Nurturing Acupressure Massage for the Elderly and the Ill - 1.2
By Mary Kathleen Rose
Originally published in Massage & Bodywork magazine, December/January 2004. Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.
Technique and Training
Techniques for practicing Comfort Touch follow the principles described above, using broad, encompassing contact applied to the part of the body being touched. While the techniques are simple, it is important that they be practiced accurately for greatest effect.Comfort Touch is not a light form of Swedish massage. It does not use effleurage, petrissage or kneading, as these strokes can damage the tissue of the person whose body is compromised by age or ill health. More importantly, Comfort Touch acts on the nervous system in such a way that it causes deep relaxation by sedating the nervous system. This also accounts for its effectiveness in relieving pain.
There are many specific techniques that can be used in this work, given the condition of the client and the training and skill level of the practitioner. I will share two with you.
- Encompassing -- This technique is especially suitable for the limbs. A good way to begin a session is to encompass the hand and/or the arm. Hold the body part (arm, hand, leg or foot) between your hands. Let your thumbs be parallel to each other, to avoid poking pressure from their tips. Use the full surface of your hands to contact and encompass that body part. Pressure is firm and evenly distributed.
Example: Client may be either seated in a chair or lying on a bed. To massage the arm, begin by encompassing the upper arm, gently pressing into the center of the arm with both hands. Continue to move down the length of the arm, releasing pressure between each placement of your hands. Maintain a steady and easy rhythm of contact as you sequence down the arm. Encompass the whole surface of the hand, including the thumb and fingers.
Intention and benefit: Comfort, assurance, provides a sense of connection, alleviates tension in the muscles.
- General Contact Pressure -- This technique is used to apply pressure to a specific area or series of points. Pressure can be applied with the whole hand, the palm or heel of the hand, or base of the thumb.
Example: With the client seated in a regular chair or wheelchair, stand at his left side with your left hand gently holding the left shoulder. Place the heel of your right hand at the top of the erector spinae muscles to the right of the spinal column. Press into center, at a 90-degree angle to the surface of the skin. Hold the pressure for 2-5 seconds. Release, and continue to move down the erector spinae muscles, pressing with each placement of the heel of your hand. Let the client move forward as you continue to support him with your left hand, and apply pressure to the erectors with the right hand. Move down until you reach the base of the back. You may then apply pressure directly to the sacrum.
Move to the other side and repeat the sequence while standing to the client's right, with right hand on his right shoulder. Apply pressure to the erectors of the left side of the back. End with the sacrum.
Intention and benefit: Relaxation to the muscles of the back, generally calming.
Communication and Consent
It is always important to state your intention to the client. I introduce myself, saying, "I am here to offer Comfort Touch. Is there anywhere you would particularly like me to work?" Throughout the session I ask or listen for feedback, whether verbal or non-verbal. I let clients know that this touch should feel good. It should not be uncomfortable or painful. I notice their breathing and watch for facial expressions and other movements in their bodies.
Sometimes people shy away from touching the most seriously ill person or someone who is in the hospital surrounded by medical equipment. They refrain from touch because of their fear and lack of knowledge about how to touch in a safe and appropriate way. Yet, I have seen the most profound responses to touch, sometimes from people who were labeled as comatose, or from those who are termed uncommunicative because of dementia, or otherwise unable to speak. Even in these situations I introduce myself, stating my intentions to the person I am about to touch. I listen and watch for their response.
Precautions in the Use of Touch
When people ask me "What are the contraindications for Comfort Touch?" I answer, "There is only one: If a person does not want to be touched." Otherwise, there is a way to touch them using these principles and guidelines. The touch may be very simple. For example, it may only involve holding the hand, or gently holding and encompassing the feet.
There are certain conditions, however, where touch is not recommended for specific areas:
- the site of tumors or lumps
- the site of recent surgery
- deep vein thrombosis (This situation often arises following surgery and it is advised to avoid touch below the waist until cleared by a doctor.)
- phlebitis (inflammation of a vein)
- burns, rashes, undiagnosed or contagious skin conditions or areas of skin irritation
- open sores or injuries
- areas of infection or inflammation
- any area that is painful to the touch
- areas of acute pain, or pain of unknown origin (Use caution in working with people with arthritis, headaches, fever and edema.)
In these situations it is best to have further training, and/or the guidance of another health professional who can assess the situation.
Applications of Comfort Touch
While this work is specifically designed to be safe and appropriate for the elderly and the ill, it has a much broader range of applications. Because of its adaptability and the specificity of the contact, I have found it useful during pregnancy and labor. I have used it with newborns, infants and children. Many of my students who work in the professions of nursing and physical and occupational therapies have incorporated it into the work they do in medical settings.
The principles and techniques of Comfort Touch also lay a foundation for the practice of other forms of massage and bodywork. The attitude, intention and techniques of this practice give a starting place for establishing a healing intention. Bret Williamson, who teaches Deep Tissue Therapy, incorporates this awareness in his practice: "Comfort Touch should be in everyone's toolbox. 'Encompassing' and 'contact pressure' ground the client, helping to integrate the other modalities. It is a beautiful way of balancing deeper work."
Comfort Touch is a much-needed healing balm for a world filled with pain and suffering. The intentions and attitudes of comfort and respect become a way of interacting with others, whether through physical touch, a caring presence or a conversation with a friend. While it can be used to ease the physical and emotional pains of the elderly and those in medical settings, it can also enhance the quality of life for anyone in need of a caring touch.
Comfort Touch in the Supine Position
The client can be in a bed, with or without a head lift. Pillows are used to support the neck and spine in proper alignment and allow for the comfort of the client. Soft pillows give the greatest comfort to the neck. Place pillows under the knees to support the lower back.
1. Place one hand under the base of the neck, supporting the area around the seventh cervical vertebrae. Let your hand be full and soft, allowing the tension to melt. Place the other hand on top of the shoulder to encompass the whole cervical and shoulder region. The pillow is positioned for support.
2. Gently do a butterfly press of the upper arm. Move on to a general press and hold the lower arm.
3. Hold the hand and generally press into it, then into the palm of the hand.
4. Work down to a general press of the hip and upper thigh. Encompass the knee, then encompass and general press the lower leg.
5. Remove the client's socks, if necessary. Encompass and general press the foot from ankle to toes, then replace the socks.
6. Encompass the abdomen and low back. The left hand is placed under the client in the small of the back. Allow the weight to sink into your hand. The upper hand rests on the abdomen, rising and falling with the client's breath. Make light contact with the abdomen and upper chest. Hold for 10-12 seconds to balance the breath and energy in the body.
7. Make light contact with the abdomen and forehead. Hold for a few seconds.
8. Place one hand behind the client's neck and rest the other hand lightly on the forehead. Hold for a few seconds to encompass the head.
Mary Kathleen Rose, CMT, has more than 25 years experience in the holistic health field. She supervises the massage therapy program at HospiceCare of Boulder and Broomfield counties in Colorado, and offers trainings in Comfort Touch in various massage schools and medical settings. She can be reached at 303/449-3945 or firstname.lastname@example.org.
Rose, Mary Kathleen. The Gift of Touch -- Comfort Touch: Massage for the Elderly and the Chronically and Terminally Ill. Hospice of Boulder County, 1996.
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This beautifully produced video introduces the viewer to the principles and techniques of Comfort Touch, a nurturing form of acupressure massage designed to be safe and appropriate for the elderly and the ill. Drawing on her many years of experience practicing and teaching this work in home-care and medical settings, Mary Kathleen Rose shares the essential elements of Comfort Touch with demonstrations of its applications in the seated, supine and side-lying positions.
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