Issue link: https://www.massageandbodyworkdigital.com/i/1471270
L i s te n to T h e A B M P Po d c a s t a t a b m p.co 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 77 PATHOLOGY PERSPECTIVES speed, and duration will you use? What other accommodations will you need to make? CLD has a lot of unknowns about its pathophysiology, but some safety parameters are easy to identify: If our client has good sensation and healthy cardiovascular function, then most massage therapy that is comfortable is likely to be safe. If they have common complications such as facial paralysis, swollen joints, or muscle and joint pain, then it is possible to make adjustments in depth and focus of the massage. 6. Reflect on Results This step is often shortchanged, usually because we interpret a client booking another massage as evidence that our work was successful. But especially with chronic, painful, hard-to-treat conditions, it is vital to track whether the choices we made were effective. This happens when we follow up—by communicating at the end of the session, the following day, or the following appointment—on if or how well the session we gave met the client's goals. Your work is probably safe and welcome. But there may be things you could do to get even better results—so find out what that might look like. RISKS VS. BENEFITS In summary, risks include that massage might make inflammation or other pain-causing symptoms worse and the possibility that a massage therapist might be dismissive of a client's experience or appear disrespectful of their choices. Benefits include that massage might help reduce pain and stress and the therapeutic relationship might be supportive to the client. I will leave it to you to identify how to minimize these risks and maximize these benefits—that will depend on each person's field of expertise and approach to bodywork. Chronic Lyme disease and post- treatment Lyme disease syndrome are persistent, painful, and often resistant to conventional treatment options. In this, they share a lot with other protracted, possibly post-infection conditions such as chronic fatigue syndrome, long COVID, fibromyalgia, and post-sepsis syndrome. Another common thread in all these conditions is that patients who are frustrated with their conventional medical options may seek massage therapy as part of their coping strategies. It is not our job to decide if our client has CLD or not. It is not our job to share our opinion on whether CLD is real or our thoughts on the medical treatment they have decided to pursue. It is our job to be supportive of our client's choice to receive massage and to celebrate their commitment to their health. Let's do that. Note 1. Not her real name; details have been edited for privacy. 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 ruthwerner.com or wernerworkshops@ruthwerner.com. 2. What are the Relevant Variables? Among the many variables before us, we must consider the client's level of distress, any contributing factors we can identify, medications they use to manage their situation (and what side effects they cause), activities of daily living they can do easily, and activities that make them feel worse. 3. Challenge Assumptions It is always good practice to check in on our assumptions about what our clients want and what we think is in their best interest because they're not always the same things. Your client with CLD may have forward-head posture and a hiked-up hip, but if they have asked for an hour's gentle respite from all- over pain and fatigue, then it's not appropriate to try to "fix" their alignment today. 4. Consider Possible Strategies (and Alternatives) In this step, we need to survey our own experience and history with similar situations. This is also a time to see what other health- care providers suggest for patients with similar goals—this, of course, is where research literacy becomes important. I can save you a step: PubMed.gov offers nothing with search terms "chronic Lyme disease and massage" or "PTLDS and massage," and Google Scholar has very limited information. These resources provide lots of material on chronic Lyme disease problems, but little or nothing about these issues in the context of massage therapy. 5. Plan and Execute Your Session It's time to get to work. Knowing what you know now about your client's particular situation and goals, how will you design your session? What techniques, depth,