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International

Therapist fht.org.uk

Touch type

Growing pains

Challenge conquered

Different approaches to facial touch

Injuries in young athletes

Rethinking challenge

MOVING FORWARD Amputation and its impact on clients

PUBLISHED BY THE FHT ISSUE 126 (AUTUMN 2018) THE LEADING MAGAZINE FOR PROFESSIONAL THERAPISTS 01 Cover_Autumn 2018_International Therapist 1

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CONTENTS

International

Therapist fht.org.uk

ISSUE 126 (AUTUMN 2018)

12

ON THE COVER

36

FEATURES 12

Moving forward The FHT looks at amputation, its impact on clients, and how touch therapies can help

16

Flow motion Yvette Jordan discusses the importance of the lymphatic system

20

Touch type Dr Katerina Steventon discusses different approaches to facial touch and the science behind it

24

38

Challenge conquered Dr Phillip J de Prez discusses the concept of challenge

26

Growing pains Sarah Catlow, MFHT, and Lance Doggart, MFHT, discuss injuries in young athletes

30

Hilda Kalap, MFHT, talks about her work in a hospice as a paid reiki practitioner

20 36

38

LEARNING ZONE

08

Your views

34

10

News update

2018 FHT Conference and Excellence Awards

18

Ask an expert

45

Research

Measuring outcomes, and liability insurance

46

2018 Michael Pittilo Student Essay Award

Essential oil profile

49

Medical A-Z

Clary sage

What’s new at FHT

42

Local support group news

60

Industry news

66

54

CPD questions and diary dates New in the reading room and spiral quiz

On the couch…

56

FHT learning

with Christopher Byrne, President of the FHT

58

FHT accredited courses

03 contents Contents_Autumn 2018_International Therapist 3

44

Breast cancer awareness As October is Breast Cancer Awareness Month, we look at warning signs of the disease

MEMBERS’ PAGES 50

A day in the life of… Geraldine Flynn, semi-permanent make-up technician and 2013 FHT Excellence Award Winner

Lichen planus

55

FHT.ORG.UK FHT F FH H T.O HT .O OR RG G.U G. ..U UK UK

Life before death Jane Duncan Rogers gives pointers for therapists new to working with terminally ill clients

REGULARS

32

Remedial recipes Karen Gilbert shares two homemade product recipes, for a body scrub and post-sport massage oil

26 19

Hospice healing

51

Members’ news… Annette Roachford, MFHT, discusses being a community wellbeing champion

52

Reviews, competition and new products

AUTUMN 2018 INTERNATIONAL THERAPIST

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FHT.ORG.UK

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EDITOR’S WELCOME

WELCOME Federation of Holistic Therapists 18 Shakespeare Business Centre Hathaway Close Eastleigh Hants SO50 4SR

Contact

T. 023 8062 4350 E. info@fht.org.uk W. fht.org.uk

Editor

Karen Young

Deputy Editor Daniel Ralls

Sub-editor

James Hundleby

Designers

Sarah Auld, Carrie Bremner

Picture Editor Charlie Hedges

Advertising

Annabel Boorman-Shiffer T. 020 7880 6230 fht@redactive.co.uk

Deadlines – Winter 2019 (Issue 127)

Editorial – 30 Oct Classified adverts – 3 Jan 2019 Display adverts – 8 Jan 2019 Published – 24 Jan 2019

Senior management team

Jade Dannheimer; Julie McFadden; John Parsons; Annie Walling; Karen Young

Governing Council

President – Christopher Byrne Vice Presidents – Gerri Moore; Mary Dalgleish; Herman Fenton Lay members – Helen Chambers

FHT Expert Advisers

Julian Baker, MFHT; Lynne Booth, MFHT; Amanda Brooks, MFHT; Lorraine Davis, FFHT; Christine Fisk; Sally Kay, FFHT; Maria Mason, MFHT; Cameron Reid, MFHT; Tina Reid; Neil Sheehan, MFHT; Denise Tiran

A

t the FHT, we receive lots of queries from members looking for information about different therapies. In the majority of cases, we can point members to relevant research on the FHT website, or recommend other trusted resources. Sometimes, we’ll suggest looking into postgraduate training, as often there is no substitute for learning first-hand from industry experts. Occasionally, however, we hit a wall, like we did when Paul Story, MFHT, contacted us in January this year. Paul had been treating a client who’d had both of her feet amputated as a result of trauma. She had been experiencing phantom pain and hypersensitivity in her residual limbs, but it was clear that Paul’s massage therapy treatments had made a huge difference to her, physically, mentally and emotionally. Sadly, his client had to undergo further surgery to remove her left leg just below the knee. She told Paul that she wanted to continue with her massage treatments, and she had also started recommending him to some fellow amputees. While he had already researched this area of work, Paul contacted the FHT to ask, did we know of any specialist training to enhance his knowledge and skills when providing massage to amputees? And could we publish an article about working with amputees in International Therapist to raise awareness about this population and the benefits of massage? The answer to his questions were ‘no’ and ‘yes’, respectively. That is why – with great thanks to Paul, his client Michelle, Zak Robertson and

USEFUL FHT CONTACTS

our interviewees – our lead feature this issue focuses on supporting amputees. Does it cover all of the incredible stories shared by those who contributed? Sadly, no (there simply wasn’t room). Will it teach members the specifics of how to treat amputees? Unfortunately not (but it will offer some useful insights). Will it help to raise awareness and give other members the confidence to work with amputees? I hope so. After all, every year tens of thousands of people from the UK and Ireland lose a limb due to road traffic accidents, conflict and conditions such as type 2 diabetes, which means there are many more people out there who, like Michelle, could greatly benefit from the support of a professional therapist.

Karen Young, Editor

International Therapist (IT) is printed on FSC® responsibly sourced paper. If you can bear to part with your copy of IT, please pass it on to a friend to read or recycle.

ACCREDITATION Annie Walling E. accreditation@fht.org.uk W. fht.org.uk/accreditation

INTERNATIONAL THERAPIST Daniel Ralls E. dralls@fht.org.uk W. fht.org.uk/IT

CPD REQUIREMENTS

MEMBERSHIP AND INSURANCE Beverly Bartlett E. bbartlett@fht.org.uk W. fht.org.uk

Heidi Hinton E. cpd@fht.org.uk W. fht.org.uk/cpd

PRESS AND MEDIA Karen Young E. kyoung@fht.org.uk W. fht.org.uk/press-and-media FOLLOW FHT ON FACEBOOK, TWITTER, LINKEDIN & INSTAGRAM

FHT is a trading name of the Federation of Holistic Therapists, which is authorised and regulated by the Financial Conduct Authority (FCA) under firm reference number 502095. You may check this on the Financial Services Register by visiting the FCA’s website, register.fca.org.uk or by contacting the FCA on T. 0800 111 6768. Registered in England and Wales, No. 02864349. Registered office: Chilworth Point, 1 Chilworth Road, Southampton SO16 7JQ. This issue of International Therapist has been published on behalf of the Federation of Holistic Therapists by Redactive Media Group, 78 Chamber Street, London E1 8BL. The Federation has taken all reasonable steps to ensure the accuracy of the information contained in the magazine. Except in respect of death or personal injury caused by the Federation’s negligence, the Federation shall not be liable, by reason of any error in or omission from the information contained in this or any previous editions of the magazine, for loss or damage whatsoever arising therefrom. Neither FHT, Redactive Media Group nor the authors can accept liability for errors or ommisions. Neither the Federation nor Redactive Media Group necessarily associates itself with any views that may be expressed in this magazine, to which readers are invited to submit articles of general interest for publication. Responsibility cannot be accepted for unsolicited manuscripts or transparencies. No part of this magazine may be reproduced in any form or by any means, whether electronic, mechanical or optical without written permission from the Federation.

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05 editorial wel_Autumn 2018_International Therapist 5

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PRESIDENT’S WELCOME

WELCOME

D

id I blink? I can’t quite believe that it’s autumn already, which of course means the FHT conference is just over a month away. Like many of you who have already booked, I’m really looking forward to listening to all of our expert speakers, but I have to confess that I’ll be particularly interested in the discussions surrounding evidence base and the best way to measure treatment outcomes. Positive feedback from clients is always great – it’s a strong indication that we’ve done our job well – but I believe we’ve now reached a point in time where we need to find the best way to evidence that what we are doing on the ground is making a real difference. I am pretty confident that speaker Dr Michael Dixon and others will be highlighting that the health and social care climate is changing, and there are more opportunities than ever before for therapists to get involved and show that they can be part of a wider workforce responsible for supporting the wellbeing of our local communities. As far as I can see, the more we can arm ourselves to support us in this effort, the better. Looking for effective ways to audit what we do is also good for our clients. It’s a way of showing those who have come to us with

a specific challenge that ‘this is where you were when you first came for a treatment, and this is where you are now’. And if they haven’t improved as much as you or they hoped, then that’s important to know too – it means their treatment plan needs to be revisited, or perhaps they need to be referred to another health professional, which is all part of best practice. Of course, the other thing I’m looking forward to is the announcement of our 2018 FHT Excellence Awards. Having looked through all of this year’s entries during the shortlisting process, we were once again really impressed by the calibre of those who entered, along with the diverse range of services and support they offer. Good luck to our finalists and keep up the excellent work. I look forward to seeing you on the day but if you haven’t booked your ticket yet, please hurry – spaces are running out fast. Visit fht.org.uk/2018-conference for more information or see page 34.

Christopher Byrne, President

FHT GOVERNING COUNCIL PRESIDENT

VICE PRESIDENTS

Christopher Byrne ICAT (International Council of Acupuncture Therapists) and PACT (Professional Association of Clinical Therapists) FHT EXPERT ADVISERS Julian Baker, MFHT; Lynne Booth, MFHT; Amanda Brooks, MFHT; Lorraine Davis, FFHT; Christine Fisk; Sally Kay, FFHT; Maria Mason, MFHT; Cameron Reid, MFHT; Tina Reid; Neil Sheehan, MFHT; Denise Tiran.

Gerri Moore IFHB (International Federation of Health and Beauty Therapists)

Herman Fenton HFST (International Council of Health, Fitness and Sports Therapists)

Mary Dalgleish ICHT (International Council of Holistic Therapists) and Association of Therapy Lecturers (ATL)

LAY MEMBER Helen Chambers (representing the interests of the public)

For biographies, please visit fht.org.uk/about-us 6

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6 presidents welcome_Autumn 2018_International Therapist 6

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HAVE YOUR SAY PLEASE KEEP IN TOUCH WITH US... Email dralls@fht.org.uk Facebook facebook.com/fht.org.uk

Your views

FHT website fht.org.uk

Instagram fht_org

Twitter @FHT_Org

Write to 18 Shakespeare Business Centre, Hathaway Close, Eastleigh, Hants S050 4SR

STAR COMMUNICATION

Fascinating fascia

PICTURES: © LUCY DONLEAVY 2018

I have spent many hours talking to my clients about fascia, what it is and how it behaves. During my daily massage treatments, clients were asking me questions about it. I’m also an artist, so I started to explore the imagery of fascia through my painting. I felt that I finally had a symbiotic relationship between my art and massage. I could show clients what I had been talking about and, after hanging the paintings in my treatment room, could begin to use them as visual aids. I have tried to show how the fascia in the body is a matrix design, strong, resistant and shaped by the tensional forces it experiences – how it holds most of the body within its network, suspended and in balance. It has so many sensory receptors, sensitive to pain, touch, temperatures, emotion and trauma. I find it fascinating that the fascia constantly moves and changes, depending on the demands made of it. Some of my

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paintings show how the fascia has thickened in areas, and I am able to explain to clients how this can lead to restrictions and postural change, which can result in chronic pain. Other paintings show a nice uniform bouncy-looking web, holding other structures in suspense, ready and able to move freely. I think that giving clients the knowledge of this relatively new understanding, with some visual aids, is empowering for them to make changes to their lifestyle and potentially helps them take back control of their bodies and speed up recovery from chronic pain. My clients have told me they have found the images useful and their new-found knowledge of fascia makes sense to them. I recently had the chance to showcase some of my paintings at the British Fascia Symposium (BFS). The BFS is a biennial trade event, taking place since 2014, aimed at bringing the latest knowledge about fascia to therapists, movement teachers and sports coaches. I did a series of 16 paintings, all oil on canvas, which were displayed in the main auditorium at the BFS. This area was used to host the wide variety of speakers who had been invited to the weekend. I also had the images for sale as A3 limited edition prints. The main social event at the symposium on the Saturday evening was also held in the auditorium, so it was a good opportunity for people to look more closely at the paintings and speak to me about them. The paintings and prints were very well received by the people I met. I have enjoyed exploring this subject area to paint, and feel like I have learnt much from closely observing videos of moving fascia and then recreating the sense of these images into an art form. Lucy Dunleavy, MFHT

FHT.ORG.UK

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HAVE YOUR SAY

Relaxation with reiki Last year, I was asked to work in conjunction with Age UK Manchester, to attend its dementia hubs and demonstrate reiki to service users, their families and carers. I am a 10th-generation reiki master/teacher, specialising in the Dr Mikao Usui system of natural healing, so thought this sounded like a wonderful opportunity to share the benefits of reiki. I immediately responded with a resounding ‘yes’. After my initial contact with Age UK, I was asked to attend the Hale, Urmston and Sale dementia hubs. I asked two of my colleagues to assist me in attending these hubs – Tracey Edwards and Sharon Whiteley, both FHT members. We attended the first of these hubs in April 2018 with the others following in June and July. We met many service users, their families and carers. The meetings lasted for two hours, with around 25 service users attending each hub. Each meeting started with a short introduction about reiki and its benefits. We then set up two reiki treatment couches and two chairs so the clients had a choice of how best to relax. We treated 16 service users between us, with each session lasting between 15 and 20 minutes.

Shortlisted for success

Nicolle Mitchell, MFHT @Massage4Dmentia I made the finalist list for [2018 FHT] Complementary Therapist of the Year... bit exciting for a Wednesday morning. It’s great to celebrate aspirational achievements in our field and amazing to have been shortlisted... good luck to all the finalists!

We were often told that the service users had great difficulty remaining still, yet they would commonly fall into a deep sleep during our treatment sessions. So much so that we would often have to wake them up at the end of sessions. When talking to the service users afterwards, we found they responded positively, were calm and seemed more aware overall. We have been asked to return to Age UK later this year to follow up with our treatments and have shown carers, families and friends some techniques they can use to support those in their care. We met many lovely people at these hubs and are definitely looking forward to returning. Martin Thirlwell, MFHT

Brian Jauncey, MFHT @heka_therapies Very excited & humbled to be nominated as one of 2 finalists in the student of the year category in the @FHT_Org excellence awards!

Spreading wellness in Norfolk As a practitioner and trainer with FHT accredited course provider The Balance Procedure, for the last nine years I have been working at the Norwich Mind Body Spirit events organised by Steve Hudson. During one conversation with him, we both realised we had the same vision: to bring yoga, nutrition, health and complementary therapies together under one roof. So we created the first-ever Norwich Wellness Festival, a twoday event held in May (I’m pictured below, right, at the festival). We wanted to be able to offer a wide variety of therapies, products and demonstrations for the public. We ended up with 100 stands, 40 talks, workshops and demonstrations, 18 different therapists and three sound practitioners. These included FHT members AnnaLouise Haigh, Robert Brown and Carla Leonna Amos. It was amazing and exciting for me to step out of my comfort zone. We gave away goody bags to the early-bird visitors and the FHT kindly sent us some magazines, which all went down a storm. We supported Guide Dogs for the Blind, and their local support group volunteers had a stand. I also had the opportunity to talk on local radio to promote the event. We are already planning to run the festival again next year, with even more exciting additions. Adrienne Green, MFHT

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Positive energy Tanja Lay, MFHT @BellaArmonia

It’s all about positive energies, a great read in the FHT summer issue @FHT_Org

STAR COMMUNICATION

Recognise Yourself: p Beauty Despite Cancer In the next issue of International Therapist, the lucky member who wins our star communication prize will receive a copy of Recognise Yourself: Beauty Despite Cancer, C by b J Jennifer if Young. Get in contact for a chance to win (details at top of page 8).

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NEWS

Sensory-based food education in early childhood leads to healthy eating habits Sensory-based food education given to three- to five-year-old children increases their willingness to choose vegetables, berries and fruit, according to a new study. The researchers, from the University of Eastern Finland, used the sensory-based food education method Sapere, which makes use of children’s natural way of relying on all of the five senses when learning: by looking at, smelling, tasting, touching and listening to new things. The researchers compared children in different kindergarten groups: some were offered sensory-based food

education, while others were not. Children were offered a snack buffet containing different vegetables, berries and fruit to choose from, and the researchers analysed their preferences. On average, children of lower-educated parents tended to eat less vegetables, berries and fruit. The study offers new tools for promoting healthy dietary habits in early childhood and evening out dietary differences between families. Read more on the FHT blog at fht.org.uk/IT-126-healthy-eating

Scottish sport prepares to receive a boost in funding

Active students improve their wellbeing Students who engage in regular physical activity are less likely to suffer from mental ill health than those who don’t exercise often, according to a recent report. The British Active Students Survey presented data from 6,800 students, and revealed that those who were active scored better in all four aspects of personal wellbeing than those who stated they were ‘fairly active’ or ‘inactive’. The four aspects were life satisfaction, thinking life was worthwhile, happiness and anxiety. In addition, students who regularly went to the gym or participated in team sport felt more socially included than those who said they rarely or never got involved in these activities. The report was released by ukactive, British Universities & Colleges Sport, Precor and Scottish Student Sport. Access the report at fht.org.uk/ IT-126-active-students

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Sport projects in Scotland could receive part of a £1m cash investment that aims to change lives and health through physical activity. The Changing Lives Through Sport and Physical Activity Fund will offer two-year grants ranging from £30,000 to £70,000 to organisations supporting positive changes in communities across the country. Funding will be available for projects that support sport for inclusion, sport for health and wellbeing, sport for skills and sport for communities. Find out more about the project at fht.org.uk/IT-126-sport-Scotland

Men more likely to buy gender-neutral cosmetics More than a quarter of British men aged 25 to 34 say they would be more likely to buy cosmetics if they were marketed as gender neutral, according to research. A study conducted by Future Thinking looked at the grooming habits of more than 4,300 British men. It showed that just 10% of 18- to 24-year-old men used cosmetics, compared with 19% of 25 to 34 year olds.

Analysis suggests that cosmetic brands may need to do more to promote gender-neutral products if they want to attract younger male consumers. Non-gendered products are also often less expensive than gender-specific items, which could be another reason why they appeal to younger men. Read more at fht.org.uk/ IT-126-gender-neutral

FHT.ORG.UK

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NEWS

Smoking increases risk of lupus for black women BLUE-LIGHT EXPOSURE CAN HARM THE EYES Blue-light exposure from the sun and digital devices, such as smartphones and laptops, can transform molecules in the eye’s retina, leading to age-related macular degeneration, a leading cause of blindness. The findings by chemists at the University of Toledo were published in the journal Scientific Reports. Access the study at fht.org.uk/IT-126-blue-light

BOWEL CANCER SCREENING TO START EARLIER IN ENGLAND Bowel cancer screening in England will be automatically offered to people from the age of 50, to allow cancers to be detected at an earlier stage. Screening is currently offered to men and women from age 60 and home test kits are sent every two years, up until the age of 74. Find out more at fht.org.uk/IT-126-bowel-cancer

Black women who smoke have a 45% higher risk of lupus than women who have never smoked. A study examining the health of 59,000 US black women over 20 years also found that the risk of lupus was lower among women who consumed alcohol in moderation. Those who drank four or more drinks each week were 57% less likely to contract lupus than those who never drank alcohol.

Black women in the US are more likely to experience lupus than people of any other race or sex. This was the largest study on risk factors for lupus among black women; previous studies were largely of white and Asian women. Lupus is a chronic condition that causes the immune system to become overactive and attack healthy cells, tissues and organs. Read an abstract of the research at fht.org.uk/IT-126-smoking-lupus

Anti-ageing negativity harms health and wellbeing The Royal Society for Public Health (RSPH) has published a report highlighting how negative attitudes towards ageing can harm our health and wellbeing. The report says that attitudes towards ageing are generated and reinforced with negative newspaper headlines, pressure from the beauty industry to use ‘anti-ageing’ products, prejudice in the workplace and lack of contact between older and younger generations. The RSPH calls for more to be done to promote positive attitudes towards ageing, including through educational and workplace programmes, analysis of the representation of older people in the media and to end the use of the term ‘anti-ageing’ in the cosmetics and beauty industry. Access the report at fht.org.uk/IT-126-ageing-report Read how language affects body image at fht.org.uk/body-image-language

Turmeric extract could help treat glaucoma

PICTURES: ISTOCK

BRITISH WORKERS TAKING FEWER SICK DAYS Workers in the UK are now less likely to take time off work because of illness than ever before, according to findings by the Office for National Statistics. However, experts warn that more people may be turning up to work when they are ill. Read more on the FHT blog at fht.org.uk/IT-126-sick-days

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Eye drops containing curcumin, found in turmeric, could be used to treat the early stages of glaucoma. Researchers from University College London (UCL) and Imperial College London discovered that delivering eye drops containing curcumin directly to the back of the eye led to a reduction in the loss of retinal cells in rats. The loss of these cells is an early sign of glaucoma, and researchers believe that the eye drops could become a treatment option.

