There are myriad ways massage therapists can make contact with other health care professionals, and in today’s climate, these opportunities are probably only going to increase. Because there’s some substantial research showing how effective massage therapy can be for relieving pain and stress, one natural fit for massage therapists looking to make inroads in a health care environment is working with clients who suffer from diseases that involve chronic pain. When thinking about clients who need help managing chronic pain, a number of demographics come to mind.
One special population you might consider is clients with lupus.
Lupus. Ruth Herold, owner of Ruth’s Massage Therapy in Staten Island, New York, worked on a friend who had lupus, along with a few other medical conditions. In the beginning, Herold had a difficult time convincing her friend that massage therapy may be able to help with some of her more troublesome symptoms, like joint and muscle pain, and stress. “She just wasn’t comfortable with massage at first,” explains Herold. “She did like when I worked on her feet, and she could lay on her back propped up with pillows.”
Herold did what every massage therapist working with clients who are dealing with disease and in chronic pain should do: she accepted where the client was in the process. “I didn’t push her to try massage,” she says. “Rather, I waited until she asked me to help her because her neck, back and shoulders hurt.” Letting the client call the shots is particularly important here, as chronic pain often isn’t only manifested physically. These clients may have emotional responses to pain that cause them to withdraw, as well as behavioral responses that lead to differences in function and mobility. So, even if you know massage therapy can help with symptoms your client is experiencing, if they’re not ready, respect that feeling.
Flexibility. When her client was ready for massage therapy, Herold needed to be flexible in how she worked on her. “Getting on and off the table was very difficult, and laying on the table was uncomfortable,” she explains. “I worked on her sitting in a chair with her head resting on a pillow. That was much more comfortable for her, and she didn’t have to bother with dressing and undressing and climbing onto a table.”
Intake. Every client you see is unique, and a client with lupus is no different. With these clients, however, you need to make sure you discuss how lupus is affecting them so you can make the best decisions about treatment. “You want to know what hurts, and what areas have been affected by the lupus,” Herold says. “You need to know if there is any organ dysfunction that would contraindicate massage.” Remember, too, that these clients are likely going to be on medications, such as prednisone and Vicodin, so checking with their physician regarding the use of massage therapy is a good idea.
Seraphina Tisch, a licensed massage therapist in Brooklyn, New York, regularly asks her clients with lupus some basic information. “I want to know about their activity level,” she begins. “I also want to know if they feel fatigue, how their body image is, any changes in medication and the results of any tests they’ve had.”
Doctor's orders. Both Herold and Tisch believe in having a physician’s approval for massage therapy, though both leave the communication with the doctor up to the client. “I think it’s important that lupus patients talk to their doctors about massage and approval,” advises Herold. “I don’t insist that they do, nor do I ask for anything in writing. Though with some, that might not be a bad idea.”
For Tisch, the experience is similar. “I have not been in contact with the client’s physician or any specialists, although the client has reported talking with her health care team about receiving an OK for massage treatment,” she says. “I do feel it’s important to at least have a prescription from an advising physician, or permission to contact a member of the client’s health care team.”
Helping hands. Some of the most common symptoms of lupus can be helped with massage therapy, Herold believes, including joint and muscle pain. “Some light fascial techniques and compression can help soothe the connective tissue,” she says, adding that lupus can attack any area of the body, as connective tissue is everywhere. “Very light frictions at the joints and ligaments that are affected would be useful to strengthen those areas and promote healing.”
Tisch also uses light Swedish-style massage, as well as shiatsu, to help clients with lupus deal with a broad spectrum of symptoms, from tissue inflammation to skin and joint problems. “A typical session lasts about 90 minutes,” she adds. “This time includes 20 to 30 minutes for discussion of the client’s current state of health and treatment goals for that particular session.”
According to Tisch, increased mobility, decreases in pain and an increase in energy are some of the benefits clients with lupus can experience with massage therapy.
