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A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 43 PATHOLOGY PERSPECTIVES Resources Backes, J. M., et al. "Managing Statin-Associated Muscle Symptoms." American College of Cardiology. May 3, 2017. Accessed November 2017. cardiology/ten-points-to-remember/2017/05/03/10/43/ statin-associated-muscle-symptoms. Bruckert, E. "How to Manage Muscle Pain in Patients on Statins." Medscape. October 16, 2015. Accessed November 2017. Consumer Reports. "Women and Statins: When the Drugs May Not Make Sense." June 2010. Accessed November 2017. and-statins-when-the-drugs-may-not-make-sense/index. htm#. Diep, F. "Cholesterol Conundrum." Scientific American. November 1, 2011. Accessed November 2017. www. Eisenberg, T. and M. T. Wells. "Statins, Cholesterol, Women and Primary Prevention: Evidence-Based Medicine or Wishful Thinking?" Future Cardiology 5, no. 1 (2009): 1–4. Eliasson, P. et al. "Simvastatin and Atorvastatin Reduce the Mechanical Properties of Tendon Constructs In Vitro and Introduce Catabolic Changes in the Gene Expression Pattern." PLoS ONE 12, no. 3 (March 6, 2017): e0172797, doi:10.1371/journal.pone.0172797. Hansen, K. et al. "Outcomes in 45 Patients with Statin- Associated Myopathy." Archives of Internal Medicine 165, no. 22 (2005): 2,671–6. Healthline. "Cholesterol-Lowering Drugs." Accessed November 2017. cholesterol-lowering-drugs. Healthline. "Side Effects of Statins." Accessed November 2017. list-of-common-types#risk-factors3. "Heart Risk Calculator." Accessed November 2017. Norton, A. "Conflicting Statin Guidelines Leave Millions in 'Gray Zone.'" HealthDay. April 18, 2017. Accessed November 2017. cardiovascular-health-information-20/statins-news-780/ conflicting-statin-guidelines-leave-millions-in-gray- zone-721752.html. Reimold, S., A. Khera, and J. Hill. "10 Truths About Statins and High Cholesterol." The University of Texas Southwestern Medical Center. February 2, 2016. Accessed November 2017. year-2016/statins-answers.html. WebMD. "Side Effects of Cholesterol-Lowering Statin Drugs." Last updated July 25, 2016. Accessed November 2016. of-statin-drugs#1. WebMD. "Understanding Cholesterol Numbers." Last updated July 21, 2016. Accessed November 2017. www.webmd. com/cholesterol-management/guide/understanding- numbers. This isn't for lack of trying! I looked for research on SA MS and massage; I found nothing. Then I searched for recommendations about exercise—which can sometimes serve as an indication about the safety of massage therapy— and found that exercise and stretching are not among the conventional treatment options for this problem. I discussed this question with a couple of medical professionals in my circle, and the conclusion we came to was this: if someone needs statins, and has identified SA MS, then rigorous massage therapy is probably not an ideal intervention. Instead, what their massage therapist can do is strongly advise them to pursue this problem with their prescribing physician. Statin medications can be adjusted for dosage or type—and if this is not satisfactory, then other strategies for lowering cardiovascular risks can be tried. To make a confident prediction about the safety of massage therapy for a client with SA MS, we need to know why people sometimes develop musculoskeletal pain as a side effect of statin use, and that is still an open question. One theory suggests that the enzymes limited by some statins also impact growth and repair in muscles and tendons, but this has not been firmly established yet. Research suggests that statin use may negatively affect the structural integrity of some connective tissues. Some patients with SA MS experience a rise in creatine kinase levels, which suggests muscle inflammation. And statins have a low-but-not-zero association with muscular breakdown that can cause kidney damage and potentially dangerous rhabdomyolysis. For all these reasons, my advice is to proceed with caution. The best choice is to encourage the client to consult with their prescribing physician so they can make adjustments, or change their dosage or prescription to a different statin that doesn't cause SA MS. Then, we can design a massage therapy strategy that is customized to fit that client's ability to adapt to the homeostatic challenges our work may bring about. But if a person has some milder or subtler signs of SA MS, and if they choose not to pursue a change in medication, then any massage therapy must be conservative and incremental— not looking for big changes (that require substantial homeostatic adaptation), but for smaller, cumulative improvements in symptoms. Do you have clients who have SA MS? Do they seek massage therapy to help with their symptoms? Perhaps now you have some clearer ideas about the risks and benefits of working with this population. Please do us all a favor, and with the permission of the client and the cooperation of their prescribing physician, write a case report about massage therapy for someone with SA MS, and share your wisdom with the world. Ruth Werner, BCTMB, is a former massage therapist, a writer, and an NCBTMB-approved provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2016), now in its sixth edition, which is used in massage schools worldwide. Werner is available at

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