Issue link: https://www.massageandbodyworkdigital.com/i/87297
all that needs to be done in one session; patience and keen listening skills will help keep each session in perspective. Deep breathing exercises can be interjected at any point during your session. Passive ROM (remember not to fully stretch) will help ease stiffness and prevent contractures. If you notice edema, gentle effleurage and stroking performed cephalically will help. If your client experiences a spasm during your session, stay with the spasm—don't come off the body, but instead gently hold the limb, stop massaging for a moment, and continue to apply gentle pressure. The spasm will stop and you will be able to continue your work. In this way, you are training the body to let you in, and the cumulative effects cause the muscles to more readily yield to your work. Detailed, medium-pressure digital work into and around each joint is extremely important to maintain joint health, assist lymphatic flow, help reduce contractures, and soften hypertonic tissue. At each session, digitally explore each joint to familiarize yourself with the body so you can objectively track functional and anatomical progression or digression. The ill effects of contractures, spasticity, and spasm are bilateral, so remember to work both sides of the body. Keeping copious and detailed SOAP notes will increase your effectiveness and help the client realize she is making progress, even if it's minimal. Your client is seeing multiple medical specialists and dealing with an insurance company; your notes, or at least a treatment summary, may be requested by a physician or an insurer at some point. Before your client's first appointment, ask whether she uses a cane or wheelchair. Arrange your reception and treatment rooms accordingly. Practice transferring a client from a wheelchair to the massage table (with a colleague) to ensure a confident, accident-free process. During inclement weather, have towels available at the door so you can wipe off the wheelchair wheels and not track mud, rain, or snow into your professional area. ASSIGN SELF-CARE HOMEWORK After your session, you can provide much-needed holistic support as your client attempts to maintain her regular daily activities and bolster her wobbly self-image. While reminding her not to work to the point of exhaustion and to always be gentle with herself, you can offer the following homework assignments with this language: • "Purchase a big exercise ball; blow it up until it's firm. Place the ball next to a couch, a sturdy armchair, or the wall. Put one hand on a secure surface to steady yourself, and sit on the ball. Gently begin bouncing. Bounce as long as you can. Take frequent deep breaths. You'll start to feel this in your thighs. When you feel the slightest bit tired, stop and rest. Then, resume bouncing. This simple exercise helps keep your thigh muscles strong and is extremely effective in maintaining your sense of balance." • "Find a gentle yoga or tai chi class. Both will help strengthen your balance and maintain your flexibility without overheating your central body core or major muscles." • "Consider swimming or a water aerobics class, but be sure the water is not too warm. You should not sweat while in the water or when getting out of the pool." • "Take deep breaths several times throughout the day. Inhale deeply, hold it for a few seconds, then forcibly exhale." • "Investigate personal deep relaxation techniques that work for you, and set aside time to practice one daily." • "Be sure to get enough hours of deep, restful sleep." YOU CAN MAKE A DIFFERENCE Be aware that clients with MS are waging a battle that is subtle, frustrating, life changing—and that changes hourly. By using this knowledge to understand the disease—and your compassionate hands to help her journey—you can make a difference in your client's body, spirit, and quality of life. Charlotte Michael Versagi is a national presenter and the author of Step-by-Step Massage Therapy Protocols for Common Conditions (Lippincott Williams and Wilkins, 2011). This article was adapted from an excerpt in that textbook, which explores treatment of more than 40 medical conditions. Contact her at charlotteversagi@gmail.com. www.abmp.com. See what benefits await you. 65