Indications for Massage: Lupus

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 causes 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.

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 docto 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 are 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 flare-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.

For more, read the full article in the Spring 2012 issue of Massage Therapy Journal.

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