The study’s lead author, Professor Francesca Cordeiro of the UCL Institute of Ophthalmology, said: ‘Curcumin is an exciting compound that has shown promise at detecting and treating the neurodegeneration implicated in numerous eye and brain conditions from glaucoma to Alzheimer’s disease, so being able to administer it easily in eye drops may end up helping millions of people.’ Access the research paper at fht.org.uk/IT-126-glaucoma

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05/10/2018 11:27


WELLBEING | Amputees

THE FHT LOOKS AT AMPUTATION, ITS IMPACT ON CLIENTS, AND HOW TOUCH THERAPIES CAN HELP

MOVING FORWARD

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Amputees | WELLBEING

n its simplest terms, amputation is ‘the surgical removal of part of the body, such as an arm or leg’ (NHS Choices, 2016). What is much less simple for those affected is dealing with the physical, mental, emotional and social challenges that can follow the procedure. Adapting to life after amputation can be extremely difficult and emotional, but with the right support, many go on to enjoy a good quality of life.

“The reflexology treatments dramatically reduced my client’s phantom pain. He even decreased his pain medication” Debra Newman, MFHT

THE AFTERMATH OF AMPUTATION As with any surgery, amputation can bring with it a number of risks, including heart complications, deep vein thrombosis, slow wound healing and wound infection. The level of risk is influenced by factors such as age, the type of amputation, if the amputation was carried out in an emergency situation, and the patient’s overall health. In addition, there are a number of other, longer-term challenges that can impact someone who has had an amputation – physically, mentally, emotionally and socially.

Stump and/or residual limb pain

PICTURES: GETTY IMAGES; ISTOCK; SHUTTERSTOCK

Originating in the remaining portion of the amputated limb, often on or near the stump, this is commonly described as a sharp, shooting or burning pain. There are many causes of stump and residual limb pain, one of which is irritation caused by a prosthetic. Another is nerve damage; following surgery, the nerves can become extremely sensitive or may try to heal and regenerate, producing little nodules called neuromas, which continue to send pain signals back to the brain (Roche, 2011). Oedema, poor blood circulation, adhered scars/excessive scar tissue, muscle spasm, progressive muscle tightening, thickening

TREATING THE MISSING LIMB Massaging or treating the missing limb – carrying out the movements as if the body part was still there – can bring pain relief to some clients. It is believed that this is due to ‘mirror neurons’ in the brain, which help us to process, believe and even ‘feel’ what we see (Das et al, 2016; Werner, 2014; Thomson, 2008). Debra Newman, MFHT, discussed this with a client, and they agreed that she should treat both his remaining and prosthetic foot: ‘The reflexology treatments dramatically reduced my client’s phantom pain. He even decreased his pain medication, which was remarkable. His pain returned when he was admitted to hospital for an illness, but was soon back under control once his treatments resumed.’

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of the tendons and ligaments and referred pain can also generate pain in this area (Werner, 2014; Kania, 2004).

Phantom limb pain Phantom limb pain (PLP) is a common problem in amputees. The exact cause is unknown but linked to ‘reorganisation’ of the brain’s wiring, which occurs when the spinal cord and brain lose signals from the missing body part (Hanspal, 2011; Hester, 2011; Roche, 2011; Ramachandran, 2000). Some amputees may never experience PLP, while those that do may be affected immediately after amputation or several years later (Roche, 2011). A recent study indicated that up to 72% of amputees experience PLP within the first week of surgery, with 60% continuing to experience pain at six months (Das et al, 2016).

Beyond the physical Losing a body part can have a huge psychological impact. NHS Choices (2016) notes that suicidal feelings are not uncommon, and negative thoughts and emotions are more likely in those who have had an emergency amputation and didn’t have time to mentally prepare for the loss of a limb. Horgan and MacLachlan (2004) found that depression and anxiety appeared to be relatively high for up to two years postamputation, after which both symptoms seemed to decline to a level typically seen in the general population. Socialising can also become a challenge. Angela Macaulay, MFHT, who treats a client with both legs amputated above the knees, says: ‘My client maintains a cheerful and positive disposition to the outside world [...] but is very anxious about going out to new places, meeting new people and travelling on public transport.’

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WELLBEING | Amputees

Emotional distress, anxiety and physical Some of these factors are obviously illness can exacerbate the symptoms of PLP, beyond the scope or control of the therapist. and patients who receive less support before However, therapists can support clients in amputation tend to be more prone to PLP many other ways as they adapt to life post(Werner, 2014; Hanspal, 2011). amputation (Werner, 2014; Kania, 2004). Those who’ve had an amputation Residual limb, stump and phantom as a result of trauma and/or conflict, limb pain – self-help measures and such as members of the armed forces or complementary therapies outlined by NHS civilian casualties, are also reported to Choices and other sources have an increased that may help relieve pain risk of developing in some people include post-traumatic stress applying hot or cold to the disorder (PTSD) (NHS limb; massage (to increase Choices, 2016). circulation and stimulate Zoe Warner is a 2014 muscles); acupuncture FHT Excellence Award (to simulate the nervous winner and founder system and relieve pain); of Therapies4Forces, transcutaneous electrical which offers free nerve stimulation (to complementary block pain signals); therapies to injured and mental imagery service personnel, (to imagine using the veterans and their missing limb and reduce carers. She says: Sue Stretton, Healing pain symptoms). ‘The physical and Hands Network emotional impact of an amputation varies from client to client, and can depend on what support they have in place. Many have suffered complex injuries and have mental health issues, such as PTSD, which not only impacts their overall recovery and rehabilitation, it also impacts their family.’

Kania (2004) writes that massage therapy ‘may increase sensory input from the residual limb that may override the brain’s perception of pain, providing temporary or partial relief from phantom pain’. Treatment may consist of directly massaging the stump or the muscle and soft tissues above the amputated area, which can also be beneficial for residual limb pain. Before carrying out massage, therapists should bear in mind that the residual limb and stump can be hypersensitive. Paul Story, MFHT, who works with a number of amputees, says: ‘For the first few sessions with one of my clients, I used cotton wool balls with massage oil to introduce touch to the residual limb as it was highly sensitive. On further visits I progressed to very gentle stroking and tapotement, progressing to a firmer massage stroke as the sessions went on, allowing the client to guide me about the level of pressure at all times.’ Muscle spasms, tightening and stiffness – as the client learns to adjust to living with a missing limb, compensatory patterns emerge in the body. Massage and sports therapists will be able to help assess and treat these problems, using techniques such as soft tissue massage, trigger point therapy, and stretching and mobilisation techniques. Scar tissue – it is very important that the scar tissue surrounding the amputation site can move as freely (and as pain-free) as possible over the underlying tissue, especially if the client is using a prosthetic. While the area is likely to be hypersensitive in the early stages, massaging the scar with the client’s guidance (once the wound has healed) will help to reduce stiffness, pain and itching, and improve mobility and skin integrity. Oedema – swelling caused by excess fluid can result in tingling, numbness or pain, and linked to the whole war experience – lost loved prevent the client from ones, torture, rape, or witnessing these atrocities wearing a prosthetic. inflicted on others. We find that working with Massage techniques that the emotions and memories helps them to specifically support the cope better with their limb loss. We use EFT lymphatic system can help (emotional freedom technique) where we to reduce the swelling can, along with reiki, relaxation, breathing and make the area more techniques and reflexology, which all help.’ ⦁ To read an article by Sue Stretton about comfortable. Improving the Healing Hands Network and its work, visit localised blood circulation fht.org.uk/amputees-healinghandsnetwork to the residual limb/stump area will also ensure the tissues continue to have a

“We find that working with the emotions and memories helps them to cope better with their limb loss”

REHABILITATION AND THE ROLE OF THE THERAPIST According to Horgan and MacLachlan (2004), ‘factors associated with a better adjustment to limb loss include increased time since amputation, higher levels of social support, higher levels of satisfaction with the prosthesis, higher levels of active coping, an optimistic personality disposition, lower levels of amputation, and lower levels of PLP and stump pain’.

EMOTIONAL SCARS Sue Stretton is a director of the Healing Hands Network, which sends volunteer therapists out to Bosnia to support those affected by war. ‘Losing a limb or body part as a result of mortar shell fire, a sniper attack or landmine has a huge emotional impact,’ she says. ‘The scars that are left behind serve as a constant reminder of what caused the injury, but in addition, looking at or touching these, or feeling pain associated to the limb that’s been lost, can trigger memories

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Amputees | WELLBEING

A CLIENT’S PERSPECTIVE

good supply of oxygen and other nutrients. Stress and anxiety – the evidence for massage and other complementary therapies for improving mood and reducing anxiety is compelling. Werner (2014) also highlights that helping someone to manage their depression and anxiety might encourage them to invest more energy into self-care and wellbeing.

POINTERS FROM FHT MEMBERS There seems to be no specific training available for therapists in terms of treating amputees, but the following advice and thoughts from FHT members who have worked with amputees may prove helpful: ⦁ ‘Research the best approach to massage and have an extended consultation before the treatment to find out what the client needs and hopes to achieve, so that they feel understood, safe and prepared. Build extra time into the early sessions and take these slowly. Clients can find this an emotional process, particularly if they are a recent amputee, and a lot of the session will be about finding what’s right and comfortable for that client’ – Paul Story, MFHT. ⦁ ‘Talk to the client. They are the expert in their particular condition and adaptation methods, so follow their lead in planning your sessions. Don’t be afraid to work with people who have had amputations. It is fantastic to see them develop and improve in both physical and psychological elements’ – Sister Marianne Donnelly, MFHT.

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⦁ ‘Consider working with clients’ families

too, so they can also benefit from treatment. With reflexology, we have found Carol Samuel’s nerve reflexology and Lynn Booth’s VRT techniques very helpful. Other treatments we simply adapt as we would for any other client – constantly communicating with the client is key. The use of an electric massage couch has been invaluable’ – Zoe Warner, Therapies4Forces. ⦁ ‘Bear in mind adaptations you may need to make for wheelchair access. While it goes without saying, treat your client with the same dignity and courtesy you would any client – it is this ‘normality’ that they seek. Take time to listen. Often a treatment is a safe space for them to talk about their concerns’ – Angela Macaulay, MFHT. ⦁ ‘Doctors can advise on mental health support and physiotherapy, but by integrating support in any way possible, following responsible guidelines, you will have a huge impact by giving time to your client. Be confident and well informed, liaise with the client’s health professionals, and be sure to have consent and approval prior to treatment’ – Francisca Ruiz, MFHT. ⦁ ‘Don’t make assumptions or say ‘I know how you feel’ – ask, and allow individual expression. Mastectomy is amputation and under-recognised as such by both clients and health professionals, and phantom pain not always acknowledged

Michelle experienced a trauma in 2014 that led to both feet being amputated at the Lisfranc joint. Since then she has had several surgeries, including a below-knee amputation of her left leg in January this year. Here she talks about how Paul Story, MFHT, has helped her: ‘I visited Paul for the first time in 2017 and the massages he performed, which included work on my residual limbs, had such a profound and positive effect. He helped to alleviate the neuropathic pain and the increased warmth to the area reduced the phantom pains in my feet too, which was really encouraging. It was not only the actual massage I gained benefit from – it also had a positive impact on improving my mental health around the trauma and my low self-esteem improved immensely. When I had to have my left leg amputated below the knee earlier this year, Paul supported me through my amputation, recovery and rehabilitation, which again had an amazing impact on me, physically and psychologically. Seven months later, I am continuing to enjoy the benefits of massage with Paul, who I now recommend to fellow amputees.’ ⦁ Read Michelle’s testimonial at fht.org.uk/amputation-michelle

or treated properly. Refer the client to other professionals for symptom management where appropriate’ – Janet Le Sueur, MFHT. ⦁ ‘Do not be shocked by what you see or afraid to touch the wound or stump, but ask permission first – you may be the only non-medical person to touch the area. Be prepared for tears and emotional release. Be supportive and allow it to flow out. Offer help to get on/off the treatment couch but accept that this may be refused’ – Sue Stretton, Healing Hands Network.

REFERENCES For references and further reading, visit fht.org.uk/IT-references

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HEALTHCARE | Lymphatic system

Flow

MOTION YVETTE JORDAN DISCUSSES THE IMPORTANCE OF THE LYMPHATIC SYSTEM

T

he lymphatic system is covered in therapy training, but often in a relatively small way that leaves therapists thinking it is ‘secondary’ or a less important part of the circulatory system. It plays a dynamic role in our health, and having a greater understanding of the lymphatic system can greatly enhance your clients’ overall health and wellbeing, and your therapy outcomes. The purpose of the lymphatic system within the body is to: ⦁ Replace white blood cells ⦁ Remove excess fluid from around our cells ⦁ Destroy waste and toxins ⦁ Regulate our protein levels ⦁ Transport fat from our small intestine.

and plays a vital role for our immunity in the development of T-lymphocytes, an important type of white blood cell. Secreting a hormone called thymosin, it stimulates the development of T-cells to defend the body from potentially deadly pathogens such as bacteria, viruses and fungi. Bone marrow is also a key component of the lymphatic system, producing lymphocytes that support the body’s immune system. The appendix is rich in lymphoid tissue, and recent studies suggest it could be a haven for useful bacteria.

The lymphatic system begins with blindended lymph capillaries (pictured below) lying adjacent to each blood capillary by the venous return. They are bigger than blood capillaries as they need to remove cellular waste and larger molecules such as fat and protein. Lymphatic capillary cells resemble overlapping tiles on a roof and have anchoring filaments attached to the cells, containing the protein fibrillin (microfibrils that resemble elastic). Due to pressure changes, these filaments initiate the opening of the cells of the lymphatic capillary to collect waste.

LYMPH CAPILLARY OPENING

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Lymph capillary

Tissue cells

Blood capillary Arteriole

Venule

Interstitial fluid

PICTURES: SCIENCE PHOTO LIBRARY

To carry out all these functions, it must be able to move uninterrupted along and through its pathways. Briefly exploring the lymphatic system, we look at how it moves through the body and the components that are part of its functionality: the spleen, thymus, bone marrow and appendix, along with lymph capillaries, vessels and lymph nodes. The spleen is the largest of the lymphatic organs, usually the size of a clenched fist. It is mainly a mass of lymphoid tissue, dark purple in colour, and lies under the lower ribs on the left side of the upper abdomen. In old age, the spleen naturally wastes away through cell degeneration. Scattered in the splenic pulp are lymph nodes, each containing an arteriole network, which carry lymphocytes (small white blood cells) and macrophages (cells that destroy harmful bacteria). Lymphocytes released from the lymph nodules pass directly back into the bloodstream. A large lobed structure, the thymus lies behind the upper part of the sternum

Lymphatic vessel

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Lymphatic system | HEALTHCARE

Pressure changes are fundamental for the lymphatic system to work effectively and keep us healthy. This happens when the correct pressure drives fluid out of the blood capillary, highest at the arteriolar end and lowest at the venular end. The tiny lymphatic capillaries are very sensitive to any change in this pressure, relying on it to initiate the collection of excess fluid from within the interstitium. Once filled, the lymph fluid stretches the lymphatic capillary wall, and its smooth muscle responds with a contraction, causing lymph movement towards the bigger lymph vessels. Regulation and direction of flow throughout the body is determined by the direction of the valves within the lymph vessels, which pertain towards the lymph nodes. These contractions are supported by skeletal muscle and joint movement, arterial respiratory pressure changes and negative pressure in the central veins. Their contractions are also determined by autonomous regulation through the sympathetic nervous system, with additional external support given externally, through lymphatic massage. The lymphatic system is divided into two adjoining one-way circuits. One collects waste from the legs, abdomen, left thorax, left arm, and left side of the head, face and neck. The other collects waste from the small right thoracic region, right arm, and right side of the head, face and neck. The left side of the lymphatic system therefore has much more fluid to collect and clean. Lymph nodes (pictured above right) are the main players in our lymphatic system, and can be spherical, oval, spindle or kidneyshaped depending on their position. They are imperative to our health and continuity of our lymph flow because they filter waste, defend the body against infection and regulate protein concentration, which helps maintain blood pressure. Lymph nodes have a contractile outer capsule, which is densely packed with collagen fibres, a few elastic fibres and isolated smooth muscle cells. This allows fluid movement when we are at rest and for the nodes to swell when required to fight infection. From 0.2cm to 3cm, they vary in size, with additional factors influencing them in respect of shape, number and size. Between 700 and 1,000 nodes are spread throughout the entire body, approximately 300 to 500 in the abdomen, with more in and around the joints that facilitate the contraction and filtration effect through musculoskeletal movement. Lymph reaches lymph nodes via afferent vessels and is then moved along and through the system by efferent vessels; this is perhaps more easily remembered as

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LYMPH NODE

Afferent vessels Trabecula Lymphocytes

Macrophages Lymphocytes

Trabecula

Medulla Efferent vessels

Blood capillaries

Vein Artery Collagen and elastic capsule

arriving and exiting vessels. Usually, many lymph vessels arrive into the lymph nodes with the waste to be cleaned with only one, two or three exiting. Ensuring a slow exit allows better filtration of waste and toxins. Once the lymphatic system has cleaned and filtered cellular waste from within the body, it is passed back directly into the bloodstream via entry into the left and right subclavian veins and then into the heart. Clean lymph fluid mixes with the arteriole blood again and will travel throughout the cardiovascular system until the venous return where pressure changes again allow waste to be expelled into the lymphatic capillary. The lymphatic system moves lymph through the entire body very slowly, unlike the continuous blood flow being pumped by the heart. It is easier to visualise if you imagine the lymphatic flow as resembling a fully laden lorry moving along a road. These roads must have a directional flow with gates (the valves) preventing back flow to allow forward movement, and the road ahead must essentially be clear for the fluid to move into. If the road ahead is blocked, swelling occurs.

Subcapsular sinus

Essentially, the lymphatic system needs to be kept continuously moving to keep us healthy, and hundreds of lymph nodes all over the body are necessary for clean lymph fluid to be ready for re-entry. If lymphatic fluid is left to stagnate because of immobility, this may result in longer recovery from illness or infection. In addition, if swelling is not reducing naturally it indicates there is a system blockage or a problem.

Yvette Jordan has worked as a massage therapist for over 35 years, ďŹ rst training in lymphatics 13 years ago. As a teacher and founder of UK Lymphology Clinics, Yvette hopes to awaken new interest in the lymphatic system for all therapists. theuklc.com

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BUSINESS | Members’ questions

Q. I HAVE RECENTLY STARTED WORK FOR A CHARITY AND WOULD LIKE TO MEASURE THE OUTCOMES OF THE THERAPY SERVICE WE ARE PROVIDING. CAN THE FHT MAKE ANY SUGGESTIONS? Karen Young, FHT editor and communications manager, says: There are a number of measurement tools available, but two often used by FHT members are MYMOP and MYCAW. MYMOP (Measure Yourself Medical Outcome Profile) is a person-centred questionnaire developed by Dr Charlotte Patterson, an experienced GP, practitioner of acupuncture and Chinese medicine, and honorary senior research fellow at University of Bristol. The initial MYMOP questionnaire is completed during the consultation, with the client identifying one or two related symptoms that they would like help with, such as ‘pain across my lower back’ and ‘pain down my left leg’. They can also choose a daily activity that the problem limits or prevents them from doing, such as

‘walking to the local shops’. These choices are written down in the client’s own words and they score the severity of each over the past week, on a scale of 0 to 6, with 0 indicating ‘as good as it could be’ and 6 ‘as bad as it could be’. On the follow-up questionnaires, the wording of the previously chosen items remain the same (‘pain across my lower back’) and the client once again scores each choice on a scale of 0 to 6. The form also asks about medication use because, for a number of clients, reducing the amount of medication they are taking for a problem will be a key treatment objective. The advantages of MYMOP are that it is quick and easy to complete, sensitive to change, and identifies what is most important to the client. Its simplicity also makes it easy to chart the scores of individual patients over time, and it has been used successfully by both orthodox and complementary practitioners. A disadvantage of MYMOP is that it is problem/symptom-specific, so it’s not suitable for clients who can’t identify their

‘most important problem’. The seven-day timescale also makes it unsuitable for less frequent problems, such as migraines or menstrual problems. The forms are available, free of charge, at the University of Bristol website: bris.ac.uk/primaryhealthcare/ resources/mymop. It is important that the layout and wording of the MYMOP forms aren’t changed and anyone using MYMOP must read the accompanying ‘instructions for administration and scoring’. Those using MYMOP in audit, evaluation or research studies are also asked to register as a user. To help you use MYMOP correctly, there are some FAQs available on the website, along with three excellent training videos featuring Dr Patterson. If you are evaluating complementary therapies in cancer care, MYCAW (Measure Yourself Concerns and Wellbeing) may be a more appropriate tool. It is an adaptation of MYMOP and while very similar, contains elements that may be more relevant to this client group (and a number of others). Again, the forms and guidance can be accessed on the university website.

Ask an expert KAREN YOUNG AND BEVERLY BARTLETT ADVISE ON MEASURING OUTCOMES AND INSURANCE

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Beverly Bartlett, FHT membership and insurance services manager, says: It is a condition of the FHT’s medical malpractice, public and products liability insurance that members who are ‘unqualified’ in (studying) a therapy recognised by the FHT must:

Inform each client, prior to treatment, that they are unqualified in that therapy ‘Make no charge for the treatment’ (see ‘Your obligations’, section 1d, of the policy wording at fht.org.uk/insurance). Our underwriters, Hiscox, have confirmed that, providing every penny donated goes to the charity, this would not be classed as ‘charging’ for treatment, and would in no way impact your insurance cover.

PICTURE: ISTOCK

Q. I AM STUDYING REFLEXOLOGY AND – IN RETURN FOR PROVIDING TASTER TREATMENTS AT AN EVENT – I WOULD LIKE TO ASK PEOPLE TO DONATE MONEY TO A CHARITY THE ORGANISERS ARE SUPPORTING. SOMEONE MENTIONED THAT THIS COULD BE AN INSURANCE ISSUE – PLEASE COULD YOU CLARIFY?

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Clary sage | ESSENTIAL OIL PROFILE

excessive sweating, muscular tension, poor hair growth, postnatal depression, premenstrual

CLARY SAGE

tension, sexual problems, stress.

