September 23rd, 2008
Just knowing that cirrhosis makes someone ineligible for massage is insufficient. By comprehending the stages of liver disease and the scope of problems that can lead to cirrhosis, massage therapists can provide affected clients with a higher level of care.
by Nicole Cutler, L.Ac.
Routinely taught as one of the premiere contraindications for massage therapy, cirrhosis is commonly encountered in mainstream society. Unfortunately, the likelihood of harboring a health condition that can develop into cirrhosis is on the rise. Learning about the ailments that can cause this advanced stage of liver disease helps healthcare workers realize its growing prevalence. Additionally, understanding how liver disease progresses to cirrhosis helps caregivers envision the process that affected clients endure.
As the body’s largest internal organ, the liver is essential for many life-sustaining functions. A few of the liver’s responsibilities include:
- Removing or neutralizing toxins, viruses and bacteria from the bloodstream
- Producing immune agents to control infection
- Making proteins to regulate blood clotting
- Manufacturing bile to help absorb fats and fat-soluble vitamins
When a person has chronic liver disease, the liver is likely to become increasingly damaged. A basic progression of liver disease is described below:
- Inflammation – As the liver battles infection, excessive toxicity, fatty tissue or other insults, it becomes inflamed, tender and enlarged.
- Fibrosis – Persistent inflammation causes the liver to scar. The accumulation of scar tissue replaces previously healthy cells and can cause a reduction of liver function. As one of the few organs capable of regeneration, new liver cells can grow if there is enough of an inflammatory respite.
- Cirrhosis – When the liver becomes so fibrotic that it can no longer heal itself, cirrhosis has occurred. Disrupting the flow of blood, the severe scarring of cirrhosis prevents the liver from completing its important tasks. Due to this mechanical restriction on hepatic blood flow, increasing the circulatory demand on an already cirrhotic liver can cause a dangerous backup of toxins in the bloodstream. The potential for an overwhelming toxin load explains why cirrhosis contraindicates many kinds of massage.
- Liver Failure – If the liver completely loses its ability to function, the life-threatening condition of liver failure occurs.
While there are dozens of chronic liver disease causes, the following are the most common culprits for developing cirrhosis:
- Viral Hepatitis C – With about four million infected Americans, Hepatitis C accounts for approximately 25 percent of chronic liver disease cases. Currently, the standard treatment for Hepatitis C can only help approximately 50 percent of infected people overcome the virus.
- Alcoholic Hepatitis – Alcohol abuse is one of the most common causes of liver disease in Western societies. In the United States alone, alcoholic liver disease affects more than two million people. However, the true prevalence of alcoholic hepatitis, especially in its milder forms, is unknown because patients may be asymptomatic and never seek medical attention.
- Non-Alcoholic Fatty Liver Disease – This buildup of fat in the liver may be associated with diabetes, protein malnutrition, obesity, coronary artery disease and certain medications. A recent study estimates that 25 percent of American adults have some degree of fatty liver disease.
- Viral Hepatitis B – Although there is a vaccine to prevent its acquisition, there are an estimated 1.5 million American carriers of Hepatitis B and 300 million carriers worldwide.
- Autoimmune Hepatitis – The prevalence of autoimmune hepatitis in the United States remains uncertain because it tends to be grouped with other diagnoses. However, the surge of autoimmune disease findings suggests this problem is on the rise.
- Bile Duct Obstruction – When the ducts that carry bile out of the liver are blocked, bile backs up and damages liver tissue. The most common cause of this is primary biliary cirrhosis, which is estimated to affect one in every 3,500 people.
- Inherited Liver Diseases – Alpha-1 antitrypsin deficiency, hemochromatosis, Wilson’s disease, galactosemia and glycogen storage diseases are among the inherited diseases that interfere with the way the liver produces, processes and stores enzymes, proteins, metals and other substances the body needs to function properly.
A person with chronic liver disease may or may not be aware of how far his or her condition has progressed. Especially crucial for cases advanced to cirrhosis, administering bodywork should be carefully considered, and consent from the client’s physician should precede any sessions. In addition, all applied techniques must be gentle and non-circulatory to prevent a toxin overload.
Recognizing the various etiologies of cirrhosis raises a bodyworker’s awareness of this condition. Whether a client just learned he or she has Hepatitis C, is trying to manage fatty liver disease or struggles with alcoholism, responsible practitioners must inquire about the staging of their client’s liver disease. Armed with this information, therapists are better able to appreciate the severity of an illness and assess the safety of any given bodywork application.
Braun, Mary Beth, Stephanie J. Simonson, Introduction to Massage Therapy, Lippincott Williams and Wilkins, 2007.
http://digestive.niddk.nih.gov, Cirrhosis of the Liver, National Institute of Diabetes and Digestive and Kidney Diseases, 2008.
http://en.wikipedia.org, Primary Biliary Cirhosis, Wikimedia Foundation, Inc., 2008.
http://pubs.niaaa.nih.gov, The Epidemiology of Alcoholic Liver Disease, Robert E. Mann, Ph.D., Reginald G. Smart, Ph.D., and Richard Govoni, Ph.D., National Institute on Alcohol Abuse and Alcoholism, 2008.
http:///wiki.answers.com, Can you have a massage if you have cirrhosis of the liver?, Answers Corporation, 2008.
www.allabouthepatititisc.com, Hepatitis C Statistics, Schering Corporation, 2008.
www.emedicine.com, Alcoholic Hepatitis, WebMD, 2008.
www.medscape.com, Autoimmune Liver Disease, Current Opinion in Gastroenterology, 2003.
www.redorbit.com, 1-in-4 U.S. Adults Has Fatty Liver Disease, redOrbit.com, 2008.
www.umm.edu, Liver Disease, University of Maryland Medical Center, 2008.
www.wrongdiagnosis.com, Prevalence and Incidence of Alcoholic liver disease, Adviware Pty Ltd., 2008.
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