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Facial self massage and Sjogren's Syndrome: parotid, submandibular, submental, and lacrimal areas

What is Sjogren's Syndrome?

Sjogren's syndrome is an autoimmune disorder in which immune cells mistakenly attack and destroy the body’s own moisture producing glands (exocrine glands), such as those responsible for creating tears and saliva. The hallmark symptoms of the disorder are dry mouth and dry eyes. In addition, Sjogren's syndrome may cause skin, nose, and vaginal dryness, and may affect other organs of the body including the kidneys, blood vessels, lungs, liver, pancreas, and brain. Sjogren's syndrome is also associated with rheumatic disorders.

Sjogren's syndrome affects 1-4 million people in the United States. Most people are more than 40 years old at the time of diagnosis. Women are 9 times more likely to have Sjögren's syndrome than men.

Where are the Parotid, Submandibular, Sublingual, and Lacrimal exocrine glands of the face located?

What are the muscles of the face?

An understanding of the muscles of the face will be helpful in massaging these areas. Here are the major muscles you may feel as you're working:

Can massage benefit exocrine gland function for those with Sjogren Syndrom?

The autonomic nervous system (ANS) is a subdivision of the peripheral nervous system (PNS). ANS sends nerve fibers to three tissues: cardiac muscle, smooth muscle, and glandular tissue. The two subdivisions of the ANS are the parasympathetic nervous system (PSNS) and the sympathetic nervous system (SNS).

Actions of the parasympathetic nervous system can be summarized as "rest and repose", as opposed to the "fight-or-flight" effects of the sympathetic nervous system.

Stimulation of the sympathetic and parasympathetic nerves controls smooth muscle contraction, regulate cardiac muscle, and stimulates or inhibits glandular secretion.

Parasympathetic stimulation (rest and repose) produces a water-rich serous saliva. Sympathetic stimulation (fight-or-flight) leads to the production of a low volume, enzyme-rich saliva. This is done by vasoconstriction which inhibits blood supply to the parotid gland reducing the potential for water collection - not by inhibiting nerve supply to the gland.

In Sjogren's Syndrome, concentrations of enzymes in the saliva, such as amylase, are found to be normal, although the production of amylase is reduced, as is the amount of fluid. Therefore, researchers have found that the measurement of amylase is not useful for the evaluation of salivary gland function in SS patients (Mandel, 1980).

Although there is currently no research available on the effectiveness of massage for Sjogren's Syndrome, extensive research concludes that moderate massage stimulates the parasympathetic nervous system, relieving anxiety and pain, and increasing blood flow. A few of these studies are summarized here: http://www.massagetherapylaketahoe.com/massagetechniquesresearch.html
Via parasympathetic stimulation, it is possible that massage may enhance the PNS production of water-rich serous saliva, rather than SNS function of increasing enzymes in the saliva.

Cautions

When massage is applied too vigorously, over stimulation may occur. For those with autoimmune disorders, overstimulation may trigger onset of symptoms. Therefore, moderate pressure is advised.

Caution: vigorously tapping the face may cause headache-like sensations, which may defeat the purpose of the massage. Remember, the idea is to release tension and stimulate blood circulation.

Facial Self Massage Techniques

NOTE: Use light to moderate pressure for all techniques. Fascial muscles are delicate so please do not use excessive pressure.

