Complementary Approaches for Elder Comfort

(GER 233)
Lecture 3
Quiz is next week
Fri Sept 29 in class

Discussion Post #1 is due in 3 weeks

Fri Oct 13 by 11:59pm EST on LMS
 Content Test
Do NOT enter the classroom until 1:30pm

Leave belongings (except pencils, erasers,

clear water bottles, and student ID at back
of classroom)

Sit where YOUR test is placed.

No children/babies allowed in the

classroom during the test.
 Content Test …cont’d

NO TALKING TO OTHER STUDENTS DURING

THE TEST (students that talk will fail the test
on the spot).

NO CELL PHONES OR SMART WATCHES AT

THE DESK DURING THE TEST (students that
have cell phones or smart watches will fail
the test on the spot).
 Lecture Topics
Therapeutic touch
Myofascial release
Pilates
Energy Therapy
 Energy Therapy
Energy therapy: a type of
complementary and alternative
medicine based on the premise that a
vital energy exists in and around the
human body.

The goal of energy therapy is to

balance the energy flow in the patient
by channeling and manipulating
energy.
Energy Therapy …cont’d

Examples of energy therapies:

• Reiki
• QiGong
• Acupuncture
• Dry Needling
• Therapeutic Touch
Therapeutic Touch
 Therapeutic Touch – What is It?

Therapeutic touch: a type of

complementary and alternative
medicine based on the premise that
vital energy exists in and around the
human body and that a practitioner
can repattern a patient’s energy
field to enhance the patient’s own
ability to heal.
Therapeutic Touch – What is It? …cont’d
Therapeutic touch may be done with or
without physical contact between the
practitioner and the patient.

Often, the practitioner’s hands hover

over the patient’s body.

If the practitioner touches the patient, it

is a light touch on the patient’s
shoulders, arms, and legs.
 Therapeutic Touch – What is It? …cont’d

Based on the theory that mind,

body, and emotions form an
energy field.

Good health occurs when the

energy field is balanced while
illness occurs when the energy
field is unbalanced.
Therapeutic Touch – What is It? …cont’d

Used to help:
• Heal wounds
• Decrease pain
• Decrease anxiety
 Therapeutic Touch – What is It? …cont’d
The patient remains fully dressed and
may either sit or lie down during the
session.

Sessions last anywhere from 5-40min.

Patient experience varies; some

patients fall asleep while others feel a
tingling sensation in their body.
Therapeutic Touch – What is It? …cont’d

There are 3 steps to therapeutic touch:

1. Centering. The practitioner centers

him/her/their self so that his/her/their
mind, body, and emotions are in a
focused state.

…continued
 Therapeutic Touch – What is It? …cont’d

…continued

2. Assessment. The practitioner

notes any differences in the quality
of energy flow as the practitioner
moves his/her/their hands from the
head to the feet, 2-4 inches from
the patient’s body.
Therapeutic Touch – What is It? …cont’d

…continued

3. Intervention/Unruffling. The
patient’s energy field is
redistributed and rebalanced as
the practitioner moves
his/her/their hands in a gentle,
rhythmic motion.
 Therapeutic Touch – What is It? …cont’d

After the session, the patient has

a 20+ min rest period to allow
the body’s natural healing
mechanisms to respond to the
altered energy field and
continuing the healing
momentum.
 Therapeutic Touch – What is It? …cont’d

What is therapeutic touch video

https://www.youtube.com/watch?v=KkXbUvU9HuI
Therapeutic Touch – History
Developed in the 1970s by
Dolores Krieger (a professor at
New York University School of
Nursing) and Dora Kunz (a
natural healer).

Originally, these women limited

teaching therapeutic touch to
Krieger’s graduate nursing
students.
 Therapeutic Touch – History …cont’d

The treatment grew through a

grassroots effort after Krieger’s
professional research grew in
popularity.

Therapeutic touch is practiced

mostly by nurses.
Therapeutic Touch – Benefits
Therapeutic touch does not cure
disease but some healthcare
practitioners believe it helps
stimulate the body’s natural healing
process.

