Archives for June 2018

Jun 27 2018

Diabetes and Carpal Tunnel Syndrome

I was surprised to learn recently that diabetes mellitus is recognized as a risk factor for carpal tunnel syndrome. [i] Couple the high numbers of people living with diabetes [ii] with the increased use demanded of our hands for laptops, smartphones and tablets, it’s just a matter of time before more and more people present in your office with carpal tunnel syndrome.

Although the reason for the correlation between diabetes and carpal tunnel syndrome is unclear, the fact remains true according to 36 different studies conducted over a 65-year period. [iii]

What Is Carpel Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is defined as a medical condition that causes tingling, numbness, burning and pain in the wrist, hands and all fingers, except the fifth. Although those symptoms may sound merely like an inconvenience, those sensations, if left unattended, lead to debilitating agony and the loss of ability to use the hand(s).

The condition results due to continual pressure on the median nerve as it travels under the transverse carpal ligament through a narrow path between the wrist bones. Repetitive actions, especially when the hand is extended and abducted, can cause swelling in the area that puts pressure on the cramped nerve. Certain professions and activities increase the risk of developing CTS – think massage, hair stylists, typing, using a mouse for a computer.

Impingement anywhere along the median nerve’s long route from the brachial plexus to the palm of the hand can cause the symptoms named above; however, true carpal syndrome is a result of pressure on the median nerve in the tunnel between the carpal bones (wrist bones) of the hand.

A number of other conditions can cause similar symptoms, and explain why many people are misdiagnosed. Some doctors can be quick to blame CTS (carpal tunnel syndrome) when the cause may be something totally else. My father was a great example of this. The pain in both of his hands had progressed so much that he was barely able to use them. Surgery for CTS provided no relief. Blood work ultimately showed he had rheumatoid arthritis.

In addition to RA and diabetes, CTS-like symptoms can arise from impingement of the median nerve at the brachial plexus, nerve compression at C5-C7 in the neck, wrist injuries such as a fracture or ligament damage, or long-term use of birth control pills or pregnancy, both of which cause a depletion of vitamin B6 in the body.

Tests

Following a detailed medical history and physical examination, a doctor may conduct the following two tests to determine whether CTS is evident:

* Tinel Test

The doctor will vigorously tap the median nerve in the wrist, either with her fingers or a reflex hammer. Tingling in the fingers or an electric shock-like sensation indicate a strong possibility of carpal tunnel syndrome.

* Phalen’s Maneuver

The patient presses the backs of his hands and fingers together with the wrists flexed and fingers pointing downward – for two minutes. Tingling or numbness in the fingers indicates CTS.

Reflexology and CTS

Reflexology for the hands is very helpful for people with carpal tunnel syndrome, especially if they are following through with a committed self-care program.

Make sure to include lots of gentle range-of-motion of the wrist and the digits. Traction the bones of the hand away from those of the forearm.

If your jurisdiction allows you to perform massage therapy, and you are trained in the art, then do connective tissue massage on the muscles of the forearms.

Self-Care

Different things work for different people, so you or your clients will have to experiment.

* Some people find that gently flexing and extending the hand while soaking in warm water three or four times/day helps. Others find icing the wrist for about 10 minutes a few times in an hour helps.

* Wearing a wrist brace to bed is reported by many to be very helpful, since people often end up bending their wrists while sleeping.

* Take breaks often and stretch your hands. Use only as much force as is necessary for a task, and use both hands to complete tasks, not just your dominant.

* This one is very important: Stop or correct whatever it is that is causing the carpal tunnel syndrome. Make whatever adjustments you need to make to improve work ergonomics and body mechanics. Keep the wrist straight!

* Do wrist curls with light weights (one to 3 pounds); both flexion and extension. As above, keep the wrists straight!

If you know any other strategies for addressing carpal tunnel syndrome, either as a practitioner or sufferer of the condition, please share. That way we can all learn from our collective experiences.

[i] http://www.ncbi.nlm.nih.gov/pubmed/22628597

[ii]According to the most recent numbers form the US Centre for Disease Control (2012) there are 29 million people living with type 1 or type 2 diabetes in the USA, and 2 million in Canada.

[iii] https://www.ncbi.nlm.nih.gov/pubmed/26173490

Jun 20 2018

Muscle Cramps

Whether you call it a muscle spasm, a charley horse or a muscle cramp – it hurts! A muscle spasm can wake you in the middle of the night, interrupt a tennis game, reward you after a long run, or surprise you in the middle of a foot reflexology session.

There are a number of situations that are generally referred to as a cramp:

* Tic or twitch – not usually painful

* Tremor – a quivering that usually precedes a full-on cramp

* Spasm – what most people refer to as a cramp – an involuntary state of contracture in a muscle; ie. a muscle that will not voluntarily or willfully relax.

Muscles spasm when the normal balance of electrolytes in the muscle cells is disturbed for a longer period of time than the muscle can withstand.

Causes

There are a number of things that can contribute to an imbalance of these electrolytes:

* Dehydration from inadequate fluid intake or excessive sweating.

