COMBINING MEDICINAL HERBS WITH MASSAGE THERAPY:CHRONIC INFLAMMATION MANAGEMENT
In our work as bodyworkers we mostly use the tools that Mother nature gave us, being these our hands, forearms, elbows and even our knees. And ultimately, our goal is to empower the individuals who seek us by supporting them to take good care of themselves, so they won’t need to rely on us to feel better. So, as dedicated soft tissue specialists, it could be said that part of our mission is to acquire fresh knowledge and develop new skills to increase the quality of the treatment that we offer.
As a qualified herbal medicine practitioner and bodyworker, I have witnessed how herbs and herbal extracts can work synergistically with intentioned touch to support the client in achieving a deeper state of well-being. This article aims to provide tips on how to integrate medicinal herbs into the massage practice and will specifically focus on managing inflammation.
MUSCULOSKELETAL INFLAMMATORY CONDITIONS AND THE BODYWORKER PERSPECTIVE
Swelling, redness, heat and tenderness are the notorious four for diagnosing an inflammation. Inflammation is like stress: if occurs for a short period and with the right timing is immensely beneficial, but when it lingers for too long it can be severely detrimental (1). When signs and symptoms of inflammation show up and remain for a long time in one or more joint, the suspect is usually arthritis, being this osteo, rheumatoid or psoriatic depending on the presentation; if such symptoms are experienced around soft tissues such as muscle attachments and bursae, they can be referred as Soft Tissue Rheumatisms (STR).The most common STR are subacromial bursitis, epicondylitis, trochanteric bursitis, anserine bursitis, and fibromyalgia, which are medically treated with painkillers and non-steroidal anti-inflammatory drugs (NSAIDs) (2). From the bodyworker perspective, the help that we can offer in chronic (but also acute) inflammatory conditions include manual lymphatic drainage, gentle mobilisation and the correction of musculoskeletal imbalances that might have resulted. We might as well terminate our session by suggesting to our client some stretching or strengthening exercises in combination with rest or other lifestyle adaptations.
THE ROLE OF HERBS IN REGULATING INFLAMMATION
Medicinal herbs contain compounds termed bioactive phytochemicals which, when absorbed, positively interact with the physiological processes of the body. Usually, most herbs have few main compounds that are accountable for their properties; nevertheless, they may have dozens to hundreds of less bioactive phytochemicals that work in a synergistic fashion to increase bioavailability, enhance potency or minimise toxicity of the most bioactive compounds (3). That is why often herbs have little to no side effects, while unfortunately there is plenty of evidence that the most commonly prescribed NSAIDs can have detrimental consequences on the digestive system (4) and even impair the growth of articular cartilage (5). In regard to inflammation, herbs work by directly inhibiting inflammatory factors, by promoting lymphatic flow or by supporting the body’s excretory channels in removing pro-inflammatory agents. To target an inflammatory condition, herbalists would probably prescribe a blend of herbs which have all the three aforementioned properties.
POPULAR ANTI-INFLAMMATORY HERBS
TURMERIC RHIZOME (Curcuma longa radix)
Turmeric has gained such an outstanding popularity in recent times to the point that the Western market has put this yellow rhizome in the hall of fame of the cure-all herbs. In specific to inflammation, the medical literature mostly focussed in studying its yellow pigments, called curcuminoids. Curcuminoids have shown to be potent anti-inflammatory in vitro, in animal studies and in human trials (6); their mechanism of action involves the inhibition of several cytokines and enzymes which exert a pro-inflammatory action.
How to take it: The most common and easy way to have turmeric is through food. Turmeric can be easily found on the shelves of the local supermarket in both fresh and powdered forms. Using turmeric in combination with black pepper to enhance its absorption in recipes such as golden milk, Indian curries and Summer juices is a great way to keep chronic inflammation under control in the long run but won’t probably be enough to exert a noticeable change in short times. The website Examine.com shows that standardised turmeric extracts with high curcuminoids (esp. curcumin) concentration works faster and more efficiently than turmeric by itself (7). The bottom-line therefore is to take turmeric regularly in combination with black pepper for prevention and long term inflammation management and to take a high curcumin concentration supplement (500-1000mg and still in combination with black pepper) for fast-acting relief.
