Originally published in Massage Bodywork magazine, December/January 2006.
Copyright 2005. Associated Bodywork and Massage Professionals. All rights reserved.
It's not unusual to find little collections of essential oils hidden away in the treatment rooms of massage therapists and bodyworkers. While the addition of these oils to your massage repertoire can take your work to a new level, using them haphazardly, or without forethought or training, can be potentially harmful to you and your clients.
The issue is a delicate one for some aromatherapists, concerned that bodyworkers take too carefree an approach to essential oils. Others think massage therapists can offer a great service by adding essential oils to their therapeutic toolbox, if they also use some common sense and a humbled approach to the medium.The Big Question
Should bodyworkers dabble in aromatherapy? "That's a big question," reflects Cheryl Hoard, two-time past president of the National Association for Holistic Aromatherapy (NAHA). "I think it's OK for massage therapists to use essential oils ... if they proceed with caution." Hoard knows that more therapists than not utilize essential oils in their practice, whether it be through diffusers in the client waiting room or added to a carrier oil for application during bodywork. That's fine, she says, as long as common sense is made a part of the "blend" as well.
"Essential oils combined with a skilled massage fosters healing on many levels," says Laraine Kyle, R.N., cofounder of NAHA and today an aromatherapy consultant. And it's OK for massage therapists to help clients reach those new levels via oils, she says, but the best path is with some training under their belt.
"There are some simple ways to begin," Hoard says, starting with milder oils like lavender and eucalyptus. But even at a very basic level, education is still key. "Massage therapists would be wise to at least see what the cautions are in the oils they use," she says.
While Hoard says short-term courses coupled with a few key books are a "good beginning" for those interested in this work, they in no way give license to a more intense aromatherapy approach. That should be left to those certified and/or registered in aromatherapy.
Like so many massage experts have expounded on these pages, including ethics guru Nina McIntosh, a weekend course does not an expert make. The same holds true in the use of essential oils.
"For massage therapists who would like to build the use of true, therapeutic essential oils in their practice, I would recommend at least a basic course in clinical aromatherapy, if not a full diploma-level certification," Kyle says.
Pam Conrad, an Indiana-based R.N. and certified clinical aromatherapist, agrees. "It's important to know the oils you're using," she says. "Therapists must understand the safety issues with each oil they put on themselves and their clients. Don't use an oil if you're not knowledgeable about it."
And therein lies the challenge. "The hardest thing to define for somebody is what is an essential oil," says aromatherapy author and educator Jeanne Rose. "It's in a little brown bottle; it's basically an invisible liquid with an odor. People are more respectful of herbal studies than they are of aromatherapy, because they feel it's so simple. They feel it's so easy that they don't have to study it."
How is such a nonchalant attitude about essential oils formed?
The mixed messages haven't helped. You can walk down the health and beauty aisle of your local grocery store and find a variety of essential oils packaged for consumer use with nary a warning. Yet, you also find "loud" caveats in various aromatherapy books and websites that say some oils can be extremely toxic.
There are easily two issues creating this disparity (for more on this discussion, read Australian aromatherapist Ron Guba's opinions on the NAHA website). The obvious one is a concern for public safety. For example, on most aromatherapy-based websites, including those that sell essential oils, there is typically a warning about not using oils internally. Well-trained aromatherapists, however, know that there are situations when ingesting oils is entirely appropriate. But, because people -- professional and consumer alike -- often treat essential oils so casually, the "External Use Only" warning remains.
It's the same reason that recommended dosages on essential oil products meant for consumers are relatively low compared to professional dosing instructions. Protect the public ... at all costs.
The other reason for disparity, in dosing instructions specifically, is that aromatherapists come from both ends of the spectrum. In France, for example, aromatherapy is practiced enthusiastically within a medical paradigm. There, the practice is more aromatic medicine, with physicians administering the therapy to patients. At the other end of the spectrum is holistic aromatherapy with a gentler, less aggressive approach. Both are equally valuable, but it goes toward explaining why there exists such a range of advice on the subject.The Rules
If you are going to use essential oils in your practice, there are some rules that apply. We asked the experts to chime in on some things you must know when working with essential oils. Here's what they had to say:
--The most important rule of thumb when using any essential oil is to properly dilute it in a quality carrier oil. While recommendations on exact percentages vary, a general consensus says up to 15 drops of an essential oil can be added per 1 ounce of carrier oil. Hoard says that should be the maximum, total amount of essential oil(s) used in an overall body massage.
