Appreciating Clients’ Health Challenges – Hopes of Relief

When people with chronic diseases cross the threshold of a massage therapist’s office, they bring with them hopes of relief. Some health issues, like fibromyalgia (FM), cause clients pain. Others, like Parkinson’s disease (PD) and multiple sclerosis (MS), match pain with life-altering disabilities.

While numerous studies confirm the usefulness of massage as a tool for total health, recent research explores the potential value of bodywork as a means to a higher quality of life for people living with health challenges. In the case of FM, a new Zealand study highlighted how massage therapy can bestow higher pain tolerances and lessen negative emotions.1, 2People with PD may find living easier and, embedded within a particular therapy, the possibility of a normal appearance.3, 4And with the help of massage, people with MS may complete daily living tasks.5

It’s common for clientele with FM, PD, and MS to endorse massage as a valuable component in their struggle to keep life normal. “Massage therapy twice a month has been part of my overall healthcare plan for ten years,” says Gloria, an Ohio mother of three and grandmother of six who was diagnosed with FM thirty years ago. “It is not a cure-all. However, an hour of treatment improves blood circulation and removes toxins from my body.”

With research like that above demonstrating the effectiveness of bodywork, techniques targeted for special conditions should be basic knowledge for therapists, right? Unfortunately, the answer is no.

“I’ve had several different therapists over the years and only one knew something more about fibromyalgia than that it existed,” Gloria says. “And she only had more knowledge than the others because her therapist ex-husband specialized in fibromyalgia patients.”

When presented with clients who need special treatment, like Gloria, massage therapists may find themselves in uncharted waters. “Most therapists don’t really know a great deal about pathological conditions and, therefore, will be uneasy about dealing with adverse health conditions,” says Whitney Lowe, director of the Orthopedic Massage Education & Research Institute (OMERI) in Sisters, Oregon. He advises bodywork professionals to admit to clients when they don’t know much about a condition and, then, to get as much information as possible. That way, they can make more informed judgments about what type of massage interventions might be appropriate.

Until training and education correspond with research and necessity, therapists will have to rely on the words and wisdom of their more experienced peers. “In school, aside from not massaging arthritic areas during a flare-up, we didn’t cover conditions,” says Christy Wilson, a licensed massage therapist with a practice in the Los Colinas area of the Dallas Metroplex. Wilson credits advanced study and years of practical experience with making her feel comfortable treating clients with significant ailments.

Tracey Dronet, a licensed massage therapist in Frisco, Texas, agrees. “School taught the basics of touch, as well as the possibilities of our profession. But my real education began with my first client and continues with each subsequent client.”

At his school, Tony Scanu, a massage therapist at the Center for Natural Wellness in Guilderland, New York, says the students learned some general facts about special conditions, “but not nearly enough. We didn’t go over particular syndromes or how to resolve them with bodywork.” To increase his knowledge base, Scanu attends workshops. He researches diseases either with books or on the Internet. Then, he supplements those sources with articles by industry gurus like Whitney Lowe and Ben E. Benjamin. “They explain clearly and in detail the exact procedures for specific complaints,” Scanu says. “If I’m concerned with contraindications, I use A Massage Therapist’s Guide to Pathology by Ruth Werner.”

Continuing education workshops and academic and peer-reviewed periodicals like the Journal of Manipulative and Physiological Therapeutics, Journal of Bodywork and Movement Therapies, and Complementary Therapies in Medicine offer the best venues for learning about various diseases and provide cutting-edge research and a glimpse into coming trends for those in the field.

Dronet, like so many others, researches medical conditions on the Internet, in books, and through health professionals. “But, when I want to know what it feels like to live with a particular condition, I turn off my computer, put the books down, skip the medical professionals, and ask the experts–those people living with that particular challenge. They usually share their stories freely and with great candor. I can’t imagine a better education than that.” Websites like DailyStrength.org and WebMD.com provide community networks for people affected by an ailment to connect and converse.