Therapeutic touch might:

• Speed wound healing
• Stimulate cell growth
Therapeutic
Touch –
Benefits on
Pain

Therapeutic touch might:

• Relieve tension headaches
• Reduce pain from surgery, burns, and osteoarthritis
 Therapeutic Touch – Benefits on Sleep

Therapeutic touch might

improve sleep quality.
Therapeutic Touch – Benefits on Depression

Therapeutic touch might

improve depressive attitudes
and symptoms.
 Therapeutic Touch – How Does It Work?

It is unknown if/how therapeutic

touch works. There have been
multiple theories suggested:
1. Cell communication
2. Quantum physics
3. Placebo effect
4. Relaxing nature of the therapy
 Therapeutic Touch –
Cell Communication Theory
This theory hypothesizes that disease
is caused when pain accumulates in
cells which prevents the cells from
working properly with other cells in
the body.

Therapeutic touch restores

communication between the cells;
thus, promoting healing.
 Therapeutic Touch – Quantum Physics

This theory hypothesizes that an

electromagnetic field is produced
in the body when blood
circulates.

Individuals that practice

therapeutic touch develop the
ability to see the electromagnetic
field.
 Therapeutic Touch – Placebo Effect

This theory hypothesizes that

the patient experiences a
beneficial effect that is the
result of the patient’s belief in
therapeutic touch rather than
any property of therapeutic
touch.
 Therapeutic touch is generally very safe; but
Therapeutic post-treatment, patients may feel:
Touch – • Thirsty (lasting days)
Potential • Lightheaded (lasting 15 min)
• Need to urinate
Safety • Increased pain, restless, irritableness, anxiety,
Concerns or nausea (if flooded with too much energy)
 Potential Safety Concerns …cont’d

Caution should be used in the following:

• Children (brief treatment time only)
• Elderly (brief treatment time only)
• Very sick (brief treatment time only)
• Cancer (no treatment where cancer present)
• Fever (no treatment)
• Active inflammation (not treatment)
• Pregnant women
• Some mental illnesses
 Therapeutic Touch – Effectiveness

Peters, R. M. (1999). The effectiveness of therapeutic touch: A meta-

analytic review. Nursing Science Quarterly, 12(1), 52–61.
https://doi.org/10.1177/08943189922106413.

Therapeutic touch can produce a medium effect for:

• Physiological outcomes within treated subjects
• Psychological outcomes within treated subjects
• Physiological outcomes when comparing treatment with control groups
Effectiveness …cont’d

…continued

BUT there is currently not enough

empirical data to support
therapeutic touch as more effective
than control measures in improving
psychological well-being.
 Effectiveness …cont’d
…continued

More rigorous research is needed to establish the

effectiveness of therapeutic touch. Future research must
addressed the following weaknesses:
• Sampling procedures
• Intervention practices
• Practitioner skills
• Underreporting of data
 Effectiveness …cont’d
Garrett, B., & Riou, M. (2021). A rapid evidence assessment
of recent Therapeutic Touch Research. Nursing Open, 8(5),
2318–2330. https://doi.org/10.1002/nop2.841.

A rapid evidence assessment approach was used to review

recent therapeutic touch research to investigate the
effectiveness and safety of therapeutic touch as a
complementary therapy in clinical health applications.
 Effectiveness …cont’d
…continued

The authors concluded that there is currently no high-quality

evidence for any of the benefits claimed:
• 18/21 studies reported positive outcomes
• 4/21 studies exhibited a low risk of bias
• 17/21 had serious methodological flaws, bias issues, were
statistically underpowered, and scored as low-quality studies.
 Effectiveness …cont’d

Video of simple test of therapeutic touch

https://www.youtube.com/watch?v=mNoRxCRJ-Y0
 Therapeutic Touch –
Licensing/Regulation of Professionals

Therapies are regulated in Ontario; however,

therapeutic touch is a technique, not a therapy;
therefore, therapeutic touch is NOT regulated in
Ontario.
 Therapeutic Touch –
Training Requirements of Professionals
The Therapeutic Touch Network of
Ontario (TTNO) is a non-profit
organization that provides a referral
service between patients and
Recognized Practitioners.