Contraindications. As with any disease, massage therapists need to be aware of when massage therapy is contraindicated for clients with lupus. “You need to avoid working during an acute fl are-up,” both Herold and Tisch recommend. “Avoid heat treatments where there is inflammation, as well as any range of motion work with inflamed joints. Vigorous massage or deep tissue techniques also would be contraindicated,” Herold adds.
Adjustments. With clients who have lupus, you are going to have to make some adjustments to how you work during a massage session. “You need to work with these clients very, very slowly,” Herold encourages. “Ask if they think they will be more comfortable with a chair massage, or if they think they can manage to get on a table.”
Herold suggests starting with a 15- to 30-minute chair massage to see how the client does, and be sure to regularly check in and ask how they are managing the massage session. Herold also found that she really needed to be cognizant of the different expectations of her clients with lupus. “Most of my other clients were interested in deep tissue massage for pain relief, so this was challenging for me at times,” she explains. “I had to step back and really listen to her thoughts and complaints and try to adjust my techniques to suit her.”
Tisch agrees. “You need to establish right away what level of pressure is comfortable for them,” she says. “This may be significantly lighter than you might think.” Tisch also cautions that clients with lupus will sometimes have to cancel at the last minute due to emergencies or other medical appointments, so being flexible in scheduling is important. “Lupus clients might also be on a fixed income, and have huge medical costs to deal with,” Tisch adds. “If this is a population you are interested in working with, you sometimes need to be able to work out a fee that is affordable for the client and agreeable to you.”
There are times, too, when your inability to help may be frustrating. “One time, she wanted me to help her ease her back pain, but kept telling me it was hurting,” Herold recalls. Not one to give up, Herold tried simply holding her hands on the client’s back, and was surprised to find how much this seemingly simple action helped her client. “I felt the tissue beneath her skin move, so I gently moved upwards without losing contact, and felt more movement. She felt it too, as a release, and said it was very intense and very helpful.”
Tisch adds: “The best advice I can give is to really listen to your client, and be hyper-aware while you are working so that you can respond to nonverbal cues during your treatment,” she says. “Lupus is a very difficult disease to live with, and your clients will appreciate a positive attitude that does not pity them or dismiss their challenges.”
For more information on lupus and the symptoms of lupus, visit the Lupus Foundation of America’s website, lupus.org.
Talking to a Client with Lupus
Shahana Hanif was diagnosed with systemic erythematosus lupus (SLE) in 2008. “I started my senior year of high school with severe headaches, fevers, achy joints and swelling in my right foot,” she explains. “It wasn’t until my right foot was as big as a baseball glove, however, that I decided to go to the doctor.”
Having never before been severely ill or hospitalized, Hanif was scared. After a week in the hospital undiagnosed, doctors finally told her she had SLE. “I’d never heard of lupus before,” she explains. “My initial reaction was to ask if I was going to die.” Hanif wasn’t going to die, but she was going to have to deal with the varying symptoms of this disease— many of which are painful.
Seraphina Tisch, her college counselor and massage therapist, is who first talked to Hanif about therapeutic forms of pain management, including massage therapy. “My mother and siblings would massage specific areas with Ben-Gay,” she says. “So, I was optimistic.”
A typical massage therapy session for Hanif lasts about two and one-half hours, beginning with a detailed evaluation of any new problems, and where she’s experiencing the most pain. “The massage itself is usually about an hour long,” she says.
The difference massage therapy makes for Hanif is summed up in one word: independence. “It gives me the ability to go to the supermarket and walk down the aisles, and shop on my own,” she says. “Feeling pain free, though it’s temporary, is the best feeling ever.” In addition to physical pain relief, Hanif feels uplifted and positive about her entire life after a massage therapy session. “I feel good about everything,” she explains.
For more information on how massage therapy is used with clients with lupus, visit the S.L.E. Lupus Foundation, where you'll find their Massage Therapy Resource Guide.