Helping Patients After Surgery
Learn how massage therapy can be helpful for post-surgical pain, scarring and other common physical and emotional issues.
Postoperative pain isn’t always short-lived— research shows persistent or chronic post-surgical pain lasting two to three months is responsible for nearly 1 in 4 cases of chronic pain. Postoperative pain can also mess with mood, sleep and other cornerstones of mental and physical health, according to 2013 research in the Journal of Pain.
And surgery doesn’t just lead to acute pain at the incision site or surrounding areas. As days and weeks pass after the procedure—and patients’ lives return to something resembling normal—they may have adopted new ways of moving to compensate for that initial discomfort, experts point out. This can disrupt the normal alignment of muscles and joints, which can trigger additional aches and pains and even lead to long-term dysfunction.
“With any invasive procedure to the body, tissues are broken down and they have to get back to normal,” explains Daniel Vaccaro, a massage therapist from Norwalk, Connecticut, who frequently works with clients who’ve undergone surgery. Some research shows massage therapy can help with inflammation and scar tissue, helping postoperative patients regain full range of motion without discomfort.
A growing body of research supports the notion that massage therapy has much to offer postsurgical patients by easing their path toward healing. A major review of 16 existing studies published in September 2016 in the journal Pain Medicine indicated massage therapy can effectively reduce the severity of pain and anxiety in those who’ve undergone surgery. The study—commissioned by the Massage Therapy Foundation with support from the American Massage Therapy Association— concluded that patients should consider massage as a therapeutic option to manage these issues.
Bridging Gaps in Care, Understanding
Jenice Mattek, a Chicago-area massage therapist, says the profession can bridge the gap between the focus of the surgeon on performing a specific procedure, and what patients may experience physically and mentally afterward. By educating clients about potential post-surgical challenges and tackling them hands-on, massage therapists play a valuable role in their patients’ postoperative recovery.
“Doctors can explain surgery,” says Mattek, who presented a session on “Moving Your Client Beyond Low Back Pain After Abdominal Surgery” at the 2017 AMTA National Convention. “But they can’t always explain what happens after surgery, because they may never see that patient again. So I think there’s comfort in understanding and knowledge.”
What are some of the most common types of surgery massage therapists may encounter in their practice, and what’s involved in these procedures? More importantly, how can massage therapy help? Here’s what the experts say.
What's Involved: Abdominal surgeries take place in the area between the first rib and the pelvic floor and can be performed on a variety of abdominal organs, such as the reproductive organs, stomach, gallbladder, intestine, appendix, liver, spleen or esophagus. Surgery may be warranted for many reasons, including obstruction, infection, inflammatory bowel disease or tumors. Larger incisions are generally used in open abdominal surgery, with smaller incisions made for laparoscopic surgery.
Most Common Post-surgery Complaints or Complications. “People often feel they’ve lost control of their abdominal muscles after abdominal surgery, which is called muscle inhibition, or develop scar tissue,” Mattek says. More than 9 in 10 people who undergo abdominal surgery will develop some type of scarring or adhesions, she adds. These can become tighter even years after surgery.
Back pain often results because patients “compensate” for muscle inhibition and scarring by changing “what habits they form, how they may move or even bend differently,” Mattek says. “If you’re not using your abdominal muscles because they’re compromised due to surgery, you start to move differently, which in some people leads to back pain or discomfort.”
How Massage Therapy Can Help: A February 2014 study in Scientific World Journal indicated that massage helped patients with chronic low back pain, with study authors suggesting massage therapy acted similarly to anti-inflammatory pain drugs. A 2017 study in the journal Pain Medicine co-authored by Niki Munk, Ph.D., a massage therapist who’s also an assistant professor of health sciences at Indiana University’s School of Health and Rehabilitation Sciences in Indianapolis, bolstered those findings. It suggested massage therapy produces meaningful benefits in lowering pain, disability and other health- related effects for patients with chronic low back pain.
“Massage therapy helps with changing alignment due to complications post-surgery—the alignment of the body itself or any joint,” Mattek explains. “It can help to turn muscles back on that may not be working as they should be. So if the transversus abdominus, for example, isn’t working when and how it should, the rectus abdominus and/or obliques may take over for stabilization, but not as efficiently. You can get the transversus abdominus to do its job by working on it at the right time. By helping decrease the tone of other muscles, you can help the brain and muscle connect together again.”
