Issue link: https://www.massageandbodyworkdigital.com/i/230373
Self-Care Compliance Client self-care is a major component of this protocol. In fact, 15-minute self-care sessions every day, for each hand and/or foot, for the duration of symptoms, is absolutely essential. You must convince the client to perform her homework assignments daily; this is not optional, unless she is willing to visit you every day. Usually, you will offer one or two one-hour sessions during which you teach the self-care protocol to both the client and her caregiver. Understand the Work The session protocol itself is simple but extremely detailed, working into every crevice of the hand, foot, fingers, and toes (see Neuropathy Massage Protocol, page 86). If the 60-minute session includes two feet, you will spend 30 minutes on each foot. If the session includes both hands and feet, you will spend 15 minutes on each hand and then each foot. It may seem incomprehensible that you can work on a foot for 30 minutes, but you are trying to displace, wash out, and return venous blood from the depths of this foot or hand and allow the body to replace it with freshly oxygenated arterial blood. Your goal is to massage to the bone, which means your massage works through all superficial tissue until it pushes against underlying bone. Although this may seem counterintuitive for a client with painful neuropathy, you will start very gently. It often takes several sessions, performed with gradual intensity, to get the client to the level that she can experience maximum therapeutic effectiveness—and then can be graduated to perform solo at home. For the client's understanding and compliance, you must be able to explain oxidative debt and how therapeutic massage can help by increasing local circulation, combined with a finely honed diplomacy. Explain you are going to start gently and only progress to her tolerance. The Session This protocol can be performed with the client supine on a massage table, or seated comfortably (however, it cannot be performed in a massage chair). The client need not disrobe more than necessary to expose the hands and feet. Since the work includes detailed massage between the toes and can last for up to 30 minutes, you may want to wash the client's feet first. Use a basin and towel, or one warm, wet towel and one dry towel. Do not use soap or other cleansing products, as the feet may be sensitive to chemicals. If washing the feet is not possible, you can wear nonlatex gloves during the entire procedure to protect your hands. All massage techniques are performed in the cephalic direction, toward the head. Stroke the client's feet or hands frequently during this protocol, to give her a chance to relax from the fear of being hurt, and to assess tissue temperature. After you are thoroughly familiar with performing the 60-minute protocol as written, it can be altered according to your client's needs, the time available, and your own creative instincts. Trust yourself. YOU CAN MAKE A DIFFERENCE Think about your ability to save a foot from amputation. Think about your client's ability to put on shoes without pain, walk upright, and enjoy life again. This deceptively simple protocol can make a profound difference for you and your clients. Dry Gangrene: Know the Signs While diagnosing dry gangrene (the type of gangrene most often experienced by diabetic patients) is well beyond your scope of practice, you will examine your client's feet before each protocol and should know the warning signs of this serious condition. On the feet, watch for an extreme sensitivity to touch, unusually cold patches of tissue, a small area of dark purple tissue, or more alarming, a tiny spot (sometimes the size of a poppy seed) or larger area of black tissue. Any of these signs indicates possible gangrene, and your client should see her physician immediately. Charlotte Michael Versagi is a national presenter and the author of Stepby-Step Massage Therapy Protocols for Common Conditions (Lippincott Williams & Wilkins, 2011). Contact her at charlotteversagi@gmail.com. It pays to be ABMP Certified: www.abmp.com/go/certifiedcentral 89