* Muscle fatigue from a prolonged position or vigorous exercise, especially when stretching before and or stretching/adequate cool down afterwards do not occur.

* Lack of minerals including sodium and magnesium; potassium and/or calcium deficiency being the most common.

* Decreased oxygen delivery to muscle tissue due to poor circulation in the legs.

* Drug effects. Diuretics, statins and many other medications can cause muscle spasming.

* Spinal cord injury.

Muscle Spasms and Reflexology

So why does a cramp occur when someone is receiving reflexology?

Muscles that have been overly taut for a period of time, such as those of the lower leg or sole of the foot, relax during a reflexology session. That sets up a disruption of the electrolyte balance, causing the muscle to cramp.

If this happens when you are giving a session, don’t panic. The solution is as simple as switching an on/off button. Two actions – reciprocal inhibition and digital pressure will change the neural signal to a muscle, allowing it to relax again.

To relax any muscle in the body, you actively engage the antagonistic (opposing) muscle, which will increase circulation to the affected muscle and allow it to lengthen and relax. This is known as reciprocal inhibition.

If someone on my table cramps in the bottom of the foot or in the calves, I immediately place the palm of my hand on the dorsal side of their foot and ask them to strongly pull their foot towards their face (dorsi-flex). At the same time my hand resists their motion, attempting to pull their foot towards my face (plantar-flex). This combined action engages the foot extensor muscles and relaxes the flexor and intrinsic foot muscles. The hold is held for a couple of seconds and then both the client and I relax our efforts. We immediately do it again, and continue to repeat the sequence of engagement and relaxation until the cramping stops. Applying massage to the muscle bellies and pressure in the muscle spasm will also help.

Preventing Cramps

Adequate hydration, regular foot reflexology, massage of the muscles prone to cramping, a diet high in potassium and calcium, and daily stretching can prevent the re-occurrence of muscle cramps.

Drink before you’re thirsty. Restoring an adequate level of hydration in your body will take a few days. It’s kind of like pouring water on a super dry plant and expecting the soil to retain the moisture; the water just pours out the bottom. It will take a few days for the minerals to recirculate and invest your tissues. Evian water is a good water to drink for a few days if you are dehydrated. It contains a higher salt content than regular drinking water.

I don’t recommend relying on Gatorade as a general source of hydration. It’s great for an acute situation – think triage – perhaps after a strenuous exercise activity. It’s too high in sugars and chemicals to be good for you as a regular habit.

Do any of you have other strategies for dealing with foot and leg cramps?

Jun 13 2018

How Did We Get Here?

This is a very different post for me to share, but I hope you will allow me the space to unload some thoughts and feelings that have stubbornly taken up residency inside me these days.

* Annual suicide deaths in the USA now outnumber deaths from auto accidents.

* Twice the numbers of people die in the USA from suicide than from murder.

* Between 1999 and 2016 (latest figures), suicide rates in the USA have increased by at least 25%. In some areas of the country it has reached 30%.

* More females commit suicide than males. Between 1999 and 2016, the incidence of suicide committed by white females between the ages of 45 and 64 rose by a whopping 80%.

* Two thousand teens commit suicide annually in the USA.

Professionals who work in fields related to suicide agree that almost all suicides result from severe depression and/or mental illness. So, how is it, in a country that boasts a quality of life better than anywhere else in the world, that so many people are so out-of-balance that they feel the only way out of their emotional pain is to terminate their lives?

How did we get here?

More importantly, how do we move towards a culture of understanding and compassion that commits to providing care, support and direction to the thousands more just steps away from their self-induced demise?

How many more senseless deaths will it take before we recognize that, even if not evident by physical disability, depression and mental illness are real – very real. And like any other unattended illness, left to its own, guarantees a poor outcome.

This seems like a national crisis to me, more so than the influx of parents and children from other countries trying to carve out a safer existence for their families.

Retail therapy distracts us – for awhile – from the pain and emptiness that result from a lifestyle detached from self and others. Social media tricks us into believing that we are connected – when we’re not.

When I hear of another pointless suicide or murder I have to work hard not to resort to anger or despair. I struggle to understand the choices people make; I’ve never experienced those levels of hopelessness. How do we stop this madness?

My early life – a critical time in everyone’s development – was blessed by loving parents, grandparents and siblings, and a stable, safe home-life. There was no violence, substance abuse, absenteeism or poverty.

My early childhood taught me the importance of others in my life. Throughout my entire life, I have always surrounded myself with friends that made me laugh, stood by me when I cried, called me out when needed, and are just plain ‘there’ for me – and I, them.

Later, massage school taught me to connect with myself and how to create a safe environment in which to invite others to do so. Beyond helping people with chronic foot pain or headaches, I think the power in the work that I offer is the opportunity for someone to experience herself as safe and deeply relaxed. To get out of the ‘talking head’. To feel stress-free – if only for an hour. To connect with self and maybe with another (me) in a meaningful way.

