Issue link: https://www.massageandbodyworkdigital.com/i/918051
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 41 greater impact on whether a person develops dangerous atherosclerosis. Furthermore, statins are not a risk-free intervention. Their side effects sometimes make them impossible to use. Among the side effects noted with these drugs are a slightly increased risk for developing type 2 diabetes, some cognitive symptoms (fuzziness, loss of short-term memory and concentration), digestive discomfort, and the topic of this article, SA MS. STATIN-ASSOCIATED MUSCULOSKELETAL SYMPTOMS It is well recognized that a substantial proportion of people who use statins develop some muscle and joint pain— SA MS. Some resources use the acronym SIM, for statin-induced myopathy. SA MS can include muscle pain, cramping, weakness, tendinopathies (usually at the Achilles tendon), and diffuse- aching pain. Back pain is common, and many people report achiness and stiffness at proximal joints: shoulders and hips. The pain is typically bilateral, although one side may be worse than the other. For most affected people, SA MS appears to cause diffuse and widespread pain. But the medical record has some reports about patients with much more specific damage, including ruptured tendons and rhabdomyolysis (muscle breakdown that can damage the kidneys). SA MS is found most often in patients who have some combination of these risk factors: they are female, they have a low body mass index, they are 65 years old or older, they use an additional drug to manage cholesterol, they have a history of kidney or liver disease, or they are vitamin D deficient. People outside this profile can also develop SA MS, but this is the most commonly observed pattern. SA MS usually has a specific onset: it develops within a couple of weeks of beginning a new prescription of statin drugs. One of the ways to confirm that a person's pain is related to their prescription is for them to stop using the medication for two weeks. If symptoms go away, then SA MS is confirmed. In this case, it is a good idea to make some adjustments, change the dose of the medication, or switch to a different statin. If the symptoms don't subside with a two-week break from the medication, then the problem is likely not to be related to statins. In this case, a different solution for musculoskeletal pain, including massage therapy, can safely be sought. Many people report that their SA MS symptoms are severe enough to negatively impact their quality of life, but an open question remains: How many people experience low-level muscle aches and pains that they never associate with their statin use? And how many of them may seek massage therapy for these symptoms? How common is SA MS? It depends on who you ask. Estimates range from about 2 percent of statin users (with the strictest quantitative criteria) to 29 percent (from observational data). Most experts agree that more than 10 percent of statin users will develop SA MS. In the United States, that means that 2.5 million people or more may live with this problem. HOW IS SAMS TREATED? When SA MS is identified (and the trial cessation of the drug should only happen under a doctor's supervision), then a number of options can be tried. Doctors will begin by looking for modifiable risk factors for SA MS. Many patients find their symptoms subside when they supplement vitamin D or CoQ10 (an enzyme that protects tissues from free-radical injuries). If these adjustments work, a person can use their statin without accompanying musculoskeletal pain. Sometimes these supplements are not sufficient, however. At this point, the doctor and patient must assess the risk/ benefit ratio of the medication. This may lead to changes in the prescription, such as lowering the dose or changing to another type of statin. In rare cases, even this is not sufficient, and the doctor and patient must consider nonstatin alternatives to managing cholesterol levels. PROCEED WITH CAUTION This topic has been challenging to write about, because while an abundance of information about statins and their side effects is available, we don't have any well-supported information about whether massage therapy is a good idea for someone who has statin- associated musculoskeletal symptoms. If you are totally confused at this point, I don't blame you. I hope the flow chart we've created on page 38 might help you follow all the routes to "massage therapy is OK"—with the understanding that massage therapy is always adapted to whatever other cautions may be present, of course. I don't mean to suggest that we can't touch clients with SA MS. The types of massage therapy or bodywork that I suggest to avoid for these clients include any technique that focuses on pushing a lot of fluid through the body (e.g., petrissage-heavy work) and any work that may challenge the structural integrity of muscles, tendons, or ligaments that might be compromised by medication (i.e., intrusive or painful frictions or stretching). Bodywork that is less challenging to receive is probably safe, but I still recommend conservatism and follow-up with clients to check on their well-being. It is important to emphasize that these suggestions are just that: suggestions, based on lots of information, but no systematically collected data as of yet.