Issue link: https://www.massageandbodyworkdigital.com/i/969285
A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 43 PATHOLOGY PERSPECTIVES easiest example to point to here is someone who uses insulin to manage their diabetes. It is generally a good idea to schedule a session in the middle of their eating cycle rather than when they're already hungry (low blood sugar that could be exacerbated by massage), or when they've just taken a dose of insulin with a meal (massage might impact insulin uptake). 3. Accommodations with Equipment This heading covers how we use tools to help create the best and safest experience for our clients with health challenges. Bolsters and other support. This is an obvious one that doesn't just apply to people with health challenges: all our clients have a better experience if proper bolstering allows them to relax fully. But for people with bone or joint problems, osteoporosis, surgical implants, or other factors that might limit their comfort on the table, good support—with cushions, bolsters, rolled- up towels, or other devices—is essential for safe and effective massage therapy. Furniture. Not all massage has to happen on a table. Some situations call for a massage chair, a recliner, a wheelchair or hospital bed, or working on a pad on the floor. An example of this might be someone who has recently had surgery and isn't ready to lie flat on a table—a good massage chair might provide a more relaxing experience. Another thing to consider is table height. Some clients with limited mobility might need a stepstool or a lower table to get safely on or off. (If I were still in practice, I would invest in a hydraulic table that allowed me to adjust height for every client without having to reset all the legs every time.) Oils, lotions, creams. This is hard to overemphasize: not all oils, lotions, and creams are appropriate for all clients, or even all massage therapists. We may have our favorite oil or lotion, but it is imperative to keep something hypoallergenic on hand—not just for those with sensitive skin, but also for those prone to respiratory allergies who can have a delayed reaction to some types of oils. Tools. We made passing reference to massage tools in the section on temperature, but some devices may be especially useful, or important to avoid, for clients with various challenges. Clients who have limits to pressure or intensity of massage need for us to be especially sensitive: these are people for whom we must avoid using tools that might interfere with our ability to sense subtle changes in the tissues. In short, don't use your thumb protector for clients with heightened pain sensation. Hot and cold applications also fall under this heading, again with cautions for temperature tolerance. What other massage tools might need to be altered or avoided for clients who live with health challenges? 4. Accommodations with Service Lots of massage therapists offer special add- on services, from hot towels on the feet to facial moisturizers. These can be wonderful additions to your practice, but there are some services that are specifically geared toward clients with pathologic challenges. Help getting on or off the table. Some clients will benefit from your presence as they get on and off the table. This may create some challenges for draping; it's up to you and them to work out what works best. But if your client is not steady on their feet, they need you with them during those transition moments. Similarly, it is worth taking a fresh look at what it takes to get from your parking lot into your office. Are there areas that get icy? Do you have some steps that might be tricky for a person who uses a cane or a walker to negotiate? Some clients may need assistance getting safely into and out of your office. Time to transition back to full speed. A number of people can benefit from some recovery time after a massage: those who use blood pressure drugs or other medication that makes them a little logy, those with some numbness or lack of good sensation in the feet, and others. This can be an important accommodation for people who might experience some dizziness when they sit up after a massage therapy session. However, this is something a lot of massage therapists may not be able to control. If we work in a spa or franchise that is built on a specific turnover time, then we can't always encourage a client to linger for a few minutes before getting dressed. One workaround is to attend to them while they sit up, and encourage them to stay in the waiting area for a few minutes before going back out into their normal pace. In short, we cannot rubber-stamp decisions about massage therapy in the context of pathologies. Each practitioner, each client, and each appointment produces a different set of variables that must inform choices about bodywork, practically on a minute-to-minute basis. One of the most important jobs we do is to keep all those variables and accommodations in our consciousness all the time. Only in this way can we be sure we are bringing our very best to the table. Do you have other accommodations that you find useful in your work with clients who live with pathologies? I would love to hear about them. Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology (available at BooksofDiscovery.com), now in its sixth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com or wernerworkshops@ruthwerner.com.