In addition, they provide standards

for competent therapeutic touch
practice.
Training Requirements of Professionals …cont’d

Anybody can become a

therapeutic touch practitioner.

Therapeutic touch is taught by

the TTNO in 3 workshops which
take a minimum of 24 hours to
complete:
Basic Level 1
Basic Level 2
Basic Level 3
 Training Requirements of Professionals …cont’d

In order to achieve the status of

Recognized Practitioner, one must
complete:
The 3 Basic Level workshops;
An addition 32+hours of study; and
A workbook with 75 case studies
Questions?
Manipulative and Body-Based Therapies
 Manipulative and Body-Based Therapies
Manipulative and body-based
therapies: a type of complementary
and alternative medicine that involves
the movement or manipulation of one
or more body parts.

The goal of manipulative and body-

based therapies is to control
symptom(s) and/or help overall
health.
Manipulative and Body-Based Therapies …cont’d

Examples include:
• Myofascial Release
• Therapeutic Massage
• Cranio-sacral Therapy
• Decongestive Therapy
• The Ida Rolf Method of
Structural Integration
Myofascial Release
 Myofascial Release – What is It?

Fascia: a thin sheath of

stringy connective tissue that
surrounds and supports every
body structure.

Think of fascia as the skin of

an orange.
Fascia
 Myofascial Release – What is It? …cont’d
Fascia are flexible structures
able to resist great
unidirectional tension forces.

Fascia bind some structures

together, while allowing
others to slide smoothly over
each other.
 Myofascial Release – What is It? …cont’d

Fascia is one of the

richest sensory
organs in our body
as it has nerve
endings and
mechanoreceptors
embedded within.
 Myofascial Release – What is It? …cont’d

Video about fascia:

https://www.youtube.com/watch?v=T-UsSmD7miI&t=139s
 Myofascial pain: pain resulting from
Myofascial Release – inflammation or irritation of the
What is It? …cont’d muscle or the fascia surrounding the
muscle.

Fascia restriction: areas of tightness

and tension the fascia.

Injury or stress can cause the

naturally flexible fascia to become
tight and rigid and not move
properly.
Myofascial release: a type of
gentle hands-on massage in Myofascial Release –
which sustained pressure is
applied to the myofascial tissues What is It? …cont’d
in order to releases tightness and
pain.

The practitioner applies slow,

sustained, gentle pressure to
cause the fascia to elongate and
return to its normal state (freeing
restrictions).
Myofascial Release – What is It? …cont’d

Myofascial release introduction videos:

https://www.youtube.com/watch?v=xw3j1OANkjQ
https://www.youtube.com/watch?v=2kgiGIszWlM
Self myofascial release: a type Self Myofascial Release
of myofascial release that is – What is It?
done by the individual and a
foam tool (as opposed to a
practitioner).

Examples of self myofascial

release tools:
• Foam rollers
• Lacrosse or tennis balls
• Handheld rollers
• Rolling pin
 Myofascial Release – History

American Physical Therapist John

Barnes is credited with creating
myofascial release.

Since 1960, Barnes has worked as a

PT but did not develop myofascial
release until the 1970s.
Myofascial Release – History …cont’d

Barnes has spent his career teaching

about myofascial release. He has:
• Trained more than 50 000 therapists
• Taught seminars
• Published 2 books
• Published in medical journals
 Myofascial release can help the following pains:
Myofascial • Back pain
• Bulging disc
Release – • Bursitis
Benefits on • Carpal tunnel syndrome
Pain • Cervical and lumbar injuries
• Chronic pain
• Degenerative disc disease
• Endometriosis
• Fibromyalgia
…continued
 …continued
Myofascial
• Frozen shoulder
Release – • Herniated disc
Benefits on • Headaches and migraines
Pain … • Menstrual pain
cont’d • Myofascial pain syndrome
• Neck pain
• Osteoarthritis
• Pelvic pain
• Plantar fasciitis
• Pudendal nerve entrapment
 …continued
Myofascial
Release – • Scars
• Sciatica
Benefits on • Shin splints
Pain … • Tennis elbow
cont’d • TMJ syndrome
• Trigeminal neuralgia
• Vulvodynia
• Whiplash
 Myofascial Release –
Benefits on Sleep and Depression