EASY DOES IT
With some guidance from industry experts and clients, massage therapists can construct perfect bodywork sessions for those suffering from health challenges. But tailoring the type of massage to the client is equal amounts technical knowledge and the artistry and intuition of the therapist. “Choosing modalities should take into account the person’s individual circumstances,” says Bradly P. Jacobs, MD, senior medical director, and head of Integrative Medicine for RevolutionHealth.com, a website dedicated to health topics. “Each person’s health issues, preferences, experiences, expectations, and cultural beliefs should be weighed.”

Wilson says, “Regardless of the condition, I tend to blend techniques to achieve the best results for that particular client on that specific day. I’ve found that fibromyalgia, arthritis, and chronic fatigue symptoms decrease with traditional Thai massage. Myofascial release and primal reflex release techniques complement the deep-tissue techniques that benefit so many people with health complaints.”

When working with people who have significant health problems, an easy-does-it philosophy is most prudent. “During the massages, I felt wonderful,” says Jane, a thirty-five-year-old Ohio mother with fibromyalgia. “But afterward, I felt nauseated, light-headed, and just plain rotten. No one could figure out why I had those reactions.”

Another massage recipient experienced migraines after her treatments–a common complaint that sends many newcomers scurrying in the opposite direction of what might be their salvation.

“I suspect that in both cases too much work or too aggressive an approach caused the typical symptoms of what I call ‘overload,'” Wilson says. “Less is often more, especially with people’s heavily taxed physical systems. These clients frequently hurt so much that they believe deep-tissue massage will bring them respite. But I have much better results when I combine a calming and balancing atmosphere with gentle physical manipulation.”

To prevent these painful backlashes, Wilson recommends shortening the session time. She also blends a bioenergetic synchronization technique, myofascial release, traditional Thai sen work, and primal reflex release. Wilson recommends checking in with the client during and after the session–including the next day and a few days after that–then, for the next session, adjusting the amount of time and type of treatment accordingly.

RESPECTFULLY PRESENT
Accommodating the needs of clients comes naturally to most therapists. And that generous attitude easily translates in situations where their clients are in need of particular support due to chronic illness. “Most therapists will do whatever they can to help their clients,” Whitney Lowe says. “This would include unique positioning on the table, extra blankets, customized techniques, or special lubricants.”

“Even if you never treat someone with limitations, having handicap-accessible offices with nearby parking will assure clients they’ll always be able to reach you,” Wilson says. “Clients in pain appreciate not having to climb stairs or walk long distances. First-floor accommodations with nonslip surfaces will lessen the chance of falls.” Extra bolsters, pillows, and adjustable tables ensure optimal experiences. Clients appreciate offers of assistance while moving on and off the table, as well as disrobing and, later, dressing.

Lia Baker, a massage therapist with the Pritikin Longevity Center & Spa in Aventura, Florida, says, “We have to pay close consideration to the responses of our clients. Reactions to massage vary by individual and time. Clients might endure the slightest touch with difficulty on one day and, at another time, easily tolerate the most aggressive and invasive techniques.” Baker says that cold or heat packs relax or distract the more anxious clients, so they are more receptive to the deep, trigger-point massages. “Packs applied to tender spots bring instant relief, while those placed distant to the area being massaged divert attention,” she says.

Alan M. Abromovitz, a Phoenix physician who uses massage, osteopathic manipulation, and acupuncture to treat his patients, says, “Chronic conditions require longer and more persistent treatment. Massage, moist heat, and healing oils such as olive oil and peanut oil improve local circulation and fluid mobilization. Most chronic conditions require treatment three to five times weekly for six to eight weeks initially. Ongoing maintenance ensures maximum continued benefits.” To make massage pressure and stroking most effective, Abromovitz advocates positioning the areas being treated to maximize the benefit of gravity with elevation. This technique will assist fluid return toward the heart.

Some of the more immobile clients might require special treatment. “If clients cannot come to me, I am happy to go to them,” Wilson adds.

“Avoid bodywork on infected areas,” Jacobs says. “Same with limbs that have blood clots in the veins. People with immunosuppression issues, bleeding disorders, or low platelet counts–such as people undergoing chemotherapy–benefit from gentle and light bodywork.”

