Why a regular massage may help depression in my opinion …..

In recent years there has been a movement where Physiotherapy treatment has had a more “hands off” approach, where physical activity and exercise has been the main choice of therapy for rehabilitation instead of the traditional manual therapy. I have found this very difficult to swallow, now don’t get me wrong, exercise as therapy is powerful! In almost every instance a regular exercise and movement practice is a must in order to assist the body to heal. However I am wondering if as therapists we have forgotten the power of therapeutic touch.

Besides the intention of providing joints more freedom of movement and releasing myofascial restrictions, there is something deeper that happens with therapeutic touch. Field et al (2004) studied the effects of massage therapy on 84 depressed pregnant women. The researchers put the women in three groups; a massage group where the women received hands on massage twice a week for 16 weeks, a progressive muscle relaxation program and the third group received standard prenatal care alone. What the researchers found was that the women who were in the massage group had a 23% decrease of cortisol in their saliva, a 25% increase of dopamine and a 23% increase of serotonin in their urine.

Now remember cortisol is the end product of the sympathetic nervous system or the “fight or flight” response, basically cortisol is what is released in your body as a response to stress or danger. On the other hand dopamine and serotonin are activating central nervous system neurotransmitters that contribute to feelings of well being and happiness.

Field and another group of researchers did another study looking at 32 depressed adolescent mothers. They had 2 groups; one group received relaxation therapy over 5 weeks while the other group received ten 30 minute massage sessions over the same time. In this study the researchers found that only the massage group showed behavioural and stress hormone changes, in particular there was a decrease of salivary and urine cortisol by 28% at the end of the 5 weeks.

The positive biological and physiological effects of human touch is not just seen in “therapeutic touch” but also in hugging! A study completed by Light et al (2005) examined 59 premenopausal women before and after contact (hugging) with their husbands. What they found was that frequent hugs between spouses and partners are associated with lower blood pressure and higher oxytocin levels in premenopausal women. Oxytocin is a hormone this is often called “the love hormone” as it plays a role in social bonding, sexual reproduction and childbirth.

In another study where researchers took 230 cancer patients and put them into 2 groups; one group received massage therapy and “healing touch”, while the other group received standard care. What they found was that the group that received massage and “healing touch” had a decrease in blood pressure, respiratory rate and heart rate, basically they were more into their parasympathetic nervous system or “rest and digest”.

So as you can see interpersonal touch wether in the form of manual therapy or a hug plays an important role in governing our emotional and physical well-being. So if you’re on a healing journey and your addressing your physical health through diet and exercise; why not also think about receiving or seeking out regular manual therapy to improve your emotional and physical health.

Ericka offers Zen Thai Shiatsu massage therapy, with a special interest in head, neck and jaw and pre and post natal care.

Field, T., Diego, M., Hernandez-Reif, M., Schanberg, S., & Kuhn, C. (2004). Massage therapy effects on depressed pregnant women. Journal of Psychosomatic Obstetrics & Gynecology, 25(2), 115–122. doi:10.1080/01674820412331282231

Field,T., Grizzle, N., Scafidid, F., Schanberg, S. (1998) Massage and relaxation therapies’ effects on depressed adolescent mothers. Complementary Therapies in Medicine, 6(1), 57. doi:10.1016/s0965-2299(98)80070-8

MuLight, K. C., Grewen, K. M., & Amico, J. A. (2005). More frequent partner hugs and higher oxytocin levels are linked to lower blood pressure and heart rate in premenopausal women. Biological Psychology, 69(1), 5–21. doi:10.1016/j.biopsycho.2004.11.002

Post-White, J., Kinney, M. E., Savik, K., Gau, J. B., Wilcox, C., & Lerner, I. (2003). Therapeutic Massage and Healing Touch Improve Symptoms in Cancer. Integrative Cancer Therapies, 2(4), 332–344. doi:10.1177/1534735403259064

How your thoughts and emotions help create an environment conducive to healing in my opinion …..

As physiotherapist I am very interested in helping individuals create an environment conducive to healing and I personally do this in many ways including things that are outside the traditional physiotherapy parameters. However traditional physiotherapy helps individuals do this by assisting mainly the physical body, by ensuring muscle length tension around joints is balanced, strength of muscles is appropriate and that joints have the optimum range of motion. But often we forget that your mind has a lot to do with how quickly you get better and has a significant contribution in creating an environment conducive to healing.

There has been a strong understanding of the mind body connection in many ancient healing modalities but western allopathic medicine also knows this to be true and a double blinded placebo study shows how strong this connection is.

