Wednesday, September 30, 2009

Professional Practice

Blog 4: Sustainability - Discuss Issues of Sustainability and How They Relate to Massage Practice.

Central to issues of sustainability in massage practice are the three main elements of Economic, Social and Environmental Sustainability. A balance of these three lead to a satisfied massage practitioner, a wider positive community/social network and environmental awareness, aiming to positively impact the world on a global scale.

Economic Sustainability

This refers to the ability to make enough money to result in profit and reasonable quality of life for the practitioner, thus affecting the practitioner's mood, and everyone they come into contact with (explored more in social sustainability). The idea of business is that a profit is made, and that the business is not running at a loss, as most likely this is the main source of income for the practitioner, assisting with their survival (food/accomodation) and general expenses. In some ways, being imbalanced in the environmental and social areas of sustainability (buying products that end up being too expensive to realistically make a reasonable profit, e.g. expensive organic cotton sheets) may lead to a need to address this imbalance by purchasing in this case, cheaper sheets which may have been made by slave labour. However, this depends on the views of the practitioner. It is very possible to use and buy products that are both environmentally and socially sustainable, without a massive price tag (e.g. eco-friendly laundry powder, fair trade teas/coffee/sugar). These products may be marginally more expensive, but that entirely depends on whether you make the most of supermarket discounts, sales offers, bulk buys and wholesale prices when ordering these in. In some cases, it is cheaper to buy fair trade/eco-friendly (e.g. trade aid green tea, eco-friendly products that are on special), so it comes back to the intention of the practitioner.

Social Sustainability

This refers to the effect that the massage practitioner and their massage practice has on the wider community network that they contact (via their clients).
The very intention of massage is to improve and maintain people's wellbeing by relaxing & treating them physically, helping them psychologically and generally assisting them on a holistic level. This has the trickle down effect of affecting all other people in that person's network that they contact in some way, usually positively. This as a whole affects society positively, leading to better relationships within the community, greater tolerance of others, lower crime rates and conflict, and more altruistic behaviour.
From a survival point of view, a society with a more functional interpersonal network will have a greater chance of surviving, a higher birth rate, lower premature death rate (due to lower crime levels/conflicts), and be more egalitarian: not have so many issues related to inequality, which can lead to riots and strikes.
In relation to the massage practice, practitioners can actively use their consumer power by choosing to purchase products that support social sustainability locally and overseas, by choosing items that donate a percent of the profit to charity, fair trade items and products, slave-free linens and furniture as a few examples.
The massage practice could also network with grassroots businesses and local organisations that have socially conscious goals to contribute to social sustainability.

Environmental Sustainability

To practice environmental sustainability within a massage business, the easiest ways to address this is by reducing power usage, using environmentally friendly laundry products, recyclable paper and buying recyclable packaging whenever possible, so mainly aiming to reduce throwaway plastic. The therapist can try using small glass bowls for mixing the oil in, for use during the massage rather than plastic bottles (this would be particularly beneficial for practitioners mixing aromatherapy oils prior to the massage) and storing oils in glass bottles.
The massage therapist can look at using soy candles (instead of paraffin which is carcinogenic and adds to air pollution - Rezaei, Wang & Johnson, 2002) during the massage rather than electrical lighting, and switching off lights/appliances when not in use. By using more sheets rather than towels, and line drying linen where possible, this will reduce electricity usage and waste byproducts. Recycling grey water (water that has been used to wash dishes/linen) to use on the garden or potentially in the cistern is another method of conserving water. Again, using the power of active consumer choice, selecting an environmentally friendly power company and advocating for the use of eco-friendly practices and products in the massage industry will have an effect on a wider scale, particularly when networking with a group of like-minded practitioners, in an effort to lobby for positive, sustainable change.
The three spheres of economic, social and environmental sustainability interlink with each other, contributing to sustainable practices and awareness on the part of massage therapy as a whole. The implementation of strategies that address these spheres of sustainability have a beneficial effect at a personal, social and finally global level, reaching far beyond the practitioner and the practice.


Elluminate: Sustainable Practice (23rd September, 2009) Otago Polytechnic Massage Therapy Diploma Course.

My own thoughts.

Rezaei, K., Wang, T. & Johnson, L. (2002) Combustion Characteristics of Candles Made from Hydrogenated Soybean Oil. Journal of the American Oil Chemists' Society, 79 (8).

Monday, September 14, 2009

Pathology: Condition 3

Pathology: Immune, endocrine, gastrointestinal & renal systems
Condition 3: Jaundice
Final due: 16th October, Peer assessment due: 23rd October 2009.


