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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 79 PATHOLOGY PERSPECTIVES • Nausea, vomiting, diarrhea • Sensitivity to noise, light • Shortness of breath • Temperature dysregulation, poor tolerance for heat TREATMENT Dysautonomia has no specifi c cure, so treatment options target symptomatic relief. This may change from day to day, so a person with this problem must develop a strong set of coping skills. Dysautonomia symptoms can be addressed fi rst by taking steps to ensure healthy blood pressure. That might mean consuming more electrolyte-rich liquids, wearing compression garments to minimize pooling in the extremities, and avoiding being overheated. Patients are counseled to take care when rising to an upright position—coming from reclining to sitting, and from sitting to standing. Isometric contractions of the muscles of the extremities can help prepare the body for these transitions. Having a dysregulated heart rate and unpredictable faintness can make exercise a special challenge for many people, but exercise is recommended for its many other health benefi ts. A workaround that has been successful for some patients is to use a recumbent exercise bike, a rowing machine, or swimming as a way to safely get some physical activity. Some medications can help maintain healthy blood pressure and support heart function. IMPLICATIONS FOR MASSAGE A person with dysautonomia may not know from one day to the next (or one moment to the next) how stable they will be, or whether they'll get dizzy or weak or tachycardic. It's hard to exercise or do physically intense activities because their blood pressure isn't reliable. They may have the sense that their bodies are not trustworthy, and they can't depend on being able to do simple physical tasks—much less activities that give the session so the massage therapist can be present during these transitions. Dysautonomia was common before COVID-19 came along. It will be far more common in the near future, as millions of people with long COVID fi nd that their ability to maintain normal blood pressure, heart rate, and other autonomic functions is not as reliable as it used to be. Massage therapists are in a position to be helpful and supportive to this population, if we are informed and prepared. 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, now in its seventh edition, which is used in massage schools worldwide. Werner is also the host of the podcast I Have a Client Who . . . on The ABMP Podcast Network. She is available at or wernerworkshops@ VIDEO: "TALKING WITH—AND ABOUT—LONG HAULERS" 1. Open your camera 2. Scan the code 3. Tap on notification 4. Watch! them joy. What a gift it would be, then, to experience their body as a fully integrated and beloved whole—if only for an hour. Like many nervous system disorders, massage therapy is unlikely to "fi x" dysautonomia, but our work may add to the quality of life of clients who live with this sometimes-diffi cult condition. We can support the sense of self-effi cacy and help decrease the fear of not knowing how it will be to meet the next challenge. We may also help people feel well enough to pursue exercise on their own. But to do this safely requires some specifi c accommodations. Short Sessions, at Least to Start If the client is new to massage, it may be best to propose starting with shorter sessions until you know more about how they respond to the changes massage brings about. Don't Overheat A common symptom of several kinds of dysautonomia is poor tolerance to heat. This is not the client who needs a room at 90 degrees while you use hot rocks and put a heating pad under their feet. Finish with Lively Strokes and Muscle Contractions We want to help normalize blood pressure to ease the shift from the end of the massage back to physical activity. For this reason, it is sensible to conclude the massage with strokes that promote alertness and energy, rather than sleepiness. This can look like rapid effl eurage, gentle tapotement, or whatever unique options you love to do. In addition, it's a good idea to coach the client to contract and relax the muscles of their extremities to help prepare the body for a change in position. Attend During Transitions Because people with dysautonomia may have symptoms when they change positions—especially when they come to sitting or standing—it is wise to organize TAKEAWAY: Dysautonomia is a common factor in long COVID; there is an excellent chance that therapists will encounter clients with this kind of ANS dysregulation.

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