PATHOLOGY PERSPECTIVES
Resources
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The chronic pain, gas, and diarrhea seen with SIBO
are signs that this is a situation that needs to be pursued
with a primary care provider. SIBO itself can be a serious
disorder, and other conditions that look like it—celiac
disease, small intestinal diverticulitis, Crohn's disease,
and so on—can also make people very ill. It is not within
our scope of practice to determine whether someone's
persistent and repeating stomachache is dangerous or
not, and in this situation it is important to refer out.
If a client has been diagnosed with SIBO and wants
to receive massage, then some special accommodations
may be necessary. It would be irresponsible to suggest
that massage therapy can help treat this condition, but we
may be able to make living with it less stressful. Gentle
work to the abdomen, offering positioning adjustments
like side-lying, and simply putting a warm hand on the
belly may be very soothing and calming to a person with
chronic digestive pain. Of course, we must also anticipate
the need for a sudden and urgent trip to the bathroom.
Therapists who have advanced education in
visceral manipulation may be able to offer work that
promotes intestinal motility to help move materials
through the system more efficiently. But this is not
something to do for clients with diagnosed GI tract
disorders unless the therapist has extensive training.
Clients whose conditions are severe may find rigorous
massage uncomfortable and overwhelming. Further,
long-term nutritional deficiencies may create substantial
health problems that impact decisions about massage
therapy. Examples include bone brittleness and muscle
spasms related to low calcium absorption, skin rashes
related to a lack of selenium and essential fatty acids,
and easy bruising related to a shortage of vitamin K.
Are you likely to have clients who have SIBO?
At this point, it's hard to know, because the medical
community's diagnostic capacity for this condition is so
limited. But many massage therapists have clients whose
digestive systems do not operate at optimal levels. Let's
be sensitive and sensible about how we structure our
work with these clients, and let's be sure to give them
ethical and responsible advice for their self-care.
Ruth Werner is a former massage therapist, a writer and an
NCBTMB-approved continuing education provider. She wrote A
Massage Therapist's Guide to Pathology (available at www.
booksofdiscovery.com), now in its sixth edition, which is used
in massage schools worldwide. Werner is available at
www.ruthwerner.com or wernerworkshops@ruthwerner.com.
Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 39