	Sit comfortably and take several slow, deep breaths. As you inhale imagine energy entering your body from the outside of each nostril, filling your body with warm, calming light.
	Rub your hands together briskly for 15 seconds to increase the energy flow. Move your hands about 3 inches apart and notice a sensation between them. Increase the distance to 6 inches then back to 3 inches. You might become aware of the energy that you've generated.
	Apply moderate to light pressure in circle around eyes with fingertips
	Tap both right and left sides of upper jaw with middle fingers, then rest fingers on the points for a count of 5. Repeat 3 times.
	Working from your chin toward your ear, rest your thumbs under your jaw while pressing your fingers into the top of your jawline.
	Starting toward midline with your thumbs under your eyebrows and index finger above your brow, press gently up into the brow. Move laterally a bit and apply pressure up again. Continue along the brow toward your ear.
	Working from chin toward ears with thumbs under jawline, apply upward pressure at 1/4 inch intervals.
	Feel the muscle behind your ears and massage in small circles with moderate pressure. Move skin and muscle with your fingertips.
	Place one thumb under your chin while resting the side of you index finger on the top of your chin. Apply moderate upward pressure with your thumb as you allow your neck and shoulder muscles to relax and soften.
	Place the tip of your index finger on your upper lip halfway to your nose. With the same hand, place your thumb below your lower lip at the mid-point of your chin. Hold these points lightly and notice a sensation of connectedness.
	With your index fingers along each side of your nose just outside the nostrils, press in and up until you feel moderate pressure. Hold these points for several seconds as you slowly inhale and exhale, then release. Repeat 5 times. Life energy (also refered to as Chi) enters the outer edge of the nostrils as we inhale. Once inside the body, it joins the circulatory system and is carried to every cell.
	With both index fingers, locate points on the chin that might feel like small indentations. Hold these points lightly and feel the shift in your jaw muscles. This is an energy balancing technique.
	Locate a point at the top of each jaw just above the Masseter muscle and in front of the lower edge of your ears. Using your middle fingers, apply light pressure and imagine energy flowing from your right finger toward your left. As the energy reaches your left finger, send it back across to your right finger. Alternate back and forth as you notice the flow smoothing out and becoming more rapid. This is also an energy balancing technique.
	With your middle finger, locate a point on the top of your head - the "soft spot". With the thumb of your other hand, hold a point under your chin. Imagine energy flowing from your finger to thumb. As the energy reaches your thumb, send it back up to your finger. Alternate back and forth as you notice the flow smoothing out and becoming more rapid. This is another energy balancing technique.

Nutritional considerations for Sjogren's Syndrome

Lack of adequate synthesis of prostaglandin (PG) E1 may be the key factor in Sjogren's syndrome. PGE1 is important for lacrimal and salivary gland secretion and for T lymphocyte function: a deficiency could therefore account for the main features of Sjogren's syndrome and the sicca syndrome. PGE1 could also account for many of the other features often associated with these syndromes. These include the Raynaud's phenomenon, the abnormalities of renal function and the precipitation of the syndrome by vitamin C deficiency.

Vitamin C is important in PGE1 biosynthesis.

PGE1 treatment has been shown to correct the immunological abnormalities in the NZB/W mouse, the animal model of Sjogren's syndrome. An attempt to treat humans with Sjogren's syndrome by raising endogenous PGE1 production by administration of essential fatty acid PGE1 precursors, of pyridoxine and of vitamin C was successful in raising the rates of tear and saliva production.

Reference: Horrobin, D. F., et al. Sjogren's syndrome and the sicca syndrome: the role of prostaglandin E1 deficiency. Treatment with essential fatty acids and vitamin C. Medical Hypotheses.6(3):225-232, 1980.

The body converts linoleic acid into prostaglandin E1 (PGE1) in the following sequence: linoleic acid to gamma-linolenic acid (GLA) to dihomo-gamma-linolenic acid to prostaglandin E1.
Dietary Sources of Gamma-Linolenic Acid become particularly important for people who are unable to manufacture the Delta-6-Desaturase Enzyme which allows the conversion of Linoleic Acid to Gamma-Linolenic Acid (GLA).

Gamma-Linolenic Acid is found in:
Blackcurrant Seed Oil
Borage Seed Oil
Evening Primrose Oil
Hemp Seed Oil
Red Currant Seed Oil
Fruit: Avocado
Meats: Chicken Liver
Nuts:Pine Nuts
Peanuts
Brazil Nuts
Gooseberry Seeds
Poplar Seeds

Onions are one of the only foods known to contain PGE1.

However, these substances may stimulate the production of Prostaglandin E1:
Bromelain
Dihomo-Gamma Linolenic Acid (DGLA) is a precursor for the production of PGE1 and can increase its production by up to 400%.
Gamma-Linolenic Acid (GLA)
Vitamin B3 is a cofactor for the production of (PGE1) from DGLA. 
Vitamin C is a cofactor for the production of PGE1 from DGLA.

Reference: Hyperhealth Encyclopedia of Nutrition and Natural Health

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