(Salvia sclarea)

Blends with

A native to Italy, Syria and southern France, clary sage is now widely cultivated across Europe, Russia, Morocco and the US. A biennial herb, the plant grows up to a metre in height, with heart-shaped leaves and whorls of two-lipped, white-to-pink flowers that have distinctive mauve bracts and grow on single or branched spikes. The essential oil is steam-distilled from the flowering tops, is colourless or very pale yellow, and has a herbaceous, nutty aroma and top note. In Aromatherapy A-Z, Davis (2005) highlights that clary sage is often used in aromatherapy in preference to common sage (Salvia officinalis) ‘because while clary shares many of the same properties of sage, it does not present the risks of toxicity associated with the high level of thujone in common sage (up to 45% of some sage oils)’. The name clary is believed to come from the Latin word clarus, which means ‘clear’, as Culpeper reported that the mucilage (sticky substance) from the plant’s seeds was traditionally used to clear mucus from the eyes. Clary sage was also believed to be a popular remedy for night sweats when tuberculosis was widespread. Today, the plant’s essential oil is more likely to be used in aromatherapy for its antispasmodic and relaxing properties.

Basil, bergamot, cedarwood, cypress, frankincense, geranium, grapefruit, jasmine, juniper berry, lavender, lime, mandarin, orange, patchouli, rose, tangerine, sandalwood, ylang ylang.

Safety data Numerous texts stress that clary sage essential oil should not be used during pregnancy. Tiran (2018) writes that while it may be useful for midwives to incorporate it into a ‘post-dates pregnancy’ treatment, it should not be used before 37 weeks of labour, or during established labour. Tiran also provides a table outlining both obstetric and medical contraindications/precautions to the use of clary sage, including previous caesarean section, attempting to conceive, history of oestrogendependent tumours, being under the influence of alcohol and avoiding prolonged exposure. Under the ‘Safety summary’ for clary sage in Essential

Botanical family Lamiaceae

Chemical composition Esters – linalyl acetate (up to 74%), geranyl

Oil Safety, Tisserand and Young (2014) state

can vary greatly, according to the plant

that the essential oil has no known hazards or

species; climate, altitude and soil where the

contraindications, and that it is non-phototoxic.

plant is grown; and when it is harvested. Refer

NB: Safety concerns may be dependent on the

to the manufacturer’s safety data sheet for a

specific chemical profile of an essential oil, but

breakdown of an oil’s chemical profile.

aromatherapists would be urged to err on the side

acetate, neryl acetate

Body systems

of caution, particularly where there is a lack of

Alcohols – linalool, α-terpineol, sclareol

Digestive, circulation, endocrine, musculoskeletal,

evidence base/research into its effects.

Hydrocarbons – sesquiterpenes: caryophyllene,

nervous, reproductive, respiratory, skin.

Therapeutic properties

RESEARCH Diabetes mellitus

Anti-infectious, antifungal, antispasmodic,

A recent study (Raafat and Habib, 2018)

calming, decongestant, deodorant, emmenagogic,

investigated the phytochemical composition

germacrene. Monoterpenes: myrcene, pinene NB: The chemical composition of any essential oil

of Salvia sclarea essential oils collected in two

sedative, tonic.

different regions in Lebanon and explored their

Indications

acute and subchronic antidiabetic potentials.

Amenorrhoea, anxiety, asthma, circulatory

They concluded: ‘ Salvia sclarea essential oils have

problems (including varicose veins, haemorrhoids

shown potential antidiabetic activities, and […]

and cholesterol), convalescence, digestive

might be used in the future as a complementary

problems (especially stomach cramps, colic-like

or an alternative medicine in the management of

pains, flatulence), excessive sebum production,

diabetes and related complications.’

Sleep quality and quality of life A study in Taiwan compared the effectiveness of aromatherapy and acupressure massage intervention strategies on the sleep quality and quality of life (QOL) in 132 career women. The researchers found that a blend of essential oils (Lavandula angustifolia, Salvia sclarea and

Origanum majorana) ‘exhibited greater dual benefits on improving both QOL and sleep quality compared with the interventions of lavender essential oil and acupressure massage in

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career women’.

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REFERENCES For references and further reading, visit fht.org.uk/IT-references

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BEAUTY | Skincare

Touch

TYPE DR KATERINA STEVENTON DISCUSSES DIFFERENT APPROACHES TO FACIAL TOUCH AND THE SCIENCE BEHIND IT

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A

s a skin scientist and facialist, I am aware of the intimate relationship between the skin and the brain. When touching a person’s face, we enter a gateway into their world, including their self-esteem, thoughts and feelings, heart rate and breathing – vital signs of their physiology. In this article, I would like to inspire you to approach the face differently. I would like to help and encourage you to build an in-depth knowledge of the skin, muscles and bone structure, as well as empirically connect with the client’s feelings. My background is in studying clinical biochemistry of the skin – I have a PhD in transdermal absorption – but science is useful when applied in life. I run an independent skincare clinic and address skin concerns of clients from all walks of life, ranging from signs of ageing to mild acne.

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Skincare | BEAUTY

TYPES OF TOUCH Touch is approached differently across cultures. These different approaches include intensive muscle insertion lifting, backed with ancient Chinese techniques; medium pressure-based massage originating in central Europe; Sorensen’s facial reflexology (using Andean, Vietnamese, Chinese and Japanese therapies); and the light touch of manual lymph drainage, originating in Austria. Each requires a different type of touch and are consequently at their most effective when used as tools for specific results. The techniques have to be performed correctly as per an area of the face. How massage oil feels on the skin, according to skin types, and the mood of the client dictate the type of touch used to enhance efficacy and sensory aspects of wellbeing. Facial massage introduces single or multiple stresses to the different types of skin tissue, with different parameters: timing, frequency and specificity. The daily functionality of cleansing and moisturising with different application techniques reflect cultural paradigms. For example, Japanese or Korean skincare routines are different from European. However, regardless of the technique you choose, the sensory experience in the salon should be underpinned by understanding the biology of skin touch in detail. Advising clients on a daily routine at home, you should also acknowledge that daily touch builds connections impacting on relationships and self-esteem.

PICTURES: ISTOCK; SHUTTERSTOCK

THE FACE AS A CANVAS The professional market is booming with strategies to enhance facial appearance: skincare products, devices and minimally invasive procedures. Science has discovered more about the qualitative mapping of the skin in different facial zones, which is essential for better efficacy of these products and interventions. Targeting the signs of ageing that are most relevant in the face represents the first step; this can vary from one culture to another. In the Caucasian face, research in eye movement tracking suggests that judgement of the age and attractiveness of female faces is linked to fixations on the eye region – the forehead, undereye area and the lips. Even small changes affect perceptions among family and friends. The traditional approach to facial zones has been simple: differentiating the T-zone as an area with high sebum secretion and the U-zone as an area with low sebum

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“Massaging the whole face with medium pressure can support circulation, stimulate cellular turnover and provide a healthy glow to any complexion” in combination skin types. Continuous colour maps can visualise patterns of these parameters in the face; the first mapping of skin hydration and skin barrier function showed remarkable gradients in distinct facial zones. However, functional maps of other biophysical skin parameters (such as sebum content, skin blood flow, pH, temperature and bacterial flora) that examine distinct inter-regional differences are yet to be done. Paying attention to the skin around the eyes and lips is important. Eyelid skin is sensitive and different from other zones. It has a low level of skin surface lipids and a thin upper part of the epidermis, the stratum corneum, with high hydration but poor barrier function. The vermilion borders of the lips, covered by an exposed part of the oral mucosa, show remarkably poor barrier function and low hydration. The movement of the mouth and eye orbicular muscles is taxing, and targeted massage can address crow’s feet and lip lines that concern some clients.

Professional facial massage is one of the most pleasurable and intimate treatments. Touch can bring a wave of emotions, and understanding the different facial touch modalities helps the therapist determine which type to use; they need to understand what different movements bring to the body and have a clear rationale in specific protocols. For example, effleurage on the forehead can be calming, working on the parasympathetic system, while intensive friction in the glabella area will support blood flow and increase product penetration. Massaging the whole face with medium pressure can support circulation, stimulate cellular turnover and provide a healthy glow to any complexion. Stroking the face gently, working on C-tactile fibres, initiates a rewarding response in the brain, releasing neurotransmitters: the loving and bonding hormone, oxytocin, and rewarding hormone, dopamine. Most facial protocols ask the therapist to perform a European, medium-pressure massage, and the evidence behind the clinical outcomes is as follows: ⦁ On the epidermal level, medium-pressure massage will encourage corneocyte shedding, increase epidermal proliferation (generating new cells) and potentially increase skin thickness. ⦁ Dermal tissue benefits from increased blood flow and tensional forces induced by deeper mechanical stimulation, where dermal fibroblasts produce more collagen. Dermatologists have often recommended rubbing when applying topical treatments, and research shows that this increases the penetration of active ingredients and their retention in the skin. As mentioned above,

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BEAUTY | Skincare

this would benefit the frown line but would be best avoided on the vertical marionette line areas because of the sensitivity of the zone.

THE SKIN AND BRAIN There is a strong relationship between the skin and the brain; they have the same origin in the embryo. As the largest sensory organ, the skin acts as our protective barrier between our internal beings and external environment. The skin is also a visible emotional envelope that reflects our feelings but can also sense external information in the same way that the brain does – it can assess the strength of sounds, colours and light. A therapist’s touch can be powerful in modulating emotion and can play a role in nurturing and social communication. Pleasant touch can increase quality of life, and decrease stress in pre-operative situations in medical settings. Facial massage can help with relaxation, in turn reducing anxiety and insomnia. Its impact on the brain can be shown by functional magnetic resonance imaging (fMRI) or electroencephalography (EEG). My project with Hull York Medical School, using gentle facial massage as a tool to aid relaxation showed that alpha brainwave activity, associated with relaxed mental states, increased through a cumulative self-massage application. Signature treatments of many professional brands around the world revolve around facial massage focusing on four skin types: dry, oily, combination and normal. Research shows that the subjective assessment of oiliness doesn’t correlate with objective sebum measurement. Sebum is detrimental to the skin barrier. Although oily skin is considered to be more resilient, it is challenged by its own sebum and should not be massaged extensively with deep techniques. French Jacquet massage works best for oily skin that is not prone to acne. This involves stimulating the skin by pinching to increase the blood flow, regulate sebum and optimise absorption of skincare products. This is particularly relevant for Asian skin, regardless of where the client lives. All human senses are integrated, and the first appreciation of touch is very important. Touch is much more emotionally coloured and subjective than other senses and a client’s state of mind should always be

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“A therapist’s touch can be powerful in modulating emotion and can play a role in nurturing and social communication” considered. It is gentle touch in particular that makes people feel good, altering emotional state and bringing about calm. It is essential that the massage technique chosen by a therapist respects skin barrier integrity.

BRINGING IT ALL TOGETHER IN YOUR TREATMENTS A key element in advancing one’s professional development is to keep up with new research and newly launched skincare products. Beauty therapists aspire to provide the best service to benefit their clients, and personalised routines are becoming increasingly popular. Having gone through their initial training and worked with professional skincare brands for a few years, some beauty therapists might feel that they have nowhere else to go, in terms of further education, to understand the science of touch in different cultures and innovative emerging trends. Niche skincare brands often provide new trends in the market – Japanese and Korean skincare have been a source of inspiration, and blue-chip companies provide depth of skincare research, but it is the role of the

therapist to integrate these into hands-on treatment protocols and translate them via touch to the client. Understanding active ingredients in detail – from the pharmaceutical brands to prestige skincare and niche natural brands – is a prerequisite, and thinking independently about the types of touch, skin type and ethnicity can personalise the treatment and make a difference to the therapist’s credibility and clinical results. When building connections with their clients, they need to listen to client feedback on how the skin feels, and adjust techniques accordingly by understanding what is often intangible and not fully expressed: their clients’ needs and expectations. Anti-ageing touch-based therapies are in vogue, yet a number of people suffer from difficult-to-treat skin types, both dry and oily, and prone to periodical inflammation in specific areas. Skin conditions not serious enough to warrant medication – such as adult acne, dermatitis and rosacea – are on the rise, as well as concerns about uneven skin tone, including increased redness, a dull, ashy appearance, milia or pigmentation. In order to deliver a good result when massaging the face, the therapist needs to first achieve a detailed understanding of skin type and concerns, and to optimise the effectiveness of the treatment and products. Consultations should be holistic and take into consideration clients’ health and lifestyle. Adding a specialist scar treatment course (ScarWork for example) for facial scars to your therapy portfolio may also provide a more rounded and comprehensive treatment package.

Dr Katerina Steventon combines clinical expertise and science at her private therapy practice in East Yorkshire. She provides training in advanced facial techniques, and has developed two unique anti-ageing serums (2017 and 2018 Pure Beauty Awards finalists), with targeted massage techniques for salon and retail. katerinasteventon.com

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Advertorial

Ever considered becoming a chiropractor? The route may be easier than you think! If, like me, you are a therapist working in the complementary/integrative field of health, you may have thought of upskilling, only to discover the road is a long university based programme requiring a huge commitment and probably having to move home to be near one of the four chiropractic education providers in the UK, or even go overseas. Back in the 1980s and working as cabin crew for the ‘worlds’ favourite airline’, I became fascinated with holistic medicine due to the fantastic results I had experienced. This started me down a new path and within a two year period had gained qualifications in massage, aromatherapy and systematic kinesiology. By this time, I had reduced my working hours as cabin crew and was able to balance working in a complementary therapy practice 3 days per week. I loved this work balance and of course being able to help people feel better was just the best possible reward. What I found though was that there were cases that didn’t respond and didn’t get better. I simply didn’t have the training to deal with these cases. I was lucky, we had a chiropractor at the same practice and I would often refer to him to assess and treat patients that were beyond my knowledge and skillset. I witnessed repeated remarkable results. I often felt frustrated that my knowledge was limited but I never even considered becoming a chiropractor until he suggested that I apply. My immediate response was ‘I don’t have the time and I live 180 miles from the nearest chiropractic college!’ ‘I also have a family, dogs, a horse, a house with a mortgage to pay and I cannot possibly give up work!’ I had never even looked into it because I never considered it a possibility. Then everything changed - I was presented

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with a prospectus for the McTimoney College of Chiropractic and my life changed overnight! Within a few months I had applied, attended an interview and enrolled on the January intake! You see, the McTimoney College of Chiropractic offered a programme that allowed me to continue to work whilst training. They deliver classes at weekends and through summer schools which is specifically designed for adult learners. It meant that I could manage my study workload and family commitments, keep earning, look after my family and did not need to move home. It was hard work juggling everything, but I loved every minute and the time literally flew by. I can honestly say that I have never looked back and have worked as a chiropractor for many years now, while still using my complementary therapy skills alongside chiropractic. The opportunities and options open to you as a chiropractor are truly fantastic. Many chiropractors go on to specialise in different areas such as paediatrics, pregnancy, sport or even animal chiropractic! There is an abundance of Postgraduate training available to help you develop your knowledge and skills further. If you have an interest in natural and holistic health care, a career as a chiropractor could be right for you! Bernadette Martin, Chiropractor Contact the McTimoney College of Chiropractic for more information and mention this advertorial to receive a £500 scholarship. W: www.mctimoney-college.ac.uk E: admissions@mctimoney-college.ac.uk T: 01235 468575

14:16 03/10/2018 12:42


HUMAN PERFORMANCE | Challenge

DR PHILLIP J DE PREZ DECONSTRUCTS THE CONCEPT OF CHALLENGE

Challenge CONQUERED C

hallenge is something we are immersed in from an early age, but its nature and context is only implicit. We are given no formal explanation of challenge as a concept. Is it an innate drive to strive, to succeed and expand our experience? The word ‘challenge’ has immense power and emotion behind it and is used by most people, in almost a generic way, to describe many different aspects and events in our lives. Yet how many of us have considered what it really means to us and why it is important? If we can understand challenge fully, we can harness its power by setting and

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achieving our goals, enhancing our lives and pushing ourselves to heights we never thought possible. Being challenged can be highly motivational and educational. The absence of challenge can lead to boredom and wasted potential. While challenges are complex, with innumerable and very different goals, the process of taking on and achieving them is universal. When you talk to people about their challenges, you can sense the passion in their eyes. A colleague once said to me: ‘It is the burning desire and passion that doesn’t go away.’

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As a human performance coach, I have spent many hours talking to people about what challenge means to them. The idea was to move away from the generic social understanding of challenge and towards encouraging people to deconstruct the concept from their own experiences and understanding. This led to the identification of common themes and the creation of a new model of challenge. By understanding the various components that make up a challenge, and using each stage as a guide, we can successfully reach our goal and learn something new about ourselves as we develop new skills and try new experiences. I found that challenge was not a single concept but made up of four main areas. The easiest way to think of these areas is that they are similar to the links in a chain, with each link representing one of the four areas: time, emotion, achievement and motivation. A strong chain of links facilitates the conquering of challenges, whereas an incomplete chain can lead to failure.

completed successfully in the timeframe, the decision might be to lose another 5lbs in another two months, thus creating a new challenge and timeframe.

CHALLENGE AND EMOTIONS There are many different emotions connected with challenge. Initially, some people can be apprehensive about challenges, but the general consensus is that the greater the challenge, the greater the feeling of elation and happiness at completing it. One of the reasons for this may be that a new challenge usually requires the learning of new skills or information in order to complete it, but it is this pushing of personal boundaries that makes it worthwhile. One of the most important parts of emotions and challenge is the ‘Who are you doing it for?’ part. For some individuals it is about proving their capabilities to themselves, it is about self-belief and pushing boundaries. For others, however, it is about proving their abilities to the people around them. In a work situation, this could be showing you are a capable employee suitable for promotion or, in a personal situation, proving to someone who has always put you down or said you will never amount to anything that you are capable of achieving great things and surpassing their low expectations of you. Ensure the challenge excites and engages you. A challenge should be about passion and excitement; if it is boring, it is not a challenge but just another task, chore or job.

CHALLENGE AND ACHIEVEMENT

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CHALLENGE AND TIME Challenges invariably have a time element associated with them – a beginning, middle and end – but the time associated may vary from challenge to challenge. It could be short term (you need to complete a work task by the end of the week), medium term (you are furthering your education on a professional course) or long term (you are dealing with a mental or physical health issue that may be with you throughout your lifetime). This timeframe for challenges can take the form of lists of desires and dreams, to be completed by a given time. These could be work-related, such as ‘By the time I am 40, I want to run my own therapy business’, or personal, such as ‘By the time I am 30, I want to be married and settled down.’ A major challenge may be made up of several smaller challenges over time. If we take the example of losing weight, the challenge may be to lose 7lbs in two months. However, once this challenge is

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The ultimate outcome of taking on a challenge is to complete it successfully. This achievement is unique to an individual; it may be climbing Everest or taking a few steps after not being able to move through pain. If something was easy to complete, individuals may not feel that something of value had been accomplished, yet everyone who I have spoken to about challenge has said the challenge they take on has to be ‘doable’. By that they mean they recognise it may be difficult and push their skills and abilities, but they must still have the opportunity to meet that challenge successfully. This is the most important part about setting challenges; do not set yourself up to fail from the beginning. There is a very fine line between being close to the edge of your abilities, and going beyond them. Achievement is about pushing yourself but recognising when you may need to enlist the help of others, whether that be for advice and guidance, training or professional services.

CHALLENGE AND MOTIVATION Without motivation, the challenge will not be completed. Levels of motivation will change in relation to the challenge; initially, it may be very high, but dip slightly when the challenge becomes harder. As long as some motivation is kept, the challenge is usually met successfully. Individuals tend to focus on two key types of motivation when taking on a challenge: intrinsic or extrinsic. Intrinsic motivation stems from inside the person and is arguably the strongest motivator. It is driven by personal desires such as wanting to learn new skills or becoming more adept at what we do already, and is seen as an opportunity to push ourselves to new heights. Extrinsic motivation refers to rewards such as money, prizes and acknowledgment by others. People tend to be more motivated if they are in control of the challenge from the planning stage and able to set the goal of the challenge themselves. This is because it allows them a personal ‘buy-in’ to the challenge and to set their own strategies to complete it, rather than have strategies imposed on them. Challenge is hard, and can be frustrating and stressful, but there is little to beat that feeling of happiness, pride and accomplishment of taking on a challenge and achieving it.

Dr Phillip J de Prez is a human performance coach, FHT accredited course provider and highly experienced academic. He coaches individuals, teams and organisations to help them through all stages of a challenge, from initial goal setting to successful completion. challengeconquered.com

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08/10/2018 12:25


SPORT | Youth injuries

Growing

PAINS SARAH CATLOW, MFHT, AND LANCE DOGGART, MFHT, DISCUSS INJURIES IN YOUNG ATHLETES

H

ealthcare providers in the UK are faced with a parallel epidemic: the prevalence of youth sport injuries and of childhood obesity. Nearly a third of children between the ages of two and 15 are classed as overweight or obese. And children are becoming obese at an earlier age and staying obese for longer (Health Survey for England, 2015). Recent studies have shown that children are not as active as they should be and that physical activity declines as children age (Cleland et al, 2011). It must be a priority for practitioners, the government and researchers to promote athletic activities among children, noting that athletic activity is wide-ranging. Participation in sport, exercise, competitive activity and their subsequent

early specialisation, combined with a lack of physical preparedness and/or lack of free play, predisposes young children to sports injuries that may have long-term negative physical effects. The early drive and intensity of youth sports not only sacrifices fun but can also produce overuse injuries (patellofemoral knee pain, stress fractures, and juvenile osteochondritis dissecans). In addition, the increased competitive element can also expose children to more serious sports-related injuries such as concussions, physeal injuries, and anterior cruciate ligament tears. This article provides an overview of the potential types of injuries that a therapist may come across specific to young athletes. It also provides some basic guidance on how to interact with young athletes

when describing and identifying pain related to injuries, as well as potential treatment methods.

