|
by Tracy Walton, MS, LMT
*This article adapted from a forthcoming book, Medical Conditions in Massage Therapy, copyright Wolters Kluwer Health, Lippincott Williams & Wilkins.
Years ago I was teaching a continuing education (CE) course on massage and pathology when a question came up about a medical condition. The therapist asked whether a certain modality was contraindicated for that condition. A second therapist jumped in, said he thought not, and described his practice of that modality, which always employed the gentlest pressure. A third therapist jumped in and described her practice of the same modality, which used very deep pressure.
Soon, everyone was arguing. There was not enough agreement on the modality to answer the question. The modality name itself was too vague. The trade names of some modalities don't necessarily describe the range of techniques within each, nor the way the hands travel over the body. With each therapist's signature on the work, and each employing a variety of modalities and techniques, there can be marked disagreement about the meaning and application of different massage terms. Not even the term "massage" is universally understood. Massage theory and practice are rich, diverse and far from consistent across the field. The argument was growing louder by the minute. I restored order in the classroom, pointing out that it is rare for an entire discipline or modality to be contraindicated for a condition.
Instead, we spoke to specific elements of massage therapy-such as pressures, speeds, movements or areas to avoid or adjust in a given condition. We looked at specific features of the medical condition itself, and how different elements might interact with them. There was no single, categorical statement-"massage is contraindicated"-that captured all of these clinical possibilities.
Simplistic Rules
The discussion that day reflected the state of massage education at the time, before massage curriculum and textbooks began to hone our understanding of contraindications. Many of us learned a one-dimensional approach to massage and pathology: "massage is contraindicated for X" was a common phrase. Students studied long lists of such contraindications. We had simplistic, reflexive responses to conditions: "don't massage" or "don't touch."
This single decision-making step rarely reflects clinical reality. A classic example was the blanket contraindication of massage in cancer, and that contraindication was followed for decades. Among other things, this reflexive response produced isolation and pain for clients who needed care, heartbreak for therapists and a poor image for the massage profession.
It shows what can happen when people bend too easily to simplistic rules for contraindications. Fortunately, the profession is moving away from this approach (see Cancer and Massage: Essential Contraindications" in the Summer 2006 issue of mtj, with many references, for more on this).
Cancer is one example of how a simplistic rule-based approach to contraindications failed the profession. There are other examples, too. In general, the simple flow chart, "If X, do this" fails to capture our clinical reality in the following ways:
- Condition "X" can manifest very differently in different people.
- All "massage" isn't the same; it's a collection of elements mixed differently for different clients.
- Touch in some form is almost always possible, and it's usually not necessary, nor professional, to simply deny massage to a client with condition "X."
A Clearer Approach
From spending years in massage therapy classrooms focused on the nitty-gritty of massage contraindications I've heard a lot of client cases-people with multiple sclerosis (MS), diabetes, prostate cancer, bladder infections, eczema or histories of heart attack and stroke. How do you work with them? What do you avoid and where? In response to each case, try answering two simple questions:
1. What is it about the medical condition that contraindicates massage?
2. What is it about massage that is contraindicated?
Both of these questions must be explored. Identify the elements of a medical condition that are red flags for massage therapy. Then identify the elements of massage therapy that should be adjusted or avoided. In my experience massage therapists tend to be visual and kinesthetic learners and decisionmakers, so I prefer to organize questions one and two in a visual, left to right format-a "decision tree."
The Decision Tree
Continue <1
2
3
4>
|
American Massage Therapy Association®
