Rhythmical massage I Dyspnea I Palliative care

Dyspnea is one of the most common complaints of palliative care patients. It often causes anxiety or even panic (fear of death), which in turn intensifies the shortness of breath. Dyspnea is associated with degenerative metabolic processes. Patients often feel weakened, especially in chronic dyspnea, so that they experience exhaustion as an expression of reduced vitality. The approach in rhythmical massage therapy is not to solely treat pathophysiological causes, we also incorporate consideration of how the affected person feels (1, 2), aim to strengthen their life organization (3) and work with the involvement of the patient’s relatives and friends.

Basic elements of treatment

For general stress reduction and for deepening the patient’s breathing:

  • Reduce muscle tone in the upper abdominal region
    Possibly pre-treat the feet, then begin with an introductory treatment of the abdominal and thoracic region. The treatment is slightly above and below the rib arch, with large, loosening, wringing motions that gradually become smaller and more intensive.

To deepen the patient’s breathing, use:

  • Breathing thigh wringing
    Breath-deepening thigh wringing is recommended after the abdominal treatment. This technique can also provide relief without the introductory treatment.

To improve ventilation and reduce tension in the area of the respiratory auxiliary muscles:

  • Shoulder treatment
    You can improve ventilation with sucking and widening gestures. From there you can expand the treatment to include the lateral neck, shoulder and chest area to release tension in the area of the upper respiratory auxiliary musculature.

To relieve pain and tension in the thorax area:

  • Efferent upper arm massages and a back massage
    complete the treatment, whereby all manipulations should be warm, deep and have a sucking character.

To convey calm and relaxation:

  • Large strokes of the sympathetic nervous system
    This strongly dissipative gesture over the entire front of the upper body has a relieving and calming effect. It is done after sufficient pre-treatment. If necessary, the exhalation phase can be emphasized.

For general support of respiratory function:

  • The entire thorax is worked through at the front and back,
    using exhaling strokes, possibly with vibration on both sides, from back top to front bottom, whereby the lower part of the thorax should also be slightly compressed during the exhalation phase to support exhalation.

For general support of the cardiovascular system:
include carefully executed, strongly impulsive-giving

  • calf manipulations, possibly also foot manipulations,
    in the treatment. Even during a seizure, these manipulations alone can bring relief.

Supplementary massages

These exemplary basic elements can be augmented with integrated calf massages, and also entire leg massages for drainage into the periphery. If the patient reacts positively, the hip area, including the area of the sacrum, can also be treated with deep kneading, including whole abdominal massages, with special elaboration of deep wringing and treatment of the quadratus lumborum muscle.

Suitable substances may be:

  • for hardening and condensing tendencies: Peat oil with formica WANDIL (available as Torföl mit Formica D3)
  • to support the lungs: Peat oil with Iceland moss and thyme WANDIL (available as Torföl mit Isländisch Moos und Thymian)
  • for cardiac dyspnea: Hawthorn or gold, e.g., Gold massage oil LICHTERDE (available as Gold Massage-Öl)

Also suitable are:

  • Copper lavender massage oil LICHTERDE (available as Kupfer-Lavendel Massage-Öl)
  • in the morning Rosmary oil, e.g., Rosmarinus, Oleum aethereum 10% WALA
  • as a warming application Ginger oil, e.g., Ingwer Massage-Öl LICHTERDE

Treatment options for lymphedema

All treatments must be carried out gently and not flowing, but more locally, with a sucking quality.
To decongest the thorax area:

  • Efferent treatment of the back
    with a technique that stimulates the sculpting forces of the etheric body.

Suitable substances may be:

  • Peat oil with Angelica archangelica WANDIL (available as Torföl mit Archangelika) for lymph congestion, or
  • Peat oil with Iceland moss and thyme WANDIL (available as Torföl mit Isländisch Moos und Thymian) for weakness.

For revitalizing isolated areas of the body:

  • The periphery around the affected quadrants must be strongly invigorated by suction.
    The lymphatic currents are to be guided along the muscle edges and the anterior and posterior axillary folds to the buttocks. In addition to stimulating fingertip work, it is important to create a figure-eight connection between the arms and the buttocks. Consideration must always be given to any current wound status in a surgical area. The use of substances must then be adapted accordingly.