CLASSIFYING INJURIES When classifying injuries in younger athletes, it is simpler to group them into acute and overuse categories, similar to adult athletes. In both categories it is important to assess children for strength, balance and proprioceptive deficiencies. It is also extremely important to identify and therefore establish training patterns in the overuse group. Relevant questions in identifying potential overuse injuries could include: ⦁ Volume and type of training ⦁ Sports-specific strength and flexibility work ⦁ Recovery times and routines. Child and adolescent athletes differ from adults not only in terms of tendon strength and epiphyseal closure but also in the demands they put on their body. In the child and adolescent athlete, the injury incidence is predicted less by age and more by the chosen sport (McGuine, 2006).

ACUTE INJURIES Many of the injuries sustained by young athletes are very similar to those sustained by adults; however, there is a difference specific to ligament strength. In children and adolescents, ligaments and tendons can withstand more force than bones, but the growth plates at the apophyses are more prone to trauma, especially to avulsion. Bony tissue has an excellent blood supply and healing response, so a small, nondisplaced avulsion will often heal well with conservative treatment, which is often the same as treatment for a soft tissue injury.

OVERUSE INJURIES Overuse injuries are more common, and develop when repeated mechanical loading

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Youth injuries | SPORT

exceeds the remodelling capability of the structure under stress. This is one of the most common causal factors leading to injuries in young and adolescent athletes. As more children become involved in organised and recreational athletics, the incidence of overuse injuries is increasing (Brenner, 2007). Up to 50% of all injuries seen in paediatric sports medicine are related to overuse (Smucny et al, 2015). Identifying young children at risk of overuse injuries is the first step to prevention. Therefore, guidelines for parents, coaches and athletes need to be developed to provide opportunities for education, injury reduction and early recognition of overuse injury risk factors (Brenner, 2007).

A common overuse injury is patellofemoral pain syndrome. This can be linked to anatomical variations, but it is far more commonly seen as a result of poor foot biomechanics, poor medial quadriceps function, tight lateral thigh structures and inadequate gluteal activation in single leg stance. Treatment involves addressing all inadequacies in order to offload the knee extensor mechanism. Careful questioning and examination by the therapist will often help differentiate Osgood-Schlatter disease, Sinding-Larsen-Johansson syndrome (SLJ), patellar tendon pain, synovial plica pain and intra-articular derangements, such as osteochondral defects. The key difference between Osgood-Schlatter disease and SLJ is that the former affects the knee at the point

where the patella tendon inserts into tibial tuberosity, rather than at the bottom of the patella in the case of the latter. Tendinopathy is more common in adults; however, its incidence increases with age during adolescence. Younger children and adolescents are also far more likely to experience pain related to the tendon insertion compared to adults. Tendon insertion sites are exposed to a greater relative increase in stress during the adolescent growth spurt because of biomechanical factors related to long bone growth and limb movement (DiFiori, 2010). Examples are calcaneal apophysitis (Sever’s disease) and Osgood-Schlatter disease. In general, growth plate and bony injuries relate to weightbearing load (McGuine, 2006).

SUMMARY OF OVERUSE INJURIES RECORDED IN YOUNG ATHLETES INJURY

ANATOMY

SYMPTOMS

TREATMENT

Distal radial epiphysis Injury

A distal radial epiphysis injury is an injury to the growth plate at the wrist end of the radius bone in the forearm.

Symptoms include pain in the wrist, especially when the wrist is bent backward with the palm facing down. There may be tenderness and swelling around the end of the bone.

Treatment involves rest and managing the condition by changing the training programme to reduce the load on the bones.

Commonly affects young athletes between the ages of six and 10 years old, particularly gymnasts, and can come on through overuse, although fractures following a fall onto an outstretched arm can also occur.

Strengthening the forearm muscles with specific wrist and hand exercises should be done. A distal radial epiphysis injury can take months to recover from and should not be rushed.

Heel pain and Sever’s disease This injury can first appear in children aged seven to eight years. Sever’s disease normally goes away when the growth plate matures around the age of 12 to 13 in females and 13 to 14 in males.

Knee pain and OsgoodSchlatter disease This injury is common with athletes with repetitive stress on the growth plate below the knee.

Calcaneal apophysis is a growth centre where the Achilles tendon and the plantar fascia attaches to the heel.

Normally seen in children who participate in running or jumping sports. A typical symptom is heel pain that develops slowly and occurs with activity.

The young athlete should rest and modify activity to reduce inflammation, work on calf flexibility and protect the heel – change to shoes with good arch support and heel lifts.

Children have growth plates called apophyses where muscle and tendons attach. The growth plate is subject to stress from overuse when the quadriceps muscles repetitively pull.

The main symptom is pain on the tibia tuberosity after activity or a fall. The athlete experiences tenderness to touch and sometimes swelling on the tibia tuberosity.

Decrease stress at the tendon attachment (kinesiology tape, patella tendon strap) and ice the injured site for at least 20 minutes after activity.

Forceful contraction of the quadriceps can also cause pain. This may occur in one or both knees.

It is normally seen in active teens (during a growth spurt).

Perthes’ disease

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This injury affects children, most commonly aged between four and eight years old. The condition is sometimes also called Legg-Calvé-Perthes disease.

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This affects the hip joint, where the top of the femur meets the socket of the pelvis or acetabulum. The blood supply to the head of the femur is disrupted, resulting in necrosis. Once the blood supply returns to normal, the bone tissue is laid down and the femoral head reforms and hardens. This will occur over a period of one to three years.

In severe cases, athletes can rest or reduce sporting activity. Stretching the hamstring and quadriceps muscle group is recommended.

Symptoms include tiredness and pain in the groin and sometimes in the knee.

This should be referred to a doctor, where x-rays or MRIs might take place.

The child may have stiffness and reduced range of motion at the hip joint and may walk with a limp. The affected leg may appear shorter than the other leg.

Conservative treatment is aimed at maintaining hip mobility and promoting healing in the correct position.

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05/10/2018 11:34


SPORT | Youth injuries

INJURY

ANATOMY

SYMPTOMS

TREATMENT

Sinding-LarsenJohansson syndrome

Repetitive stress on the patellar tendon can cause the growth plate to become irritated and inflamed.

Symptoms include pain at the front of the knee, near the bottom of the kneecap; swelling and tenderness around the kneecap; pain that increases with activities such as running, climbing stairs or jumping; pain that becomes more severe when kneeling or squatting; and a swollen or bony bump at the bottom of the kneecap.

Ice the site of injury. Stretching of the hamstring and quadriceps muscle group is recommended.

The resulting pain is caused by the fracture of the pars interarticularis, or pedicle, in the final lumbar vertebrae.

Spondylolysis involves specific low back pain, often accompanied by pain that spreads to the buttocks and thighs, and a spasm of the muscles along the spine. This condition is often the result of a direct injury from a sport, but can also be the result of repetitive rotation and extension movements.

The child athlete should get sufficient rest, and refrain from sport and movements such as rotation and hyperextension until the pain has cleared.

The synovial plica is a synovial fold found along the inside border of the kneecap.

The main symptom is sharp pain at the front inside-edge of the kneecap. The pain may also be towards the back of the patella. The athlete may feel a sharp pain when squatting. A synovial plica may sometimes feel like a thickened band under the inside of the kneecap.

Activity modification required – reduce high-impact activities such as jumping, squatting or lunging, strengthen the vastus medialis oblique muscle and work on core strength.

This is a painful knee condition that most commonly affects children between the ages of 10 and 15 years old during periods of rapid growth. This is also called a paediatric jumper’s knee.

Spondylolysis This is a relatively common cause of back pain in sporty children.

Synovial plica pain This is sometimes confused or misdiagnosed as patellofemoral pain syndrome as the symptoms can be similar.

CLINICAL QUESTIONING Assessing a child or young adult requires different clinical questioning skills to an adult, especially when the practitioner asks the child to explain how the pain ‘feels’ or how ‘bad’ it is: that is, its quantification. Try these basic child-friendly skills: 1. Speak calmly and gently. 2. Get down on their eye level. 3. Use the child’s name. 4. Ask the parent or guardian to be in the room with you. Pain and pain perception linked to injury in children is complex and often difficult to assess. This has led to the creation of numerous age-specific pain management tools and scores. Below are examples of some scales that could be used:

Age <4 years

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Consider using an observational scale: face, legs, activity, cry, consolability scale (FLACC). This measurement scale is used to assess pain for children between the ages of two months and seven years or individuals that are unable to communicate their pain. The scale is scored in a range of 0–10 with 0 representing no pain. The scale has five criteria, which are each assigned a score of 0, 1 or 2.

Age 4-12 years

Consider using a self-reported scale such as a Faces Pain Scale. Wong-Baker Faces, for example, shows a series of faces ranging from a happy face at 0, which represents ‘no hurt’ to a crying face at 10 which represents ‘hurts worst’. Based on the faces and descriptions, the patient chooses the face that best describes their level of pain.

Age >12 years

Consider using a self-report scale such as the Numerical Rating Scale.

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REHABILITATION FOR YOUNG ATHLETES Rehabilitation programmes must be designed to be fun and interactive for young athletes, and the following aspects should be considered: ⦁ Child’s physical and skeletal maturity, skill level and performance goals. ⦁ Educate the child and parent/guardian with the knowledge/skill to avoid reinjury. ⦁ Increase physical performance through improving flexibility, range of motion, strength, coordination and endurance.

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Youth injuries | SPORT

“Injuries sustained by children while participating in sport 6 differ widely from those presented by adults… 7 it is paramount for an accurate diagnosis to be complemented with a specific management plan”

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Make the rehabilitation programme fun for the young athlete to increase adherence. For example, incorporate a play element (for example, aquatic therapy). If the athlete complains of non-specific muscle or joint problems, fatigue or poor academic performance, advise them to rest or seek appropriate medical referral. Encourage the development of educational opportunities for athletes, parents, and coaches to provide information about appropriate nutrition and fluids, sport safety, and the avoidance of overtraining to achieve optimal performance and good health.

Additional general rehabilitation guidance when treating young athletes includes: Encourage athletes to have at least one to two days off a week from competitive athletics, sport-specific training and practice to allow them to recover both physically and psychologically. Encourage the athlete to take at least two to three months away from a specific sport during the year. Emphasise that the focus of sports participation should be on fun, skill acquisition, safety and sportsmanship. Work on the strengthening and flexibility of muscle groups – for example, the quadriceps and hamstrings with lower limb injuries.

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Injuries sustained by children while participating in sport differ widely from those presented by adults. As with any injury, it is paramount for an accurate diagnosis to be complemented with a specific management plan, which ensures that time out of activity is appropriate and allows for recovery to be achieved efficiently. This is even more important in young athletes, given the growth and maturation difficulties associated with physiological and physical developments. In addition to the factors noted above, clear knowledge of the specific demands of each sport and the biomechanics of injury can also help to create an appropriate return-to-sport plan and rehabilitation programme to address other risk factors and prevent recurrent or further injury in the young athlete.

CONCLUSION Injury in any sport or exercise activity is debilitating and can have far-reaching physical, physiological and mental

consequences. This can be more pronounced, and more specific, in young athletes. As such, practitioners should be aware of the importance of their skills in ensuring that full functional movement is restored. Given the obesity data on children, it is encouraging to note that, in some instances, children are being widely encouraged to participate in exerciserelated activity, and the government is providing various opportunities. However those opportunities need to be managed and supervised accordingly, noting the physical growth and maturation factors associated with young developing athletes. Practitioners are often only consulted when injury has occurred; however, their skills and expertise in getting young athletes back to pain-free and full functional movement is invaluable, with lifelong results.

Sarah Catlow, MFHT, MSc, is programme leader of sports therapy and rehabilitation in sport and exercise at the University of St Mark & St John. Sarah holds qualifications in manual therapy, acupuncture, kinesiology tape (Rockdoc certified) and pitchside first aid. Lance Doggart, MFHT, PhD, is head of the department of sport at the University of St Mark & St John and programme leader of MRes sport and health sciences. Lance is a fellow of the British Association of Sport and Exercise Sciences.

REFERENCES For references and further reading, visit fht.org.uk/IT-references

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05/10/2018 11:35


COMPLEMENTARY | Reiki

HILDA KALAP, MFHT, TALKS ABOUT HER WORK IN A HOSPICE AS A PAID REIKI PRACTITIONER

Hospice

HEALING I

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PICTURES: ELSA TAIT

am a Devon-based complementary therapist and have been practising reiki for almost 10 years. Earlier this year, I was fortunate enough to begin working in my current role as a paid complementary therapist in a hospice. My work began on an initial one-year contract, providing reiki to cancer patients at Rowcroft Hospice in Torquay, Devon. I work at the hospice for seven and a half hours each week, spread over two days, and receive funding from the Sam Buxton Sunflower Healing Trust. I spend the remainder of the week running my own complementary healthcare practice. Last year, more than 2,000 people with life-limiting illnesses across south Devon were given the medical expertise they needed at the hospice. It was all provided free of charge, thanks in the main to fundraising efforts, donations and legacies. The in-patient unit, a beautiful building that dates back to the early part of the last century, is located in extensive gardens and woodland, full of splendid pine trees and flowers. This helps to create a calm and therapeutic setting. I found out about the possibility of being funded to work as a reiki practitioner in the hospice through one of my friends, who has been doing this work for the past two years, funded by the same charitable trust. I contacted Angie Buxton-King, founder of the Sam Buxton Sunflower Healing Trust, and soon embarked on the first step of the process: completing the trust’s ‘Healing in Hospitals and Hospices’ training. Available both face-to-face and online, the training gives complementary therapists the skills they need to work safely and competently in hospitals and hospices. The modules

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Reiki | COMPLEMENTARY

Hildda Kalap (left) and

Julie Milton

cover topics such as infection control, basic anatomy and physiology, and how to explain what reiki is to patients. Angie was one of the first spiritual healers in the country to be employed in a paid capacity by the NHS, working for University College London Hospital between 1999 and 2011. Her son, Sam, died from leukaemia at the age of 10 in 1998 and the charitable trust is named after him. Angie saw the quality of life Sam experienced after his diagnosis by receiving both the best of conventional medicine in the treatment of his cancer and regular healing from Angie. Sam lived for three years after his initial diagnosis, during which time many of the side effects suffered by others from regular chemotherapy, such as nausea, did not seem to affect him to the same degree. Angie has chronicled her experiences in two books, The NHS Healer and The NHS Healer: Onwards and Upwards. Since the Sam Buxton Sunflower Healing Trust was established in 2006, it has provided funds to employ 33

“I’ve gained valuable insight into the processes of conventional healthcare, and I am learning a great deal about some of the medical terminology that is used” FHT.ORG.UK

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reiki practitioners within cancer units and hospices. After completing and passing the trust’s course, practitioners are provided with a template for a proposal with which to approach hospitals and hospices. This outlines how their reiki and/or spiritual healing skills and training positions them to work effectively within an integrated healthcare multidisciplinary team. It also sets out that there is funding available for up to 14 hours per week from the charitable trust. I sent a proposal to one hospital and one hospice in my local area. I heard back from Rowcroft soon afterwards and organised a meeting with Julie Milton, FFHT, the complementary therapy coordinator at the hospice. We clicked, and the next step was for Angie to meet with Julie to discuss potential funding. I was successful, and Angie has since commented that getting me in this post was the fastest project that the trust has ever funded. From sending off the proposal to starting my role took just over two months. I see patients in a 12-bed inpatient unit, outpatient centre and in their own homes. I work with at least six patients a week and write quarterly evaluations for the trust as part of my role. I joined a long-established complementary therapy team with both paid and volunteer therapists, including aromatherapists, reflexologists, massage therapists, Bowen technique practitioners and others, giving patients a palette of healthcare choice. The work is highly rewarding, and the feedback I am receiving demonstrates that what I am doing is making a positive difference. One outpatient was offered a course of six reiki sessions in her home. She commented on the benefits she experienced: ⦁ ‘Total relaxation’ ⦁ ‘It helps me to bond better with my children as it helps me to relax. So, they want to be with me’ ⦁ ‘Reiki enabled me to walk a bit on my lefthand side where I have lymphoedema.’ Other patients have told me that they have had their best night’s sleep in weeks after a reiki session, and that the pain they are experiencing has reduced.

For those not familiar with reiki, it is a method of working with energy, where the practitioner gently places their hands in a series of positions on or just above the body. The whole person, including the body, emotions and mind are treated, and benefits include relaxation, reduced anxiety and feelings of peace. I am fully recognised as a member of the multidisciplinary team that works at Rowcroft, and write patient notes on the same IT system as the rest of the team of doctors, nurses, occupational therapists, physiotherapists and social workers. I also attend multidisciplinary team meetings and work with the medical team on the wards. I’ve gained valuable insight into the processes of conventional healthcare, and I am learning a great deal about some of the medical terminology that is used. I feel a mutual respect between us, and that is uplifting. In May, I gave a presentation on ‘What reiki is’ to Rowcroft’s multidisciplinary community team, so they could get a better understanding of what I do and could ask any questions. It is exciting to see this model of healthcare in action and I hope that it can be replicated in any healthcare setting in the UK, especially for cancer patients. The Sam Buxton Sunflower Healing Trust’s aim is to do just that. Angie says: ‘It’s harder to create funds in 2018 than it was in 2006. However, I have found that if I can “draw a picture” when applying to funding organisations of where and how the practitioner will work, and describe the very focused area of benefit that their donation will provide, then they are happy to donate funds. If you can help with raising funds for future practitioners to do this vital work, I would love your help.’

Hilda Kalap, MFHT, is a complementary health practitioner, teacher and writer based in south Devon. She set up her health practice, The Healing Space, in 2015. Last year Hilda published Donna and Dermot on the Move, a picture book on mindfulness. thehealingspace.global

MORE ONLINE For further information about Rowcroft Hospice, go to rowcrofthospice.org.uk To find out more about the Sam Buxton Sunflower Healing Trust, visit cancertherapies.org.uk

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WHAT’S NEW

From left: Jennifer Young, Dr Michael Dixon, Nicolle Mitchell and Carol Samuel

FHT conference speakers and other experts interviewed on UK Health Radio As the headline sponsor of Chamberlain Dunn’s Complementary Therapy Awards, the FHT was invited to put forward industry experts to promote the health benefits of complementary therapy on UK Health Radio (ukhealthradio.com). FHT accredited course provider Jennifer Young was interviewed by Robin Daly on his ‘Yes to Life’ show. Founder of Beauty Despite Cancer, Jennifer talked to Robin about developing a range of natural skincare products for people affected by cancer, and setting up an appearance and wellbeing clinic in a major London hospital. As part of the same show, Robin also talked to Dr Michael Dixon, GP and chair of the College of Medicine, who is a strong advocate of preventative medicine, healthy living and integrated healthcare. Dr Dixon tells Robin in the interview: ‘In the future, as we start to expand our view of what local health involves and who needs to be included in that, I think complementary medicine will become a major influence – not only in terms of individual treatment, but also in terms of improving local health within our communities.’ We’re delighted that Jennifer and Dr Dixon will also be speaking

at our FHT conference this November. Find out more on page 34. In addition, FHT member and accredited course provider Nicolle Mitchell talked to Duncan Ellison about how massage and positive touch can benefit those affected by dementia on his radio show, ‘The Therapy Suite’. Nicolle received an FHT Excellence Award in 2012 for developing a specialist course that enables massage therapists, healthcare professionals and carers to connect confidently with people living with dementia through meaningful touch. FHT Excellence Award winner in 2014, Dr Carol Samuel, FFHT, was also interviewed, talking to Dr Vijay Murthy about the potential role of reflexology in pain management on his ‘Unlock Your Health’ radio show. As part of her PhD, Carol researched the effects of reflexology on pain. The results of her study, published in Complementary Therapies in Clinical Practice, indicated that reflexology increased acute pain threshold and tolerance. To listen to the interviews go to fht.org.uk/blog and enter ‘UK Health Radio’ in the search box.

FHT in the press

The FHT regularly cont contributes to national consumer publications to make the public more aware of our members, the different therapies they offer, and the FHT’s Accredited Register, independently approved by the Professional Standards Authority for Health and Social Care – the largest independently accredited register for complementary healthcare therapists. Recent contributions include:

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• In the Moment magazine – FHT editor and communications manager Karen Young recently provided a full-page article on ayurvedic massage for the regular ‘Have you tried’ feature. • Health & Wellbeing magazine – FHT Vice President Mary Dalgleish also promoted therapies in print recently, with an article on acupressure.

• Natural Health magazine – In dditi M t ib t d tto an article ti l addition, Mary contributed on ‘How to feel less tired’, offering dietary tips such as drinking plenty of water, cutting down on caffeine and avoiding large, heavy meals. Look out for updates on the FHT blog and our social media channels, or see an advertising schedule at fht.org.uk/consumer-campaigns

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International Therapist shortlisted for excellence award We’re thrilled that International Therapist has been shortlisted for the Best Association Magazine category of the Association Excellence Awards 2018. The awards, organised by GCN Events, aim to ‘recognise and reward the hard-won achievements of UK trade bodies, professional membership organisations and associations and highlight excellence in how these operate and serve their members’. Karen Young, FHT’s editor and communications manager, said: ‘We’re all incredibly excited that International Therapist has been listed as a finalist in these prestigious awards. ‘It’s a real testament to everyone involved in producing the magazine – not least our members, whose contributions and feedback help us to shape International Therapist, ensuring it remains topical and one of the most highly respected publications for professional therapists.’ The category winner will be announced just as this issue goes to print, so fingers crossed!

Top blog The FHT blog brings you the latest therapy news, health information and business resources. Here are some top posts that readers have enjoyed in recent months:

NHS TO REMOVE PATIENT ACCESS TO 17 ‘UNNECESSARY PROCEDURES’

FHT ANNOUNCES 2018 EXCELLENCE AWARDS FINALISTS We were delighted to announce the fi nalists for our prestigious 2018 FHT Excellence Awards.

