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L i s te n to T h e A B M P Po d c a s t a t a b m m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 37 surgical complications. This is especially true when multiple levels are fused. Advances in technology have indeed made spinal fusion surgery safer and more effective than ever before. It would be even better, though, if we could identify who is less likely to derive benefi t from this very invasive and risky procedure before they go through this ordeal. ROLE FOR MASSAGE THERAPY The number of spinal fusion surgeries conducted in the United States has doubled in the past 20 years, but even with all that work being done, there is a remarkable lack of consensus on best practices for rehabilitation. This is frustrating on many levels, including the fact that highly customizable massage therapy seems like a natural fi t for the recovery process from a surgery of this nature. After extensive searching, I was surprised to fi nd only one published research project that looked at massage therapy for a person who had recently had spinal fusion surgery. It was published in 2012 by the International Journal of Therapeutic Massage and Bodywork. It was also the subject of a Massage Therapy Foundation Research Perch podcast with me and Niki Munk, PhD. 5 The study found that massage therapy offered considerable benefi ts for the client, with some limitations based on circumstances outside of anyone's control (the client had to return to work earlier than expected). 6 The benefi ts for pain and disability appeared to be relatively short- lived, but they were substantial. We hoped this report would spark interest in the use of massage therapy as part of the rehabilitation process for spinal fusion surgery patients, but to my knowledge, no further research on this topic has been published. That said, it seems clear that most patients who want to regain safe fl exibility and movement capacity after a spinal fusion, disk replacement, or any other kind of spine repair intervention could benefi t from skilled bodywork. It was especially notable that in this case report, the hands-on techniques used were not highly specialized, and they are within the capabilities of most massage therapists. Cautions for working with this population are the same as for all postsurgical situations, including the risk of infection, incomplete wound healing, and any reactions to medications. Additionally, people in recovery from spine surgeries are taught careful procedures for certain activities, like getting in and out of bed— these would apply for getting on and off a massage table as well. But the benefi ts we can offer are many and varied. If we coordinate with the client's health-care team, then skilled massage therapy can conceivably help manage pain, improve safe range of motion, minimize the negative repercussions of scar tissue, and otherwise support the healing process while adding to the client's general quality of life. This is a situation where our hands-on work is only part of what we bring to the table; our communication skills can support a sense of self-effi cacy and self-empowerment that are central to the healing process. The fact that almost no data has been recorded about massage therapy for people recovering from spinal fusion surgery does not mean this work isn't happening. I'm positive that many massage therapists are working with clients in this population. I encourage you to report on your work so we can get your results into the hands of doctors and patients who need to know what massage can add to the healing process of this common but complex intervention. Notes 1. American Academy of Orthopaedic Surgeons, "Spinal Fusion," OrthoInfo 2020, accessed January 2021, www.orthoinfo. org/en/treatment/spinal-fusion. 2. iData Research, "How Many Spinal Fusions are Performed Each Year in the United States?" May 25, 2018, many-instrumented-spinal-fusions-are- performed-each-year-in-the-united-states. 3. Peyman Pakzaban, "Spinal Instability and Spinal Fusion Surgery" Medscape, March 6, 2020, article/1343720-overview#showall. 4. Stephen Hochschuler, "Posterior Dynamic Stabilization Systems," SPINE-health, updated March 26, 2007, www.spine- posterior-dynamic-stabilization-systems. 5. MassageNerd, "Massage Therapy and Fusion Surgery of the Lumbar Spine—Research Perch," YouTube Video, 28:59, December 17, 2015, 6. Glenda Keller, "The Effects of Massage Therapy after Decompression and Fusion Surgery of the Lumbar Spine: A Case Study," International Journal of Therapeutic Massage & Bodywork 5, no. 4 (December 2012): 3–8, Ruth Werner is a former massage therapist, a writer, and an NCBTMB- approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology (available at booksofdiscovery. com), now in its seventh edition, which is used in massage schools worldwide. Werner is available at or SCAN AND WATCH "Spinal Fusion Controversies" PATHOLOGY PERSPECTIVES

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