Issue link: https://www.massageandbodyworkdigital.com/i/434495
F r e e m u s i c d o w n l o a d s f o r C e r t i f i e d m e m b e r s : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 39 This scenario is not radically different from the one cited at the beginning of this article, with the massage therapist working on the phantom arm of an amputee while he watched. It is possible to extrapolate that massage therapists are already doing work that employs mirror therapy mechanisms; if true, the implications are mind-boggling. Consider a client with pain, or another condition, that contraindicates massage for the affected arm. But if that arm is in a mirror box while we massage her healthy arm, she may get some relief. To her, that would seem miraculous. To us, it could be a way to ease pain while bypassing skin that cannot be touched. WHERE DOES MASSAGE FIT? Mirror therapy was developed mainly to recruit and strengthen motor responses. A relatively unexplored aspect of this therapy is what happens when the element of touch is added to the illusion. This begs the question: is mirror therapy within the scope of practice for massage therapists who have clients with intractable limb pain? The answer is not clear. This is a relatively new protocol and, outside of specialized occupational and physical therapy, it is not widely practiced. But since mirror therapy protocols are freely available for anyone to observe and try (several YouTube videos show patients using this protocol), and because home practice is considered safe and effective, 5 I would suggest that massage therapists could consider incorporating aspects of this approach, with the following caveats: • Clients who live with chronic, intractable pain are likely to have a health-care team. For the benefit of the client, massage therapists on this team need to communicate with other members about their work—and this, of course, must occur within standard reporting and privacy boundaries. These communications need to include the massage therapist's intentions and rationale, and an invitation for input from other members of the team. • When an intervention has the potential to be powerfully positive, it also has the potential to be powerfully negative. In other words, mirror therapy is not risk-free. Some adverse effects include patients reporting that the pain is made worse, that the sensation of cramping increases, or that the affected limb feels frozen, and they may have dizziness, sweating, and emotional reactions. 6 These are not trivial problems, and part of the point of being on a health-care team is to be ready to deal with them, should they arise. For instance, because dizziness is one reaction, it is important to be sure that PATHOLOGY PERSPECTIVES the client is not left unattended and that a possible stumble or fall is not likely to cause significant injury. • If you have the chance to try mirror therapy with a client, please benefit your profession by writing down and reporting the results in a case report, then sharing your experience at www.massagetherapyfoundation.org. Preparing this article has been like looking at a field of pristine snow. No one in our field has documented any exploration of this modality yet. We hear stories every day about how powerful massage therapy is in the context of many kinds of pain, and the research strongly supports this point of view. But for the population of people dealing with intractable chronic limb pain, the options are few. Let's see if massage therapy might be one of them. Notes 1. Farshad Hasanzadeh Kiabi et al., "Mirror Therapy as an Alternative Treatment for Phantom Limb Pain: A Short Literature Review," Korean Journal of Pain 26, no. 3 (July 2013): 309–11; See Young Kim and Yun Young Kim, "Mirror Therapy for Phantom Limb Pain," Korean Journal of Pain 25, no. 4 (October 2012): 272–4; G. L. Moseley, "Graded Motor Imagery is Effective for Long-Standing Complex Regional Pain Syndrome: A Randomised Controlled Trial," Pain 108, no. 1 (March 2004): 192–8; V. S. Ramachandran and Eric L. Altschuler, "The Use of Visual Feedback, in Particular Mirror Visual Feedback, in Restoring Brain Function," Brain 132 (2009): 1,693–1,710. 2. J. Foell et al., "Mirror Therapy For Phantom Limb Pain: Brain Changes and the Role of Body Representation," European Journal of Pain 18, no. 5 (May 2014): 729–39. 3. G. L. Moseley, "Graded Motor Imagery is Effective for Long-Standing Complex Regional Pain Syndrome: A Randomised Controlled Trial." 4. L. Schmalzl, C. Ragnö, and H. H. Ehrsson, "An Alternative to Traditional Mirror Therapy: Illusory Touch Can Reduce Phantom Pain When Illusory Movement Does Not," Clinical Journal of Pain 29, no. 10 (October 2013): e10–18. 5. D. M. Nilsen and T. DiRusso, "Using Mirror Therapy in the Home Environment: A Case Report," American Journal of Occupational Therapy 68, no. 3 (May/June 2014): e84–9. 6. A. Hagenberg and C. Carpenter, "Mirror Visual Feedback for Phantom Pain: International Experience on Modalities and Adverse Effects Discussed by an Expert Panel: A Delphi Study," Physical Medicine and Rehabilitation 6, no. 8 (August 2014): 708–15. Ruth Werner, BCTMB, is a former massage therapist, a writer, and an NCTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2013), now in its fifth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com.