Issue link: https://www.massageandbodyworkdigital.com/i/230373
It is important to point out that this case was unusual in that it led to a long-term problem. The vast majority of the adverse effects reported in the literature led to some need for medical intervention, but little or no enduring damage. WHAT CAN WE DO? By and large, massage therapy is a safe intervention with relatively low risk (especially in comparison with drugs or surgery). But "low risk" isn't "no risk," and we have the responsibility to minimize the chances of any adverse events. In the investigation of whether an intervention is safe, it is often compared to "usual care." In this comparison, usual care is often the safest—that is, it carries the least risk—but it may leave out powerfully positive options (like massage). That's a risk, too, because it's not ethical to deprive patients of a treatment that could be highly effective. There are only a couple of ways for massagerelated injuries to be officially recorded. A case report may make it into a research journal, or an injured client may bring suit against a massage therapist— those cases are almost always settled out of the public eye, but records are kept by liability/malpractice insurance providers who may be involved. This presents a problem because without a way to freely and openly document and share errors, we can't learn from each other's mistakes. Further, the rarity of recorded adverse effects— while a good reflection of the relative safety of massage—can also make it difficult to suggest that this profession requires appropriate education and regulation in the interest of public protection. Our best action is to be vigilant in protecting our clients, and well informed about published adverse events. When the unexpected happens in our own practice, we need to be brave enough to share that information in a publishable case report. Massage therapists wrote none of the academically recorded reports described in this article; they were all recorded by the physicians who dealt with the aftermath. If our profession is going to earn a place alongside other health-care providers, we need to be willing to speak out when we have a negative outcome. As long as we can demonstrate that we have delivered an appropriate standard of care, and if our clients give permission, we can safely write case reports that describe what happened when a massage went wrong. This will do three important things: it shows that massage is powerful enough to cause an occasional problem; it allows others in the profession to learn from our mistakes, and it demonstrates that we can take responsibility for our clients' well-being. So here is the call to action: Work hard to not make mistakes. And when a mistake happens, be prepared to report it to your profession so others can learn through you. Notes 1. P. Posadzki and E. Ernst, "The Safety of Massage Therapy: An Update of a Systematic Review," Focus on Alternative and Complementary Therapies 18, no. 1 (2013): 27–32. 2. I. A. Aksoy et al., "Spinal Accessory Neuropathy Associated with Deep Tissue Massage: a Case Report," presented to the American Association of Neuromuscular and Electrodiagnostic Medicine, October 13, 2007, Phoenix, Arizona. 3. S. Ichihashi et al., "Fracture and Collapse of BalloonExpandable Stents in the Bilateral Common Iliac Arteries Due to Shiatsu Massage," Cardiovascular and Interventional Radiology 35, no. 6 (2012): 1,500–4. 4. H. Cheong et al., "Spinal Cord Injury Incurred by Neck Massage," Annals of Rehabilitation Medicine 36, no. 5 (2012): 708–12. Author's note: my thanks to the brave and generous massage therapists who shared their stories here. Please consider writing a case report on these events! Ruth Werner is a former massage therapist, a writer, and a continuing education provider. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2013), now in its fifth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com or wernerworkshops@ruthwerner.com. It pays to be ABMP Certified: www.abmp.com/go/certifiedcentral 47