Massage & Bodywork

November | December 2014

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40 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 4 education Amputation Adaptations How Massage Therapy Can Help By Ruth Werner About one in every 155 Americans is missing some part of an extremity due to surgical removal. The chance of massage therapists having amputee clients is reasonably high, yet almost none of us get any training to prepare to work with this special population. Here, we will review some basic information about the situations that can lead to amputation, and what kinds of long-term consequences these surgeries can involve. We will also hear from several massage therapists who have generously shared their stories about some of their clients who are amputees. PATHOLOGY PERSPECTIVES DEFINITION AND REASONS The definition of an amputation is fairly straightforward: some part of an extremity is surgically removed because it is too damaged to function, and not removing it could put the patient at risk for dangerous consequences. Some people consider amputation to reflect a failure in treatment; after all, these surgeries only occur when other interventions could not save the damaged tissue. But in many cases, amputation can be considered a "successful failure": the person with the amputation can live a healthy and fulfilling life, in spite of missing part of a limb. In the United States, circulatory dysfunction is the cause of the vast majority of amputations. If the circulatory system cannot deliver adequate nutrients to cells, nor remove adequate wastes, then tissue degenerates and becomes vulnerable to infection with potentially life-threatening pathogens. Diabetes mellitus, especially type 2 diabetes, is the leading cause of amputations in this country. While treatments for diabetes are more successful than in the past, the increasing number of patients causes the number of diabetes-related amputations to rise, while the numbers of amputations due to other causes are generally falling. One exception to this trend is amputations among injured military personnel. These have risen significantly since 2007. This is a direct outcome of the wars in Afghanistan and Iraq, which have led to amputation surgeries for approximately 1,500 American servicepeople. LONG-TERM CONSEQUENCES OF AMPUTATION Many postsurgical complications are common among amputees. Some, like bleeding, deep vein thrombosis, and pulmonary embolism, are outside the reach of massage therapy, but many other issues are within our scope. As with many surgeries, postoperative pain is a major issue. The pain can be related to many sources, and the nature of the amputation procedure introduces some factors that raise the risk of long-term, sometimes practically intractable, problems. Bodywork Story #1 Buddy was a Vietnam veteran and a double amputee. He came to our school clinic almost every week for nine years until he passed away. He volunteered for class as a demonstration model, and said it did wonders for his soul and self-esteem. He encouraged people to pretend to massage the legs that were not there. He also had this horrible itching [perceived as coming from] his left big toe that he was unable to reach, of course. One day we were working, and he was suddenly startled and said, "Do that again." I did. I was just working the stump. Seems that right behind his knee, it felt like I was touching his left big toe. He sat up and scratched the spot, and sighed happily.

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