Dear Friends, Clients, Students, and Colleagues,

Welcome to the first on-line edition of my newsletter, which I've been publishing bi-annually since 1996. It's purpose to inform and educate the public about the work I do.

In this edition, I will be discussing LaStone therapy, the original hot stone massage. It is the most popular massage treatment is spas and resorts today, combining the use of smooth hot river stones and chilled marble stones into one of the most amazing massage experiences available.

Since 1997, I'm very proud to offer LaStone therapy as part of my services. This past April, I became a certified instructor in this wonderful and completely holistic treatment, teaching it to professional bodyworkers throughout California.

The following are notes I've compiled to assist me during lectures in my workshops. It reads a bit dry, clinical and scientific. Most of my colleagues and students will find its contents invaluable to their practice. However, even if you're not a bodyworker, you may still find it a very informative look at the powerful physiological effects of a LaStone therapy treatment on the human body.

I invite you to experience the magic of a LaStone therapy treatment. Come get stoned with me soon!

Best,
Tanja Barnes, LMT

THERMO-CRYOTHERAPY and LaSTONE THERAPY

Thermo-cryotherapy is the clinical application of heat and cold therapies in any curative treatment. It is beneficial in detoxifying the body and bringing it back into balance. Thermo-cryotherapy can increase the body's white cell count, and hence boost its ability to fight infection and disease. Furthermore, since the nerves in the skin are connected to the central nervous system, hot/cold treatments can also help reestablish normal neurological functions. Thermo-cryotherapy can improve circulation and metabolism in the digestive organs and increase the amount of oxygen in the blood stream. A LaStone therapy massage treatment incorporates the principles of thermo-cryotherapy to a massage by alternating the use of hot and cold stones. Let's take a look at the effects of hot and cold treatments respectively.

General Effects of Heat Application

The application of heat to the body raises muscle temperature, causing blood vessels to widen (dilate). This increases the oxygen and blood flow to damaged muscles. On a cellular level, circulation is increased, nutrients are absorbed and metabolic waste products are removed thereby facilitating the body's natural healing processes. Furthermore, heat acts as a painkiller by over stimulating the nerves in the skin to interfere with the nervous system's ability to recognize pain.

Based on current clinical testing, hot therapy also produces the following effects:

• Stimulates blood flow and circulation (vasodilatation)

• Increases cellular metabolism

• Increases muscle spindle activity

• Increases muscle flexibility

• Increases muscle contractility

• Increases inflammatory response

• Increases extensibility of collagen

• Increases nerve conduction velocity

• Reduces joint stiffness, pain and muscle spasm

• Helps resolve inflammation, edema and exudates

• Reduces synovial fluid viscosity

• Induces a general feeling of relaxation and well being

When it comes to treating injuries, heat therapy is never applied in the acute stage because it can worsen the condition. Instead, it is introduced during the healing or rehabilitation phase when healthy tissue requires enhanced circulation. During this phase, the medical use of heat to treat provides temporary relief in sub-acute and chronic traumatic and inflammatory conditions (e.g. sprains, strains, fibrositis, tenosynovitis, muscle spasm, myositis, painful back, whiplash injuries, various forms of arthritis, arthralgia and neuralgia). There is a caveat when using heat to treat injuries however: long-term exposure to heat can have the reverse effects and can aggravate the symptoms it is used to treat. When using heat to treat injuries, cold therapy should be applied alternately. Hence, thermo-cryotherapy.

The clinical applications of heat is also effective prior to exercise to decrease muscle stiffness, increase flexibility and range of motion, and thin joint fluid to minimize friction at the joint. Heat can also be used to neutralize trigger points, a nodule of tender muscle and a source of muscle pain. Treatment of trigger points is aimed at increasing local circulation so the irritated muscle spindle at the heart of the trigger point has sufficient energy to relax. Warming the musculature causes a reflex relaxation of the muscle fibers. This can be further augmented by stretching to relieve the tight band of muscle in which the trigger point is located.

The application of heat may be superficial or deep. In a LaStone therapy treatment, heat penetrates up to 1.4 inches into the muscle. The intensity and duration of the physiologic effects are determined mainly by tissue temperature, the rate of temperature elevation and the area treated.

The immune system is the body's defense mechanism against invasion by bacteria, microbes and infections. This defense mechanism includes the productions of white blood cells (leukocytes) from bone marrow and t-cells produced by the thymus gland. When a body has a fever, the immune system triggers the productions of these cells. The application of artificial heat can make the body believe it has a fever, thus stimulating the immune response.

Hot contraindications: anyone suffering from loss of sensation in a part of the body to be exposed to the treatments. You should also avoid this type of therapy if you have asthma, kidney disease, a weak heart, a bleeding disorder, or an organ transplant. Likewise, frail people such as the elderly may not tolerate the treatments well.

General Effects of Cold Application

The application of cold is one of the simplest, safest and most effective care techniques for injury, pain or discomfort of muscles and joints. Generally speaking, cold decreases pain, swelling, tissue damage, blood clot formation, inflammation to bone and soft tissue, muscles spasms and pain. At the same time, cold stimulates blood circulation, aids the removal of metabolites (waste products), increases strength and promotes healing.

The use of cold is based on known physiology. Cold causes the blood vessels to narrow (constrict) which will decrease the blood flow to the injured area. Cold lowers the muscle temperature, which in turn diminishes the oxygen and nutrient need of the muscle. The application of cold assists in decreasing edema, scar tissue, and helps break down the pain cycle. Furthermore, the use cold also speeds up the recovery time of injuries.