REFLEXOLOGY IS THE MOST POPULAR COMPLEMENTARY THERAPY, SURVEY FINDS

NHS England has proposed stopping the funding of 17 procedures that are considered unnecessary to save money within the health service.

CHILDREN AT RISK FROM BLACK HENNA TEMPORARY TATTOOS A recent British Skin Foundation survey has found that 20% of children could be in danger of having serious reactions to black henna temporary tattoos.

FHT MEMBER INTERVIEWED FOR THE DUNGANNON HERALD

FHT member Jackie Grimley has recently been featured in the Dungannon Herald as the subject of ‘The Big Interview’.

SUN SAFETY MESSAGE SINKS IN There is a growing trend of using highfactor sunscreen both in the UK and abroad, according to a recent survey published by the British Skin Foundation.

A survey conducted by the FHT has found that refl exology is the most popular complementary therapy demanded by clients, with body massage in second and aromatherapy third.

STRESS IN INFANCY AND ITS LINK TO DISEASE

Scientists have found evidence to suggest that emotional stress in infancy can have signifi cant and far-reaching effects on the body, resulting in disease later in life.

To read more, visit fht.org.uk/blog and enter a title in the search box.

PICTURES: ISTOCK

New leaflet highlights potential of Accredited Registers workforce FHT members can now download a leaflet that outlines the key findings of a special report published by the Professional Standards Authority and Royal Society for Public Health in November 2017, called ‘Untapped Resources: Accredited Registers in the Wider Workforce’. Among other things, the leaflet highlights that: • The public health challenges the UK faces are deeprooted and severe • Improving our nation’s public health is critical to reduce reliance on welfare and healthcare

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• The Accredited Registers (AR) workforce of 85,000 professionals – which includes more than 10,000 FHT h. members – is well placed to help promote public health. It also underlines that approximately one in four of the UK population access the services of an AR practitioner at some point. Download the Untapped Resources leaflet at fht.org.uk/IT-126-untapped-leaflet

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THURSDAY 29 NOVEMBER, 9AM - 6PM | THE KING’S FUND, LONDON

Learn how you can be a part of the future of healthcare Our 2018 Conference is a special one-day event focusing on the ways therapists can help support both the public and medical workforce and play an important role in the integrated healthcare agenda. Featuring talks by experts in research, education and integrated healthcare, it’s your opportunity to learn how you can be a part of the future of healthcare. We will also be holding our 2018 Excellence Awards SUHVHQWDWLRQRQWKHGD\VKLQLQJDVSRWOLJKWRQUHDOOLIHH[DPSOHVRIKRZ therapies can make a difference to the health and wellbeing of others.

Supported by:

INT.Autumn2018.034-035.indd 2

Attended by:

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The conference will take place on Thursday 29 November at The King’s Fund in the heart of London’s West End, and will include a networking buffet lunch, drinks reception and refreshments throughout the day. FHT members will also receive 5 CPD points for attending the full day of talks.

Programme* 9.00am - 9.30am

Registration and refreshments

9.30am - 9.45am

Welcome

9.45am - 10.30am

Professor Nicola Robinson Research evidence - how it is used and how should it be collected?

10.30am - 11.15am

Dr Julie McCullough, MFHT 5HVHDUFKLQJWKHHIIHFWVRIDQWHQDWDOUHÀH[RORJ\RQSUHJQDQF\ and labour outcomes

11.15am - 11.30am

Break

11.30am - 12.15pm

Anita Mehrez, MFHT Making a difference – the complementary health and wellbeing team at The Christie NHS Foundation Trust

12.15pm - 1.00pm

Sir Sam Everington Bromley by Bow Centre: a holistic approach to building a healthy community

1.00pm - 2.00pm

Buffet lunch

2.00pm - 2.45pm

Dr Michael Dixon Challenges and opportunities for complementary therapy in the current healthcare landscape

2.45pm - 3.30pm

Jennifer Young, MFHT The impact of cancer on wellbeing and providing support through therapies

3.30pm - 3.45pm

Refreshments

3.45pm - 4.45pm

on 2018 FHT Excellence Awards presentation

4.45pm - 5.00pm

Closing comments

5.00pm - 6.00pm

Drinks reception

Tickets cost just £75 for FHT members (£95 for non-members) Limited tickets are available, so we recommend booking soon to secure your place.

Visit fht.org.uk/2018-conference

to learn more and book your ticket

*FHT reserves the right to adjust talk subjects and timings where necessary.

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03/10/2018 11:57


BEAUTY | Skincare

Remedial

recipes

l Natura y t u a e B ert, en Gilb

by Kar y shed b is publi s k o o B CICO 9.99) (RRP £ .com t pe ers ryland

IN THIS BOOK EXCERPT FROM NATURAL BEAUTY, AUTHOR KAREN GILBERT SHARES TWO HOMEMADE PRODUCT RECIPES, FOR A BODY SCRUB AND POST-SPORT MASSAGE OIL

Comfrey and arnica massage oil

Ingredients

This massage oil is great after sports or any

⦁ 2 teaspoons (10ml) arnica oil

other physical exertion because it contains

⦁ 2 teaspoons (10ml) St John’s wort oil

macerated oils that help to alleviate aches,

⦁ 4 teaspoons (20ml) avocado oil

pains and strains. Comfrey is included for

⦁ 1½ fl oz (45ml) almond oil

healing bruises, strains and sprains as well as

⦁ 1 teaspoon (5ml) vitamin E

helping to regenerate skin cells in sensitive or

⦁ Approximately 20 to 40 drops of essential oils:

⦁ 2 teaspoons (10ml) comfrey oil

⦁ Relaxing blend: 6 drops lavender,

rough, damaged skin.

6 drops geranium, 4 drops clary sage,

St John’s wort is anti-inflammatory,

4 drops bergamot

antiviral and astringent. It is commonly used to treat anxiety and depression, and is

⦁ Warming sports blend:

useful for healing cuts and scrapes, soothing

4 drops coriander, 2 drops ginger,

sensitive or itchy skin, and easing rheumatism

4 drops black pepper, 6 drops orange,

and back pain. Arnica is a remedy for

4 drops cedarwood

bruising, aches and pains, and sports injuries.

Equipment

Add up to 2% of the total volume of your

(or, better still, persuade someone to do it for you) after sport, a workout, or a long day at work when your muscles are tired and aching.

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⦁ Small glass jug or beaker

properties you require. I have suggested two

⦁ Metal spoon

blends for you to try.

⦁ Airtight 3½ fl oz (100ml) glass bottle

METHOD

To use Massage into skin

own blend of essential oil, depending on the

1

2

Add the oils, one at a time,

2. Add the essential oils and

to the glass jug, then add the

mix thoroughly. Pour into the

vitamin E.

glass bottle.

FHT.ORG.UK

05/10/2018 11:37


Skincare | BEAUTY

Barbados-ready body scrub This body scrub recipe was inspired by a friend of mine with whom I shared a goal for the year: to be ‘Barbados-ready’. Initially, it meant losing a few pounds and being perfectly groomed with a capsule wardrobe that could be packed in an instant, should someone invite her to hop on a plane the next day to fly to Barbados. As the year progressed, however, it came to mean much more than that, and it was an idea that was adopted by a group of us. We cleared all our clutter, both physically and mentally. We recycled belongings that we no longer needed to others who did, and we streamlined our lives, pledging not to acquire any more unnecessary ‘stuff’. More importantly, we stepped back, took stock and decided to take a bit more care of ourselves – which is where the scrub comes in. This may seem like an awful lot to ask of a body scrub, but if nothing else it will make your skin feel ‘Barbados-ready’ and smell like a tropical cocktail.

Ingredients ⦁ 1¾ oz (50g) coconut oil (solid) ⦁ 2 teaspoons (10ml) macadamia oil ⦁ 10 drops orange essential oil ⦁ 5 drops lemon essential oil

Editor’s comment

⦁ 5 drops lime essential oil ⦁ 2oz (60g) raw (unrefined) brown sugar

Equipment ⦁ Small glass bowl or mug ⦁ Teaspoon ⦁ Airtight 3½ fl oz (100ml) jar

METHOD 1 2

3

Please note that due to space restrictions this book excerpt does not cover contraindications to essential oils. Please consult an aromatherapist or reliable resource/book for more information.

4

5

Add the coconut oil to

Add the macadamia oil,

Add the essential oils and

Add the brown sugar

Carefully spoon the mixture

the bowl or mug.

then stir the mixture

stir, ensuring they are evenly

gradually to the coconut oil

into the jar.

vigorously with a

distributed in the mixture.

mixture, stirring carefully to ensure it is all mixed in.

teaspoon, whipping it up until soft and fluffy.

Coconut oil Pure coconut oil is a great body moisturiser. Although solid at

PICTURES: STUART WEST ©CICO BOOKS

room temperature, it is soft enough to be easily rubbed into

To use Massage into damp skin

the skin. It can also be used as a pre-shampoo treatment

while in the shower, paying

for dry and damaged hair, and is sometimes referred to

special attention to knees and elbows.

as coconut butter. I have also used macadamia oil, to

Always go easy when using scrubs on

fit in with the tropical theme and for its moisturising

the delicate skin on the collarbone and

properties, but you could replace it with almond oil. Sugar

chest. Rinse off the scrub and you will

forms the exfoliating part of this recipe, and it is up to you which kind you use. The finer the sugar, the gentler the scrub will be; similarly, the chunkier the grains, the rougher it will be. I find demerara sugar works best for me, but experiment with different types until you find one you like best.

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be left with a layer of the coconut oil, which you can massage into your skin to keep it soft and supple.

Karen Gilbert is an author and natural skincare and fragrance expert who helped create many of Neal’s Yard Remedies’ award-winning formulas. Karen now runs a successful retail business as well as artisan perfumery workshops in the UK and online. karengilbert.co.uk

AUTUMN 2018 INTERNATIONAL THERAPIST

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05/10/2018 11:37


END-OF-LIFE CARE | Terminal illness

W

hen working with terminally ill clients, we are invited to come faceto-face with death itself. If we have not taken care of our own feelings about death, along with understanding the needs of a terminally ill client and how we will respond to them, then we risk being uncomfortable and not fully present for our client as they near the end of their lifeâ&#x20AC;&#x2122;s journey. So how can we better prepare ourselves for this rewarding yet often challenging area of therapeutic work?

ANTICIPATORY GRIEF It is particularly important to understand the concept of anticipatory grief and how this might impact your client. Anticipatory grief is when someone grieves for their losses in advance of these happening. It could include feelings of dread, sadness, rage, denial, depression and distaste. Even moments of joy, relief and happiness are not unknown. The impact of loss in all its forms is likely to come into play: the loss of identity, job, purpose in life, physical ability, mental capacities, friendships, and so on. It is important to remember that you

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Life before death JANE DUNCAN ROGERS PROVIDES SOME POINTERS FOR THERAPISTS WHO ARE NEW TO WORKING WITH TERMINALLY ILL CLIENTS

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Terminal illness | END-OF-LIFE CARE

yourself may experience a sense of loss in advance of your client dying. Being aware of this in advance will mean you can understand and process some of your own thoughts and feelings more easily.

THE IMPORTANCE OF SUPERVISION It is surprisingly easy to underestimate the impact of supporting someone who is dying, especially if you start treating them when they are still relatively well. A supervisor’s job is to support you in relation to the work you are doing with your clients. It is time that you take for yourself, to explore themes or issues that may arise in connection to what is being presented by your client, whether that’s in the form of physical ailments, psychological ones, or both. Supervision is also crucial for when death is sudden, which is something I learned early on in my practice as a counsellor. I had seen a young man with health issues and family challenges. After around eight sessions, we were forming a working alliance and he was making good progress. One day, he didn’t turn up for his session, so I decided that if I hadn’t heard anything by the following week, I would make some gentle enquiries. A few days later, I received in the post a cheque he had paid me, returned from his bank with ‘deceased’ stamped on it. This was how I discovered he had died. I was catapulted into shock. Without breaching his request for confidentiality, I could not find out what had happened. This was my introduction into the importance of supervision – I contacted someone immediately and was able to have a few

PICTURES: GETTY; ISTOCK

“Anticipatory grief could include feelings of dread, sadness, rage, denial, depression and distaste. Even moments of joy, relief and happiness are not unknown”

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sessions to talk this through. With many more years’ experience under my belt now, I realise that it would have been better if I had already had a supervisory relationship in place. If one-to-one supervision is not possible or is costprohibitive, peer supervision is another option and will be especially helpful if others in the group are experienced in such matters.

WHAT TO SAY? Wondering what to say to someone who is terminally ill is a common concern. However, in a session with your client, it’s important to not shy away from asking specific questions. Generally speaking, it is much better to be able to say, for instance, ‘How poorly are you?’ or ‘How long do you think you have?’ than to skirt around the issue and be left wondering what is going on. By asking these and other specific questions, you will be affirming the trust established between you both, increasing the therapeutic alliance and your ability to be fully present for your client.

ADAPTING TO CHANGE It is important to be adaptable and flexible in the face of the uncertainty that a terminal diagnosis brings. Structures of safety and routine can become even more important. Your client knowing you are there for them, consistently, at the same time and same day each week or month, may turn out to be crucial. Consider what to do regarding home or hospital visits, changes of appointment and payment issues. Be aware of both verbal and non-verbal cues as you agree next steps with your client.

FACING YOUR OWN DEATH Facing up to your own death is a crucial part of working with terminally ill clients. It can be done safely when you consider the many practical actions that need to be taken to prepare well for a good ending. While it appears to be just addressing necessary administration, such as a will, living will, and power of attorney, in fact, there is plenty of provision for you to address any hidden feelings about dying, death and grief when this is done in the wider context of creating an end-of-life plan.

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“Wondering what to say to someone who is terminally ill is a common concern. However, in a session with your client, it’s important to not shy away from asking specific questions”

hear, sense and see from that place. This is not a good time to think you can cope when you know deep down that you can’t.

SAYING GOODBYE Finally, you may not know when it is the last time you will see your client. You may have a chance to say goodbye, you may not. This means living with uncertainty and not knowing. This is challenging for many, so it will help if you have explored your own feelings about loss, goodbyes and not knowing. If you are uncomfortable with any of these areas, sooner or later events will conspire to show this to you. Being aware of this in advance, knowing how you might cope, and having a good supervisor to support you will all help.

FEELING OUT OF YOUR DEPTH What if the client asks questions or starts to talk about things that you feel ill-equipped to deal with? Again, self-awareness is key and, also at this point, lack of ego. If you feel out of your depth, you need first to be honest with yourself and acknowledge that fact. Then there are several things you can do: ⦁ Refer the client on to someone you feel is better able to help them. ⦁ Visit your supervisor to explore what is going on for you. ⦁ Keep seeing the client but encourage them to also see a counsellor or specialist in the field. To be able and willing to do this, you need to have developed your own internal supervisor, and take action on what you

Jane Duncan Rogers is an award-winning coach and counsellor. She is the founder of Before I Go Solutions, a social enterprise that offers online and offline courses to help people create good end-of-life plans, and the BIG Academy, offering training to health professionals in the Before I Go Method. Jane is the author of several books, including Before I Go: The Essential Guide to Creating A Good End of Life Plan. beforeigosolutions.com

FHT.ORG.UK

05/10/2018 11:38


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03/10/2018 10:28


REGIONAL UPDATES

Local support groups South Tyrone LSG uplifted by life coach help us see how our choices shape our future, and to support others in their transformation. Ann enjoyed meeting us and said: ‘I have only wonderful things to say about my evening in Dungannon with the FHT group. After telling everyone a little bit about my own journey,

Life coach Ann Worland recently inspired members of the South Tyrone LSG, writes group coordinator Jackie Grimley. Her aim is simple: to uplift as many women as possible and empower them to succeed in all areas of their life. Ann brought together life coaching, neurolinguistic programming and ‘green-platform’ living to

we then went on to explore many things, including taking a step back before you react, how our thinking impacts our life, some tips and ideas on how to change things, and understanding how much power we have to change the direction of our lives. ‘It was so refreshing to talk to an amazing group, who were really interested in the topics and willing to participate in the activities. For me it’s all about collectively coming together, cooperating and supporting each other rather than competing.’ I was amazed when a member pointed out it has been exactly one year since I took on the role of coordinator. It has gone so quickly. These meetings are a great asset to our area for networking together and helping each other with advice. The FHT is a great professional organisation to be part of and can put members at ease. I could never have imagined taking on the role of coordinator without the support of the FHT in the background to answer any questions I have.

Hertfordshire group hears about healthy eating We always look for ways to bring informative speakers to FHT members in the Hertfordshire area and sometimes we go a little further and work with local businesses and organisations, writes Hertfordshire LSG coordinator Jay Chandarana. Recently, we got in touch with the owners of a new vegan place in town (Letchworth Garden City) and asked if they would like to present a talk on ‘How to eat healthy the vegan way’. To our delight, the two brothers took our offer and helped us with promoting the event and using their

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premises. What a great cost saving. The evening was open to members and non-members. The talk was so inspiring and educational: it covered nutritional information on vegan foods that can cover the national healthy eating recommendations. It gave information on how the brothers became vegan and, with the help of their mum, opened a vegan café. The evening closed with some sample foods, such as pieces of jackfruit burger, smashed chickpea and mayonnaise sourdough sandwiches, and raw courgette and walnut crackers.

FHT.ORG.UK

05/10/2018 11:40


REGIONAL UPDATES

Tai chi for a pair of LSGs The Chester and Waterlooville groups recently enjoyed an introduction to tai chi. Chester’s meeting was led by tai chi practitioner Maria Yuen, who talked about the wide-ranging health benefits of the Chinese martial art, which is characterised by slow, graceful movements. Coordinator Dee Kelsall said: ‘The session at Greenhouse Therapies gave us a real insight into the scope of this unique martial art. Maria gave a demonstration, and members enjoyed the opportunity to try some of the movements.’

Maria has been practising tai chi for more than 25 years, and comes from a healthcare background as an occupational therapist within the NHS. Waterlooville were joined by guest speaker Joyce D’Silva. Joyce outlined the benefits and said that tai chi is for everyone, no matter what their age or state of fitness. The group were asked to listen to their bodies and only do what they were prepared to do. Coordinator Liz Cox said: ‘A wonderful evening of tai chi was enjoyed by all our members. It was amazing how strong some of the moves could be when they are so simple. Everyone left feeling refreshed and having

learned a little more. It was also great fun and, given the summer heatwave, we had a great turnout.’

The Chester group

FIND YOUR LOCAL SUPPORT GROUP Local groups are a valuable hub for all those with a passion for therapies. Hear from excellent speakers about the latest therapies and business ideas, take part in outings and social events, enjoy treatment swaps and share best practice. The Waterlooville group

Emmett expert entertains Gloucester group We had a fantastic meeting in July with Carol Fisher, writes Gloucester LSG coordinator Harriet Jeffrey. Carol gave a great talk on the Emmett technique, and we had the opportunity to do some practical work as well. Carol is trained in a range of therapies and offers the Emmett technique in combination with other modalities to support clients. The Emmett technique involves the application of light pressure to a series of activation points, often two at the same time. The aim is to release excess tension from muscles, support pain reduction and increase range of motion. Thank you to all the group members who came out on such a warm evening. Fortunately, we were nice and cool in our meeting room, with the windows open and the fans going.

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EAST MIDLANDS Alfreton Leicester Lincoln Northampton Nottingham EAST OF ENGLAND Ely Essex Hertfordshire Luton Newmarket IRELAND Donegal NORTH EAST Durham Newcastle NORTH WEST Blackpool Chester Lancaster Liverpool and Rainhill Manchester (North) Manchester (South) West Cumbria Wigan and Leigh

NORTHERN IRELAND Belfast Coleraine Lisburn Lisnaskea Newtownabbey South Tyrone SCOTLAND Ayrshire SOUTH EAST Chichester Dartford, Gravesham and Medway Eastbourne and South Downs Hastings High Wycombe Horsham and Crawley Kent (North) London (North) Oxfordshire (South) Worthing Waterlooville Winchester

Gloucester Ipplepen Mendip Taunton WALES Llanelli Swansea Wrexham WEST MIDLANDS Birmingham (North) Birmingham (South) Coventry Hereford Staffordshire (North) Stourbridge and Dudley Wolverhampton Redditch YORKSHIRE AND THE HUMBER Harrogate Kirklees and Calderdale Leeds Sheffield

SOUTH WEST Bath Bournemouth

MORE INFO For group contact details and information about forthcoming meetings, go to fht.org.uk/lsgs

CAN’T FIND A GROUP IN YOUR AREA? Why not become a local support group coordinator? It is a very rewarding role, and there is a range of additional benefits available exclusively to coordinators. Email lsg@fht.org.uk for your information pack.

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HEALTH | Breast cancer

OCTOBER IS BREAST CANCER AWARENESS MONTH, SO WE LOOK AT WARNING SIGNS OF THE DISEASE

B

reast cancer is the most common type of cancer in the UK, with around 150 people diagnosed every day. Affecting one in eight women and one in 870 men, the risk of breast cancer increases with age. Each year, more than 11,000 people die of breast cancer. However, breast cancer survival is on the rise, doubling in the past 40 years, with almost 90% of women surviving breast cancer for five years or more.

SIGNS AND SYMPTOMS Knowing the signs and symptoms of breast cancer can save lives, including your own and those of your clients and loved ones. A client, for example, could make a passing comment about a change in their breast that may indicate they have cancer. In instances such as this, it is important to signpost them to a GP without causing alarm. Signs and symptoms include: ⦁ A lump or thicker area of the breast ⦁ Changes in size or shape ⦁ An inverted nipple or other change in its position or shape ⦁ Redness on or around the nipple ⦁ Dimpling on the skin of the breasts ⦁ Swelling around the collarbone or armpit ⦁ Bloodstained discharge from the nipple. Not all changes are due to breast cancer, but people with any of the above symptoms should be encouraged to book an appointment with their GP as soon as they can.

