Issue link: https://www.massageandbodyworkdigital.com/i/1276187
58 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 2 0 walks. But to be clear, legs that are painful or achy are a hallmark of pregnancy, so these symptoms alone do not guarantee a blood clot. A clear determination of the presence of clots is also difficult because thrombi are often asymptomatic. 13 Given the increased likelihood that blood will coagulate in pregnancy and postpartum, the difficulty in determining the presence of clots, and the potential harm of freely circulating clots, it seems prudent to treat all pregnant and postpartum clients as though they have leg clots. For many decades, pre-coronavirus pandemic, we recommended observing the summarized guidelines in Image 5 throughout pregnancy and with postpartum clients for at least 8–10 weeks after birth. The emerging data about blood clots and COVID-19 is sobering, particularly when added to existing clot dangers during pregnancy and postpartum. Coagulopathy in COVID-19 is a disruption in blood- clotting mechanisms that can appear as organ damage, strokes, heart attacks, pulmonary embolisms, rashes, and COVID- toe, with bumps, swelling or redness as evidence of excessive bleeding and clotting in small vessels (microthrombosis). Hypercoagulation during and after this illness further reinforces the contraindication that expectant and postpartum clients with COVID-19 symptoms, suspected infection, or positive test results should not be receiving massage therapy while ill or contagious. Furthermore, because of the varied severity of symptoms and recovery time, and the unknowns related to childbearing, I recommend you seek medical or midwifery review of everyone's unique condition to request any massage therapy limitations or contraindications for that client. For those cleared for massage therapy, be sure to assess thoroughly for COVID-19 specific manifestations, whether they have had the illness, what was its severity, and any subsequent recovery concerns. Sartorius Psoas minor Psoas major Iliacus Inguinal ligament Other techniques contraindicated throughout the leg: • Percussion • Deep vibration Use broad, superficial strokes medially, avoiding: • Cross-fiber friction • Deep tissue massage • Acupressure • Ischemic compression • Rolling • Wringing • Shaking Leg discomforts indicating possible thrombi: Some thrombi are asymptomatic Lighten touch over varicose and spider veins • Edema • Heat • Redness • Achiness or tenderness that worsens when standing or walking • Palpable thrombus Iliac vein Femoral vein Saphenous veins Saphenous area Medial tibial border Landmarks for areas of greatest precaution Veins where thrombi are most likely to form When leg massage is indicated, these shaded areas and precautions must be fully respected with all pregnant clients, and up until at least 8–10 weeks postpartum. For those recovered from COVID-19, continue these guidelines for a full three months. 5