Randomized double blinded placebo control (RDBPC) studies is where individuals are randomly assigned to interventions. One group will be assigned to the ‘control group’ and given a placebo and the other will be given the intervention the group are researching. Placebo is when an individual is given a treatment that appears to look just like the actual treatment, this can be in the form of a pill, injection, liquid or procedure.

1 in 3 people who receive a placebo will have 2 things happen; they either have positive changes in their symptoms i.e they improve without the “real” treatment intervention OR they have a negative change and they get side effects, this effect is called Nocebo.

So what determines which way you will go?……………………………………………………….

YOUR MIND!!

It is your thoughts, feelings, beliefs and a big one …. your EXPECTATIONS which can change your body chemistry and allow a change either for better or worse.

An outrageous example of this is a study that looked at chemotherapy drugs for gastric cancer. Fielding et al., (1983) studied 411 individuals which were grouped into three categories; group A where given a placebo injection of normal saline, group B where given a cocktail of chemotherapy drugs and group C where given another mix of chemotherapy drugs. As you would expect group B and C had the largest group of people to get alopecia (loss of hair) but this isn’t the interesting part! GROUP A who were simply given a saline injection also had individuals who experienced hair loss, in fact 30.8% of them!!!

How?????

It was their BELIEF that chemotherapy drugs cause hair loss that created a physical change in their body chemistry resulting in a tangible physical result!!! It is a perfect example on how your thoughts and emotions can cause a physical change that will either help you heal or get worse!

Researcher and psychotherapist Kelly Turner , Ph.D, researched thousands of cases of spontaneous cancer remission only to find that these cases were not so spontaneous at all and that there were many factors that were contributing to these remissions. One of these factors was that these individuals understood the idea that thoughts and emotions have a direct effect on the body and this effect could be negative and illness producing or positive and health producing.

In her research she found that individuals understood that thoughts such as fear, worry, anxiety, anger, resentment, grief, sadness and depression had a negative impact on their health and healing. While non worry, calmness, relaxation, forgiveness, happiness, joy and love had an overwhelming positive effect on their health and recovery.

The healing journey can be a long road that can at times feel never ending, have you ever asked yourself what are the over riding thoughts and emotions that flow through your mind? What is your level of expectation that you will improve? Do you have faith that a particular outcome will occur?

Even though thoughts and feelings are difficult to change in an instant, it is important to at least acknowledge what your current thoughts and feelings are ……

References

Fielding, J. W. L., Fagg, S. L., Jones, B. G., Ellis, D., Hockey, M. S., Minawa, A., … Wrigley, P. F. M. (1983). An interim report of a prospective, randomized, controlled study of adjuvant chemotherapy in operable gastric cancer: British stomach cancer group. World Journal of Surgery, 7(3), 390–399. doi:10.1007/bf01658089

Turner, K (2014). Radical remission surviving cancer against all odds. NY. HarperCollins Publishing.

Part II Voice Physiotherapy & altered head posture in my opinion ….

In part I of voice physiotherapy I explained what MTD is and what physiotherapy for the voice involves. In this post we are going to talk about what you need for efficient voicing and things you can start thinking about for yourself .

There are a few things you need for effortless use of your voice, such as;

  • Healthy vocal cords
  • dynamic vocal cords that are able to be used in an efficient way in walking, sitting and talking
  • efficient breathing pattern and control
  • good laryngeal posture and also overall posture

In this blog my main emphasis will be overall posture. Why? Well In my experience physiotherapists loooove to harp on about “good posture” …… and well … I guess I better stick to the stereotype. But in all seriousness, it is often the one basic thing, that is contributing to peoples symptoms and often all that is needed is a little conscious awareness of habitual positions to change symptoms.

Why is it so important in voice physiotherapy?

It is because head and neck position has a direct influence on how the larynx is positioned.

An “altered head position” often results in a forward head and has been found to decrease the natural curve of the neck. As a result of this angle change, there is a change in the resting length in the neck muscles, in particular, the suprahyoid group. These muscles are located above the hyoid bone (horse shoe shaped bone) and are made up of mylohyoid, digastric, stylohyoid and geniohyoid.

What tends to be the issue is that there is a relative shortening of these muscles. The flow on effect is that this results in a lift of the hyoid bone which then results in an elevated larynx due to the fact that there are muscles that attached from your hyoid bone to your thyroid cartilage.

When this happens there is a disruption to the way the cricothyroid muscles work (see below for image). The cricothyroid muscles are not attached to the vocal folds however they influence their length and thickness by causing movement at the cricothyroid joint, which indirectly causes the vocal folds to elongate and narrow, raising the pitch of the voice. When there is an elevated larynx the cricothyroid muscles are placed in a biomechanical disadvantage where they have to work harder to elongate the vocal folds.