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LIFE AFTER A BREAST CANCER DIAGNOSIS Diane Leopard, FFHT, talks about her own experience with breast cancer and how awareness can save lives… In March 2013, I was diagnosed with breast cancer. I had begun to notice a change in the size and shape of my left breast, but as I was 49 I thought it was part of the ageing process. It was not until six months later that I noticed a lump and I went to see my GP. My husband is a retired surgeon, yet we still overlooked the early signs. I was devastated – my life changed overnight. Suddenly, normal life was on hold and everything revolved around hospital appointments. I felt overwhelmed, couldn’t sleep, became very tearful, felt exhausted, nauseous, and life had suddenly become very uncertain. I had surgery and radiotherapy, and I will need to take tamoxifen for 10 years. My family and friends were wonderful, and they gave me the best reason to overcome the disease. I still need to see the surgeon and oncologist every six months, but fortunately I have just had my five-year all clear. I now treasure every day and love nature more than ever. I have always been close to my husband and family, but cancer brought us even closer together. Every day, I open my bedroom curtains, look out of the window and say ‘thank you’. The more we can learn about the emotional impact of a cancer diagnosis, the more support, understanding and empathy we will have with those going through treatment. Ideally, therapists should receive additional training if treating clients with cancer, and seek consent from the medical professional responsible for their care (directly, or via the client). Never be afraid – their worries are far greater. Hands-on treatment is wonderful, but cancer patients need emotional support 24 hours a day. Think about teaching them self-help techniques. Remember if you notice any changes either in yourself, clients, friends or family or if anyone mentions any changes whatsoever, always encourage them – without alarming them – to see their GP. Because of my awareness, a friend has had treatment and a client has been diagnosed. Not all changes are due to breast cancer, but you might just save someone’s life. ⦁ For more information and useful resources on breast cancer, including research on treatment, go to breastcancercare.org.uk or breastcancernow.org

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RESEARCH

Reflexology can help empower women in labour SUPPORTING THE EMOTIONAL WELLBEING OF MOTHERS DURING LABOUR IS NOW OFTEN CONSIDERED AS IMPORTANT AS FOCUSING ON PHYSICAL HEALTH (RCM, 2012) Reflexology could be highly beneficial to women in labour, as a recent study suggests that the therapy can empower mothers, increase their self-confidence and allow them to gain some control over the birthing process (Arnon et al, 2018). In a qualitative study, reflexology was offered to women in labour in an Israeli university hospital. Of those offered the therapy, 36 women consented to take part in the study, where they would receive reflexology during labour and be interviewed within 48 hours of delivery. Treatments were provided by reflexologists during latent and active

labour, who were asked to leave the room as delivery approached. The interviews consisted of three main open-ended questions: on what the mothers remembered of the treatment, on physical and emotional changes, and on their impression of the treatment and whether they would again consider reflexology during labour. Of the 36 participants, 34 said they had a positive and empowering experience. The women said that while medical staff monitored physical progress and changes, such as fetal heartbeat and dilation, the reflexologists’ top priority was to ensure

they had a positive labour experience. They felt that they could confide in the reflexologists, sharing fears and feelings and felt empowered because it was the one part of labour where they were in control. They could decide whether to accept treatment, its duration and when it would end. For the full study, go to fht.org.uk/126-research-Arnon

College of Medicine rounds up its research THE COLLEGE OF MEDICINE PROVIDES ITS OWN OVERVIEW OF RECENT RESEARCH AS WELL AS NEW CONTENT

Foam rolling aids ankle range of motion

PICTURES: ISTOCK; SHUTTERSTOCK

THE NORMAL RANGE OF ANKLE DORSIFLEXION IN ADULTS BETWEEN 45 AND 69 YEARS OLD IS 10.6 TO 12.6 DEGREES IN WOMEN AND 10.9 TO 12.9 IN MEN (CDC, 2010) Foam roller massage can increase ankle dorsiflexion range of motion, according to a study published in the Journal of Musculoskeletal and Neuronal Interactions (García-Gutiérrez et al, 2018). The study looked at ankle dorsiflexion range of motion in 38 students, comparing the use of a foam roller – with and without vibration control – with a control group. The foam rolling consisted of three sets for 20 seconds, with a 10-second rest between sets. This was repeated in the roller plus vibration group, with a vibration on a

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medium setting, while participants in the control group sat down on a chair at rest. Range of motion was tested before and after each condition, using a leg motion system that measured ankle dorsiflexion during weight-bearing lunges. The ankle dorsiflexion range of motion of both legs was significantly higher in the roller groups, when compared with the control group, with the vibration control providing no extra benefit. See the full study at fht.org.uk/126-research-Garcia

The College has also supplied articles promoting the efficacy of complementary therapy, in its quarterly ‘Complementary medicine round-up’. Written by former barrister Richard Eaton, the round-up is packed with a wealth of information on the latest developments in complementary therapy, from evidence-base and advocacy, to changes in legislation and current challenges. To keep up to date, you can sign up to receive the round-up by email on the College of Medicine’s website (collegeofmedicine.org.uk), under the ‘Complementary’ tab.

REFERENCES For full references, go to fht.org.uk/IT-references

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RESEARCH | Essay award

2018

Michael Pittilo STUDENT ESSAY AWARD

LAUNCHED IN 2010 BY THE COLLEGE OF MEDICINE, THE MICHAEL PITTILO STUDENT ESSAY AWARD RECOGNISES AND CELEBRATES THE INTEGRATION OF CONVENTIONAL AND COMPLEMENTARY APPROACHES TO HEALTHCARE

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he Michael Pittilo award is open to UK students studying any healthcare discipline at degree level or above, including therapies that are statutorily regulated or on an Accredited Register, approved by the Professional Standards Authority. The FHT is delighted to have been a member of the judging panel and publisher of the winning essay for nine consecutive years. The FHT would like to congratulate this year’s winner, Benjamin Low, who has recently completed his medical training (MBBS) at University College London. Congratulations also to Prakhar Srivastava, who received second prize, and Felicity Allman, who came third. Prakhar and Felicity’s essays are available in the research section of FHT’s online reading room at fht.org.uk/readingroom

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Essay award | RESEARCH

Lifestyle medicine – the next big thing? Winning essay, by Benjamin Low, University College London In times of increasing pressure on NHS services, lifestyle advice, diet and self-care could be the key to healthier patients. But do clinicians have the time and expertise to utilise such a diverse range of interventions? Should NHS clinicians be looking outside the orthodox western, biomedical model for therapists to refer to, and what are the potential risks/ benefits if they do? The healthcare needs of our population have changed dramatically since the birth of the NHS. The epidemiological transformation that has typified the last century is that of fewer deaths from infectious diseases, and a much greater burden of chronic non-communicable diseases (NCDs) such as cardiovascular disease, cancers, chronic lung disease and diabetes (Newton et al, 2015). This paradigm shift, coupled with the change in demography experienced by the UK, with people now living longer than they ever have before, has resulted in increasing demands on both our health and social care sectors. With many of these services now reaching a tipping point, it has become apparent that a new approach is needed to address these issues. One potential solution is that of lifestyle medicine, which offers the opportunity not only to treat NCDs, but also to prevent them.

PICTURES: GETTY; ISTOCK

WHAT IS LIFESTYLE MEDICINE? Often portrayed in the media as the latest fad, lifestyle medicine is not, in fact, a new or alternative medical specialty. Hippocrates recognised the value of food, physical exercise, music and theatre as central to good health more than two millennia ago (Kleisiaris, 2014). Today, there is substantial evidence that lifestyle factors – including poor diet, physical inactivity, tobacco use, excessive alcohol consumption and psychosocial factors such as chronic stress and lack of social support – are key contributors in the pathogenesis of NCDs (Kvaavik et al, 2010). Lifestyle medicine may be defined as ‘the evidence-based practice

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of helping individuals and families adopt and sustain healthy behaviours that affect health and quality of life’ (Dysinger, 2013). A broad range of behavioural modifications are recommended to prevent, treat and reverse the progression of NCDs. These include diet, physical activity, sleep, stress management and avoidance of risky substance use (ACLM, 2018; Minich and Bland, 2013). Lifestyle medicine in clinical practice involves performing health risk assessment screening, health behaviour change counselling and clinical application of lifestyle modifications (Sagner et al, 2014).

LIFESTYLE MEDICINE AS A POTENTIAL SOLUTION The way we practise clinical medicine has changed. Long gone are the days of the patriarchal physician dictating to their patients the virtues of healthy living. Instead, we have moved towards a patientcentred approach, promoting autonomy through concepts such as shared decision-making (The Health Foundation, 2018). Lifestyle medicine fits in well with this movement. It is intended to be patient-focused, empowering individuals to take charge of their own health trajectory with input from healthcare professionals. In contrast, traditional medicine tends to centre around the ‘standard’ patient, using laboratory biomarkers with normal ranges. Should patients deviate from this range, clinicians are prompted to initiate treatment, often pharmacological therapy, according to national guidelines. While there is undoubtedly evidence to support this practice, there is a tendency to ignore patients until they meet certain criteria. However, we know that laboratory values in the low or high normal range may already

signify the onset of subclinical pathological syndromes. It is these particular individuals who make excellent candidates for lifestyle medicine, with the potential to halt progression to chronic disease. The prevention of type 2 diabetes provides an excellent example to illustrate this point. To be diagnosed with diabetes, one must have a fasting blood glucose greater than 7mmol/L, or a glycosylated haemoglobin greater than 6.5%. However, there is a wellrecognised subset of individuals who have a higher blood glucose than normal, but which is not yet high enough to be classified as having diabetes. If left undiagnosed or untreated, this so-called prediabetes has the potential to develop into type 2 diabetes, with all its debilitating complications. The incidence of prediabetes is increasing rapidly. Between 2003 and 2011, the prevalence in England more than tripled from 11.6% to 35.3% (Mainous et al, 2014). If unchecked, this carries largescale implications for the future burden on the NHS. Fortunately, research by the Diabetes Prevention Programme conclusively demonstrated that lifestyle changes can reduce the incidence of diabetes in this high-risk group (Knowler et al, 2002). Lifestyle intervention, consisting of at least 7% weight loss and 150 minutes of physical activity per week, reduced the incidence by 58% compared with placebo, and was found to be more effective than taking metformin, the classic first-line medication, alone. A follow-up study suggested lifestyle medicine was also more cost-effective. Herman et al (2005) calculated the cost per quality-adjusted life years (QALYs) to be $1,100 for lifestyle intervention versus $31,300 for metformin therapy. Thus,

“Patients must have insight into their unhealthy behaviours and be motivated to make adjustments to their lifestyle”

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RESEARCH | Essay award

lifestyle medicine has the potential to be a cheaper and more effective option than traditional medicine alone.

CHALLENGES FACING LIFESTYLE MEDICINE For lifestyle medicine to be an effective therapy, patients must have insight into their unhealthy behaviours and be motivated to make adjustments to their lifestyle. However, a recent study by Brotons et al (2012) found that a high proportion of patients attending primary care with unhealthy lifestyles do not perceive the need to change their habits. This is perhaps not surprising in an environment where conflicting health and lifestyle recommendations are conveyed through the media. Educating patients is an uphill battle against industries that have a vested interest in maintaining consumption at a level that is unhealthy to the individual. The picture is further complicated because these unhealthy behavioural patterns tend to be concentrated among poorer and more vulnerable populations (Link and Phelan, 1995). In contrast, uptake of health education is highest among those with the lowest risk of disease, thus exacerbating this health inequality. Social determinants of health inequality are arguably the single greatest challenge to lifestyle medicine but present too complex a topic to be more than touched on in this essay. Not only are patients often unaware of their unhealthy behaviours, but healthcare professionals are not providing adequate

counselling. The same study by Brotons et al (2012) found that around half the patients reported not having had any discussion on healthy lifestyles with their general practitioners. Several factors have been identified to explain the low rates of engagement by healthcare professionals, including lack of time, lack of patient interest, and lack of adequate training in counselling (Cornuz et al, 2000; Steptoe et al, 1999). There is also a phenomenon that unhealthy behaviours among clinicians is associated with negative attitudes toward lifestyle counselling (Cornuz et al, 2000). Together, these factors have resulted in cynicism among many clinicians and lifestyle medicine is frequently seen as nothing more than a tick-box exercise. I have often sat in clinic as a medical student where doctors have turned to me after the patient has left the room, face filled with scepticism, and said ‘Do you really think that person is going to stop smoking?’ This is in spite of the growing evidence supporting the efficacy of lifestyle counselling. Healthcare professionals currently seem unable or unwilling to promote lifestyle medicine effectively, and thus an examination of other available mechanisms is necessary to achieve the desired end-point. Public health campaigns promoting healthy lifestyles have proven effective over the years. Different approaches include raising awareness of risks, changing perceptions of unhealthy behaviours, and influencing social norms (Health Development Agency, 2004). Information is typically disseminated through various

“Instead of standing by, we should be challenging, educating and encouraging healthy behaviour at every opportunity”

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media outlets and supported by policy change – for example, the smoking ban in public places. These campaigns have most notably targeted tobacco use and heart disease prevention. As testament to their success, smoking rates have fallen significantly in recent decades (NHS Digital, 2018). However, government funding for public health has reduced substantially. In 2009-10, funding for anti-smoking mass media campaigns in England was just under £25m; by 2015 this figure had been cut to only £5.3m. Early indications are that these funding cuts are already threatening to halt or reverse long-term falls in smoking prevalence (Hopkinson et al, 2016). Furthermore, media campaigns are having to contend with a constantly changing environment saturated with competing products and opposing messages. Careful planning and testing of campaign content and format with target audiences is vital for success (Wakefield et al, 2010). Such vigorous planning is extremely difficult under current resource constraints.

CONCLUSION There is mounting evidence to support lifestyle medicine as an effective intervention to reduce the current burden of chronic NCDs. The concept of healthy living has been around for a long time, and therefore it is hard to market lifestyle medicine as the next big thing. Nevertheless, the current pressure on the NHS should promote public health to the forefront of the minds of government and health policy-makers. Obstacles to the success of lifestyle medicine are multifaceted. Ingrained social norms, lack of support from healthcare professionals, and commercial industries with competing motives are all barriers that must be overcome. We as healthcare professionals have an important role to play. Instead of standing idly by, we should be challenging, educating and encouraging healthy behaviour at every opportunity we have. By coordinating with public health campaigns and local community initiatives, such as stop smoking services and workplace education, we can promote a clear and unambiguous message about what a healthy lifestyle entails, and the health benefits an individual can expect to receive. Only by delivering and reinforcing this message can we begin to overcome the challenges outlined in this essay and allow lifestyle medicine to realise its full potential.

REFERENCES For full references, go to fht.org.uk/IT-references

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LEARNING

Medical A-Z LICHEN PLANUS Lichen planus is an itchy rash that can affect different parts of the body, including the skin of the forearms, inner wrists, lower legs, back, nails, scalp and mouth.

CAUSES The cause of lichen planus is unknown. However, it usually affects middle-aged people and is thought to be linked to the immune system or a reaction by the immune system in response to certain medicines. The condition isn’t infectious, so can’t be passed on to others, and it doesn’t usually run in families.

SYMPTOMS Symptoms of lichen planus include: • Shiny pink or purple raised spots (papules) • Itchy skin • Scaly patches on and around the ankles (hypertrophic lichen planus) • Rough, thinning nails that can become ridged or grooved • Ring-shaped rashes in the creases in the skin.

PICTURES: ALAMY; ISTOCK

ORTHODOX TREATMENT Mild lichen planus will heal on its own, without any intervention, within six to nine months. Symptoms can be eased by avoiding contact with soap or bubble bath on the affected areas. Washing hair over a sink can help with this, as shampoo may cause irritation. Corticosteroid drugs are often prescribed to treat the condition. Creams and ointments containing artificial hormones (topical corticosteroids) can be applied to the papules to reduce inflammation, redness and itchiness. Treatment with corticosteroids should cease when the rash turns to a brown or grey colour. Corticosteroid tablets or acitretin may be prescribed for severe cases, where creams and ointments are ineffective. Antihistamines can also be used to reduce the itchiness of the rash. And another recommended therapy is the use of light rays. Light therapy uses ultraviolet B (UVB) and psoralen plus ultraviolet A (PUVA).

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COMPLEMENTARY AND HOLISTIC BEAUTY THERAPY Research on lichen planus is limited. Most studies focus on oral lichen planus (OLP), which affects the lips or inside of the mouth, and is known to be particularly resistant to topical corticosteroid application (Shichinohe et al, 2006). Topical application of aloe vera could be beneficial to people with OLP, according to a randomised double-blind study (Choonhakarn et al, 2008). Scientists randomly allocated 54 patients with erosive and ulcerative lesions, mainly affecting the lower lip, to receive aloe vera gel or a placebo for eight weeks. Improvements were reported in more than 80% of the aloe vera group, compared with just 4% in the placebo group. Among improvements reported in the aloe vera group, 33% said that the burning pain they had experienced had gone by the end of the study. One study found the edible plant purslane efficacious for OLP. Thirty-seven patients were divided into two groups in a three-month randomised controlled trial, with 20 receiving purslane and 17 a placebo. Using a visual analogue scale, scientists found partial to complete improvements in 83% of the purslane group and just a 17% partial improvement in the placebo group. Moreover, 10% of the placebo group showed signs of worsening, compared with 0% in the purslane group.

Cedar honey could also help with OLP. A randomised controlled trial in a dental school divided 36 patients into two groups, one receiving standard treatment (dexamethasone mouthwash three times daily and one fluconazole capsule daily) alongside cedar honey (20ml three times daily, via a swish-and-swallow technique) for four weeks, and the other group received standard treatment alone (Sanatkhani et al, 2014). Both groups showed a reduction in pain, atrophic lesions and size of erosive area. However, honey alongside standard care showed greater improvements in the healing of ulcerative lesions than the group receiving standard care alone. No significant difference was found in the treatment of atrophic and erosive lesions of OLP through use of honey as an alternative treatment. However, this approach may be effective in managing ulcerative lesions of OLP; although more research with a larger sample size is necessary.

NB: The information provided in this article is not all-encompassing, and intended as an overview only. It should not be used for the purposes of ‘diagnosis’. Members or clients presenting with any symptoms should always consult a GP or other relevant health practitioner. The advice of a doctor, pharmacist or other suitably qualified person should be sought before taking any form of medication or treatment.

REFERENCES For full references, go to fht.org.uk/IT-references

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A DAY IN THE LIFE | Geraldine Flynn

A DAY IN THE LIFE OF… GERALDINE FLYNN, FFHT, SEMI-PERMANENT MAKE-UP TECHNICIAN, SKIN THERAPIST AND 2013 FHT EXCELLENCE AWARD WINNER

paperwork for the day, and set out packs with disposables and consumables for each client so I have a swift change-over. I prepare my Google Drive folder for each client to store my before and after pictures to show improvements.

9AM My first client is booked in for an

6.30AM

I wake up shortly before my two little girls, and enjoy a coffee and the brief silence while I check my social media. I use some pre-written replies, which saves me time and keeps my reply rate fast.

7.30AM The girls are up, ready and off to their childminder. I work three to four days a week, typically with hours that are flexible, to fit around children and available childcare.

8.30AM Work begins. I offer skin peels and semi-permanent make-up only. I prepare my treatment room and my

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age skin peel. I offer a variety of skin peels to treat conditions from acne to eczema, and either brows, lips or eyeliner semipermanent make-up. Every day is a bit different, and it’s never boring. I stock Medik8 skin products and a few others I use myself. Clients can pick up their favourite moisturiser or SPF on their visits too.

10.30AM I see a client who comes to me for semi-permanent eyebrows. I have been doing this treatment for 10 years now, so have a large clientele, who visit every 12 to 18 months for a touch-up on their semipermanent make-up. It’s always great to catch up and hear their latest news. My client has decided to have her eyeliner done as well today. She suffers with hair loss and has very few lashes, so she has a subtle enhancement to disguise this. It takes me a couple of hours to complete both treatments. She will return in a month for a second session on her lash line to complete her treatment. She is delighted so far, as she has been thinking about this treatment for a while now. She is so happy she finally made the decision to go through with it. I look forward to seeing the improvements when she returns for her next appointment.

1PM

I stop for lunch. I have usually prepared something healthy the night before, so I can just heat it up while I catch up on my industry magazines, tearing out any pages with good advice or information to review at a later stage. I always enter the competition in International Therapist, and I have won twice! I have a ‘to do’ folder where I keep these cuttings and work my way through them when I get time. There are always great articles with tips in International Therapist and opportunities to broaden your audience. For example, I succeeded in winning an FHT Excellence Award in 2013 for my work on clients with alopecia and hair loss conditions, and became an FHT Fellow last year. My clients love to see that I am active in my industry and am keeping up with CPD.

2.30PM

My next client has requested a semi-permanent lip liner and blush, which a lot of ladies are booking to create a more youthful, even lip rather than going down the filler route. This is typically a longer appointment. Lips can take up to two hours, so setting up and doing paperwork in advance saves me time.

4.30PM

Wind-down time: I go through all my consultations and note anything we may have talked about that could be relevant: for example, holidays or weddings coming up may affect appointments. I recheck social media, return emails and any missed calls, and confirm the next day’s appointments by text message, before closing the door on another busy day I am grateful to have.