People with significant health challenges benefit greatly from positive feedback about what their bodies can do, rather than the limitations, Wilson says. “I have never thought of my clients with ‘health concerns’ or ‘health issues’ as such. And I never allow diseases or diagnoses to define my clients.”

When asked about communication between clients and therapists, Dr. Georgianna Donadio, founder and director of the National Institute of Whole Health in Wellesley, Massachusetts, quotes Maya Angelou: “People may not remember what you do or what you say, but they always remember how you made them feel.”

“Our whole program focuses on teaching healthcare professionals how to be mindfully and respectfully present for their clients,” Donadio says. “Whenever clients speak, massage therapists should listen respectfully. Then, they should reflect back to the client their understanding of what was said. Therapists should do this, not only to gather important information relevant to their work, but to respond to the four most basic questions all clients have: (1) is anyone listening to me? (2) are my symptoms explainable? (3) does anyone care about my experience? (4) are my symptoms or condition controllable–not necessarily curable, but controllable?”

When clients ask questions that enter the territory of health advice, therapists should be clear about their expertise. “Most massage therapists have no training as health educators, health practitioners, or health coaches,” Donadio says. “So, as professionals, they need to be clear about their boundaries regarding discussions and comments on healthcare issues outside their scope of practice.”

Taking notes may be protocol in all cases but, when dealing with clients in health crises, these records become vital tools. Baker says her massage notes include trigger and tender points, areas of involvement, and observations of progress.

“I maintain records on all clients,” Wilson says. Whether done on loose-leaf paper or on sophisticated computer programs, whether elaborate and detailed or brief and focused, Wilson says she has found her comments essential components for success.

“I take detailed histories, including a comprehensive list of medications my clients take,” Dronet says. “If I don’t know what a particular medication is, I ask. Most people will gladly educate you. Then, we decide together what will work best.”

When catering to challenged clients, clear and concise communication with other professionals is vital. “Some physicians like to be kept abreast of progress and will request copies of your records,” Wilson says. “I never share any information without a client’s express authorization.”

“I speak with physicians daily in my line of work and feel perfectly comfortable doing so when necessary,” Dronet says. “I have also spoken with counselors to assist in developing care plans for several clients.”

Jacobs encourages therapists to maintain contact with clients’ doctors for two reasons. “First, the client’s quality of care improves,” Jacobs says. All healthcare providers should be aware of treatments their patients receive, he adds. Better understanding leads to better care. Open communication sidesteps conflicting treatments, while conventional or alternative treatments can be adjusted for best possible outcomes.

Second, Jacobs believes doctors need exposure to bodywork and bodywork therapists. So, the more contact, the better–whether by phone call or letter. Summaries of the client’s progress or, lack thereof, keep massage therapy in the forefront of the physician’s mind.

Beyond the physical problems, clients bring their willingness or resistance for accepting help to the table with them, Abromovitz says.

MTs with positive and open minds have the advantage. Dronet adds, “I find that clients tell me what they need. I let them guide me. Very often, they will tell me what is wrong and how to address it. Sometimes, they reveal their needs articulately. Sometimes, I have to read between the lines. Sometimes, body language does the talking.”

REWARDING AND RENEWING
Both clients and therapists cite cost as a major–and often, only–deterrent. Even though they’re a population that could most use bodywork, people with physical problems generally have more fiscal constraints. “After paying for medications, treatments, and physician fees, people with chronic medical concerns find themselves unable to afford massages, even though bodywork greatly improves their quality of life,” Dronet says. She often works with medical clients to try to accommodate their financial needs. And she’s attempting to partner with a nonprofit organization to bring in grants for those in need.

“In New York State, there isn’t any coverage under insurance, so the individual pays,” Scanu says. “It is difficult for the client. Many times, I have lowered my bill substantially. That tactic usually has an adverse affect, because the client doesn’t want to ‘take’ anything from me. It’s just a totally frustrating situation. Losing a client to fees can be heart wrenching, especially when you have achieved some success, and you believe that success can continue.”