FRANKINCENSE RESIN (Boswellia serrata)
The medicinal use of frankincense resin for rheumatic and arthritic conditions is described in Ayurvedic (traditional Indian medicine) manuals dated 700BC. These properties are now more consolidated by studies showing how a potent anti-inflammatory frankincense resin is. The most active family of compounds identified in frankincense are called boswellic acids and they have shown to be strong inhibitors of pro-inflammatory enzymes like 5-lipoxygenase and COX-2 (8). There are few studies on frankincense relevant for us bodyworkers: a study from 2007 evaluated the efficacy of frankincense for knee OA in a dosage of 333mg a day; it resulted that most participants started experiencing a significant decrease in inflammation symptoms just after 2 months (9). The remarkable finding from this study is that the anti-inflammatory effects persisted for a month after the administration of frankincense was over. A review from 2017 on the anti-inflammatory properties of boswellic acids showed a remarkable improvement of tendinopathies, arthritis, ankle sprains and sports injuries in several clinical studies just after a month of oral administration in combination with rehabilitation and bodywork (10). Frankincense is therefore a safe, reasonably fast acting anti-inflammatory for joint and tendons medical conditions,.
How to take it: Tablets. They can be found easily at the local health food shop or online. Although a standard dosage has not been established, it could be suggested to simply follow the manufacturer instructions.
DEVIL’S CLAW (Harpagophytum procumbens)
Devil’s claw is native to the Kalahari Desert in African continent and its name comes from the peculiar shape of its hooked fruits. In herbal medicine, the root is the part used to treat rheumatic conditions of the musculoskeletal system, as it contains a high concentration of its main bioactive compounds, rightly called harpagosides and procumbides.
One of the most in-depth review on devil’s claw has been published by McGregor et al. in 2005 who collected evidence on the inhibitory action harpagosides and procumbides on inflammation mediators such as TNF and thromboxane. The review and concludes stating that daily supplements of devil’s claw can be a promising side-effects-free long-term treatment for managing arthritis and rheumatisms (11).
How to take it: As for frankincense, devil’s claw root extract can be easily found in tablets form on the internet or at local health food stores. It is suggested to take 1000mg of powdered root up to three times a day (12) It can also be taken as a tincture (alcoholic extract) probably available at your local herb shop.
CELERY SEEDS (Apium graveolens fruct)
Celery seeds have been used traditionally since the middle ages as a remedy for rheumatisms, gout and water retention. Celery seed extract is not a strong inflammatory per se’, but it is a diuretic and detoxifier, promoting the removal of uric acid and other toxic by-products from joints and soft tissues (13) Because of these cleansing properties, celery seeds are a wonderful remedy to combine with traditional anti-inflammatory herbs. They can be suggested to those clients suffering from arthritis, tendonitis or gout with fluid retention characterised by swollen/ ‘boggy’ at touch tissues.
How to take it: Celery seeds can be sourced in any large supermarket or in shops specialised in spices and culinary herbs. The best way to take them is through a strong water extract (decocotion). To make a decoction it is only necessary to boil a teaspoon of crushed seeds and leave them to simmer for 10 minutes before straining and drinking.
BURDOCK ROOT (Arctium lappa)
Burdock has been listed in Western Herbal Medicine and Traditional Chinese Medicine pharmacopoeia for millennia and is classified as a tissue depurative and a blood tonic. It is indeed one of the remedies of choice when a client presents symptoms of toxic build-up and chronic inflammation. Differently from other remedies, it is not clear which pharmacologically active compounds burdock manufactures, but from a nutritional point of view it is like a chemical minestrone: it has a little bit of everything. Vitamins, minerals, bitter compounds, prebiotics and many more (14). What we can be sure of is that burdock works very well in clearing toxic pro-inflammatory compounds out of the tissues. One study on 36 patients with diagnoses knee osteoarthritis showed that consuming burdock root tea for 6 weeks significantly reduced inflammatory markers and remarkably increased endogenous antioxidants (15). So, from the herbalist perspective, the client-type who will benefit from taking burdock will present soft tissue inflammation/ arthritis alongside severe acne and fluid retention.
How to take it: Ideally as a tincture or tablets. Available at most herb and health food shop.