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MEMBERS’ NEWS

A

few years ago, I volunteered in community centres, carrying out therapies for clients over the age of 55. I saw within these centres a real need for therapies, even if it was just file and shape or eyebrow tint. Sometimes, the fast-paced environment meant there was little time to get to know the clients and find out their real needs. In 2014, I began working as a volunteer in a charity’s therapy centre, which supported people going through stress and anxiety. I did manicures and pedicures here one day a week. I was so happy to see how therapies such as Indian head massage and reflexology, carried out by other therapists, made such a difference to people’s lives. I knew then that I wanted to study these therapies, so I enrolled on a City and Guilds Level 3 Diploma in Body and Spa Therapies at Newham College, London.

LOW-COST THERAPIES After qualifying, I felt that further training and experience would help me become more employable. Looking on the internet, I found an advert for a volunteer complementary therapist position at the Margaret Centre, a cancer and palliative care unit at Barts Health NHS Trust. Following an interview, I trained for four weeks in NHS trust procedures, as well as those specific to the role. I assessed patients for complementary therapy treatments under the supervision of the complementary therapy lead, and provided massage to patients, carers, family and staff, either on the wards or in a hospice. I gained real insight into how patients, their families and friends responded to

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ANNETTE ROACHFORD, MFHT, DISCUSSES HOW A PASSION FOR THERAPIES LED HER TO SUPPORT PEOPLE IN HER LOCAL AREA

Community spirit massage. I learned that, sadly, most people had never had a massage, and if they had, it was most likely on holiday or a gift given to them by a loved one. In other instances, people said they just couldn’t afford massage therapies because it was considered a luxury. By now I had been given a start-up grant to set up my own business. I knew I wanted to offer beauty, massage and spa therapies. I remembered my time at the stress centre and that they offered low-cost therapies at £7 for half an hour of treatment. As much as I wanted to, I knew I could not match that rate in my own business. However, this inspired me to offer low-cost therapies to clients with an income of less than £12,000 per year. This is means-tested, and they can pay half price for a full-body treatment. This way, I can also fill appointments that may not otherwise have been filled. My main goal is to enable people from all walks of life to access therapies, whatever their financial circumstances. By offering low-cost therapies, these clients

will be able to experience the benefits of therapies and hopefully reach a point where they are better off financially and can afford to pay the full prices.

COPING WITH CANCER I am also a dedicated volunteer beauty therapist with Look Good Feel Better, a cancer charity that works with Macmillan Cancer Support, running workshops for women going through cancer treatment. Our aim is to help women manage the physical side effects of treatment, and to help boost confidence and self-esteem. We do lots of work with lashes and brows, and I assist colleagues with less experience. My role as an FHT member and a therapist is to help and encourage people within our community to gain access to therapies, not just for business growth and development, but to make a real difference in our communities. I am also a wellbeing champion in my local community, give light therapies at events to promote wellbeing, and give talks on mental wellbeing in the workplace.

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MEMBERS’ REVIEWS

BASE FORMULA JOINT & MUSCLE MASSAGE GEL The gel is blended with aloe vera, seaweed and black pepper, and has been formulated to use both before and after exercise and to support musculoskeletal problems.

SHARON ALLISON, MFHT

8/10

It has a fresh herbal-like fragrance, but isn’t overpowering. I would have preferred a bottle or tube rather than a tub for ease of application. The gel spread easily and massaged well into the skin, leaving no greasy residue. Clients commented on its cooling and beneficial effect on areas treated. The only negative was that I felt it worked better on specific smaller areas requiring treatment, rather than larger areas, due to it quickly drying on the skin once massaged in.

WALTER BEGUM, MFHT

7/10

Initially, I was dubious about the use of aloe vera as its base ingredient, which is not suitable for physical massage. However, I divided the jar contents into three and asked three clients to gently rub in the gel on areas affected by arthritis, initially twice daily. They all found the relief wore off too quickly. Changing to three times daily made a big difference and gave reasonably long-lasting relief. This product could be useful when advising clients of suitable self-treatment.

MEMBER OFFER RRP £18. Base Formula offers a 10% discount to FHT members. Visit baseformula.com for details.

HOLISTIC AROMATHERAPY: PRACTICAL SELF-HEALING WITH ESSENTIAL OILS, BY MARC J GIAN This book covers the foundations for self-healing with aromatherapy, including the properties and applications of key essential oils such as peppermint, lavender and eucalyptus.

SARAH BOWERS, MFHT 7/10 Holistic Aromatherapy is a really interesting book. I like the way it ties in meridians and acupressure points with essential oils. I will look at using these in both home life and work practice to bring an added extra to aromatherapy treatments for those in need of help with certain aspects of their lives. It would help a complete beginner, explaining the facts and how to use essential oils.

EILEEN REYNOLDS, MFHT

10/10

This book is a beautifully presented and inspirational resource, both for those interested in self-help and for professionals. Considering the wealth of information shared in this book, it isn’t heavy-going. The basic principles of Chinese medicine are explained in clear and easy-to-understand terms, and its connection and use alongside aromatherapy is outlined with user-friendly instructions and diagrams. I love this book, and I will be using this new knowledge to enhance my treatments.

BEST BUY RRP £12.99, available from rylandpeters.com

NEW PRODUCTS ADVANCES IN SPORT AND EXERCISE PSYCHOLOGY, BY THELMA HORN AND ALAN SMITH The fourth edition of this book provides students with a thorough examination and critical analysis of the current research in the psychology of physical activity. This revitalised text uses a traditional textbook approach, appropriate for advanced classes, as opposed to an informal handbook style. Longstanding editor and author Thelma Horn is joined by a new coeditor, Alan Smith, and 55 new and returning contributors, including leading scholars.

PRICE: £89.99, available from humankinetics.com

52

HYDRANURE™ DRY SKIN CREAM Developed specifically to help a child’s delicate skin, HydraNure™ is natural, organic and formulated to help relieve dry, itchy and sensitive skin problems. Designed originally to control eczema in infants, HydraNure™ has been successful in tests carried out by the TalkHealth Partnership on children with dry skin conditions, with 94% of parents seeing an improvement in their child’s skin in less than two weeks. HydraNure™ is vegan-friendly and contains five plant-based ingredients known for their skin healing properties.

PRICE: £14.99, available from hydranure.com

INTERNATIONAL THERAPIST AUTUMN 2018

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CUPPING THERAPY FOR BODYWORKERS, BY ILKAY ZIHNI CHIRALI

THE CONCISE BOOK OF MUSCLES, BY CHRIS JARMEY

This book explains how to use cupping techniques to treat issues including muscle tension, skin conditions and high blood pressure. Ilkay Chirali provides a wealth of information for those without knowledge of traditional Chinese medicine, covering safety information, equipment and the different variations of cupping. With more than 120 full-colour photos, it aims to inform therapists interested in adding cupping therapy to their toolbox of techniques.

This newly revised fourth edition of The Concise Book of Muscles is in a quick-reference format, showing students how to locate and identify specific muscles. It highlights those that are heavily used and therefore prone to injury in a variety of sports and activities. Each chapter now includes an overview of the gross anatomy of the body to show bony landmarks, cross-sections of muscle layers and points of attachment, as well as an overview of the nerve pathways that are most relevant.

PRICE: £24.99, available from singingdragon.com

PRICE: £19.99, available from amazon.co.uk

FHT.ORG.UK

08/10/2018 12:27


DERMALOGICA BIOLUMIN-C SERUM A vitamin C serum formulated to work with the skin’s own defences to brighten, firm and reduce the appearance of fine lines and wrinkles.

Competition

PRIZE WORT OVER H £75

LESLEY EATON, MFHT 5/10 The product is in a glass bottle with a pipette to control the amount of serum applied to the skin. The serum is easily absorbed, left no sticky residue on the skin and has no strong scent. I used the serum as directed, day and night, and it did leave my skin feeling smoother. However, I didn’t see any dramatic change in the reduction of fine lines or the firmness of my skin. MELANIE REYNOLDS, MFHT I’ve used vitamin C products before without much success. But this was 10/10 different: it absorbed really well. I’ve been using it for a few weeks, twice daily, and have received many unexpected compliments. I’ve noticed a visible reduction in fine lines, especially on my upper cheeks and around the eyes, and my skin feels plumper and more hydrated. My jawline feels slightly firmer and make-up sits much better on my face and seems to last longer. Highly recommended serum.

BEST BUY RRP £81.50, available from dermalogica.co.uk

Please note that product descriptions featured on these pages are provided by the supplier/manufacturer.

NATURAL BEAUTY, BY KAREN GILBERT In Natural Beauty, natural skincare and fragrance expert Karen Gilbert shows you how to make your own lotions and potions at home, using readily available, natural ingredients and home-friendly methods that are designed to be kind to your skin and the environment. Covering 35 recipes for the face, body and hair, each has stepby-step photographs and lists of equipment and ingredients, as well as easy-to-follow instructions. Author Karen Gilbert helped to create many of Neal’s Yard Remedies’ awardwinning formulas. Read an excerpt from the book on page 36.

PRICE: £9.99, available from rylandpeters.com

FHT.ORG.UK

52-53_Reviews_Autumn 2018_International Therapist 53

Two lucky members will win an annual subscription to In the Moment magazine (13 issues), worth more than £77. In the Moment is a beautiful monthly magazine full of feel-good features, insightful writing, mindful makes, uplifting adventures and calming ideas for a healthy body and mind. Through its four sections – wellbeing, creating, living and escaping – the magazine aims to help you make the most of every day, celebrating the little things as well as life’s big events. In the wellbeing section, you are encouraged to care for yourself, as well as your loved ones, with positive practical advice for mind and body from wellbeing experts from around the world. In the creating section, you’ll find simple, stylish projects to encourage mindfulness through making. The living section features eco-friendly home style ideas alongside healthy recipes and nutrition advice to help you feel good from the inside out. The escaping section features travel ideas that broaden the mind, while helping you reconnect and re-energise – ready for your next adventure. The FHT advertises in and writes for In the Moment. Find the latest issue at Sainsbury’s, Waitrose, Tesco and WHSmith.

TO ENTER, PLEASE ANSWER THE FOLLOWING QUESTION: Which of the following sections would you find in a typical issue of In the Moment magazine? Travelling Escaping Adventure Simply email your name, address, membership number and answer to dralls@fht.org.uk, typing ‘In the Moment competition’ in the subject box. Alternatively, send your answer and details on a postcard to: In the Moment Competition FHT 18 Shakespeare Business Centre Hathaway Close Eastleigh Hampshire SO50 4SR The closing date is 7 November 2018. For full competition terms and conditions, visit fht.org.uk/competitions

AUTUMN 2018 INTERNATIONAL THERAPIST

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LEARNING

CPD questions

FO R M O R E IN F O R M AT IO ABO UT H OW N G A IN C P D P T O O IN T S BY R E F L E C T IN G O N YO U R FAVO U R IT E A R T IC L E S , V F H T.O R G .U IS IT K /C P D

BELOW ARE QUESTIONS RELATING TO ARTICLES IN THIS ISSUE OF INTERNATIONAL THERAPIST. TO GAIN THREE CPD POINTS (UNLESS OTHERWISE STATED), ANSWER ONE OR MORE QUESTIONS RELATING TO THE SAME ARTICLE, USING A MINIMUM OF 300 WORDS IN TOTAL. IF YOU DON’T THINK THE QUESTIONS ARE HELPFUL, YOU CAN POSE YOUR OWN TO ANY OF THE ARTICLES FEATURED IN THE MAGAZINE. MOVING FORWARD (P12-15)

GROWING PAINS (P26-29)

Q

In their article, Sarah Catlow and Lance Doggart provide a summary of overuse injuries recorded in young athletes. Outline the typical overuse injuries that might affect a different age or type of client group regularly participating in sport.

In this article, we discuss phantom limb pain and other issues affecting amputees. Write about how a therapy you practise could potentially help a client who has undergone amputation, and why you think this may be effective.

Q

TOUCH TYPE (P20-22)

Q

In her article, Dr Katerina Steventon talks about how touch is approached differently across cultures. Comparing two to three different therapies you practise, write about how cultural influences have led to contrasting approaches.

2018/19 Diary Dates 21-22 November NEC Birmingham Therapy Expo therapyexpo.co.uk 29 November The King’s Fund, London FHT FHT Conference EVENT & FHT Excellence Awards presentation fht.org.uk/events

24-25 February 2019 ExCeL London Professional Beauty London professionalbeauty.co.uk 8-9 May 2019 ExCeL London COPA Series copashow.co.uk 11-12 May 2019 EventCity, Manchester Om Yoga Show manchester.omyogashow.com 19-20 May 2019 NEC Birmingham FHT STAND & 2019 Training Congress at TRAINING the Holistic Health Show holistichealthshow.co.uk

Top 10 reasons

Q

Taking inspiration from Sarah Catlow and Lance Doggart’s article, put together a prospective treatment plan for a young athlete with a specific injury. Write about how you would assess the client, treat the problem and return them to full fitness.

LIFE BEFORE DEATH (P38-40)

Q

Dr Steventon says that Japanese and Korean skincare routines are different from European ones. Choosing either Japanese or Korean skincare, discuss how this approach is different from typically European practices.

Q

Jane Duncan Rogers provides some pointers for therapists who are new to working with terminally ill clients. Reflecting on an area of your own expertise, provide some pointers for therapists new to your line of work.

2018 ANNUAL MEMBERSHIP FEES* FHT Member: £59.99 FHT Associate: £64.99 Student Member**: £24.99 FHT Affiliate: £34.99 Overseas Member: from £41.99 Qualified Combined Medical Malpractice, Public and Products insurance: from £46.81

54

INTERNATIONAL THERAPIST AUTUMN 2018

54_CPD_Diary_Autumn 2018_International Therapist 54

*Ask our membership team about paying by Direct Debit – it could save you 5% on membership fees. **Includes case study insurance cover. £24.99 deducted from full membership fee on qualifying and upgrading. Terms and conditions apply.

For membership and insurance information or an application pack, visit fht.org.uk or call 023 8062 4350. FHT is authorised and regulated by the Financial Conduct Authority, Ref: No. 502095.

for being an FHT member 1

Professional status and recognition.

2

Campaigning, promoting and protecting your interests as a professional therapist.

3

Professional representation.

4

The industry’s leading professional therapist magazine.

5

Tailor-made comprehensive therapist, salon and clinic insurance policies.

6

Discounted continued professional learning.

7

The UK’s largest local support group network.

8

FHT-branded products and member discounts on therapy supplies.

9

Members’ helpline.

10

FHT is a not-for-profit organisation run by therapists, for therapists.

FHT.ORG.UK

05/10/2018 11:50


LEARNING

DEPUTY REGISTRAR AND COMPLIANCE OFFICER KIAH MYATT’S PICK

In the reading room

I know about the damage pollution can cause to our lungs and other internal organs, but I often forget about the impact it can have on an equally important external organ: my skin. ‘The skin solution to pollution’ by Lorraine Dallmeier is an interesting article full of helpful tips on how to prevent damage caused by pollution. Find this article in the Beauty Therapy section of the reading room (fht.org.uk/readingroom) under ‘Skincare: how to protect your skin from pollution’.

FHT spiral no. 28

In the reading room section of the FHT website, you will find more than 350 therapy and business-related articles and research summaries, with more added regularly. Visit fht.org.uk/readingroom, log in and have a browse.

MASSAGE THERAPY DURING CANCER TREATMENT FHT Fellow Elizabeth Russel shares with members a small-scale systematic review she completed as part of her BSc in healthcare at the University of Bedfordshire, which looks at whether massage therapy improves wellbeing and alleviates side effects for patients receiving cancer treatment. The main themes/research findings explored in the dissertation are pain and discomfort, nausea and vomiting, psychological outcomes, fatigue and sleep and quality of life. fht.org.uk/IT-126-RR-Massage-cancer

AN INTRODUCTION TO ST ANN’S HOSPICE In this short article, Tina Dennett, MFHT, praises the complementary therapists she works alongside at St Ann’s Hospice, who provide much-needed treatments at three different sites (Heald Green, Neil Cliffe and Little Hulton). As well as outlining the services they provide, Tina touches upon the peer support groups and training she organises for the team, and appeals for more volunteers to help them to continue to provide support to hospice patients, their families and carers. fht.org.uk/IT-126-RR-StAnns

TEST YOUR A&P KNOWLEDG E AND

WIN A £20 AMAZON GIFT CARD

The winner will also receive a copy of Words that Touch, by Nick Pole (published by singingdragon.com, RRP £18.99) .99) Write your answers in a spiral from the start, working in an anticlockwise direction, towards the centre of the grid. The last letter of each answer is the first letter of the next. The shaded diagonal line will spell out a facial muscle.

TO ENTER Simply email the word that appears in the diagonal shaded boxes to dralls@fht.org.uk (writing ‘Autumn spiral’ in the subject box) or send your answer on a postcard to the usual FHT address. Please include your name, address and membership number. Standard competition terms and conditions apply (visit fht.org.uk/competitions). Entries to be received no later than 7 November 2018.

CROSSWORD CLUES 1 2 3 4 5

Clear fluid that helps protect the brain and spinal cord (13) - - - - - - - scapulae, muscle that lifts the shoulder and scapula (7) Muscles that rotate and adduct the scapula towards the spine (9) - - - - - - - - anterior, or ‘boxer’s muscle’, that draws the scapula forward (8) Other name for involuntary muscle (6)

6

Where you would find the tricuspid valve (5) 7 Section of spine with highest number of vertebrae (8) 8 Condition/disease existing since birth (10) 9 - - - - - nodes (5) 10 Occurs when an organ pushes through muscle or tissue holding it in place (6)

11 Chemical that prevents bacterial infection (10) 12 Muscle shortening/spasm (5) 13 Arrector/erector - - - -, tiny muscles associated with goose bumps (4) 14 Type of bone, eg vertebrae (9) 15 Relating to the kidneys (5) 16 Respiratory organs (5)

Where’s the solution for spiral no. 27? We do not publish spiral solutions in International Therapist, as completing spirals from the magazine can count towards your CPD (one CPD point per spiral quiz, a maximum of five points per year). Turn to page 65 for the name of the member who sent in the first correct spiral solution to be independently drawn from all eligible entries sent in by the allocated closing date for spiral no. 27 featured in issue 125 (Summer 2018).

FHT.ORG.UK

55_WNinRR Spiral_Autumn 2018_International Therapist 55

AUTUMN 2018 INTERNATIONAL THERAPIST

55

05/10/2018 11:50


Expand your skill set and grow as a therapist with an FHT Hosted Course

CPD is a requirement for all FHT Members and Fellows, refreshing DQGGHYHORSLQJ\RXUWKHUDS\VNLOOVDQGNQRZOHGJH&3'SRLQWVFDQEH JDLQHGWKURXJKDYDULHW\RIDFWLYLWLHVLQFOXGLQJFRXUVHVDQGDIXOOJXLGH can be found at IKWRUJXN&3'

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A one-day workshop on how to safely adapt your massage for clients at risk of

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INT.Autumn2018.056-057.indd 3

03/10/2018 11:54


LEARNING

FHT accredited course provider news THE BALANCE PROCEDURE TRAVELS TO SWEDEN For the last nine years I have been a practitioner and trainer of The Balance Procedure. I love it and use it all the time to consciously create the life I want – and that is how I ended up in Sweden earlier this year. I wanted to travel, and what could be better than travelling while sharing something that you are deeply passionate about? It was the first time I had been to Sweden, and the first time the country had been introduced to The Balance Procedure. I attended a two-day event,

meeting some wonderful people. I had a lecture to give each day, and have since taught my first Swedish student, who wants to become a practitioner. It really was a whole trip of firsts. Adrienne Green, MFHT

FRT SHARES SKILLS WITH SCHOOLS IN ZAMBIA FHT accredited course provider Functional Reflex Therapy (FRT) recently sent a team to Zambia for its Global Project 2018. This followed FRT’s 2017 trip to the African nation, when the

team shared reflexology with a school in Choma. This year Lorraine Senior, MFHT, and Janet Hardman shared the benefits of different therapy techniques with children and adults in schools in the towns of Siavonga, Mazabuka and Choma. Lorraine told the FHT: ‘What a privilege to share skills with children and adults and have the opportunity to work in three schools, travelling many miles throughout July. We worked with the children in the classrooms and shared simple skills with staff and pupils, as well as older siblings, p parents and grandparents who c came in from outlying villages.’ FRT has created a highlights v video from this year’s project, w which can be viewed at f fht.org.uk/IT-126-FRT-Zambia

FHT accredited course providers IRELAND SC Churchtown Institute of Beauty & Holistic Training cibht.ie Q Deirdre Murray Holistic Training deirdremurray2@gmail.com SC Golden Egg Holistic goldeneggholistic.com Q Irish Institute of Nutrition & Health Ltd iinh.net Q Kerry School of Reflexology kerryreflexology.com Q Saint Martin’s College of Physical Therapy stmartinscollegecork.com

SCOTLAND Myofascial Release UK – MFR UK myofascialrelease.co.uk SC Rosslyn Alternatives rosslynalternatives.co.uk SC Start with Touch Ltd startwithtouch.co.uk SC The Glasgow School of Massage theglasgowschoolofmassage.com Q Therapia School of Reflexology therapiagourock.com Q

NORTHERN IRELAND SC Body and Sole School of Complementary Therapies bodyandsoleschool.co.uk SC Calm Confident Kids calmconfidentkids.co.uk SC Logan Fertility Centre loganfertility.com Q New Beginnings School of Natural Therapies angelsanctuary.co.uk Q

58

Q SC Sheila Nugent School of Reflexology sheilanugentschoolofreflexology.co.uk

NORTH WEST Acupuncture Training for Therapists Ltd acupuncturetrainingproviders.co.uk SC Alternatively Better alternativelybetter.co.uk SC Ashwood Beauty & Holistic Academy ashwoodacademy.co.uk Q Breathworks breathworks-mindfulness.co.uk Q SC British Academy of Crystal Healing britishacademyofcrystalhealing.co.uk SC Dawn Alderson & Co Training Academy dawnalderson.co.uk Q SC Dorn Method Academy UK (Jacqui Hamer) dornmethod.org SC Dorn Method Lake District dornmethodlakedistrict.co.uk Q SC Elaine Ellis Courses elaineelliscourses.co.uk SC Energy for Life energyforlife.today Q SC KORE Academy Ltd koretherapy.com Q Reiki Tradition reikitradition.me.uk SC The Master Academy/Urban Body Balance urbanbalance.co.uk SC

