Massage & Bodywork

November | December 2014

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F r e e m u s i c d o w n l o a d s f o r C e r t i f i e d m e m b e r s : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 41 Depression and anxiety frequently accompany amputation surgery. These conditions have also been seen to exacerbate pain sensation. Fortunately, the evidence on massage therapy for mood improvement is strong: this is a place where we can have a profound infl uence on a person's quality of life. And if massage therapy can help manage depression and anxiety, it is possible then that a person with an amputation might have the capacity to invest more energy into self-care and well-being. One major source of postsurgical pain is muscle spasms in the remaining part of the limb. Because these are triggered by external stimuli instead of central nervous system damage, massage therapy with stretching can be a useful intervention. The joint nearest to the amputation may also be vulnerable to progressive muscle tightening, along with painful permanent contractures and thickening of tendons and ligaments. As the patient begins to adapt to the new limitations, it is inevitable that compensatory patterns emerge in the rest of the body. This is self-evident for someone who has lost a foot or a portion of a leg, but losing part of an arm can change the gait and shift the center of gravity, leading to musculoskeletal pain. Even losing a toe or two alters how weight is transferred through the leg—consequent torque on the knee, twisting at the hip, and low-back pain that reverberates into headaches may result. One of the most common sources of pain for amputation patients is poor wound healing at the site of the amputation scar, or irritation of that scar tissue from the use of a prosthetic. It is critical that the scar tissue on the stump be able to move with some freedom over the underlying tissues. Otherwise it is vulnerable to shearing injury, pressure sores, and other lesions that make using a prosthetic all but impossible. Because peripheral nerves are among the traumatized tissue in these surgeries, the endoneurium around them may develop hypertrophy and grow into neuromas: clumps of connective tissue that compress and irritate nerves. A similar situation is seen in Morton's neuroma (see "Morton's Neuroma," Massage & Bodywork, May/June 2009, page 110). Finally, phantom limb sensation is the hallmark of post- amputation complications. This is a phenomenon that most amputees experience, even months or years after surgery. In this situation, the severed nerves of the amputated limb continue to transmit messages to the brain, which interprets them as coming from a part of the body that no longer exists. When those transmissions relay pain, it is often described as extreme burning, stabbing, twisting, or crushing pain. And of course because the source of the pain (the amputated limb) is no longer there, relief seems impossible. Pain is not the only sensation that amputation patients "feel" in their missing limbs. Cold, heat, itching, and pressure changes may all be perceived through nerves that are no 135,000–185,000 Number of amputation surgeries per year in the United States 1.7 million Number of people with amputations in the United States Reasons for Amputation 54% Circulatory dysfunction 45% Trauma <2% Cancer and congenital malformation Amputee Coalition, "Limb Loss Statistics," 2014, www.amputee-coalition.org. AMPUTATION BY THE NUMBERS A Salute to Those Who Serve

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