Jaundice (Icterus) is the yellowing of the skin as a result of uncommonly high amounts of bilirubin in the blood plasma.  Bilirubin affects skin pigment, is a byproduct of broken down haemoglobin and is metabolised in the liver.  Therefore, blood disorders, diseases of the liver and gall bladder problems can affect the metabolism of these organs/tissues resulting in an unusually high level of bilirubin (Premkumar, 1999).
Jaundice is the physical symptom of a more serious underlying condition.  Hepatic jaundice which is the most common type, is often co-morbid with other serious internal diseases affecting the liver, most often hepatitis (Brienza et al, 2006).


Hepatic jaundice is typically caused by liver disease/failure, which can be caused by prescription drugs including antibiotics (Hussaini et al, 2007), alcohol leading to cirrhosis of the liver and other toxic substances, hepatitis, viral diseases such as malaria (Werner, 2005) and other chronic liver conditions (Suman & Carey, 2006).  In very rare cases, there may be abnormal liver enzyme activity present from birth, this is known as congenital jaundice (Werner, 2005).

Signs & Symptoms:

The most obvious signs that jaundice is present are that the whites of the eyes, skin and mucous membranes will appear yellow (due to the pigment change caused by elevated levels of bilirubin).  There may be a dull aching pain in the upper right quadrant of the abdomen and enlargement of the spleen in addition to jaundice in the case of co-morbid hepatitis (Premkumar, 1999)
Light coloured stools and dark urine also indicate abnormal levels of bilirubin in the blood and the presence of jaundice (Werner, 2005).


Jaundice may eventually result in bleeding disorders if the underlying condition responsible is left untreated, as the higher levels of bilirubin indicate that bile is not being adequately secreted, preventing the absorption of fats and therefore inhibiting the access of fat soluble vitamins (such as Vitamin K) that assist in normal blood clotting (Werner, 2005).

Incidence & Prevalence:

Incidence and Prevalence of jaundice will depend entirely on the underlying hepatic condition, as jaundice is only a physically manifested symptom.
In a study undertaken in France, medical researchers found that the incidence of drug-related hepatic injury was 14 in 100,000 citizens each year (Navarro & Senior, 2006).  According to Wasley et al (2007) 20 - 30% of recently infected American hepatitis patients additionally presented with jaundice in 2005.

Indications for MT:

The therapist must first identify the underlying condition resulting in the presence of jaundice, and take the necessary precautions according to this condition (Werner, 2005).  Generally, reduced session length, relaxation style massage with light pressure only and avoidance of the liver and spleen areas (upper abdomen) are advised.  If the patient presents with any form of hepatitis (including viral hepatitis) in addition to jaundice, the therapist must take stringent hygiene precautions, ask the client to leave their underwear on during the massage and preferably be vaccinated against all Hepatitis strains, particularly Hepatitis B (Premkumar, 1999).

Contraindications for MT:

Avoid moderate to heavy massage of the abdomen due to possible enlargement of the liver and spleen or do not massage this area at all (depending on their underlying condition/s).  Do not use heavier than relaxation pressure as this can easily lead to bruising, if the client presents with underlying bleeding disorders (Werner, 2005).
 Massage is generally contraindicated when jaundice is apparent (and the cause unknown), as this is a warning sign of a more serious hepatic illness and massage could inflame the liver further.


Brienza, N., Dalfino, L., Cinnella, G., Diele, C., Bruno, F. & Fiore, T.  (2006) Jaundice in Critical Illness: Promoting Factors of a Concealed Reality.  Intensive Care Medicine, 32 (2).

Hussaini, S., O'Brien, C., Despott, E. & Dalton, H.  (2007) Antibiotic Therapy: A Major Cause of Drug Induced Jaundice in Southwest England.  European Journal of Gastroenterology & Hepatology, 19 (1).

Navarro, V. & Senior, J.  (2006) Drug-Related Hepatotoxicity.  The New England Journal of Medicine, 354 (7).

Premkumar, K.  (1999) Pathology A-Z: A Handbook for Massage Therapists.  Calgary: Lippincott Williams & Wilkins, pp. 209 - 211

Suman, A. & Carey, W.  (2006) Assessing the Risk of Surgery in Patients With Liver Disease.  Cleveland Clinic Journal of Medicine, 73 (4).

Werner, R.  (2005) A Massage Therapist's Guide to Pathology.  Philadelphia: Lippincott Williams & Wilkins.

Wasley, A., Miller, J. & Finelli, L.  (2007) Surveillance for Acute Viral Hepatitis - United States 2005.  MMWR: Surveillance Summaries, 56 (SS03).