So to put it simply, having an altered head position results in vocal range difficulties due to structures and muscles having a biomechanical disadvantage. This makes muscles work harder and inevitably making them weaker. It takes time to improve your posture, you may need some flexibility in your thoracic spine, strength and endurance in the posterior muscles of your body and you may even need to increase your body awareness. However if you are having issues with your voice whether that may be poor quality, increased effort, fatigue or pain why not see if using your voice with a nice neutral position of the head and neck and see if that changes your symptoms.

References:

  1. Honda, K., Hirai, H., Masaki, S., & Shimada, Y. (1999). Role of Vertical Larynx Movement and Cervical Lordosis in F0 Control. Language and Speech, 42(4), 401–411. doi:10.1177/00238309990420040301
  2. Jull, G. A. (2000). Deep Cervical Flexor Muscle Dysfunction in Whiplash. Journal of Musculoskeletal Pain, 8(1-2), 143–154. doi:10.1300/j094v08n01_12
  3. Rubin, J. S., Blake, E., & Mathieson, L. (2007). Musculoskeletal Patterns in Patients With Voice Disorders. Journal of Voice, 21(4), 477–484. doi:10.1016/j.jvoice.2005.02.001

Voice physiotherapy (Part I) in my opinion …..

When you think of physiotherapy, your first reaction may not necessarily be to think of the voice, rather you might think about shoulder or back pain… and to be honest voice physiotherapy is a relatively new concept in the physio arena. However over the past decade there has been an increase in evidence to show that there is efficacy for the use of manual therapy of the laryngeal and perilaryngeal (around the larynx) area for Muscle Tension Dysphonia (MTD).

So lets talk about Muscle Tension Dysphonia. What is it?? MTD is a common disorder of the voice where there is excessive muscle recruitment which results in incorrect vibratory patterns of the vocal folds and altered voice production. This can really negatively impact your life especially when you think about the fact that your voice is how you communicate with the world and if you use your voice as part of your profession and daily work then it may impact you quite heavily. I think it is important to remember that it is not only singers who use their voice in their profession… school teachers, trainers, lawyers, hairdressers, call centre employees all use their voice an extensive amount.

How does MTD start? Before we answer that lets think about normal anatomy of the voice, when there is normal voice production the expiratory airflow causes the small intrinsic muscles of the larynx to vibrate. The muscles contract and relax allowing the vocal folds to move and produce sound. The larger extrinsic muscles such as the supra hyoids and infra hyoids give the larynx stability while the voice production is being made.

Tomlinson and Archer (2015) explain that MTD starts when there is an increase in tension of the extrinsic muscles, this increase in tension can cause mal-positioning of the larynx which then has a flow on effect of increasing the tension of the intrinsic muscles and vocal folds.

What symptoms do people report with MTD?

  • Altered vocal quality
  • increased vocal effort
  • vocal fatigue
  • pain
  • elevated hyoid bone and thyroid cartilage

What does voice physiotherapy involve?

The main aim with voice physiotherapy is to restore the tissue quality, length tension relationship between muscles and improve bio-mechanical efficiency, with an overriding goal to improve the efficiency of the vocal fold vibration and voice production.

Voice physiotherapy sessions may involve:

  • soft tissue and myofascial releases
  • trigger point therapy
  • laryngeal mobilsations
  • cervical spine mobilisations
  • TMJ management
  • soft palate release
  • diaphragm release
  • shoulder girdle management

A common theory that is spoken about in voice physiotherapy is the idea that a “maladaptive voice cycle” occurs with MTD. When you are in the cycle compensatory neuromuscular recruitment keeps you in the loop. It is also important to note that there are many other factors feeding into this loop such environmental, psychological and vocal load.

Because MTD is multifactorial in nature it is really important to have a team to support you on your healing journey because once you start to get a better length tension relationship with your voice muscles it is important to use this window to then reeducate the muscles in this area to produce a more efficient voice production. So as well as physiotherapy it is crucial to have one or more people on board; voice coach, speech pathologist, ear nose and throat specialist, GP.

If any of this resonates with you, please feel free to contact me to book an appointment.

