It
has been many years now that pregnancy massage has been a part of the
massage mainstream. We can thank the foremothers Kate Jordan, Carole
Osborne-Sheets and Elaine Stillerman for bringing this important work to
the national spotlight. Those of us who focus on women's bodywork know
that pregnancy massage, with all of its physiological benefits is an
integral part of a woman's health care during and just after pregnancy.
Bodywork for women however does not end there. It is time for the women's
massage and bodywork profession to supplement with education beyond
pregnancy to include all the myriad of health care issues that can arise
in a woman's lifetime.
Having
a deeper level of understanding of the reproductive cycle and its effect
on the musculo-skeletal system is a good place to begin. For instance,
there have been studies that indicate that injuries are more likely to
occur in women during the luteal (post-ovulatory) phase of the cycle due
to increases in hormones particularly progesterone and relaxin. Also,
just before menstruation begins there is an increase in prostaglandin
production, which is targeted for the uterine/pelvic areas but have
been detected systemically. These particular prostaglandins are
responsible for the rhythmic contraction of the muscle tissue in the
uterus to shed the endometrium. Unfortunately for many women the ischemic effect of the
prostaglandins when coupled with pelvic muscular hypertonicity and fascial
adhesions can exacerbate primary dysmenorrhea also known as menstrual
cramps.
Another area that Massage Therapists can and should be more educated is in
the area of gynecologic surgeries. Hysterectomies and cesarean sections
are the two most frequently performed surgeries for women in this country.
Having very specific knowledge about how these procedures are performed
are essential when evaluating a treatment protocol for the woman who
chooses massage and bodywork to augment her care. Knowing for example
that the laparotomy procedure which is used for hysterectomies,
c-sections, oopherectomy (ovary removal) and other conditions, has many
layers of dissolved stitching that creates scar tissue at each incision
that needs attending. If the scar is left to heal without massage, the
possibility of future anterior adhesions in and around the scar and pelvic
region can create a variety of symptoms including back pain, pelvic pain,
pain with intercourse, and dysmenorrhea.
There
have been a few articles written recently about massage and menopause.
This area, too, needs more of our attention and understanding. There are
currently over 50 million women in this country who are perimenopausal.
These same women will live on average 28 years beyond menopause. There
are considerations a therapist needs to make during the climacterium and
beyond if we are to consider the woman holistically when giving care.
Indeed as most articles indicate, stress reduction is an excellent
example of what massage can do. But let us think this through further.
Many studies indicate that stress reduction is imperative for optimal
adrenal function. Because the ovaries no longer produce estriadol with
the same capacity, the adrenal glands begin producing androgens which are
circulated through the blood stream and synthesized into estrone (a less
potent form of estrogen) by the liver and fat tissue. Massage during
menopause is so much more than relaxation. It is, like exercise, an
excellent way to facilitate hormone circulation while giving the adrenal
glands the rest they need to function more efficiently.
Finally, let us consider massage therapy and breast health. Massage
protocols around breast tissue have been discussed by many lately and yes,
we as a profession need to wade through the issues of safety, ethics and
draping. As we continue to work through this we can still keep in mind
that the continual changes in the breast tissue, whether by pregnancy,
lactation, or the cyclical growth and recession may be involved with
musculo-skeletal complaints especially of the upper back, mid back, neck,
jaw and head. There are also many different types of surgeries performed
on women's breasts everyday from lumpectomies to augmentation. Having an
understanding of the difference between a sentinel node dissection and
multiple node removal is important when employing lymphatic drainage
techniques on a woman with breast cancer. Or discussing the importance of
self-massage with women who choose augmentation to prevent encapsulation.
But before we can do that we must have a foundational understanding of
these procedures and the effect they can have on the body.
Considering that currently more women are seeking massage therapy than
men, it seems we need to further our education to include the natural and
normal processes of women's physiology as well as pathologies, procedures
and pharmaceuticals that many women experience in their lifetime. Every
woman who walks through your door has her own reproductive history that
affects the musculo-skeletal system and must be taken in to account.
There are times when they can dominate a session while other times the
therapist can keep this history in the back of their mind while giving
treatment. Also, we need to understand the psycho-social issues that
women face daily and how bodywork can help. Until we include the woman's
physiology into our education, whether at massage schools or with
continuing education we are missing an important piece when giving
quality, holistic care to the women who seek our help.