NORTH EAST Anna-Louise Haigh anna-louisehaigh.com SC Aries Academy of Holistic Therapies ariesacademy.co.uk SC

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SC Butterfly Touch Therapies butterflytouchtherapies.com Q ETHOS (Education, Training, Health and Online Services) ethos.uk.com Q Eve’s Garden (Alison Valerie Peart) alipeart@hotmail.co.uk SC Jong Baik Education jongbaik.co.uk SC Kinesio UK kinesiotaping.co.uk Q Leeds Holistic Training & Therapy Centre (LHTTC) lhttc.co.uk SC NHS Natural Health School nhsnaturalhealthschool.co.uk

EAST MIDLANDS Blossom & Berry Baby Massage & Yoga Training blossomandberry.com Q SC Cameron Reid Training cameronreidtraining.co.uk SC Extraordinary Kinesiology extraordinarychannels.com SC Fertility Massage fertilitymassage.co.uk SC Harmony-9 harmony-9.co.uk SC Helen Mary Perkins helenperkins.com SC Infinity Training Academy infinitytrainingacademy.co.uk Q Penny Price Aromatherapy Ltd penny-price.com SC Progressive Kinesiology Academy UK progressive-kinesiology.co.uk Q

SC Routes to Healing Sarahling1@googlemail.com Q Shirley Price International College of Aromatherapy shirleyprice.co.uk SC The Active School of Complementary Therapy ukmassagecourses.com Q Tri-Dosha tri-dosha.co.uk SC Vitali-Chi Headquarters v-chi.com

WEST MIDLANDS Ascent Therapies Training Academy ascent-therapies.co.uk SC Beyond the Limits beyondthelimits.co.uk SC Central School of Massage centralschoolmassage.com SC Just BE (Butterfly Experience) with Jacqui Mexson Jacqui.mexson@virginmedia.com Q Lorraine Davis Holistic Healthcare and Education Centre lorrainedavistraining.com SC Lymphoedema Training Academy Ltd lymph.org.uk Q Meridian School of Massage & Bodywork jlmeridian.co.uk SC Microsystems Therapies and Training annavenables.com Q Paadena School of Yoga & Thai Yoga Massage Therapy paadena.co.uk SC

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SC

FHT accredited qualification(s)

SC The UK Dorn Method Centre dornmethod.co.uk SC Time and Fitness for You timeandfitnessforyou.com/ bt-workshop SC Timeless Partnership Ltd timelesspartnership.co.uk SC Tranquil Heart Training Academy tranquilheart.co.uk

WALES Coleman’s Complementary Therapies holisticsforautism.wordpress.com SC de Prez Training challengeconquered.com SC Dynamic Massage dynamicmassage.co.uk Q Gaia Education gaiaeducation.com Q Glyndŵr University glyndwr.ac.uk Q SC Gower College Swansea gowercollegeswansea.ac.uk SC HB Training Wales Ltd hbtraining.org SC In The Pink! Therapies and Training inthepinktherapiesandtraining.co.uk SC Keep in Touch Training keepintouchtraining.co.uk SC Mandala Complementary Studies mcscourses.co.uk Q SC Physiotherapy and Complementary Therapies Ltd batts81@aol.com SC Sally Kay reflexologylymphdrainage.co.uk SC Seren Natural Fertility serennaturalfertility.co.uk NEW SC Swansea Valley Remedial Massage Clinic massagepontardawe.co.uk Q SC TEACH Therapy teachtherapy.co.uk Q The School of Naturopathic Nutrition lovenaturopathy.co.uk SC

SOUTH WEST Advanced Massage School handsonclinic.co.uk NEW SC Amethyst Trust amethysttrust.co.uk Q Barnes School of Sports Therapy barnesclinic-school.com Q SC Cheltenham School of Complementary Therapy & Beauty thetherapyschool.co.uk SC Complementary Therapy College complementarytherapycollege.co.uk Q SC Core Elements coreelements.uk.com/courses SC Cornish Wellessence Training – CWT cornishwellessence.co.uk SC Cotswold Academy of Health and Beauty cotswoldacademy.co.uk SC Devon Academy of Complementary Therapies devonacademy.co.uk Q Devon School of Massage and Bodywork lhbodywork.co.uk SC II Intuitive Ltd 2intuitive.co.uk SC

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LEARNING FHT accredited short course(s)

SC JemmaCo Limited jemmaco.com/training SC LMC Training massagefordementia.co.uk SC Paula Ryland: School of Holistic Therapies paularyland.co.uk SC Sue Chinn Holistic Training Academy suechinn@btinternet.com Q Sunshine Hair & Beauty Training Academy sunshinehairandbeauty.co.uk SC Susan Quayle Complementary Healthcare kidsreflex.co.uk SC The Good Hand Holistic Therapy Instruction thegoodhand.co.uk SC The Seed Institute theseedinstitute.co.uk SC Touchline Training Ltd touchlinetraining.co.uk SC Tranquillity Zone Training tranquillityzonetraining.co.uk Q University of St Mark & St John marjon.ac.uk SC Weston Hospicecare westonhospicecare.org.uk SC With Intention Healing withintention.co.uk

SOUTH EAST Academy of Advanced Beauty academyofadvancedbeauty.com SC Accredited Massage Courses Ltd accreditedmassagecourses.co.uk SC Aneid UK Ltd aneid.com SC Ayurveda Institute of Europe ayurvedainstitute.org Q SC Ayurveda Pura Academy ayurvedapura.com Q SC Brighton Holistics brightonholistics.co.uk SC Brighton School of Massage brightonschoolofmassage.co.uk SC Calming Influences Ltd calminginfluences.com Q Centre for Nutrition Education and Lifestyle Management cnelm.co.uk Q Cherubs Training Academy – Hampshire cherubsbabyhealth.com SC College of Classical Massage Ltd collegeofclassicalmassage.com SC Corpus et Animus Holistic Therapies corpustherapies.co.uk Q Crimson Catz crimsoncatz.com Q SC Elemi Training elemitraining.co.uk SC Freedom Therapies Training freedomtherapies.co.uk SC Functional Reflex Therapy functionalreflextherapy.co.uk NEW SC Hatton Kalinowska jointpractice.co.uk SC

SC Hawaiian Massage UK Training Centre huna-massage.com Q HypnoTC: The Hypnotherapy Training Company hypnotc.com SC Innamincka Training Services itsperou@depinaperou.plus.com SC Jane Sheehan footreading.com Q Jivita Ayurveda Ltd jivitaayurveda.com Q JB Training Academy – Bedford jbtrainingacademy.co.uk SC Key Workshops keyworkshops.co.uk SC Kneads Must/Kneader Massage (KOM) kneadsmust.com SC London College of Massage/Massageworks londoncollegeofmassage.co.uk Q London Institute of Thai Yoga Massage learntomassage.co.uk SC London School of Complementary Health Ltd lsch.co.uk Q Lucis College Ltd lucisgroup.com Q SC Mary Atkinson Holistic Therapy Courses maryatkinson.org.uk SC Neal’s Yard Remedies School of Natural Medicine nealsyardremedies.com Q Peter Symonds Adult and Higher Education College psc.ac.uk SC Purple Turtle Academy ptmassagetherapycourses.com SC Reflexmaster reflexmaster.co.uk Reflexology UK Ltd reflexologyuk.org SC RJ Buckle Associates rjbuckle.com Q SC Shared Beauty Secrets sharedbeautysecrets.com SC School of Natural Therapies schoolofnaturaltherapies.co.uk Q Shen Mantra shenmantra.com SC St Mary’s University College smuc.ac.uk/shortcourses SC Story Massage storymassage.co.uk SC The Holistic Academy holistic-academy.co.uk SC The School of Abdominal Sacral Massage abdominal-sacralmassage.com SC Total Release Experience (TRE UK®) treuk.com SC TouchPro UK touchpro.co.uk SC Training4Healthcare training4healthcare.co.uk

SC Vulsini Ltd vulsini.com SC Wavestone Therapies Ltd thewavestone.co.uk SC Ziggie Bergman with the London School of Reflexology zonefacelift.com

NATIONAL SC Essential Training Solutions Ltd essential-training.co.uk SC Fertility Massage fertilitymassage.co.uk Q SC Gateway Workshops gatewayworkshops.com Q Health Kinesiology UK hk-uk.co.uk SC Jennifer Young and Beauty Despite Cancer beautydespitecancer.co.uk SC Jenny Cox thebalanceprocedure.com Q SC London School of Massage londonschoolofmassage.co.uk Q Mind International Training Associates bodymindworkers.com Q Stonebridge Associated Colleges stonebridge.uk.com Q The College of Bowen Studies thebowentechnique.com SC The Chrysalis Effect thechrysaliseffect.com Q

INTERNATIONAL Akademi Ayu Jelita SDN BHD joanphang@yahoo.com Q ASET School for Holistic Therapies juleswiltshire@outlook.com Q Beaubelle Academy of Cosmetology and Management beaubelle.com Q Cosmo Kemp School of Thai Yoga Massage cosmothaiyoga.com Q Health Coach Institute, LLC healthcoachinstitute.com SC Holistic Therapy Practice holistictherapypractice.com Q SC Jari Jari Spa jarijari.com.my SC Liddle Kidz Foundation liddlekidz.com SC PureAroma Healing Academy purearoma.com.tw SC RAPID Adhesion Release Technique rapidadhesionrelease.com Q Rinalda Therapeutic Kneads wix.com/rinalda/rinalda SC Rustic Nirvana PTE Ltd rusticnirvana.com SC The Arvigo® Institute LLC arvigotherapy.com Q SC The Institute of Aromatherapy aromashoppe.com SC

MORE INFO Please visit fht.org.uk/accreditation for more information about FHT accredited qualifications and short courses.

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INDUSTRY NEWS

Revenue opportunities with Fit Pit natural deodorant UK brand Fit Pit, creator of the Fit Pit natural deodorant, is offering small minimum orders at wholesale prices to therapists looking to establish additional revenue streams with their clients. This is a fantastic opportunity for therapists to expand their offering further and promote natural and safe alternatives while improving revenue. Fit Pit natural deodorant is 100% organic, vegan and plastic-free. Containing all-natural ingredients, it’s also free from aluminium, parabens and BPA, and is safe for use during pregnancy. thegreenwoman.co.uk

New porcelain Penny Price Aromatherapy diffuser from celebrates 15th year in business Sanatio Naturalis

World’s most eco-friendly glitter is here A new plant-based glitter created by a UK company is the most eco-friendly in the world. OWS, an independent biodegradability testing organisation, confirmed that Bioglitter® degrades in the natural environment in just four weeks. During tests, a competitor glitter made from polylactic acid showed no signs of degradation in the same time period. Bioglitter® replaces plastics with a form of cellulose that is stable and doesn’t degrade on the shelf. But once it enters soil, compost or waste water, it naturally decomposes. discoverbioglitter.com

Elemis supports Breast Cancer Care Elemis has supported Breast Cancer Care for an 18th consecutive year by releasing a limited-edition Pro-Collagen Rose Cleansing Balm and donating £25,000. The brand has produced the super-nourishing pink product every year as a reminder that checking breasts should be as regular as applying daily moisturiser. Elemis co-founder Oriele Frank (pictured above, left) says: ‘We choose charities that we feel really make a difference in people’s wellbeing, and strongly support the organisation in its efforts to reduce barriers to breast cancer awareness.’ elemis.com

PICTURES: BIOGLITTER; ELEMIS; FIT PIT; PENNY PRICE AROMATHERAPY; SANATIO NATURALIS

The new Porcelain Ultrasonic Diffuser from Sanatio Naturalis is inspired by nature, and brings purity, elegance and relaxation to any environment. Simply add your favourite essential oils each day. The ultrasonic technology produces a fine, pure and cool fragrant mist, so clients can enjoy aromatherapy oils any time. Designed to gently emit Sanatio Naturalis’ therapeutic-quality essential oils, the diffuser is ideal for scenting small spaces, including receptions, salons, spas and offices. Trade prices are available if purchasing more than two products – simply email for details. sanationaturalis.com

Penny Price Aromatherapy has this year celebrated its 15th anniversary, a landmark made even more special by a number of award wins. The FHT accredited course provider won Small Business of the Year 2018 at the East Midlands Chamber Enterprising Women Awards, while general manager Ellie Dunmore was a finalist in the Business Woman of the Year category. In addition, Penny Price Aromatherapy won an award of excellence from Living in the Shires magazine for pure essential oil products of the year. penny-price.com

NB: The information featured on the Industry news page is based on information supplied by the training providers and product manufacturers featured. Please always check with the FHT that courses will be covered for membership and insurance purposes before booking.

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To check whether a training course will be accepted by the FHT, please contact our membership and insurance team before you book your place. Prerequisites may apply. Contact the FHT team on: T. 023 8062 4350 E. info@fht.org.uk

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Lymphatic Pressure Therapy New and unique, this advanced training offers maximum bene¿cial aftercare for breast cancer clients. Encouraging ¿ve elements of recovery for range of motion to restore muscle connection for mobility and balance, whilst stimulating lymphatic return for an overall post-operative improvement. For caring, empathetic therapists con¿dent in their own ability to provide excellent standards of UKLC aftercare!

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Thai Yoga Massage is a unique & powerful therapy combining acupressure, gentle stretching and applied yoga. Hands on training in this beautiful, ancient art under the guidance of an experienced teacher at a purpose built studio in tranquil rural Worcestershire. Suitable for complete beginners to health care professionals looking to widen their expertise and an introduction for those interested in attending the TYMT Diploma Course. Diploma Course is accredited by the Federation of Holistic Therapists, and earns 10 CPD. For more information contact Barbara on 07990 501498 mail@paadena.co.uk www.paadena.co.uk

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CLASSIFIED

GENERAL CLASSIFIED USED THERAPY ITEMS FOR SALE 60+ hot stone massage set and heater. Including cold stones. Used twice. £50 ONO. Buyer collects. Queens Park, London. T. 07721 510946 Darley massage couch. Professional quality. Adjustable height. 2’ x 6’. Plus face cradle. Green/blue. Wipe clean. With carry case. Wheeled. T. 07929 445130 Fold up Master massage table. Chicago by Costco. £40. Buyer collects. Bromsgrove. T. 07508 864377 E. stevelately@yahoo.co.uk

TREATMENT ROOMS AVAILABLE Fabulous treatment room available in newly built therapy centre. Chesterfield, Derbyshire. With full amenities and electric couch. T. 07816 326868 E. info@ theperfectbalancecompany. co.uk Ground floor treatment rooms with electric/hydraulic couches available. Suitable for most therapists. Presteigne, Powys. T.07876 796885 E. pnhc2014@gmail.com

JOBS WANTED

Massage couch cotton face ring covers. 95. Washable. Cost £18. Selling at £8 for the lot. T. 07713 733422 New Concept treatment couch. 28” width. Height range 27-32”. Aluminium. Face hole. Weight 14.5kg. £100 ono. Buyer collects. Cambridgeshire. T. 07999 718967

SITUATIONS VACANT Volunteer therapists needed for busy clinical renal units around the North West. Salford, Wigan, Bolton, Oldham and Rochdale. E. janet.cairnie@srft. nhs.uk T. 0161 206 4812

Complementary therapist (Indian head, body massage and reflexology) and yoga teacher, based in Belfast. Seeking local vacancies. T. 07890 087678 FHT, its Directors and staff accept no responsibility for the accuracy of any description within the classified section and members should ensure they are satisfied with goods and services offered/ advertised before accepting/ purchasing.

FHT DISCLAIMER: Please note that the inclusion of a product or training advert in International Therapist does not mean the FHT endorses that product or training, or that it will be automatically recognised for membership and/ or insurance purposes by the FHT.

Apologies and corrections Laws of motion (issue 125, p39) In the ‘Laws of motion’ article on manual therapy that appeared in the Summer issue, we included the letters ‘MSc’ after the author’s name. However, the letters should have read ‘BSc PGC’. Our sincere apologies to the author and our readers for this error.

MEMBERS CAN ADVERTISE IN INTERNATIONAL THERAPIST FOR FREE !

COMPETITION, SPIRAL AND PRIZE DRAW WINNERS INTERNATIONAL THERAPIST, ISSUE 125

FHT Business Pack competition (p49) Christine Dzumaga, MFHT Vikki Moore, MFHT Ann Wyatt, MFHT Spiral £20 Amazon Gift Card and a copy of Born to Walk by James Earls (p51) Corenza Roele, MFHT

BEFORE EMBARKING ON ANY PAID OR VOLUNTARY WORK OPPORTUNITY, WE STRONGLY ADVISE MEMBERS TO ENSURE THEY HAVE APPROPRIATE TRAINING, PREREQUISITES AND INSURANCE COVER (WITH THE FHT OR AN ALTERNATIVE PROVIDER) TO CARRY OUT THIS WORK.

Write your advert here:

Name: .......................................................... Membership no:........................................... Tel no: ..........................................................

Classification (please tick): † Situations Vacant † Job Wanted † Used Therapy Items for Sale † Treatment Rooms Available † Treatment Rooms Wanted † Therapy Items Wanted

Deadine date for Winter issue: 3 January 2019 Please post to: IT Free Ads, FHT, 18 Shakespeare Busines Centre, Hathway Close, Eastleigh, Hampshire SO50 4SR Alternatively email full details to classified@fht.org.uk or see online at fht.org.uk/classifieds

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Please note that members are entitled to one free lineage ad, per issue. We regret that FHT/International Therapist no longer publish lineage ads of a commercial nature free of charge. All adverts that do not meet the free ad classifications criteria and/or word count are charged at 90p per word (nonmembers £1.50) plus VAT.

Please use capital letters and one word per box only, including a contact number

Please contact Annabel Boorman-Shiffer on 020 7880 6230 or email: annabel.boorman-shiffer@redactive.co.uk

AUTUMN 2018 INTERNATIONAL THERAPIST

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27/09/2018 12:06


ON THE COUCH

Running things WE TALK TO KEEN RUNNER AND NEW FHT PRESIDENT CHRISTOPHER BYRNE

Q

TELL US A BIT ABOUT YOUR BACKGROUND…

I started work as a Rolls-Royce and Bentley apprentice in 1986. I lived close to the factory in Crewe, where engineering was the main focus for jobs; Rolls-Royce and British Rail both had headquarters in the town. I went through engineering, gaining an honours degree along the way, and then progressed to area manager, looking after a 20-car dealership in the Midlands. I’ve always had a passion for contact sports and running, so a friend suggested going along to a short course on muscle testing. I was hooked from that point and slowly planned my escape from engineering, completing around a dozen short therapy courses before taking the plunge with an acupuncture degree.

Q

WHAT MAKES A GOOD THERAPIST?

The ability to listen and empathise with the client. Being open to change and continuing to learn are also key, otherwise you can get left behind.

TELL US ABOUT YOUR CLINICAL EXPERIENCE AT HEPINGLI HOSPITAL AND THE BEIJING ACADEMY…

Q

I had the chance to spend time with doctors, treating regular patients. I was involved in day-to-day acupuncture treatments for typical conditions, such as back pain, as well as more specialised complaints. It’s an experience that can’t help but change you. The Chinese approach to health is much more holistic than the standard

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western approach. The traditional Chinese medicine philosophy has always been about keeping well, as opposed to fixing a problem.

YOU RECENTLY COMPLETED THE MARATHON DES SABLES. TELL US ABOUT IT…

Q

The Marathon des Sables is known as the ‘highway to hell’. It’s six marathons in five days, through the middle of the Sahara desert. It’s self-supported, which means you are carrying all your food, clothes and equipment for the whole event. One of the days is 56 miles long. It’s billed as the toughest foot

race on earth by National Geographic, and truly lives up to that tag. Three phrases to describe it are awesome, inspiring and lifechanging. I pulled a quad muscle badly on the last day and had to limp for 15 miles to complete the event.

WHAT ATTRACTED YOU TO THE ROLE OF FHT PRESIDENT?

Q

I had been an FHT Fellow for many years when, two years ago, I accepted the opportunity to sit on the Governing Council, representing acupuncture. The FHT is a fantastic organisation, there to support therapists just like you and me. I saw it as my time to give something back. The Governing Council is the team that helps shape the future of the organisation. As President, I am there as a focal point and voice for the organisation and members.

WHAT ARE SOME OF YOUR KEY OBJE OBJECTIVES AS THE FHT’S PRESIDE PRESIDENT?

Q

Expanding our training trai course proposition. The current c pressures on the NHS, and social care ca concerns with our ageing population are not going to slow down. We see the demand d in personal treatment choice g growing as people become more awar aware of the different treatment options available. We need to prepare our memb members for this – it truly is a great time to be in complementary, sports and beauty therapy. therapy

Q

WHAT IS THE T BEST ADVICE YOU HAVE BEEN GIVEN?

If you really want to do something, you will find a way. If yo you don’t, you will find an excuse.

Q

WHAT ARE A YOUR PLANS FOR THE TH FUTURE?

Professionally, I will be expanding the course offering off that my training academy has on offer over the next year. I a also want to get fully established quickly in the new President’s role at FHT, which will require mo more time at head office. Personal Personally, I’m booked for at least two more m marathons before the year’s end, and possibly another big run event ffor early next year.

Byrne, FFHT, MSc, Christopher B is the President of the FHT and a complementary therapist, qualified in a wide range of therapies including Swedish massage and sports massage, S Christopher also runs FHT acupuncture. Chri accredited training trainin at the Master Academy.

FHT.ORG.UK

08/10/2018 12:27


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