Suitable substances may be:

  • Peat oil with Angelica archangelica WANDIL (available as Torföl mit Archangelika) or
  • Peat oil with mistletoe WANDIL.

To stimulate excretion:

  • A kidney embrocation

Suitable substances may be:

  • Silver oil, e.g., Argentum Massage-Öl LICHTERDE; promoting elimination function
  • Copper oil, e.g., Kupfer Massage-Öl LICHTERDE; dissolving, warming and generally supportive, or 
  • Common nettle, e.g., Brennessel Massage-Öl LICHTERDE

To relieve pain:
Various approaches are conceivable, depending on the pain expression of the patient.

Gestures with a warming and enveloping character are generally suitable.

Suitable substances may be:

  • Solum oil WALA
  • Oxalis oil, e.g., Oxalis e planta tota W 10%, Oleum WALA
  • Aconite oil, e.g., Aconitum e tubere W 5%, Oleum WALA
  • Lavender oil, e.g., Lavender 10% oil WELEDA
  • Arnica oil, e.g. Arnica, Flos H 10% WELEDA
  • Rosemary oil, Rosmarinus, Oleum aethereum 10% WALA
  • Melissa oil, e.g., Melissa ex herba W 5%, Oleum WALA etc.

Treatment options for dyspnea and anxiety:

When anxiety is accompanied by muscular neck tension, a

  • neck diversion
    is performed on the seated patient. There is an independent and comprehensive treatment scheme behind this form of “diversion”, which has to be adapted to the individual circumstances. After pre-treatment, intensive drainage (“asthma grip”) can make a great contribution to relieving the patient.

Suitable substances may be:

  • Aconite pain oil WALA
  • Solum oil WALA antispasmodic 
    (Composition: Aesculus hippocastanum e semine, Equisetum arvense ex herba, Lavandulae aetheroleum, Solum uliginosum) or
  • Peat oil with St. John’s wort blossom and amber WANDIL (available as Torföl mit Johanniskrautblüte und Bernstein WANDIL , mood-lifting, or
  • Peat oil with Iceland moss and thyme WANDIL (available as Torföl mit Isländisch Moos und Thymian), for a weak constitution

For anxiety with abdominal symptoms:

  • Solar plexus treatment
    This is performed above the solar plexus and leads to the release of tension in the diaphragm, stomach and intestines.

Suitable substances may be:

  • Gold-rose-lavender massage oil LICHTERDE (available as Gold-Rose-Lavendel Massage-Öl)
  • Peat oil with wood sorrel WANDIL (available as Torföl mit Sauerklee).

Notes on treatment with rhythmical massage therapy

If the patient’s condition is so weakened that his body no longer seems to react adequately to a therapeutic treatment with rhythmical massage (“therapy crisis”), then it can prove particularly useful to administer gently enveloping treatments Rhythmical Einreibung treatments.

Once the patient’s condition has stabilized again, rhythmical massage therapy with its various grip qualities should soon be used. Additional compresses are always helpful and support the effect of the treatment.

The subjective feeling of the affected person is the decisive factor for the therapist. The duration of treatment also depends on this and can vary greatly, from a few minutes for a Rhythmical Einreibung treatment, to sessions of 15–20 minutes for rhythmical massage therapy.

Post-treatment rest after therapy is just as important as the treatment itself and must be included in the overall duration. The ratio between rest and massage time should be at least 1:1.

1 Deutsche Gesellschaft für Palliativmedizin. Leitlinien der DGP Sektion Pflege: Atemnot in der letzten Lebensphase. Available at: https://www.dgpalliativmedizin.de/images/stories/pdf/Leitlinie_Atemnot_end.pdf (27.09.2018)

2 Graf G. Dyspnoe. In: Knipping C (ed.) Lehrbuch Palliative Care. 2nd, reviewed and corrected ed. Bern: Verlag Hans Huber; 2007, p. 325.

3 Weidtke A. Rhythmische Massage nach Ita Wegman in der Onkologie. Der Merkurstab 2009;62(4):344–351.