massage," she added.
Primous agreed: "Know your own body and what your precautions might be. You can't assume a therapist you picked out of the phonebook knows what may or may not be appropriate movement for you. Make sure you work with someone who is credentialed and knows how to document what they're doing."
Good documentation helps your doctor know what's been done. "If you go back to your doctor and have an increase or decrease in function, and the doctor asks what's been going on and you say 'oh I've been getting massage,' it's nice to have those records."
SCIs are not all alike, and clear communication is essential so the therapist understands a client's specific needs and limitations. "A therapist may see your SCI level but doesn't know your disability," Martin said. "It's your responsibility to know your disability so you can direct what your care needs are."
If transfers are a problem you can take an attendant along to the appointment. Some therapists have hydraulic massage tables in their offices, and many are happy to come to the patient's home. Beds are usually an acceptable substitute for massage tables, unless they are very large or waterbeds. A massage of the upper extremities can be done on a seated patient. Clothes do not have to come off. "If you do ICP, it's important to empty your bladder ahead of time and be able to communicate your needs comfortably to therapist," Martin said.
For treatment of chronic injury, Martin recommends starting with three sessions per week, dropping to twice a week as things improve, then once a week, and so on. "I think for relaxation massage, two times per month is good, or what you can afford."
Massage schools keep lists of local therapists, including those who may specialize in certain kinds of massage or types of clients.
Brenneke School of Massage
425 Pontius Ave N #100
Seattle, WA 98109
206.282.1233 or 1.866.BRENNEKE
http://www.brennekeschool.com/
Ashmead College School of Massage
Seattle Campus
2111 N. Northgate Way Suite 218
Seattle, WA 98133
(206) 440-3090 or 888-741-4271
http://schools.naturalhealers.com/ashmead/
Naturopathy
"Naturopathic physicians (NDs) are holistic primary care doctors trained in both conventional and alternative modalities," said Leslie DeGasparis, ND, who practices in the Seattle area. Treatments include nutritional therapy, nutritional supplements, herbal therapy, homeopathy, counseling, physical medicine such as massage and hydrotherapy, and pharmaceuticals when necessary."
"Naturopathic medicine works best as an integrated part of a health care team. We work in collaboration with your physicians and therapists," she continued. "NDs strive for optimal health and for enhancing the body's immune system to help the body to heal."
DeGasparis explained that by supporting the body's immune system naturopathic medicine can help SCI patients early after injury with all stages of the healing process and on an ongoing basis with preventing UTIs and other infections, maintaining health skin and good blood circulation, promoting healthy digestion and elimination, and managing fatigue and pain. "We are also trained in mental health and counseling."
Naturopaths can admit patients to hospitals, but usually have to transfer inpatient care to a specialist. They have pharmaceutical training and take possible herbal-drug interactions into account before prescribing herbs, she said, a particular concern for SCI patients who are often on numerous medications simultaneously.
Some insurance companies cover naturopathic care. "Ask your health insurance company about your policy," DeGasparis suggested. "I bill insurance, but I never turn anyone away if they don't have coverage."
DeGasparis does not work out of an office because she prefers to make house calls exclusively. "I can spend longer with patients because of my low overhead costs," she said.
To find a naturopathic doctor in your area, go to the Web site of the American Association of Naturopathic Physicians at www.naturopathic.org .
Leslie DeGasparis, ND, can be contacted at drleslied@comcast.net or 206-817-3991.
Acupuncture
Like naturopathic medicine, Oriental medicine treatments like acupuncture and Chinese herbal medicine are best when used alongside conventional Western medicine, according to Jim Dowling and Laura Zanieski, who are both licensed practitioners of acupuncture and Oriental medicine.
"We're always working as a complementary therapy," said Dowling. "With acupuncture, you leave the conventional (medical) world and enter the world of energy."
Acupuncture is based on the idea that the body needs balanced energy in order to stay healthy. Medical problems occur when energy is blocked or out of balance, so acupuncturists work to unblock energy flow and increase energy potential.
Practitioners use pulse points to diagnose blockages. "There are 12 primary meridians on the body, and each goes through a different organ," Dowling said. "We can tell by the pulse if an organ is functioning properly or if there's a blockage." Hair-thin, painless needles are place on meridian points to clear energy blockages and increase energy flow.
Tongues also indicate problem areas. "Looking at the tongue helps us discern the internal environment of the body," he added. "For example, if you come in with a UTI, there is an area on the tongue where we'll see redness developing."
"I have seen improvements in conditions that did not respond to conventional treatment," Zanieski said. "If we sense blockage in the pulmonary system, we place needles in appropriate meridians to bring health to that system by bringing energy to that system. Herbs are used frequently to increase energy potential." Breathing exercises and massage techniques are also employed when appropriate.
"During acute phase of SCI, Chinese medicine would not be useful," Zanieski continued. "But soon after, we really want to bring the energy up to help the body to heal."
"It's important to find a therapist who's experienced with SCI. Because of all the complications that can develop, you want a therapist that can watch for the complications." While she has worked with SCI patients and has seen acupuncture and other Oriental medicine techniques improve spasticity, contractures, AD, pain and insomnia, she believes primary care for SCI patients should come from a practitioner of Western medicine.
Jim Dowling, LAc, and Laura Zanieski, LAc, can be reached at Westside Acupuncture and Herbs, 3045 California Ave SW, Seattle, WA 98116; 206-938-2055.
Other Resources:
From the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health (NIH) ( http://nccam.nih.gov in Spanish or English):
"Are you considering using Complementary and Alternative Medicine ( CAM)?" on the Web site of the, at http://nccam.nih.gov/health/decisions/ .
"Ten things to know about evaluating medical resources on the Web"
http://nccam.nih.gov/health/webresources/