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Taking Care of Yourself
Handling a Busy Life

By Karta Purkh Singh Khalsa

Originally published in Massage Bodywork magazine, July/August 2008. Copyright 2008. Associated Bodywork and Massage Professionals. All rights reserved.

Taking care of yourself is important. But busy lives often leave little time for self-care. If you'd like to still be practicing 10 years from now, it's time for a little reflection. Massage therapists not only have the stresses that accompany the day-to-day reality of being human, but also the physical demands of the profession. The result? Burnout.Take heart, though. Following you'll find a plethora of methods we can use to keep ourselves physically strong and mentally vibrant.


Fired Up Or Flamed Out?
Caregiver burnout means that all your fuel is burned up--a condition of emotional, mental, and physical exhaustion. The demands on your body and mind can easily seem overwhelming, leading to anxiety, depression, fatigue, hopelessness, and stress. Your attitude, many times, is affected and slips from being positive and caring to being negative and unconcerned.

Don't think you are immune. Clients can burn you out, and so can your children, your checkbook, your household chores, and your aging parents. When caregivers don't ask or seek help when needed, and we think we can do it all, we can be so wrapped up in the care we provide that we forget to tend to our own health. Many caregivers feel guilty if they spend time on themselves rather than on their other responsibilities.1

Burnout isn't like a cold. Much like posttraumatic stress syndrome, the symptoms of burnout can sneak up on you. It's critical to do a realistic self-assessment of how you are feeling about your work and your life and make any needed changes before a crisis hits. Being able to cope with the strains and stresses of being a therapist is part of the art of caregiving. In order to remain healthy so that we can continue to practice, we must be able to recognize our own limitations and learn to care for ourselves as well as others.2

What are your expectations of yourself as a caregiver? You can't expect that you can have a positive effect on the health and happiness of every client. That's not realistic, helpful, or even possible. Do you assume the full role of sole caregiver? You can't be all things to your clients. Professional boundaries are critical. Are you making over-the-top demands on yourself? Sometimes we think it's our ultimate responsibility to heal every part of clients' lives.

Maybe most important: are you caregiving or caretaking? Caregiving (what healthy bodyworkers do) is the giving of treatment and aid to a client with no obligation to produce certain results. Caretaking (or taking over care of a person who cannot provide for himself or herself) often derives from the practitioner's need to be needed and is the quickest road to burnout.

Look for these signs of impending slow-motion collapse:

- Changes in eating or sleeping patterns.

- Decreasing interest in work and productivity.

- Feelings of depression.

- Feelings of helplessness.

- Increased use of stimulants and alcohol.

- Increased fear of death.

- Ongoing and persistent fatigue.

- Withdrawal from social contacts.

All of this leads to persistent stress. If you develop anxiety, back pain, digestive changes, headaches, high blood pressure, shortness of breath, or problems with intimate relationships, sound the stress alarm. Take action to get your life back.


Look To The Long Haul
Taking care of yourself sounds good, and it's easy to do--tomorrow. Still, tomorrow comes all too soon. You've got to take the long view. Set realistic goals at home and work. How much can you handle per day, per week, per year?

There's no right answer to these questions, but set a pace you can sustain for many years, and make sure your financial needs are in accord with your productivity and health. With very few exceptions, therapists who perform more than about 25 hours of hands-on work per week are abusing their bodies and setting themselves up for exhaustion and a degraded quality of touch for their clients.

It is critically important to find meaning in what you do and to follow your bliss. A fresh perspective and a break go a long way toward cooling down burnout. According to the journal Business Health, men who missed out on their yearly vacation were more apt to die from coronary heart disease than were couch potatoes or smokers who did take time for an annual getaway.3

Go ahead and take that vacation. Your table will still be there when you get back. Take continuing education classes to keep fresh. Look into techniques other than your own. Dive into your spiritual practice, which is just a way to learn to connect with your own soul, in whatever way moves you. Finding and holding meaning in your life keeps you centered, effective, and optimistic about being who you are.