--Oils should only be used externally, unless otherwise directed by a certified aromatherapist.
--Keep oils away from open flames. "These are highly concentrated and volatile oils," Conrad says. They should be stored in blue or amber glass, in a cool area away from sunlight.
--Avoid getting essential oils in or around the eyes. If accidental eye contact occurs, flush the eye with whole milk.
--Obviously, wash your hands thoroughly between clients, using the sterile wash routine of surgeons. Wash your hands any time after you've touched a bottle of essential oil, but also do your best not to let the oil touch your skin. Practice Standard Universal Precautions, just as you do in your bodywork treatments.
--Use only pure oils. Unfortunately, the purest oils will be the most expensive, but there are good quality oils out there at reasonable prices. Just beware of oils that aren't what they claim. Kyle recommends looking for labels that "give the Latin binomial name of the botanical used, the country of origin, and the chemtype (if relevant) such as with rosemary, thyme, eucalyptus, lavender, and others."
--Avoid toxic oils. This list varies from practitioner to practitioner, but most have a core group of essential oils considered unacceptable for consumer use. Many of these are not readily marketed within the industry, but it's best to know their names anyway.
Steer clear of calamus, sassafras, boldo leaf, tanzy oil, and wintergreen, Kyle says. Other experts add these to the list: mugwort, pennyroyal, wormwood, savory, and cloveleaf.
--Be cautious with phototoxic oils (those causing light-related irritation or darkening of the skin when exposed to ultraviolet light) including lemon, bergamot, angelica, lime, grapefruit, orange, mandarin, tagete, and verbena. Warn clients to avoid the sun and tanning beds for up to 12 hours after a massage using any of these oils.
--Be conscious of which oils are sensitizing. "This is not just a skin issue," Hoard says. "A reaction might show up years later, maybe a strange rash on a part of the leg where you didn't even put the oils." Sensitizing oils include cinnamon bark, fig leaf, verbena, and ylang ylang.
--Expand your intake form. If you plan on using essential oils in your sessions, then you need to ask clients a few additional questions that may not already be a part of your current intake process. Hoard offers this list of things to ask when using essential oils:
- Do you have any allergies or skin sensitivities?
- Are you on blood-thinning medicine?
- Do you have asthma or any respiratory conditions?
- Do you have high or low blood pressure, cancer, epilepsy, or liver, kidney, or bladder disease?
- Are you pregnant or nursing?
A positive response to any of these questions would require you to make significant changes in what sort of essential oil approach you might take. For example, Hoard says, if someone has skin cancer, you would want to avoid phototoxic oils. Pregnant clients should avoid wintergreen, spearmint, sage, rosemary, cedarwood, and fennel, to name a few. And for a client with high blood pressure, a full-body massage using eucalyptus could be dangerous. These are exactly the cautions aromatherapists are concerned bodyworkers have yet to learn.
Hoard says it's important to remember that while the proper use of essential oils poses no danger for most of us, the "wrong" essential oils could be very problematic for people with severe organ impairment or other diseases and ailments like hepatitis or epilepsy.
--Be careful working on the face, neck, and scalp. Some think without proper training, this area should be avoided altogether, as the skin is so thin, it allows permeability on an almost instantaneous basis.
--If you are pregnant, avoid using essential oils on your clients for the duration. There's no reason you need take a chance, and your clients will certainly understand. Send them home instead with a nice oil blend that they can administer themselves.
--If you see a reaction with the client, stop, Rose says. "If you see any reddening or bumps or nervousness, if they ask, 'What is that smell?' stop immediately." She says if you're using essential oils to deal with emotions, it has to smell good to work. "If you're dealing with the physiological, it doesn't have to smell good to work."Doing it Right
So you're aware of the cautions and you're eager to continue learning the craft. What else do you need to know before getting started?
