Issue link: https://www.massageandbodyworkdigital.com/i/1276187
C h e c k o u t A B M P 's P o c k e t P a t h o l o g y a t w w w. a b m p . c o m / a b m p - p o c k e t - p a t h o l o g y - a p p . 49 Watch "Covid Screening Questions" Several COVID-related processes can cause muscle and joint aches. Some patients develop severe fatigue with muscle pain after the acute stage passes. This version of myalgia is probably safe for gentle massage. However, hypoxia and blood-clotting problems can lead to poor tissue perfusion, which can also cause pain in muscles and joints. Severe infections can cause rhabdomyolysis—a situation where muscles degenerate, and their by- products damage the kidneys, leading to renal failure. And of course, deep, severe muscle and joint pain can also be signs of systemic inflammation that has rebounded, or not yet subsided—although typically this would be accompanied by fever. Disrupting any of these problems with the challenge of vigorous massage is not appropriate. Implications for Massage Therapy This is a tricky one to parse. If a person's pain is widespread and not focused in one particular area, then it is probably not rhabdomyolysis. Gentle massage and stretching may help ease pain while not disrupting compromised capillary activity deep in the tissues. However, if someone complains of increasing localized pain and any signs of kidney problems (changes in urination, edema, headaches, altered mental state), then it is necessary to refer them to a primary care provider because of the imminent risk of kidney damage. ACUTE KIDNEY INJURY Patients with preexisting kidney disorders, especially related to diabetes, are at risk to develop new kidney problems with COVID-19, as are some people with no history of renal impairment. As we see with heart, liver, and central nervous system (CNS) problems, kidneys can be damaged through tiny clots and infarctions (this time clogging the glomeruli), low tissue perfusion due to hypoxia, direct viral attacks on the nephrons, and extreme inflammation with immune system overreactions leading to tissue damage, scarring, and loss of function. Many hospitalized COVID-19 patients require dialysis while they are in the acute phase of the infection, but some need it during recovery and may require long-term treatment. Implications for Massage Therapy As with any client with kidney problems, any bodywork that focuses on fluid movement could be overwhelming to a compromised system. This is a situation that calls for consultation with the health-care team, conservative and relaxing massage, and follow-up communications to check for unexpected responses.