Let Your Sessions Heal You, Too
It's possible to quell the flame of burnout and feel healed by your own sessions. Feel your own heart as you work, and welcome yourself in. Invite your client in, too, fully and warmly.

The call to do our work refreshes the call to merge energies with others. And therapists are right to ask about managing strong feelings. Touch intensifies the connections between us. Our emotions can bounce all over while we work. But as the operations manager of your inner life, learn to create the energy infrastructure to dissolve into the feelings that pass through you, the feelings of personal cultivation of mindfulness and universal compassion.

Being of service is a compassionate way to be with clients and their concerns. Being of service, and not attempting to fix others, is a way of working with clients that allows them their pain and allows healing to come to them as appropriate for them at the time. This means learning to feel, staying present, and letting go of reacting out of the pain of the past or the fear of the future.

To do this, your first priority is to build and maintain your own reservoir of healthy inner resources. You become aware of what nurtures and feeds you, and you become more constant and grounded. You honor your client's internal place, and pace, of healing. Your energetic connection becomes palpable, and you increase your effectiveness dramatically.

Before the session, cultivate the conviction that you deserve to take care of yourself and remind yourself that you are not your client's only resource. Then, during the session, hold a space of compassion and acceptance and preserve a vision of your client as whole, healthy, and free of pain. When you are done, acknowledge your client's commitment to heal and help him or her stay aware of the bigger picture. Consecrate each session with an attitude of gratitude.


Eat To Serve
One of the most profound things a bodywork professional can do is to eat a healthy diet. Scientific reports proliferate about the importance of what you put in your body.

Choose food that says, "I will support you in your work today." Eat that diet mindfully with thanks and the sense that it gives you life itself. Let good food choices ease out poor ones. And rely on good food, not caffeine or sugar, for energy.

Eat fruits and veggies. Your heart will thank you for it. At least, that's the indication of a study published in The American Journal of Clinical Nutrition. Women who ate between four and 10 servings of fruits and vegetables per day reduced their risk of cardiovascular disease by 20-30 percent.4 Women without any cardiovascular risk factors, such as diabetes or hypertension, fared even better.

The researchers maintain that in addition to the antioxidants, vitamins, minerals, and plant hormones found in food plants, other enzymes and hormones, which both protect the plant from fungus or help to pollinate it, may help prevent disease in humans.


When Food May Not Be Enough
Despite our best gustatory efforts, we may do better if we add nutritional supplements to our daily routine. A 2007 study, published in The Nutrition Journal, found that avid dietary supplement users who, on average, take 17 different supplements daily, were judged to be far healthier than adults who take only a single supplement, such as a common multivitamin, or who don't take dietary supplements at all. The researchers found suboptimal levels of nutrients were far less common among the multi-supplement users.5

Risk for disease was far lower among the multi-supplement users compared to non-users. Risk for diabetes was 73 percent less, coronary heart disease 52 percent less, and self-determined health status (report health status was rated as "good or excellent") 74 percent more often, compared to non-supplement users. Multi-supplement users had significantly higher HDL "good" cholesterol; lower triglycerides and C-reactive protein; and lower blood pressure--markers of cardiovascular health--than non-users and multivitamin users.

Many experts think vitamin D is the most common nutrient deficiency in America. In 2007, The New England Journal of Medicine reported that 85 percent of all Americans are vitamin D deficient.6 Lack of this critical nutrient has been associated with Alzheimer's disease, arthritis, cancer, cold and flu, diabetes, fibromyalgia, heart disease, and premenstrual syndrome.

One recent study found that this critical substance increases life span by decreasing the morbidity of chronic disease. Americans who supplement with vitamin D lived 7 percent longer than those who did not. Another study, in Circulation, based on the Framingham Heart Study, says that deficient levels of vitamin D are associated with double the risk of experiencing a cardiovascular event, including heart attack, heart failure, or stroke, within a five year period.7


Heal Your Joints
Keeping your joints strong is the ultimate challenge for a bodyworker. Many massage therapists leave the profession because they develop repetitive strain injuries like carpal tunnel syndrome. One cause of many therapists' injuries is that they overwork to "fix" clients and overextend their physical limitations, thus taxing their body and emotions.

