Dealing with Reaction and Aggravation Following Massage Therapy

Dealing with Reaction and Aggravation Following Massage Therapy

As an RMT you know better than anyone that every patient is different. In fact, every injury and condition is different and can affect patients in different ways. Because of this you may encounter patients who come back to you following an initial treatment with concerns of pain or sometimes even worse pain than when they arrived. Understanding the difference between aggravation, pain and contraindications is key to making the right decision at their next appointment.

Reaction: No Pain, No Gain

Massage therapy can be one of the most challenging to perform for patients with complaints of pain. Pain management infers that the pain will be alleviated which in some cases is not the first or expected result. Many patients do not realize that when undergoing any form of pain management in certain scenarios the no pain no gain phenomenon actually applies. For example a patient who has complaints of pain and stiffness may feel relief at their first appointment but within a few hours following their appointment begin to feel discomfort again. Although this is a normal “reaction” it can make a negative impression on the patient. In some cases, because their first feeling was relief, when the pain returns they may interpret it to have worsened when in fact it is either the same or slightly lessened. The cause of this reaction is the increase in blood circulation returning to the area. You might liken it to the case of a foot falling asleep that when returned to action tingles and hurts until the circulation is completely returned. Although the pain is unpleasant, once circulation returns the pain is relieved. As with returning mobility and decreasing pain the return of blood circulation is temporarily unpleasant but a necessary reaction to improve the overall condition. Knowing this will make patients less nervous about continuing treatment.

Aggravation: Pain, No Gain

In the case where a massage causes aggravation this is a pain, no gain scenario. Aggravation can be caused with massage improperly applied. Too much aggression, pressure or too vigorous a massage can work to make the area undergo further trauma and result in unwanted aggravation such as developing trigger points and facet joint subluxation. It is not an intentional occurrence but it shows how important choosing the right technique for each patient is vital to the success of their therapy. Sometimes a patient themselves requests a more aggressive massage which can be misleading to you as an RMT. It might seem they require a deeper massage because the patient is associating the pressure as effective. It is important to consider the patient’s condition and if it is wise to apply further pressure. If it does not make sense it is important to explain to the patient that further pressure or aggression could actually cause damage. Ignoring the basic rules of contraindication will cause aggravation and worse, serious damage to patients.

Further Injury

A common mistake for many massage patients is to feel sudden relief and want to test out their new flexibility. They may reinjure the area without even realizing it and associate the new pain with something that occurred during the massage. It is important to review with each patient how best to treat their improving range of motion and that they must avoid any undue or excessive strain even if they feel better. If they understand that it is possible to strain or sprain the area as a result of their new flexibility they are more likely to continue with their more cautious movements until treatment is completed and they have the thumbs up to return to exercise and activity.

The Importance of Communicating with Patients in Layman’s Terms

Try to remember how you reacted to the first classes you attend in massage school. You probably strained to catch the medical terms and body parts trying to conjure up their meaning without appearing confused. Now you can rhyme them off in everyday conversation without missing a beat. But if you are using these terms to explain treatments and conditions to your patients you can be guaranteed that unless they are in the healthcare profession you’ve lost them with the first mention of Cranial Sacral Therapy. Learning to speak to your patients in layman’s terms will help keep your patients comfortable with the treatment you are recommending and allow them to make informed decisions based on their needs.

Body Language

One of the best ways to communicate with patients about their body is to use their body or yours. When you begin a long and in-depth description about their injuries or intended treatment and how it will affect parts of their body you will lose them if they don’t understand what you are saying. Using their body or your own to point out the body parts you are discussing will allow them to follow along visually making it easier to understand what you are saying. You can choose to use the medical terms while doing this, but do it while pointing to the body parts so they will understand. Indicate where it is located so that they will know what to expect and understand more about their condition.

Medical Text Books Don’t Lie

It may be tempting to quote the terms and modalities you wish to use for treatment because you know the medical text books are accurate in their explanations. As honourable as this might seem, you will definitely do nothing more than confuse your patient. Remember that in the case where you are literally trying to sell them on a recommended treatment to encourage them to return. If they don’t understand the benefits of the treatment they are less likely to spend their money. Think of it as going to an ethnic restaurant where the foods are all named by their ethnic names. If there isn’t a description of the food you will be eating chances are you will want to go to another restaurant where you will recognize the food you will be eating. It is not new flavours that scare you away. It is the unknown that you don’t trust.