Discovering new and effective ways to empower our clients in getting better can be considered part of our homework as bodyworkers. As we deal with more complex cases like chronic inflammatory conditions, having some extra arrows in our quiver. The purpose of this article then is to shape some of these arrows into well-researched herbal remedies that will provide our clients with the opportunity to climb one step further on the stairway of health.
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2. Reveille, John D. “Soft-Tissue Rheumatism: Diagnosis and Treatment.” The American Journal of Medicine, vol. 102, no. 1, Jan. 1997, pp. 23S-29S, 10.1016/s0002-9343(97)00413-0. Accessed 24 Aug. 2020.
3. Zhang, Lijuan, et al. “Synergistic Anti-Inflammatory Effects and Mechanisms of Combined Phytochemicals.” The Journal of Nutritional Biochemistry, vol. 69, July 2019, pp. 19–30, 10.1016/j.jnutbio.2019.03.009. Accessed 24 Aug. 2020.
4. Scheiman, James M. “NSAIDS, GASTROINTESTINAL INJURY, AND CYTOPROTECTION.” Gastroenterology Clinics of North America, vol. 25, no. 2, June 1996, pp. 279–298, 10.1016/s0889-8553(05)70247-8. Accessed 27 Dec. 2019.
5. Brandt, Kenneth D., and Marshall J. Palmoski. “Effects of Salicylates and Other Nonsteroidal Anti-Inflammatory Drugs on Articular Cartilage.” The American Journal of Medicine, vol. 77, no. 1, July 1984, pp. 65–69, 10.1016/s0002-9343(84)80021-2. Accessed 26 Aug. 2020.
6. Chainani-Wu, Nita. “Safety and Anti-Inflammatory Activity of Curcumin: A Component of Tumeric (Curcuma Longa).” The Journal of Alternative and Complementary Medicine, vol. 9, no. 1, Feb. 2003, pp. 161–168, 10.1089/107555303321223035. Accessed 20 June 2019.
7. Patel, Kamal. “Curcumin UPDATE for 2019: Benefits, Dosage, Side Effects.” Examine.Com, Examine.com, 5 Feb. 2015, examine.com/supplements/curcumin/. Accessed 1 Mar. 2019.
8. Siddiqui, MZ. “Boswellia Serrata, A Potential Antiinflammatory Agent: An Overview.” Indian J Pharm Sci, vol. 73, no. 3, 2011, pp. 255–261.
9. Thawani, V, et al. “Open, Randomized, Controlled Clinical Trial of Boswellia Serrata Extract as Compared to Valdecoxib in Osteoarthritis of Knee.” Indian Journal of Pharmacology, vol. 39, no. 1, 2007, p. 27, 10.4103/0253-7613.30759. Accessed 17 Mar. 2020.
10. Riva, A , et al. “A Novel Boswellic Acids Delivery Form (Casperome®) in the Management of Musculoskeletal Disorders: A Review.” European Review for Medical and Pharmacological Sciences, vol. 21, 2017, pp. 5258–5263.
11. McGregor, Gerard, et al. “Devil’s Claw (Harpagophytum Procumbens): An Anti-Inflammatory Herb with Therapeutic Potential.” Phytochemistry Reviews, vol. 4, no. 1, Jan. 2005, pp. 47–53, 10.1007/s11101-004-2374-8. Accessed 2 Sept. 2019.
12. Bartram, Thomas. Encyclopaedia of Herbal Medicine. first ed., Dorset, Grace Publishers, 2007.
13. Fazal, Syed Sufiyan. “Review on the Pharmacognostical & Pharmacological Characterization of Apium Graveolens Linn.” Indo Global Journal of Pharmaceutical Sciences, vol. 2, no. 1, 2012, pp. 36–42.
14. Light, Marylin. “Chemical Constituent of Burdock.” Www.Herballegacy.Com, 2020, www.herballegacy.com/Light_Chemical.html#:~:text=Chemical%20Constituent%20of%20Burdock&text=
15. Maghsoumi-Norouzabad, Leila, et al. “Effects OfArctium LappaL. (Burdock) Root Tea on Inflammatory Status and Oxidative Stress in Patients with Knee Osteoarthritis.” International Journal of Rheumatic Diseases, vol. 19, no. 3, 28 Oct. 2014, pp. 255–261, 10.1111/1756-185x.12477. Accessed 29 June 2020.