I’m so grateful for the path I have been led to follow. It has given me opportunities, through my reflexology practice and teaching, to connect with others and to witness people ‘falling into themselves’. It’s those moments, in addition to my friends and family that remind me to give thanks. Self-care, connection, love, friendship – that’s how I got here.

Jun 06 2018

Are You Up For A Challenge? I Was.

I doubt there is a reflexologist who hasn’t encountered the client who reveals upon arrival that she or he is extremely ticklish on the feet. I admit that it sometimes confounds me that someone who is uncomfortable having his or her feet touched would book a reflexology session to relax – but that’s a thought to pursue some other time, perhaps.

That was not the case though with the man who walked into my office recently – the most extreme and novel case of ticklishness I had ever encountered.

I have always been able to work past the ticklish issue with clients using slow and firm movements. Historically, by the time I reach the second foot, the person is usually in la-la land.

The Challenge

This 30 plus year-old man was so ticklish he could not touch his own feet, especially the toes. They were off-limit. (He couldn’t even handle a sheet touching his toes.) He obviously was not coming to relax; he braved the appointment because of painful plantar fasciosis in both feet. He was desperate. Doctors were talking surgery and he did not want that.

I decided to do a little research to better understand what sets the situation off, hoping that it would help me figure out how to deliver my protocol for plantar fasciosis without too much discomfort. Here’s what I learned:

What’s Going On?

There are two classifications of tickling (Who woulda thunk!):

Gargalesis – Coined by psychologists Arthur Allin and G. Stanley Hall, this is what most people think of; the kind that causes squirming, laughing and sometimes takes your breath away. It happens when you are lightly touched by another person on certain parts of the body, such as the armpits, ribs, neck, inner thigh and/or the feet.

One theory on how/why gargalesis developed is that it is an evolutionary mechanism against unwanted touch of vulnerable parts of the body. We squirm to get away from non-violent touch such as being tickled by a feather or someone’s fingers as a method of self-defense; to teach ourselves how to protect ourselves from touch that could injure or harm.

Why we laugh though is a mystery. And why does someone experiencing gargalesis laugh when touched by another but not when they touch themself?

Dr. Anthony Komaroff, a renowned medical doctor and researcher, has doubts about the theory that claims that the lack of surprise is what negates the sensation if we touch ourselves. He cites evidence that even without the element of surprise or with the full knowledge that you will be tickled by someone, some people still laugh as a response.

Another theory posits that it is a form of bonding, which is why we only laugh if the tickler is someone we are familiar and comfortable with, not a stranger.

Like I said, it’s a mystery.

Knismesis is very light stimulation of the skin that produces a tingling sensation that produces an itch, or makes you want to rub an area and/or move away from it. It rarely produces laughter and can be brought on by someone else, by a crawling insect or the self.

I believe the latter is the form of ticklishness that my client lives with.

My Strategy

I’m thrilled to report that other than a brief couple of seconds the strategy I conjured up worked! My client was pleasantly surprised that he was “okay with it”, and was just as surprised perhaps to learn where the root cause of the plantar fasciosis likely lay.

Here’s how the game plan played out:

* First off, very clear and ongoing communication. I relayed what I proposed we do, got his buy-in, and then continued to communicate throughout the entire session as to the next step I was going to move on to. There were no surprises.

* I start all my foot reflexology sessions with a foot soak and an exfoliation with a ‘scrubbie glove’. In this case, I asked him to put his feet in the water and gave him the option to scrub his own feet or just remove them from the water and dry them off himself. He chose not to scrub.

* I then instructed him to put his socks back on and lay supine on the table. I explained that I would grab hold of his foot firmly and showed him on my own hand how I would, again firmly and slowly, knuckle walk the bottom of his foot and thumb-walk along both sides for about 15 minutes per foot. I informed him that the conventional reflexology techniques would begin to relax his nervous system and communicate with the other parts of his body involved with plantar fasciosis. I assured him that I would do nothing ‘light or fluffy’ nor would I touch his toes. He even accepted my offer to place an eye pillow over his eyes! I think the slow, repetitive movements helped him to be able to receive this part easily. No surprises. The next segment was the trickier part of the session.

* Now we were going to move into some different techniques to address plantar fasciosis. He removed the socks and turned over onto his stomach while I applied nitrile gloves. I was hoping that the gloves would provide a bit of a barrier between his skin and my hands, just as the socks had done on his feet.

I applied the techniques to the lower leg with no problem – not his feet, right? And then I had to apply some lubricant to the bottom of his feet before proceeding. That was very uncomfortable for him, and fortunately lasted but a couple of seconds. We were both pleasantly surprised that he was able to lie still to receive the various remaining gliding strokes on the bottom of his feet.

He reported that his feet felt better when he got up to walk, which pleased me to no end. I felt satisfied with the session and had enjoyed the extreme focus it took not to inadvertently move in any way that might aggravate the situation.

Whether gargalesis and knismesis are the result of reflex actions or a learned behavior, no one seems to really know. I guess it’s just not one of those conditions high on the list of needed research. I’m just glad that I was able to help this man and hope he is comfortable enough to return to knock this plantar fasciosis to the curb!