Bedside Thesaurus

Keep a thesaurus at your bedside and look for words to replace medical terms. For example, instead of acute you can say sudden, instead of fascia you can say body tissue. Suddenly a sentence that sounds like this: “Deep tissue massage is a modality that reaches structures far beneath the superficial fascia through palpation for efficacious alleviation of chronic muscle problems or injuries to the physiology” becomes this: “Deep tissue massage will offer relief from muscle pain through gentle touch that will relax muscles and improve circulation.” You take the response from “Huh?” to “Ohhhh.”

Learning to communicate with your patients on their terms will help you form stronger bonds. It’s much like the old saying, “Give a man a fish he will eat for a day. Teach a man to fish he will eat for life.” Educating patients in a language they understand will help them trust you and feel comfortable with the treatment you recommend.

Special Considerations When Treating Dementia Patients

Throughout your career you will choose who you wish to treat. You can choose a spa setting where your main focus is providing relaxation and stress relief, work with pregnant moms or sports injury patients or work in a senior care facility. If you choose to provide massage therapy to the elderly there are special rewards you will gain from providing care to those in need of attention and care. You will also face challenges especially when dealing with patients with dementia. Knowing how to deal with the very special needs of dementia patients will help you remain professional while providing the compassion required to work with them successfully.

Communication with Dementia Patients

One of the greatest struggles care givers face is communicating with patients with dementia. Dementia can cause sudden changes in communication which can provide unforeseen road blocks even in mid treatment. As well you might find some patients communicate using non-verbal cues or even through touch. Understanding that human contact is a need we all share will be a good start to remaining patient with dementia patients. It may take a while to learn what communication works best with each patient and it may be difficult when one day your patient is perfectly fine and communicative and completely shut down the next. Learning to expect these changes will make caring for each patient a little easier. As well, when patients are having difficulty communicating sometimes simply stating you are aware they are trying to communicate are not certain what they are trying to say can help validate their feelings. Many people treat patients with dementia less respectively speaking to them like children. Unless your patient responds to this tone and approach it is best to be respectful and treat them as an adult using kind and gentle tones.

First Contact and Appointment

When you have your first appointment with a dementia patient approach them as you would any of your patients and introduce yourself warmly and politely. Always maintain eye contact when possible and explain to them you are there to provide care and a therapeutic massage. It is not uncommon for dementia patients to be unaware of appointments they require or what treatments their doctors have recommended for them. When dealing with any elderly patients it is always a good idea to speak loudly and clearly in case they have hearing issues. Most will have the gumption to tell you to stop shouting if they don’t have hearing problems. Ask them the name they prefer and make a note of this in their chart. This way you will remember to use their preferred name as opposed to general terms such as dear. This is more respectful. If you need to ask them questions speak slowly and clearly and wait for their response. Elderly patients and patients with dementia may take longer to respond than you expect.

Elderly patients are people with the same interests, feelings and emotions as any other patients you will treat. Learning the proper way to deal with your dementia patients will help you maintain a caring, yet professional relationship.

Are There Times When I Shouldn’t Have a Massage?

It’s not a good idea to schedule a massage appointment if you are experiencing any of the following:

  • Have a fever
  • Were recently involved in an accident
  • Are dizzy or nauseated
  • Are bruised or have wounds, rashes, or severe sunburn.

In these cases, it’s important to stabilize your medical condition first. After you have recovered, or the condition is under the management of a medical provider who agrees that massage would be helpful, you can call to schedule an appointment.

In general, medical concerns or conditions might mean the therapist needs to adapt the massage technique or length of session.

What should I do if I have a specific condition?

If you have a temporary or chronic health condition, it is important to select a therapist who demonstrates sensitivity to and an understanding of your conditions or symptoms. Many therapists have advanced massage training on how to provide an effective treatment protocol that will complement other treatments/efforts you are following to reduce or eliminate symptoms.

Before you make an appointment, review the list of medical conditions below and inform your therapist if any of these conditions apply to you. Also be sure to let your therapist know who diagnosed your symptoms/conditions (your physician or primary care provider, a complementary therapy provider, or you, yourself).

It is important to let the therapist know if the conditions/symptoms are ongoing but managed effectively, or new and not managed effectively. To help you identify which is which, read the descriptions below.

