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The Many Faces of Botox

By Ruth Werner

Originally published in Body Sense magazine, Summer 2011. Copyright 2011. Associated Bodywork and Massage Professionals. All rights reserved.

Consider this scenario: You are having a well-deserved spa day,
and part of your indulgence is a series of Botox injections.
Next on your list: a massage. What kind of adjustments does your massage therapist need to make to accommodate for your treatment?

Or this one: You have a condition called cervical dystonia, which involves painful twitches and tics of your neck muscles. Your recent Botox injection will provide some relief, and you are looking forward to receiving a massage as well. Does your therapist know how to help you get the most benefit with the least risk from your injections?


Wrinkles, Muscles, and Botulism
As we age, the tissues that stabilize our skin get progressively looser. A history of sun damage, smoking, or poor nutrition doesn't help either. But what really carves those deep lines are habitual muscle contractions that crinkle our forehead or purse our lips and make us look like we're frowning.

If somehow we could prevent those muscles from contracting, those deep lines would be much less noticeable. That's where botulism comes in.

Clostridium botulinum is a bacterium that secretes a toxin that kills the tips of the nerves that make muscles contract. This damage is permanent: the nerve branches that are destroyed will never work again, and the affected muscle cells are effectively paralyzed until they regenerate, a process that can take weeks or months: this is botulism poisoning.

The neurotoxin that causes the paralysis was once considered as a possible biological weapon, but other uses have prevailed. A diluted and purified version of it was first used therapeutically in 1980 for an eye condition. In 2002, the FDA approved the use of botulinum toxin for other conditions, as well as for cosmetic uses. After that, the industry grew fast, and Botox injections are now commonly used for cosmetic and medical purposes in which involuntary muscle contractions limit function or cause pain. It is even sometimes injected into palms and armpits to address hyperhydrosis: too much sweating.


Botox and Massage: Allies or Adversaries?
The full effect of Botox injections may take several days to develop. Cosmetic injection patients are encouraged to gently exercise facial muscles immediately, but to not touch, compress, sleep on, or disrupt the injection sites for a minimum of four hours after treatment. This limits massage as well, and not only to the face; the pressure of lying face down on a massage table with a new Botox treatment may create problems. So for that spa day, it's best to receive massage before the injections if possible.

The role of massage for someone receiving Botox to deal with a medical issue is less clear. Research suggests that massaging the injection site can help the toxin reach its target areas better, but can also allow it to seep into unintended muscles. This is why it is so important to put together a team of health-care providers; a general practitioner or neurologist can help your massage therapist make the best choices for your successful outcome.

Ruth Werner is president of the Massage Therapy Foundation. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams Wilkins, 2009). Werner can be reached at www.ruthwerner.com.




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