That's where the herb turmeric comes in. Long a favorite of yoga practitioners in India, turmeric curbs inflammation. One of the active ingredients, curcumin, the pigment that gives turmeric its distinctive yellow color, has anti-inflammatory effects comparable to cortisone and phenylbutazone, the standard in drugs for inflammation.8 Curcumin is nonsteroidal, so it has none of the ravaging side effects of steroid anti-inflammatories.9 These anti-inflammatory qualities make turmeric suitable for the treatment of conditions as diverse as arthritis and bodyworker's elbow.

In fact, turmeric is a good general treatment for all connective tissue. Being a polyphenol, curcumin has the property of stabilizing collagen. It is used to enhance healing after surgery, reducing adhesions and scarring.

Turmeric is a mild herb. For acute inflammation, like a sore knee from a long bike ride, the dose might be as high as one ounce (4 Tbs.) per day. Stir the powder into water and swallow, or make it into a paste with honey or a bite of oatmeal. For smaller doses, less serious conditions, or ongoing health benefit, use 1 gram per day in capsules. If using standardized extract containing a high proportion of curcumin, the dose is 1,500 mg of total curcumin content per day.


Exercise, Rest, And Sleep
To be strong enough to meet the demands of your work, you need to exercise. Massaging is great movement, but, sorry, it doesn't qualify as exercise. Make an appointment with yourself to move by yourself and for yourself, in addition to your work. Walk, jog, or stretch. Take a class in some kind of movement, preferably something that requires full concentration. The stress relief can be remarkable. Fluid movements (think skating and tai chi) free the soul, and percussive movements (how about dance and kung fu?) release pent up feelings.

And give yourself a break, whadaya say? A study in the Journal of Sleep Research looked at the effect of taking a 20-minute nap during a 12-hour shift. Those who napped improved significantly the speed of their response on a vigilance task measured at the end of the shift.10 Taking a quick nap during a break is a powerful technique to refresh and renew. Use those few minutes between clients for a little shut-eye.

We live in an uneasy world, and bodyworkers are not invulnerable. The pace of life continues to increase, and our whole civilization becomes more and more frantic. We are a nation of insomniacs, unable to shut off our mental chatter. Furthermore, we're a national of tired people. When surveyed, 24 percent of people complain of fatigue that lasts longer than two weeks. Tiredness is included in the five top reasons for doctor visits.11

Changing sleep patterns in midlife could be costing men as much as 75 percent of a hormone known to prevent aging.12 Previous sleep research has centered on growth hormone deficiencies in older men and women, a shortage associated with increased obesity, loss of muscle mass, and reduced exercise capacity. Recent findings that the hormone decreases beginning when men are in their 30s were unexpected.

A study in the Journal of the American Medical Association involved 149 healthy men aged 16 to 83, none of whom had a history of sleep disorders or took drugs. Researchers mapped age-related changes in sleep and found that the first stage of waning sleep quality starts between the ages of 25 and 45.

Although total sleep time stayed the same as men moved into midlife, the proportion of time spent in deep sleep diminished from 20 percent for men under 25 to less than 5 percent for those over 35. Their amount of growth hormone, secreted primarily during deep sleep, declined by about 75 percent.

Researchers also studied the second stage of worsening of sleep due to aging, which occurs after age 50. Total sleep time begins to reduce by about 27 minutes for each decade into the 80s, and men experience a significant reduction in rapid eye movement (REM), or dream sleep. REM sleep decrease appears to be connected with elevated cortisol levels.

Anything that you can do to improve the quantity and quality of your sleep will stand you in good stead for a lifetime.


Ladies Who Lunch
Burnout is a lonely game. When close friends begin to grow distant, eventually you are alone without a support structure. Allow those who do care for us, who are involved enough to say something, to tell us about our behavior--perhaps a decrease in energy or mood changes. Stay connected and open to your friends. Perhaps a weekly potluck or lunch at a favorite restaurant with your close colleagues is in order.

