Massage + Medically Fragile Clients


About 15 percent of the current U.S. population is 65 years or older, and as the baby boomers continue to age, the size of this group will continue to grow. Combine this population with those who are chronically ill or have suffered a serious injury, and it’s easy to see how now and in the future you may have clients who are deemed medically fragile.

1. Who They Are. 

Julie Goodwin, a massage therapist and educator, considers a wide array of variables when thinking of how a medically fragile status may apply to her clients. “To me, assignment of a medically fragile or medically frail status evolves from an interview, observation, assessments of medical treatment and medication side effects, physical and social risk, and a review of medical records or treatment transcripts,” says Goodwin. “This often represents multiple health conditions from which recovery or rehabilitation is unlikely, medical treatments and medications that create side effects that interfere with daily functioning, and impairments to mobility and cognition.”

Remember, there is really no “typical” medically fragile client, so you’re going to need to be able to adapt quickly and be flexible.

2. How Massage Helps.

The most common therapeutic reasons medically fragile clients see massage therapy include pain and stress management, decreased swelling, improved range-of-motion, relief from nausea, fatigue, insomnia, and a feeling of calmness and improved mood.

Massage can also be beneficial for clients who suffer from psychosocial issues such as isolation, hopelessness, depression and anxiety. “Massage can bring comfort to these clients and their caregivers,” says Susan Salvo, a massage therapist and author who specializes in the medically fragile, “which can be especially important when spoken language is difficult or impossible.

3. What You Need to Know. 

From the location of the massage therapy session to how you approach massaging clients who are medically fragile, there are mulitple things you need to consider when working with this population.

Client safety, accessibility to the massage space and emergency protocol should all be top priority. Also, intakeThe length of intake will differ based on the client, but make sure to have extra time allotted as most times you’ll need to talk with these clients longer. “Intake is extensive, and likely to comprise most of the client’s initial visit,” says Goodwin. “I prepare the client ahead of time by letting them (or the person making the appointment, who is often a family member) know what information to bring, including a list of health conditions, a list of all prescribed and over-the-counter medications, and the names of primary and specialist health care providers, to name a few.”

During a massage session, you'll also need to be flexible, letting go of any preconceived notions you might have about how a session might unfold. The length of any given session, as well as the techniques you use will also be different. Differences in positioning, too, will exist. “They’re rarely going to get disrobed,” says Salvo. “Depending on how medically fragile or how mobile they are, you’ll have to be willing to massage through clothing or just with what they have on, which might be a hospital gown or leisure clothing.”


For more information on working with medically fragile clients, read the full article in the Spring 2016 issue of Massage Therapy Journal.  

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