Massage & Bodywork

MAY | JUNE 2020

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30 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 2 0 education PATHOLOGY PERSPECTIVES "Low Risk" Does Not Equal "No Risk" An Overview of Reports of Adverse Events By Ruth Werner An adverse effect or an adverse event in massage therapy is a situation in which a problem arose or was made worse by massage. We work in a profession that is widely recognized to be a safe intervention, with a low risk of such circumstances. However, "low-risk" is not the same as "no-risk," and massage-caused injuries certainly occur. While this usually means mild soreness following a session, sometimes massage-related adverse events can be serious. When I was in massage school, students and practitioners shared whispered stories detailing catastrophic massage-related injuries. "He ruptured the abdominal aorta, and the client died right there on the table." "They massaged the leg, and wham! a DVT broke loose and went to the lungs. The client didn't make it." "She did pressure going down the legs, and her client got these awful varicose veins." These anecdotes may or may not be grounded in reality. I know some are true; I have been a consultant or expert witness in litigations about similar injuries. But if they don't make it into the public record, they must stay in the realm of massage mythology. We teach endangerment sites (see "Take the Danger Out of Endangerment Sites," page 44) to enable massage therapists to avoid becoming part of one of these stories, but it's hard to base education on unsubstantiated claims and cautions. PUBLISHED CASE REPORTS The following tables provide a sampling of published case reports about massage therapy and adverse events. As a reminder, a case report is a description of an interaction between one patient and one practitioner. Its conclusions cannot be generalized to apply to a broad population, but these stories can help us learn more about our work. The case reports discussed here were not written by massage therapists. Instead, they were written by physicians who treated patients after they had been injured. For the sake of space and sanity, I present just a small sampling here, organized by what types of tissues were damaged. However, the whole collection is available in the reference list. WHAT I LEARNED In the process of gathering this information, I found out a few things. First, massage therapy is usually safe. This is indicated in several ways: a paucity of case reports on adverse events, a plethora of massage therapy studies stating "no adverse events were reported," and our low malpractice insurance rates. And for a reality check: there are thousands more articles documenting massage therapy doing good than doing harm. Second, several adverse events reported in the medical literature were precipitated by the use of massage machines (tools, chairs, etc.) or by people without appropriate training to provide massage. This points to the value of accurate and thorough education on this topic. Several of the case report authors point this out as well, which is heartening. And finally, only a tiny portion of adverse events make it into the medical literature. A different tiny portion of them are pursued in malpractice lawsuits, and those are never made publicly available. There are many reasons for low reporting of massage-related injuries, but this doesn't make it acceptable to be careless. Even though massage is by and large a safe modality, it is our responsibility to our clients and to our profession to keep it that way by knowing how to avoid accidentally causing injuries. Isn't it convenient then, that a webinar on this very topic is now available at www.abmp. com/ce? For more on endangerment site education, whether it is over-taught or under-taught, and the importance of critical thinking skills, please enjoy my video conversation with Whitney Lowe.

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