That massage therapy can be effective in helping relieve pain is fairly well-established. Knowing this opens up a great deal of opportunity for massage therapists, especially when you think about the myriad conditions—from fibromyalgia to lupus to arthritis—that have pain as a primary symptom. One area where research indicates massage therapy is showing some real promise is with arthritis.
What You Need to Know
Getting to know them. With patients who have arthritis, your intake is likely going to have to be a little longer and more detailed. “Allow a longer time so the client can tell the history of their disease, as well as treatments they’ve previously tried,” advises Nancy Hess, owner of A Still Place in Oak Park, Illinois. “This gives the therapist more information, but more importantly, allows the client to be heard.”
You’re also going to need to ask what medications, if any, the client is taking for their arthritis and be familiar with potential side effects. “Evaluate the range of motion of each of the affected joints,” explains Mary Ann Benitez, owner of Masajes Therapeutic Massage in Knoxville, Tennessee. “Try to determine how to best—and if—to mobilize.”
Lighter touch. This population may need a little gentler touch. As some recent research suggests, however, that doesn’t mean you should be afraid to use moderate pressure. “We start with more gentle techniques that focus on circulation,” says Sandy Saldano, a 25-year-plus veteran and president at Therapeutic Knead in Highland Park, Illinois. Using techniques such as effleurage, Swedish massage and craniosacral therapy, Saldano typically works with her clients suffering from arthritis for about an hour, focusing on the areas where they are currently experiencing pain.
Hess uses some of the same techniques as Saldano when working with clients who suffer from arthritis, though sometimes her clients remain clothed during the session, depending on how bad their arthritis is. “Some like a lighter touch, but not necessarily,” Hess explains. “These clients may have come to experience their bodies as the enemy. Allowing them to experience relief in even a part of their bodies can be very helpful.”
Make adjustments when necessary. Remember, these clients are probably going to be in some kind of pain when they come to see you, so you need to be aware of places in their body that might not be suited for massage therapy during any given session. “Don’t work right at a joint during a major flare-up,” says Hess. “Reschedule or work on surrounding areas only, and no deep pressure.”
Regular appointments. Additionally, Saldano sees the benefits massage therapy offers her clients reinforced by regular massage sessions. “Many clients who can continue regular therapy have discovered that their pain not only decreased, but their activity levels increased, thereby helping the pain to stabilize to a tolerable level,” she says.
Help them sleep. No matter the cause, pain can be a pretty significant factor in sleep disturbance, so be aware of this problem when working with clients who have arthritis. “Sleep disturbances are a real contributor to pain syndrome,” notes Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami School of Medicine. “It’s sort of like a vicious cycle because you have sleep disturbance, then you have pain syndrome, and when you have pain syndrome, you can’t sleep.”
Know when it’s time to refer out. Most, if not all, of these clients are going to be working with other health care providers, so you need a good understanding of other treatments they’re using. Again, know what medications they’re using, as well as if they see a physical therapist, for example.
Additionally, you have to be aware of when it’s time to refer to a specialist. Perhaps it’s another massage therapist who you know has additional education in helping people with arthritis. Or, maybe you need them to get a referral from their rheumatologist before a massage therapy session because you’ve noticed swelling or joint pain that wasn’t present before. Whatever the case, knowing when you need to involve other health care providers is crucial.
Help them help themselves. For this group of clients especially, helping them find relief between massage sessions is beneficial. Any self-massage techniques you can share with your clients dealing with pain will be helpful.
As part of the study “Rheumatoid arthritis in upper limbs benefits from moderate pressure massage therapy,” conducted by Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami School of Medicine, participants were taught a self-massage protocol that proved helpful in reducing the pain associated with their arthritis.
The following self-massage was specific to the arm and shoulder:
> Stroking. Stroking from the wrist to the shoulder with moderate pressure, then from the shoulder back to the wrist three times. On the top of the hand, stroke from the wrist to the tips of the fingers and back to the
wrist. Repeat on the underside of the arm.
> Milking. On the top of the arm, cup fingers with thumb on the underside, pulling the flesh between them and gradually moving down to wrist and back up to shoulder from the wrist. Again, use moderate pressure. Repeat on bottom of the arm.
> Friction. Make circular movements with four fingers on top of the arm, moving across the shoulder and down the arm and top of hand. Repeat same on underside of arm.
> Skin rolling. Similar to the milking, squeeze the arm between the fingers and the thumb, then crawl fingers across skin with moderate pressure, first on top of arm and then underside of the arm and top of shoulder.
Reach Out to These Clients
Along these same lines, you might think about reaching out to any pain management clinics in your area, or connect with an integrative health facility. Additionally, Saldano suggests putting together an educational seminar you can present at local retirement or senior centers. “Doing talks at senior centers about the benefits of massage is another way to educate them about alternatives to medications and introduce them to massage therapy,” she says.
Don’t overpromise, and show compassion. Especially when working with people in pain, paying close attention to how you describe your work is imperative. So when developing marketing materials and talking to potential clients who have arthritis, make sure you are very clear about what they can expect. “You can’t make claims about a cure or permanent relief,” Hess explains. “Instead, talk about pain management and improved quality of life.”
Compassion, too, will go a long way in helping you connect with these clients. “People who have conditions like rheumatoid arthritis and fibromyalgia can become pessimistic from the constant pain they endure, especially when these patients are relatively young,” Benitez says. “Giving them time where they are comforted physically is encouraging to them.”
With more research confirming that massage therapy is a real benefit for people dealing with pain, there is real opportunity for massage therapists. Knowing how to work with these clients is important and can better help you reach the people who would benefit from massage therapy.