References:

Tomlinson, C. A., & Archer, K. R. (2014). Manual Therapy and Exercise to Improve Outcomes in Patients With Muscle Tension Dysphonia: A Case Series. Physical Therapy, 95(1), 117–128. doi:10.2522/ptj.20130547

Rubin, J. S., Blake, E., & Mathieson, L. (2007). Musculoskeletal Patterns in Patients With Voice Disorders. Journal of Voice, 21(4), 477–484. doi:10.1016/j.jvoice.2005.02.001

Van Lierde, K. M., Bodt, M. D., Dhaeseleer, E., Wuyts, F., & Claeys, S. (2010). The Treatment of Muscle Tension Dysphonia: A Comparison of Two Treatment Techniques by Means of an Objective Multiparameter Approach. Journal of Voice, 24(3), 294–301. doi:10.1016/j.jvoice.2008.09.003

In my opinion…..Why we may find it hard to do things that are good for us.

Over the years working as a physiotherapist I have given countless exercise programs, advice for injury prevention and have provided things for people to do to promote an environment conducive to healing. During my initial years of practising as a physio I became confused and frustrated with the amount of times that people didn’t follow through with what I had asked of them. I wondered why they didn’t do the very things that would help them out of the situation they were in. Along the way on my own healing journey, I realised that in different scenarios I too was much the same. I found it difficult to maintain a regular meditation practice and strengthening program in the mornings, the very things that I knew would really benefit my health.

It has only been recently that I’ve started to ponder why we as humans find it hard to do things that are good for us. Then I heard about the “I am not enough” epidemic. Have you heard of this?

Therapist and behaviour expert Marisa Peer talks about an “I am not enough” epidemic that starts at a very young age. From infancy to age 3 we can do absolutely anything and still feel unconditional love from our caretakers. We can break expensive pieces of furniture, throw our entire plate of dinner on the ground, spill milk and we still will always receive unconditional love. However beyond the age of three we start a process where we need to ‘do things’ to get positive reinforcement and praise, which sets up a thought process where we feel that we need to do something external to be loved. We need to put toys back in the toy box and then we get love, we need to get a sticker on our homework then we will be loved, we need to excel at school and get good grades then, we will be loved. Peer talks about how these messages can be translated into core beliefs about ourselves and as adults we may feel that we are not enough until others say we are enough.

When you really think about it, feeling that you are enough is a feeling of self love and acceptance. If we don’t have this basic self acceptance and self love it would be difficult to conjour the motivation and energy to do the very things that we know are good for us. If you don’t feel that strong sense of self love there may be a lot of resistance to doing nice things for yourself.

I have realised that there is no use in feeling frustrated or lecturing people about what they need to do… but rather, to simply help support them and encourage a space where they can cultivate this self love and acceptance themselves. Inevitably they will become the the loving parent, the encouraging teacher, and their own greatest fan. When we live from a place of such high self worth, doing even just a little self care in the morning becomes easy. Once we are at the top of our own priority list, those things we need to do for ourselves become easier to get done.

So in honour of loving ourselves I share this poem written by Charlie Chaplin, written the day he turned 70! It is said he discovered that self-love puts everything in a different perspective and makes life light and more beautiful.

As I began to love myself I found that anguish and emotional suffering are only warning signs that I was living against my own truth. Today, I know, this is “AUTHENTICITY”.

As I began to love myself I understood how much it can offend somebody if I try to force my desires on this person, even though I knew the time was not right and the person was not ready for it, and even though this person was me. Today I call it “RESPECT”.

As I began to love myself I stopped craving for a different life, and I could see that everything that surrounded me was inviting me to grow. Today I call it “MATURITY”.

As I began to love myself I understood that at any circumstance, I am in the right place at the right time, and everything happens exactly at the right moment. So I could be calm. Today I call it “SELF-CONFIDENCE”.

As I began to love myself I quit stealing my own time, and I stopped designing huge projects for the future. Today, I only do what brings me joy and happiness, things I love to do and that make my heart cheer, and I do them in my own way and in my own rhythm. Today I call it “SIMPLICITY”.

As I began to love myself I freed myself of anything that is no good for my health – food, people, things, situations, and everything that drew me down and away from myself. At first I called this attitude a healthy egoism. Today I know it is “LOVE OF ONESELF”.

As I began to love myself I quit trying to always be right, and ever since I was wrong less of the time. Today I discovered that is “MODESTY”.

As I began to love myself I refused to go on living in the past and worrying about the future. Now, I only live for the moment, where everything is happening. Today I live each day, day by day, and I call it “FULFILLMENT”.

As I began to love myself I recognized that my mind can disturb me and it can make me sick. But as I connected it to my heart, my mind became a valuable ally. Today I call this connection “WISDOM OF THE HEART”.

We no longer need to fear arguments, confrontations or any kind of problems with ourselves or others. Even stars collide, and out of their crashing new worlds are born. Today I know “THAT IS LIFE”!”

― Charlie Chaplin