Get energized with hugs, support, and a place where everyone knows how you feel. Discuss difficult clients, billing problems, and being an entrepreneur. Or participate in a support network to receive feedback and coping strategies. Often sharing with other professionals will bring fresh insights that help you get unstuck.


A Little "Me" Time
Can I tell you how many times I've had a massage therapist start a conversation with, "I give massage all week, but never get one because ... (cue the long, creative list of excuses)."? Enough said? Now go make the appointment. (By the way, it's not mandatory that you have to trade. You can pay for this essential service, for your own health. Really.)

Hobbies are a great way to inject a little sanity back into the marathon you call a life. Remember how you enjoyed collecting stuffed bunnies before you opened that energy black hole you call your massage practice? Go back to the bunnies.

But, of course, you have no time for frivolity, there's healing to be done! Wean yourself onto the slow track with a little slice of hobby time each week. If only you had collected original Beanie Babies, you'd be living in Tahiti now.


Make Room For Meditation
Meditation is a way to take yourself out of your daily mental chatter and immerse yourself in a pool of de-stressing energy. It's one of the best ways to stay committed and fresh every day.

Ultimately, meditation is a way to balance the mind and become a healthier, more effective, and happier person. It often has lifelong relaxation and quality-of-life benefits. Meditation lowers cortisol levels and improves brain and immune function.13

A 2004 article in the Journal of Alternative and Complementary Medicine describes meditation techniques that are useful for a wide range of anxiety disorders: learning to manage fear, tranquilizing an angry mind, meeting mental challenges, and turning negative thoughts positive. In addition, a number of other meditation techniques are included for grief, insomnia, major depressive disorders and other sleep disorders.14

Fitness educators are encouraging fitness teachers to practice and teach meditation for a more well-rounded approach to health. According to fitness experts, mediation has been proven to reduce atherosclerosis and to bring a sense of mental clarity and peace of mind.15 A study published in the journal Stroke looked at 60 patients with atherosclerosis who practiced meditation for six to nine months. The meditators showed a striking decrease in the thickness of their artery walls. The change represented an 11 percent decrease in the risk of heart attack and an 8-15 percent decrease in the risk of stroke.16

Yoga, of course, is closely aligned with meditation. Researchers looked at health-related quality of life associated with three months of yoga mind-body training. One hundred ninety-four adults new to yoga were enrolled in the study. After three months of training, patient change scores improved in mental health, body pain, emotional role, general health, physical role, social role, and vitality. The more depressed they were to start, the more mental health improved from the yoga.17

Anxiety can improve with yoga, too. An article published in The Journal of Personality and Clinical Studies compared the drug diazepam to yoga practiced five days per week for three months. At the end of the treatment period, the yoga group had less anxiety than the drug group.18


Ergonomics
Consider that physical strain may just really be the result of not taking care of yourself emotionally, mentally, and spiritually, and that your physical symptoms are a sign that something is out of balance in your world.

Bodywork is a physically demanding profession. To stave off injury, use wonderful body mechanics when you work. Your legs should get tired first, not your arms and hands.

Watch yourself in a mirror sometime while you give a massage. Have someone watch or videotape you while you work. Shoulders are hiking? Head sagging? Joints becoming rigid? Do some serious work on your ergonomics, or get some advanced instruction in body mechanics.

The wrong table will produce a poor experience for you and your client and put excessive strain on your body. It can mean the difference between a thriving career and a painfully stunted one.


Aging And Body Changes
Okay, you're a master of ergonomics. Still, time takes its toll. Be honest with yourself about what you can, and still want to, accomplish in a session. Many therapists, as they age, shift to techniques that are more about energy and less about physical labor. Acupressure comes to mind.

As you become an elder statesperson of your profession, you may find your career more focused on helping the next generation and less about hefting quadriceps. Imparting your wisdom to clients and students may be just as healing as your touch. Look for opportunities to do more with less.


Healing The Healer
Every client who comes to you has chosen you from the many therapists out there. Each of them is a gift with something to teach you. If you can come to your practice every day with a beginner's heart, and an elder's spirit, you will thrive for a long, prosperous career.

