Issue link: https://www.massageandbodyworkdigital.com/i/87297
MULTIPLE SCLEROSIS CONSIDER POSSIBLE INJECTION SITES Most people are needle-averse, and many people with MS have to administer weekly or monthly self-injections, alternating between thighs and belly fat, and/or endure intravenous infusions to control their symptoms. Be aware of injection sites and frequency of injections or infusions, whether the injection has occurred within the last 24 hours, and whether the injection site is tender. Here are some questions and points you can consider regarding your client's medications: • Does my client complain about giving herself injections? Does she know about auto-injectors? • If my client has recently self-injected, I should not apply local heat because I could increase the rate of drug absorption; conversely, I should not apply cold, which might impede drug absorption. • Is she bruised locally from her injections? How close can I work around her injection site, and how should I adjust my pressure in this area? • Is her physician suggesting over-the-counter pain relievers, such as nonsteroid anti-infl ammatory drugs, which can be taken an hour before each injection and then about every six hours after the injection for the fi rst 24 hours? If she is not aware of this avenue Step-by-Step Protocol for Multiple Sclerosis TECHNIQUE FOR LOWER EXTREMITIES Adjust this protocol to fi t your time limit and your client's tolerance. If time allows, work on her back or any other areas that demand your attention; this protocol focuses only on her lower extremities. To begin, after positioning the client comfortably supine, ask which massage technique she fi nds particularly relaxing. (Scalp massage? Face or foot massage?) Perform this technique for a few minutes to initiate deep relaxation. The following instructions should be performed bilaterally. Effl eurage and petrissage, medium pressure, slow, evenly rhythmic, working cephalically (toward the head/heart). • Both lower extremities including feet. Digital kneading, medium pressure. • Every toe, between the toes, between all metacarpal, plantar, and dorsal surfaces of the feet, in between all bones and ligaments, around the malleoli. Passive range of motion (watch the extent of your stretch, move only to mild resistance and stop). • At the hip. • At the knee. • At the ankle. Attempt full circumduction and plantar and dorsal fl exing and extending. Effl eurage, slightly more briskly, medium pressure, not necessarily rhythmic. • Entire lower extremity. Position the client in a side-lying position. Effl eurage, medium pressure, slow, evenly rhythmic. • Hamstrings. • Gastrocnemeus. • Heel. Digital kneading, medium pressure, slow, evenly rhythmic. • Origin and insertions of the hamstrings. Work up into the ischial tuberosity. • Origins and insertions of the gastrocnemeus. • Around and into the calcaneus. Stroking, using your fi ngertips only, brushing cephalically. Entire lower extremities, including around malleolus. • Reposition client on the other side, and repeat side-lying protocol. End the session with a few minutes of a deep relaxation technique. Say something positive to the client about her progress. of pain relief, suggest that she talk to her physician about this option. Since fl u-like symptoms lasting 1–3 days are a common side effect of most MS self-administered medications, remind your client to schedule massage sessions either immediately before, or a few days after, her injection. CONTRAINDICATIONS AND CAUTIONS Here are some important things to consider when working with a client with MS: • Never stretch the limbs of an MS client. You learned in massage therapy school to stretch your client's limbs to the point of resistance, ask them to take a deep breath, and then stretch slightly beyond that point. Exactly the opposite is true when working with MS clients. Here's why: 1) These