Myofascial release can

indirectly improve sleep and
depression by treating pain.
 Myofascial Release –
Potential Safety Concerns
Individuals taking blood-thinning
medications and/or those with the
following conditions should not have
myofascia release:
• Burns, injuries, or painful wounds
• Fractures
• Fragile or weak bones
• DVT or deep vein issues
 Myofascial Release –
Potential Safety Concerns …cont’d

Myofascia release has very few

risks but it may cause:
• Internal bleeding
• Temporary paralysis
• Nerve damage
 Myofascial Release – Effectiveness

Research has found the following benefits of myofascial release:

1. Reduced pain and tension
2. Reduced inflammation
3. Improved flexibility and mobility
4. Increased blood flow and circulation
5. Improved posture
6. Improved lymphatic drainage
7. Reduced stress and anxiety
8. Better sleep quality
 Myofascial Release –
Licensing/Regulation of Professionals
Myofascial release is a therapy and therapies are
regulated in Ontario. The following regulated health
professions may provide myofascial release in Ontario:
• Trained chiropractors
• Trained physiotherapists
• Trained registered massage therapists
 • Audiologists
• Chiropodists
Regulated • Chiropractors
• Dental Hygienists
Health
• Dental Technologists
Professions
• Dentists
• Denturists
• Dieticians
• Homeopaths
• Kinesiologists
 • Massage Therapists
• Medical Laboratory Technologists
Regulated • Medical Radiation Technologists
Health • Midwives
Professions • Naturopaths
…cont’d • Nurses
• Occupational therapists
• Opticians
• Optometrists
• Pharmacists and pharmacy technicians
 Regulated Health Professions …cont’d
• Physicians and surgeons
• Physiotherapists
• Podiatrists
• Psychologists and psychological associates
• Registered psychotherapists
• Respiratory therapists
• Speech-language pathologists
• Traditional Chinese medicine practitioners and acupuncturists
 Myofascial Release –
Training Requirements of Professionals

Myofascial release training

can either be incorporated
into the healthcare
professional’s postsecondary
education (as a course or part
of a course) or it can be taken
as a seminar.
 Training Requirements of Professionals …cont’d

Seminars are generally 2-5 days long, either

in a row or spaced out over multiple
weekends.

PT John Barnes continues to teach courses on

myofascial release
(https://myofascialrelease.com/seminars/hea
lthcare/seminar-directory/myofascial-
release-I.aspx)
Questions?
Mind-Body Therapy
 Mind-Body Therapy
Mind-body therapy: a type of
complementary and alternative
medicine that combine mental
focus, breathing, and body
movements to help relax the
body and mind.

The goal of mind-body therapy is

to control symptom(s) and/or
help overall health.
Mind-Body Therapy …cont’d

Examples of mind-body therapies:

• Biofeedback
• Yoga
• Tai-Chi
• FATM
• Pilates
Pilates
 Pilates – What is It?
Pilates: a form of low-impact
exercise which focuses on
strengthening the body
(particularly the core) by adapting
a position and then moving the
legs or arms.

Pilates focuses on:

• Posture
• Balance
• Flexibility
 The 6
Principles
of Pilates
 1. Centering: In Pilates, all movement starts from
the center or powerhouse and flow out to the
limbs.

The 6 Center/powerhouse: encompasses the abs, upper

Principles back, lower back, hips, buttocks, and inner thighs.
of Pilates …
cont’d 2. Control: In Pilates, every exercise must be done
with control.

