Massage for Atherosclerosis

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The goal in giving massage to an atherosclerosis patient is to provide passive exercise to the muscles, in order to increase blood flow.

Atherosclerosis is a thickening and loss of elasticity of medium and large arteries due to deposited plaque, and is a form of a more general condition, arteriosclerosis.

Arteriosclerosis usually refers to changes of the small muscular arteries, arterioles. This happens most often as a result of the aging process, when both fibrosis and loss of elasticity develop in the arterioles and small arteries.

The role of cholesterol in developing atherosclerosis

To understand atherosclerosis, the role of cholesterol in the development of the disease must be explained. In the last couple of decades we have been made very aware of cholesterol and how it causes cardiovascular disease. The labels on products we buy tell us that they are low in cholesterol and saturated fat, and this knowledge makes us feel better. But how many of us have probably wondered what this really means, and how the amount of ingested cholesterol helps or hurts our health?

When we eat any fats we are giving the body building-blocks for fatty acids, some of which we actually need to live a healthy life (linoleic and linolenic acids found in most plants and fish cannot be made by the body and are needed); and other fats such as unsaturated fats, which our bodies don't need in large quantities.

Our bodies make cholesterol, and numerous studies have shown that the amount of cholesterol we eat does not seem to affect our bodies' production of cholesterol. At the same time, eating foods high in saturated fat does cause higher cholesterol production. Saturated fats are those fats that are hard, or not liquid. Most animal fats and some tropical oils are saturated. Oils that undergo the process of hydrogenation -- like corn oils that were made into a solid margarine -- become saturated fats.

A diet high in saturated fats does increase our bodies' cholesterol production -- and therefore increases the risk of cardiovascular disease.

High-density and low-density lipoproteins

As fat enters the body it combines with proteins to form lipoproteins -- which is a way in which fats, or lipids, get transported by the blood or lymph. These lipoproteins are the substances that health professionals look at to determine cardiovascular conditions or risk of cardiovascular disease. When lipoproteins are examined they are divided into two groups: high-density lipoproteins (HDL) and low-density lipoproteins (LDL). Although both types of lipids carry fats, HDLs are smaller, denser clusters and have fewer lipids in them. LDLs are larger, lighter in weight and contain more lipids. High levels of LDLs in blood are associated with a greater risk of cardiovascular disease, whereas higher levels of HDLs are associated with a lower risk of cardiovascular disease.

As you can see, not all cholesterol is bad -- in fact, if a person can produce higher levels of HDL blood cholesterol then there will be less chance of cardiovascular dysfunction. And if there is a greater amount of HDL cholesterol in the blood, then the LDL cholesterol level will go down. The presence of HDL cholesterol plays the most important role in the reduction of LDL cholesterol.

Low-density lipoproteins, LDLs, are prone to deposit in the arteries, especially if there is a great amount of it circulating through the system, thus forming atheromas -- a soft, yellow, fatty plaque. These atheromas cause the artery to lose its elasticity, and also decrease the size of the vessel opening. These changes within the vessel decease the amount of blood that can travel through the vessel -- as not only is the opening of the vessel smaller, but its ability to expand is also diminished.

With this decreased blood flow through the vessels, the body gets less nourishment than required, which induces the heart to pump harder in order to supply the blood needed throughout the body. As the atheromas remain present in the artery and there is no change in the LDL cholesterol level, the artery will gradually become harder -- thus almost permanently changing its elasticity. The resulting weakness in the vessel muscle can contribute to the development of an aneurysm (a small sac of fluid within an artery). The plaque, if unnoticed or ignored, will grow in size over the years, thus producing almost-complete or complete occlusion. If this occlusion goes untreated, then the person is most likely to suffer a myocardial infarction, more commonly known as a heart attack, caused by total occlusion of the major arteries or aorta.

Patients suffering from atherosclerosis do not exhibit signs of their condition until more critical situations, such as thrombosis (a blood clot that develops due to a rupture of plaque) or clinical stenosis (narrowing) of the aorta, develop.

Although the signs of atherosclerosis are hard to see until it's late in their development, there are a few contributing factors that are well-known to us, and that can be eliminated by a change in lifestyle.