--Start with the basics. Hoard thinks a starter set of essential oils for bodyworkers might include german chamomile, lavender, neroli, pamarosa, patchouli, rose otto, sandalwood, and vetiver. Noting pregnancy precautions, she also might add roman chamomile and frankincense. A final tier of basic oils Hoard would add, taking into consideration the possibility of skin irritation if not diluted properly, includes black pepper, cajeput, cardamom, fir, myrrh, peppermint, rose absolute, and tea tree.
--While her general recommendation for a full-body massage is 15 drops of essential oil per 1 ounce of carrier oil, Hoard says it's the more extensive training of aromatherapy principles that would make clear why that recommendation doesn't hold firm with every oil. With peppermint, for example, Hoard says she would not use 15 drops of this potentially skin-irritating oil, but would instead go for a blend of 5 drops peppermint and 10 drops lavender, if utilizing the blend for a traditional Swedish massage.
--Kyle says when using essential oils in a therapeutic massage, she would drift toward those associated with relaxation (lavender, roman chamomile, marjoram, ylang ylang, clary sage), detoxification (juniper, rosemary, lemon, eucalyptus globulus), spiritual or energy work (jasmine, rose, vivitier, angelica, clary sage), and skin care (lavender, rose geranium, myrrh, frankincense). She also recommends a 2 percent to 3 percent dilution, equaling approximately 12 to 18 drops of essential oil total, per ounce of quality carrier oil or lotion.
--For an application of essential oils to the face, Kyle recommends a 0.5 percent to 1 percent dilution, or three to six drops of oil per one ounce of carrier. And obviously, make sure the essential oils you've chosen, as well as the carrier oil/lotion, are suitable for more delicate skin care.
--Despite an August 2004 survey published in the Archives of Dermatology ("Aromatherapy Products Increase Risk of Hand Dermatitis in Massage Therapists"), Hoard says it's easy for massage therapists to avoid essential oil sensitivities. "Mix it up," she says. Conrad says another way to avoid reactions is to keep the concentration of essential oils you use on clients relatively low and to obviously avoid oils to which you have known reactions. Along the same lines, Conrad says there's no crime in starting with a lower-than-expected dose of oil on clients to first assess their response to it. Then, you can increase it as needed.
--If you become overwhelmed by an essential oil you've been using on a client (i.e., headache or nausea), get to a ventilated area, or even better, walk outside. "Get some fresh air," Kyle says. Also, do what you can to dissipate the aroma before the next client arrives.
--Finally, Hoard says keep good records of your oils -- when you purchased them, how you blended them, etc. This is especially important both for re-creating a great combination and for ensuring only the freshest ingredients go on your clients' backs.
"Don't let your essential oils get 3-4 years old," she says. While they won't necessarily become rancid, like vegetable-based oils, they can become more sensitizing. For example, she won't give her citrus oils more than six months before discontinuing their use on the body. But don't fret. There are other ways to use these products.
"Use them to fragrance a room, add them to your cleaning routine, or use them as disinfecting agents," she says. And if you want a great way to keep bugs out of your space, especially those that like the dark, dampness of store rooms and utility closets, wash your floors with essential oils. Those bugs might find other ways into your area, but they won't be traversing the newly-cleaned floors.
There is much to be said about bringing elements of aromatherapy into your massage session. But all the experts agree -- don't be fooled by the seemingly simple nature of essential oils.
Some of those who work in the trenches that connect massage therapy and aromatherapy say that while herbal remedies are being appreciated (and researched) for their therapeutic benefit, essential oils are being undervalued in regards to their power. And it may be that additional mixed message that the plant is stronger than its essence that has consumer and professional alike underestimating the ancient therapeutic medium of these oils.
"Essential oils are the strongest form of herbs available today," Hoard says. "It's so important to know how strong they are. Casual use is the danger." Karrie Osborn is contributing editor to Massage Bodywork magazine.