3. Concentration: In Pilates, exercise technique is

extremely important. Focus needs to be on the
entire body to ensure smooth movements.
 4. Precision: In Pilates, the goal is for precise and
perfect movement (as opposed to many repetitions
with poor technique)
The 6
5. Flow: In Pilates, exercises are intended to flow
Principles into each other. Strength and stamina are built
of Pilates … when flow occurs.
cont’d
6. Breathing: In Pilates, coordinating breathing with
movement is important. Breathing out should
occurs with effort while breathing in should occur
on the return.
Pilates can be done:
• Independently or in a group
• With or without apparatuses
• On the floor with or without a mat or exercise ball
Springboard Cadillac
Chair

Ladder barrel
Pilates can:
• Improve posture
• Improve balance
• Improve flexibility
• Enhance core stability
• Increase strength
• Decrease risk of injuries
Pilates was created in the 1920s by
the German-born Physical Trainer
Joseph Pilates.
Pilates – History
During World War I, Pilates was
interned in England. Living
conditions were terrible but Pilates
helped others stay physical and
mentally well by designing daily
exercise routines.

Pilates attached springs to hospital

beds so that even bedbound
individuals could participate.
 Pilates – History …cont’d

Video about the history of Pilates:

https://www.youtube.com/watch?v=vWkxhtfw0A8
 Pilates – Benefits on Pain
Denham-Jones, Laura et al. “A systematic review of the
effectiveness of Pilates on pain, disability, physical function,
and quality of life in older adults with chronic
musculoskeletal conditions.” Musculoskeletal care vol. 20,1
(2022): 10-30. doi:10.1002/msc.1563

Pilates is significantly effective for reducing back pain, neck

pain, OA knee pain, and OP knee pain.
 Pilates – Benefits on Pain …cont’d
Lin, Hui-Ting et al. “Effects of pilates on patients with chronic
non-specific low back pain: a systematic review.” Journal of
physical therapy science vol. 28,10 (2016): 2961-2969.
doi:10.1589/jpts.28.2961

Pilates can significantly improve chronic lower back pain.

 Pilates – Benefits on Pain …cont’d
Wells, Cherie et al. “The effectiveness of Pilates exercise in
people with chronic low back pain: a systematic review.” PloS
one vol. 9,7 e100402. 1 Jul. 2014,
doi:10.1371/journal.pone.0100402

Pilates improves pain compared to usual care and physical

activity in the short-term.
 Pilates – Benefits on Sleep
Chen, Zehua et al. “Effect of Pilates on Sleep Quality: A Systematic
Review and Meta-Analysis of Randomized Controlled Trials.” Frontiers in
neurology vol. 11 158. 24 Mar. 2020, doi:10.3389/fneur.2020.00158

A meta-analysis was performed to evaluate the effect of Pilates on sleep

quality, assessed using the Pittsburgh Sleep Quality Index (PSQI).

Pilates improved sleep quality but had no significant effect on the use of
sleep medication.
 Pilates – Benefits on Depression
Mokhtari, Mahyar, Nezakatalhossaini, Maryam & Esfarjani,
Fahimeh. “The Effect of 12-Week Pilates Exercises on
Depression and Balance Associated with Falling in the
Elderly”. Procedia - Social and Behavioral Sciences vol. 70.
1714-172325 January 2013. doi:10.1016/j.sbspro.2013.01.246

This 12-week study found that the Pilates Group experienced a

decrease in depression, time for functional reach test, and
timed-up-and-go tests.
 Pilates – Benefits on Depression …cont’d
Fleming, Karl M, and Matthew P Herring. “The effects of
Pilates on mental health outcomes: A meta-analysis of
controlled trial.” Complementary therapies in medicine vol.
37 (2018): 80-95. doi:10.1016/j.ctim.2018.02.003

This study found that doing Pilates can result significantly

decrease depressive symptoms, anxiety symptoms, and
feelings of fatigue and increase feelings of energy.
Pilates – Potential Safety Concerns

Pilates is a low impact type of

exercise but with all types of
exercise, it is best to speak to
with a family physician or nurse
practitioner before starting.
 Pilates –
Licensing/Regulation of Professionals
Pilates is a type of exercise. In Ontario,
in order to teach Pilates, one must , be a
qualified Fitness Instructor which
includes:
• Completion of college program in
Recreation Education or Physical
Education OR extensive experience in a
specific recreational or sports program
activity.
• Demonstrated ability in a particular
recreational, sports or fitness discipline.
Questions?
Quiz is next week
Fri Sept 29 in class

Discussion Post #1 is due in 3 weeks

Fri Oct 13 by 11:59pm EST on LMS