Based on current clinical testing, cold therapy produces the following effects:

• Decreases blood flow (vasoconstriction)

• Lowers inflammatory response

• Lowers muscle contractility

• Raises pain threshold

• Lowers collagen tissue extensibility

• Lowers response of muscle spindle to stretch

• Increased viscosity of synovial fluid

• Reduces pain by lowered nerve conduction velocity

• Decreases edema and swelling by limiting fluid infiltration into an area

• Decreases arterial, soft tissue and bone blood flow, thus limiting hemorrhage

• Decreases cell metabolism decreasing secondary hypoxic injury

• Considerably reduces of the spasticity of muscles and increases power

• Increases favorable hormones in the blood serum

• Increases immunity

• Considerably improves of mood; feelings of briskness and physical analgesic effect

Cold is always used when treating acute injuries. In these instances, it is directly applied to the site of acute discomfort and pain, but can also be used to treat chronic (long term) problems and in the later stages of injury rehabilitation as well. The use of cold decreases cellular activity by reducing swelling and inhibiting internal bleeding at the injury site. Cooling the muscle tissue reduces muscle spasms by reducing the muscles ability to maintain a contraction (contractility). In other words: it reduces muscle spindle spasticity.

Cold controls muscles spasms by allowing the affected muscles to relax. Cold is used on soft tissue injuries, penetrating deep into the tissues, reducing the inflammatory effects on bone and in joints. Deep muscles take longer to cool than a joint, which is closer to the skin. Muscle cooling occurs within 10 minutes in thin athletes. Heavier athletes may take 30 minutes to achieve the same results. Marble stones help to cool the area and also adds the benefit of compression.

Cold decreases feeling in the area in which it is applied by reducing the ability of the nerve endings to conduct impulses. When it comes to pain management, cold applications have a direct effect on the conduction velocity of sensory nerves, which carry pain messages to the brain.

In a classic study, a 20-minute application of ice packs slowed nerve conduction significantly enough to provide analgesia. Slowing the conduction rate of sensory nerves reduces the number of impulses per unit of time and less "pain information" reaches the brain for recognition. Cold applied to an area of pain slows the release of chemicals that cause pain and inflammation. It may also reduce pain by "countering" the injury. For example, you might counter the pain of a sore tooth by pinching yourself hard in the leg.

Short-term application of cold initially constricts blood vessels and decreases tissue temperature. This constriction decreases blood flow and cell metabolism, which can limit hemorrhage and cell death (necrosis) in an acute traumatic injury.

In long-term application of cold (after approximately 20 minutes) blood vessels in the area then dilate (open) slowly, increasing the tissue temperature, an effect that is termed "reactive vasodilatation". Cold therapy can help the area heal faster and there will be a decrease in pain and swelling and an increase in lymphatic drainage.

Cold contraindications: rheumatoid arthritis, Raynaud's Syndrome, cold allergic reactions, paralysis, or areas of impaired sensation, malignant diseases, purulent skin ailments, circulatory insufficiency, decompensated organic heart diseases, pneumonia, arteriovenous shunts in limbs, claustrophobia, untreated hypertension. Refrain from the use ice over superficial nerve areas. Do not use ice with: those with circulatory problems, or who are unable to respond or cannot feel cold (i.e. someone after a stroke with a neuropathy), or who has a paralysis of a limb, any one who is allergic to cold (yes some people develop a rash and blisters to cold).

 
REFERENCES

Abramson, D. I., et al. Comparison of Wet and Dry Heat in Raising Temperature of Tissues. Arch Phys Med Rehabil. 1967:48. p. 654.

Bromiley, M. Facts About Backs. 12th Annual Bluegrass Laminitis Symposium. Kentucky. 1998

Cohn, B. T. et al. The effects of cold therapy in the postoperative management of pain in patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med. 17:1989. 344-348.

Currie, D. M. Self-Directed Learning and Medical Education: A Comparison. Arch Phys Med Rehab. 1985:66, p. 454

Currier, D. P., and Nelson, R. M. Dynamics of Human Biologic Tissues. F. A. Davis: 1992. p. 68.

Greenberg, R. S. The Effects of Hot Packs and Exercise on Local Blood Flow. Phys Ther. 1972:52. p. 273.

Kaplan, P. and Tanner, E. D. Musculoskeletal Pain and Disability. CT: Appleton & Lang. 1989. p. 83.

Lee, J. M. et al. Effects of ice on nerve conduction velocity. Physiotherapy. 64:1978. 2-6.

Lewis, T. Observations upon the Reaction of the Vessels of the Human Skin to Cold. 1930:15. 177-208.

Michlovitz, S. L. Thermal Agents in Rehabilitation. F. A. Davis:1986. pgs. 99, 102, 270.

Olson, J. E. and Stravino, V. D. A Review of Cryotherapy. Phys Ther. 1972:52. 840-853.

Porter, M. J., and Porter, J. Electrical Safety in the Training Room. Athletic Training. 16:1981. pp. 263-264.

Robinson, A. J., and Snyder-Mackler, L. Clinical Electrophysiology. Williams & Wilkins:1995. p. 389.

Utsinger, P. D. et al. Efficacy of Cryotherapy and Thermotherapy in the Management of Rheumatoid Arthritis Pain: Evidence for an Endorphin Effect. Arth Rheum. 1982:25. s113.

Zarro, V. Mechanisms of Inflammation and Repair, in Thermal Agents in Rehabilitation. S. L. Michlovitz and S. L. Wolf eds. Davis Co:1986. p.5.

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