Truly, your own healing is vital. It is a life's journey. It is, every last bit of it, worth equally as much as your clients' healing, and it's worth paying for, praying for, working for, fighting for, and thriving for.

Karta Purkh Singh Khalsa is the founder of Seattle's first multipractitioner holistic health center and the author of The Way of Ayurvedic Herbs (Lotus Press, 2008). He is the course director for the International Integrative Educational Institute in Eugene, Oregon.

NOTES
1. Working Caregiver, "Surviving Caregiver Burnout," www.workingcaregiver.com/articles/generalinfoarticles/caregiverburnout.
2. M. Ross Seligson, "Caregiver Burnout, Today's Caregiver," www.caregiver.com/articles/caregiver/caregiver_burnout.htm.3. Wendy D. Lynch, "Health Affects Work, and Work Affects Health: We Know Health Affects Productivity, but Do We Understand How Work Affects Health?" Business Health, Nov-Dec, 2001.
4. Fran Berger, "Eat Your Heart Out," Health Scout, www.healthscout.com/cgi-bin/WebObjects/Af.woa/wa/article?ap=1id=103368.
5. Gladys Block, et al., "Usage Patterns, Health, and Nutritional Status of Long-Term Multiple Dietary Supplement Users: a Cross-Sectional Study," The Nutrition Journal 6, no. 30 (2007).
6. M.F. Holick, "Vitamin D deficiency," New England Journal of Medicine 357, no. 3 (2007): 266-81.
7. T.J. Wang et al., "Vitamin D Deficiency and Risk of Cardiovascular Disease," Circulation 117, no. 4 (2008): 503-11.
8. Michael T. Murray, "The Healing Power of Herbs," Prima, Rocklin, California, 1995.
9. Michael Murray and Joseph Pizzorno, "Encyclopedia of Natural Medicine," Prima, Rocklin, California, 1998.
10. M.T. Purnell et al., "The Impact of a Nap Opportunity During the Night Shift on the Performance and Alertness of 12-H Shift Workers," J Sleep Res 11, no. 3 (2002): 21-27.
11. Newsweek, March 6, 1995, p. 58.
12. Janice Billingsley, "Decline in Deep Sleep Ages Men Faster," Health Scout, www.healthscout.com/cgi-bin/WebObjects/Af.woa/wa/article?ap=1id=101097.
13. Dharma Singh Khalsa, author of Meditation as Medicine, personal communication.
14. Shannahoff-Khalsa DS. An introduction to Kundalini yoga meditation techniques specific for the treatment of psychiatric disorders. J Altern Complement Med. 10, no. 1 (2004): 91-101. The ancient system of Kundalini yoga includes a vast array of meditation techniques and many were discovered to be specific for treating the psychiatric disorders as we know them today. One such technique was found to be specific for treating obsessive-compulsive disorder (OCD), the fourth most common psychiatric disorder, and the 10th most disabling disorder worldwide. Two published clinical trials are described here for treating OCD using a specific Kundalini yoga protocol. This OCD protocol also includes techniques that are useful for a wide range of anxiety disorders, as well as a technique specific for learning to manage fear, one for tranquilizing an angry mind, one for meeting mental challenges, and one for turning negative thoughts into positive thoughts. Part of that protocol is included here and published in detail elsewhere. In addition, a number of other disorder-specific meditation techniques are included here to help bring these tools to the attention of the medical and scientific community. These techniques are specific for phobias, addictive and substance abuse disorders, major depressive disorders, dyslexia, grief, insomnia and other sleep disorders.
15. Michele Hebert, Musings on Meditation IDEA Health Fitness Source, Sept, 2000.
16. Cary Barbor, "The Science Of Meditation," Psychology Today May 2001.
17. S.W. Lee, C.A. Mancuso, M.E. Charlson, "Prospective Study of New Participants in a Community-based Mind-Body Training Program," J Gen Intern Med 19, no. 7 (2004): 760-5.
18. G. Sahasi, D. Mohan, and C. Kacker, "Effectiveness of Yogic Techniques in the Management of Anxiety," Journal of Personality and Clinical Studies 5 (1989): 51-55.




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