In 2016, the Department of Veteran Affairs reported there were roughly 20 million U.S. veterans, and with more of them grappling with symptoms such as post-traumatic stress disorder (PTSD), insomnia, stress and anxiety, just to name a few, massage therapists are in an excellent position to help veterans take control of their health and wellness.
Following, you’ll find more information about some of the most common health issues veterans face, as well as how massage therapy can help and what you need to know when working with veterans. To make sure you’re staying up-to-date with the massage therapy profession, recent research discussing the benefits of massage therapy for some of the issues veterans face is also highlighted.
Common Health Conditions in the Veteran Population—And How Massage Can Help
PTSD. Feeling fear and a whole host of other emotions either during or after a traumatic event is not uncommon. But for some people, those feelings never completely resolve and they continue to feel stressed or frightened even when not in danger. Some research estimates that between 5 and 20 percent of veterans who were deployed to Iraq and Afghanistan have PTSD.
PTSD comes with both physical and psychological symptoms, and can include higher rates of musculoskeletal or cardiovascular issues, flashbacks and nightmares, increased feelings of detachment and isolation, and irritability and difficulty falling asleep.
Because these symptoms are so wide-ranging and sometimes contradictory, getting help with PTSD can be difficult for some. “So, for example, not only can you have a flashback or memory you don’t want to have, but you also feel separate and alienated from others,” explains Frank Ochberg, M.D., and founder of Gift from Within, a nonprofit organization providing educational resources to people suffering from PTSD. “That makes it difficult to be trusting, to want to be with the very people you need to be with.”
There is research that suggests massage therapy can help veterans with PTSD. One small pilot study found massage significantly reduced headache, anxiety and pain interference. In another randomized controlled trial examining the effects of a web-based, self-directed program that included mindfulness and body-based wellness skills for veterans and their significant others, partner massage was found to produce significant reductions in self-reported levels of pain, tension, irritability, anxiety and depression. Massage was also found to be a positive addition to veteran health care in a June 2017 study.
Chronic Pain. Chronic pain is another major issue within the veteran population. According to Niki Munk, Ph.D., a researcher and massage therapist in Indiana, musculoskeletal pain is common, with research showing it’s the leading cause of disability among veterans and that as much as 70 percent of the veteran population is affected. Additionally, research published in 2016 suggested veterans are more likely to develop musculoskeletal disorders, such as arthritis, low back pain and hip pain.
“One of the benefits of massage is it’s uniquely situated to help chronic pain conditions, especially musculoskeletal conditions such as low back pain, osteoarthritis-related pain, neck pain and fibromyalgia,” says Matthew Bair, M.D., MS, a health-services researcher with a special interest in pain management. “While most veterans have not experienced massage therapy, many are interested in trying it for their chronic pain conditions and hearing explanations of why a massage therapist is using a specific technique to treat them.”
Studies back up the benefits massage therapy offers people dealing with chronic pain, including back pain, neck and shoulder pain and osteoarthritis. For example, one study comparing two different types of massage to usual care on 401 participants with nonspecific low back pain found massage to be an effective treatment, with benefits lasting at least six months.
Anxiety. For veterans especially, anxiety can present as generalized anxiety disorder (GAD)—what’s described as a persistent and uncontrollable anxiety and worry. In a 2013 study investigating the prevalence of GAD in the Department of Veterans Affairs primary care settings, researchers found that 12 percent of the 884 participants met the diagnostic criteria for GAD. Additionally, GAD was found in 40 percent of those participants who had been diagnosed with PTSD.
A 2016 study of the effect of Swedish massage therapy on symptoms of GAD found that participants’ anxiety was significantly reduced at the start of week three, suggesting massage may be an effective acute treatment for GAD.
Depression. Both Drs. Bair and Munk agree that depression is problematic within the veteran population, and some research bears out this concern. A 2016 study on PTSD and depression symptoms in U.S. veterans found that veterans with PTSD and depression who also had low social support were at an increased risk for suicide.
And although the comorbidity rate between PTSD and depression is fairly high, a 2017 study found that approximately 40 percent of veterans not diagnosed with PTSD had other mental health issues, most frequently depression.
Here, too, massage therapy shows promise. A 2010 meta-analysis considering the treatment effects of massage therapy for depression found a significant association between massage and alleviated symptoms of depression. Additionally, a 2013 study found massage therapy significantly reduced depression in HIV patients when compared to no intervention or light touching.
Insomnia. While insomnia is a common issue among the general U.S. population, this condition presents an even greater problem to veterans. A study conducted in 2017 involving primary care providers’ perspectives on veterans showed that more than half of the veterans already enrolled in VA health care centers in the Midwest demonstrated having significantly higher levels of insomnia.
As with so many other conditions, sleep disturbances can lead to other problems. For example, a 2017 study found that sleep disturbances and nightmares may be linked to an increased risk for suicide.
What Massage Therapists Need to Know When Working with Veterans
Make a real connection before your first massage. First things first: Make a connection with the veteran before they even get on your massage table. Trust is going to be key for most veterans, and so you need to spend time talking before your first session. Some veterans may want to talk or visit your practice before they decide to schedule a session.
Pre-assessments and intakes are another excellent way to determine how to best structure a massage session, as well as the techniques that will prove most beneficial. “As a massage therapist myself, I like to know what kinds of issues my veteran clients are dealing with before the session even starts,” says Kelly Konicki, a massage therapist from Georgia and director for Hands for Heroes, an organization that provides massage therapy to veterans.
Konicki also insists that proactively reaching out to veterans makes good sense. “I think veterans are eager to try different modalities to keep themselves well, so it’s important to reach out to veterans and let them know what we can offer them.”
Be flexible and adjust to the client's individual needs. Because each veteran may have different health issues and come from a different background, no single technique will offer the same benefits to all, according to Sara Dawdy, CEO of Mission 22, an organization dedicated to helping veterans. “Veterans have many things going on that need to be addressed,” she says. “Massage therapists are effective when they consider veterans on an individual basis. Every single massage session needs to be specifically geared toward the individual veteran on the massage table.”
Faith Davis, a massage therapist in Colorado, agrees, acknowledging that each massage session should be catered to the veteran client. “Get to know your veteran client’s health history, injuries and preferences, and adjust the massage as needed,” she explains.
It is also a good idea to use massage techniques and approaches during massage sessions that will put the veteran at ease, especially if they have a condition that might make the session more complicated, such as PTSD.
“Veterans with PTSD often do not like to be approached from their back, so massage therapists should try to be in visual sight,” says Dr. Bair. Techniques that focus on the whole body also help, according to Carol Schneider, a licensed massage therapist in New York and Pennsylvania.
Set expectation early and communicate often. Schneider finds that clients who have PTSD especially have the tendency to arrive feeling nervous about the session, so it’s helpful to set expectations early and make sure that the client knows they are in full control of the massage session, including the music, how dark the room is, what areas of the body are OK to massage and how much pressure is used. Veteran clients also need to know they can stop a massage session at any time.
You can get a great deal of information during intake, but don’t forget to check in during the session, too. Make sure the client is comfortable and feels safe enough to give you feedback, and be extra aware of anything that might trigger a flashback or response, such as specific smells, loud noises or even some kinds of touch.
Know that generational differences exist. In addition to ridding yourself of any preconceived stereotypes about veterans, according to Dr. Munk, considering generational differences that exist among veterans is important. “The veteran population is a diverse group of people, so it’s important to keep generational concepts in mind,” she explains. “Veteran populations are going to be different, not only because of the era during which they served in the military, but also because the age they are now may have additional overlying implications.”