Change for the better

Persons who are physically inactive will have a greater chance of developing atherosclerosis and cardiovascular disease. This is because one of the only known ways in which to decrease LDL cholesterol production is by increasing HDL cholesterol levels in the blood. One measure for increasing HDL cholesterol is by aerobic exercise. Patients who start even a very moderate exercise program can reduce their LDL levels in this manner.

Another contributing factor to high LDL level is smoking. Smoking seems to cause a decrease of HDL, and therefore increases LDL. Stopping smoking will raise the level of HDL in proportion to LDL.

Obesity is another common agent for causing increased levels of LDL cholesterol. Weight reduction will increase HDL production (although it is not known whether exercise during weight reduction programs plays the main role in higher HDL production).

A high intake of saturated fats causes a greater production of LDL cholesterol -- and therefore is also one of the factors that can be changed.

As you can see, eating foods low in saturated fats, maintaining normal weight, exercising and not smoking will all lead to a lower level of LDL cholesterol, and decrease the chance of atherosclerosis developing. Conditions that seem to predispose persons to atherosclerosis are hypertension and diabetes. Men are more likely to develop this condition than are women.

Allopathic treatment of atherosclerosis

Standard allopathic treatment -- other than the above-mentioned lifestyle changes -- consists of surgical cleaning of the blocked arteries and, if significant changes are present in the elasticity of the artery or a portion of an artery, replacement of that vessel or segment is performed.

Massage treatment: rationale and goal

Massage is completely contraindicated when thrombosis, aneurysm or embolism are present; however, physiological massage is very appropriate when the therapist is addressing atherosclerosis. Massage will, in fact, act as a mild form of exercise.

When administering massage to an atherosclerosis patient, the primary goal is to provide passive exercise to the muscles. The massage treatment will increase blood flow, one of exercise's main functions.

Strokes used

Twenty-five percent of the treatment will consist of strokes of continuous flat and clasping effleurage in order to increase blood flow. Friction, which makes up 20 percent of the treatment, will increase vasodilation in a local area. Use gentle (not deep) strokes of friction with fingers, friction with the heel of the hand and cresting friction. Petrissage, which makes up 35 percent of the massage, will provide the most exercise-like effects. Horizontal and vertical petrissage are the two main strokes to use, and they should be used primarily on the extremities. Continuous vibration is done for the remaining 20 percent of the time.

The massage session

Begin by massaging the back with strokes of effleurage done at a regular pace (not too slow or deep). Now you have to pay extra attention to the direction of your effleurage, as well as its depth. Make sure not to press downward, but rather move from the buttocks toward the scapula draining into the underarm. These strokes should be done continuously in a regular rhythm. Proceed to the strokes of friction and vibration. Continuous vibration strokes like light shaking should be done in the direction of venous flow (upward) only. Continue with massage of the lower extremities, beginning at the thigh. Use strokes of effleurage, gentle horizontal and vertical petrissage (most of the time) and light shaking vibration done in the direction indicated on the illustration. Once again, these strokes should be done gently and without any discomfort. Move on to the calf with the same routine used on the thigh. Then have the patient turn over. Repeat as before on the front of the thigh. This massage should be done two to three times a week, lasting 30-40 minutes each time. These treatments are done in 10-15 sessions per set, with the sets being repeated three to four times a year.

Recovery from surgery

Even people who just went through surgical intervention for the removal of any occlusions can be treated for atherosclerosis. The main difference from the treatment which I described above is in the goals. The only goal when treating the patient who is recovering from surgery is to increase blood flow and improve overall cardiovascular work. A 10-15 minute massage done daily will consist of two strokes only: continuous effleurage and light shaking vibration. Massage should begin on the areas that have not been operated on, starting from the point further away from the area and moving toward it. Remember, the main contraindication for massage is thrombosis -- and you will be increasing the patient's circulation so significantly that if thrombosis is present, you will endanger the patient's life.

All of the strokes that you use should be done in moderate speed and very gently. If you do effleurage very slowly your hand has a tendency to press downward, which can be dangerous as it causes vasoconstriction during increased blood flow. As the patient continues to progress in his or her recovery process, you can slowly add strokes of gentle petrissage to your massage, as well as increase the time to 20-25 minutes. Make sure that the treatment set does not go over 15 times, as doing so may cause the patient's progress to stop, or the patient's condition to regress.

Massage Magazine, Inc.

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By Zhenya Kurashova Wine

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