Despite the extra effort and education involved, working with clients who have physical problems can be rewarding and renewing. “Having a person come into your office in pain and leave feeling at least a little better inspires me,” Scanu says. “This is especially true when I’m the last resort before surgery.”

“My patients say all the time that massage represents a gift of energy,” Donadio says. “They say that energy uplifts them.”

Physical therapists may think of bodywork as strengthening exercises and balance training, chiropractors may consider it relaxation prior to spinal adjustment, and physicians may refer to it as a spa day, Abromovitz says. Clearly, the medical professions underappreciate the benefits of attaining and maintaining maximum skeletal and muscular function. “In my opinion and experience, bodywork is as essential to health and well-being as diet, exercise, love, compassion, forgiveness, and gratitude,” Abromovitz says.

Dronet says, “My most challenged clients teach me about loss, joy, and grief. Being invited to join them on their journeys honors me, as does being allowed to see their pain and fear. Diseases might be breaking their bodies, but they find the courage to present themselves to me. I find their faith very humbling, spiritual, and grounding.”

Now, how many occupations can claim similar perks?

By Diane M. Marty a Colorado-based freelance writer who specializes in holistic health topics.
Originally published in Massage & Bodywork magazine, January/February 2008. Copyright 2008. Associated Bodywork and Massage Professionals. All rights reserved.

NOTES
1. Kieren Faull, “A Pilot Study Of The Comparative Effectiveness Of Two Water-Based Treatments For Fibromyalgia Syndrome: Watsu And Aix Massage,” Journal of Bodywork and Movement Therapies, 9: 202-10. When thirteen females diagnosed with FM completed watsu treatments, researchers noted significant changes in bodily pains, vitality levels, and physical and social functions.

2. In another study published in the Journal of Clinical Rheumatology a month of biweekly massages improved sleep patterns and decreased pain, fatigue, anxiety, depression, and cortisol levels in people with fibromyalgia. T. Field, M. Diego, C. Cullen, M. Hernandez-Reif, and W. Sunshine, “Fibromyalgia Pain and Substance P Decrease and Sleep Improves After Massage Therapy,” Journal of Clinical Rheumatology, 8, no. 2 (April 2002): 72-6.

3. At the Touch Research Institute in Miami, sixteen adults diagnosed with PD received either thirty minutes of massage therapy or progressive muscle relaxation exercise sessions twice a week for five weeks. Massage participants improved in their ability to complete daily living activities. They also rated themselves as having better sleep and had lower stress hormone levels. M. Hernandez-Reif, T. Field, S. Largie, C. Cullen, J. Beutler, C. Sanders, W. Weiner, D. Rodriguez-Bateman, L. Zelaya, S. Schanberg, and C. Kuhn, “Parkinson’s Disease Symptoms Are Reduced By Massage Therapy And Progressive Muscle Exercises,” Journal of Bodywork and Movement Therapies, 6: 177-182.

4.Researchers at the Montreal Neurological Institute in Montreal, Quebec, noted that after Trager therapy on their most rigid arms, patients with Parkinson’s disease (PD) experienced a 36 percent reduction in involuntary movements immediately following treatment. The study strongly suggests that Trager therapy may reduce muscle rigidity and eventually lead to the development hybrid therapies for PD. C. Duval, D. Lafontaine, J. Hbert, A. Leroux, M. Panisset, and J. P. Boucher, “The Effect Of Trager Therapy On The Level Of Evoked Stretch Responses In Patients With Parkinson’s Disease And Rigidity,” Journal of Manipulative and Physiological Therapeutics, 25, no. 7 (Sept 2002): 455-64.

5. Weekly one-hour therapeutic massage treatments conducted over a sixteen-week period at the Sutherland-Chan School of Massage Therapy in Toronto, Canada, indicate that massage therapy increases the effectiveness of clients with MS, potentially resulting in an improvement in their emotional state. This outcome dissipated with time, suggesting that the positive changes require on-going treatments. Paul Finch and Pauline Becker, “Changes In The Self-Efficacy Of Multiple Sclerosis Clients Following Massage Therapy,” Journal of Bodywork and Movement Therapies, 11, no. 3 (July 2007): 267-72.

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