Conditions/symptoms are ongoing, but managed effectively if they are:

  • Familiar, you understand what makes condition/symptoms better or worse
  • Under control with medications
  • Managed effectively with supportive activities, such as exercise
  • Successfully stabilized and tested over time or with specific activities

Conditions/symptoms are new and not managed if:

  • You are just beginning to balance medication dosage and daily activities
  • You are just beginning to observe the control or lessening of symptoms
  • Your symptoms seem to be better, but have not been tested by additional daily activities

Tell the therapist if you have these conditions:

Tell your therapist if you have (or in some cases have had) any condition from one of these categories:

  • Contagious skin conditions (boils, warts, or herpes)
  • Other skin conditions (burns, rashes, or sores)
  • Circulatory system issues (high blood pressure, varicose veins, or stroke)
  • Digestive system issues (ulcers, irritable bowel syndrome, or colitis)
  • Edema
  • Endocrine system issues (diabetes or thyroid dysfunction)
  • Musculoskeletal system conditions (carpal tunnel syndrome, fibromyalgia, osteoporosis, rheumatoid arthritis)
  • Lymph/immune system issues (chronic fatigue or HIV/AIDS)
  • Nervous system conditions (herpes or Parkinson’s disease)
  • Respiratory system issues (asthma)
  • Miscellaneous conditions (pregnancy, migraines, cancer)

What are some other cautions?

There are additional conditions where massage therapy could cause adverse effects. Once again, if you have any condition (chronic or acute), or are taking any medications, you should consult with your primary healthcare provider before seeing a massage therapist. In some cases, massage may be appropriate with some changes to the techniques or session.

For example, if you have an open wound or burn, the massage therapist would avoid that area. Or if you have any pins, staples, or artificial joints, the massage therapist may need to alter the techniques as well. Individual decisions must be made according to circumstances and, in many instances, medical advice.

Also, if you are allergic to certain massage oils, creams, cleansers, or disinfectants used on sheets and or tables, you may need to ask the therapist to use different products, or bring your own.

References

Expert Contributor:
Beth Burgan, MA, MFA

Reviewed by:
Dale Healey, DC

 

CranioSacral Therapy To Treat TMJ

Four Important Facts about treating TMJ Patients

Temporal Mandibular Joint (TMJ) pain can be one of the most difficult to live with for many patients. It can be related to many causes both physical and psychological as it is heavily tied to side effects from stress. Grinding teeth and jaw clenching are common physical signs of stress and can lead to serious pain from TMJ as well as headaches. CranioSacral Therapy is believed to be one of the most effective treatments of TMJ pain in hand with the use of dental appliances such as mouth guards. Here are four important facts about TMJ:

1.       Symptoms of TMJ

The symptoms of TMJ can include:

  • Pain and aching in the jaw joint
  • Difficulty opening the mouth without discomfort
  • Clicking or popping when the mouth is being opened and closed
  • Jaw can lock when opened wide
  • Headaches
  • Earaches
  • Ringing in the ears

All of these symptoms can be very disruptive to a patient’s life and the level of pain and the number of symptoms can vary from patient to patient.

2.       Diagnosis

The symptoms of TMJ pain are often identified by the patient’s dentist who may opt to provide a mouth guard which can be used to correct the bite of patients using occlusal therapy with the use of appliances such as mouth guards. Although mouth guards can be very effective in easing the symptoms, it is not a “cure” for TMJ.

3.       Complementary Treatments

As an RMT you may have patients seeking relief from TMJ pain. Although a mouth guard can assist in pain relief it is not always completely effective. CranioSacral therapy is believed to be an effective treatment for many holistic care providers but is also a controversial treatment in the opinion of many medical professionals. CranioSacral therapy is a newer modality and health care providers who specialize in this treatment see improvements in patients as early as two sessions. Patients can often stop wearing their appliances or at least wearing them less. As well many are able to enjoy foods that they were unable to eat due to pain and limited motion opening the jaw and mouth. In eight to 12 treatments most patients have completely been relieved of their pain while others continue regular intermittent treatments in order to continue to benefit from treatments for a pain free life.

4.       Non-Invasive Treatment

CarnioSacral therapy is non-invasive and very gentle. It works by changing the fluid pressures inside the skull gently and subtly. Although it is not recommended for patients who have suffered from a brain hemorrhage it can be used for most patients with great affect. Because many TMJ sufferers have stress related symptoms it is believed CranioSacral therapy also works as it is a very relaxing therapy.  This modality may begin to become more popular as therapists continue to see results.

Being aware of these four TMJ facts will assist you in deciding on appropriate treatment.