Vaccaro says he works on minimizing scar tissue in abdominal surgery patients with “a myofascial process, stretching out the tissue to diminish the scar. It’s going to be there, but it will reduce.”
Hip Replacement Surgery
What's Involved: Known medically as hip arthroplasty, this procedure replaces a worn out or damaged hip with an artificial joint because of problems such as a hip fracture or arthritis. Traditional hip replacement involves a several-inch incision over the hip joint, while minimally invasive versions use one or two smaller incisions. Surgical approaches include an incision from the front—called anterior hip replacement—which may result in less trauma to muscles; a posterior approach is more traditional and involves a back or side incision.
Most Common Post-surgery Complaints or Complications: The surgical approach in hip replacement greatly determines how each patient’s surrounding muscles are affected or how their body forms scar tissue. But “then again, it’s that unconscious or conscious holding or splinting that happens in the musculature” that can create misalignment in muscles and joints, and produce prolonged pain, Munk says.
How Massage Therapy Can Help: A 2017 study in the Journal of Orthopaedic Science showed that manual calf massage can contribute to a lower incidence of deep vein thromboembolism a major potential complication of many surgeries—in hip replacement patients. And Mattek contends that massage therapy helps greatly in hip replacement patients with troublesome scar tissue. “Everyone develops scar tissue in different ways, which can make the healing process harder or slower,” she says. “A massage therapist can address those muscles that have become overcontracted— like the hamstrings, quads and larger glute muscles, which may be hypertoned to help protect the surgical area from injury. To help release those areas is probably the biggest thing massage can do.”
What's Involved: Designed to treat heart or lung disease, cardiothoracic surgery may involve splitting the chest open—as in open-heart surgery—or more minimally invasive techniques.
Most Common Post-surgery Complaints or Complications: Much discomfort can result, especially from impaired movement in the nearby shoulders, back and neck, Vaccaro says. And Mattek notes that cardiothoracic surgery often prompts patients to “feel short of breath or be afraid to breathe— it feels tight or uncomfortable as the area heals.”
“It’s interesting because the heart is on the left side, but for some reason people experience a lot of right shoulder pain post-surgery,” Mattek adds. “I think it has to do with the pectoral muscles and the chest area being insulted during surgery, which decreases strength overall in the shoulders, leading to some compensation.”
How Massage Therapy Can Help: A research review of 12 studies published in September 2017 in the journal Heart & Lung assessed patients with acute postoperative pain from thoracic surgery, finding that patients receiving massage therapy in combination with pain-relieving medications reported less pain than those who’d received “sham” massage or those receiving only pain medication. Notably, the combination of massage therapy and pain medication was deemed more effective than drugs alone.
“In several of our studies looking at the role of massage after open-heart surgery, for example, we saw a great deal of additional benefit because the massage therapist could work on whatever area or areas the patient desired,” says Brent Bauer, MD, the director of the Mayo Clinic Complementary and Integrative Medicine Program in Rochester, Minnesota. “Many of them indicated the upper back, where there is a lot of discomfort sometimes from having the rib cage sprung open during surgery.”
What's Involved: General surgery may be done on many various body areas and for many reasons, including cancer surgery or procedures to treat the bones, skin or soft tissues. Trauma surgery also falls under this definition.
Most Common Post-surgery Complaints or Complications: Any resulting issues rely greatly on what body area has been operated on. To better pinpoint them, Munk suggests figuratively stepping into a client’s shoes to assess what physical problems may have resulted from their surgical trauma.
“Try to put yourself in the stance of guarding that specific area and feeling in your own body what isn’t necessarily in alignment so you can address that in the patient,” she says. Also important is picking up on a client’s unconscious body language and cues, such as grimaces or changes in breathing patterns during treatment, Munk adds.
Among patients who’ve undergone minimally invasive surgery, which is typically performed through small incisions, patients expect quicker recoveries, but Mattek notes that research shows minimally invasive surgery can still produce significant scar tissue. “I’ve had patients with simple lipomas removed from their shoulder area, and it still decreased their shoulder strength by 50 percent,” she says. “Or with an appendectomy or gall bladder surgery, for instance, you can barely see a scar, but it’s important to assess and look for that even if the surgery was a long time ago.”
How Massage Therapy Can Help: As with other types of surgery, massage benefits general surgery patients by reducing surrounding discomfort and re-aligning muscles and joints. Mattek says palpation around the surgical site can determine if scar tissue is forming near the area or distantly as well. “Is it the muscle inhibition, the scar tissue, causing the complications and have they related it back to their surgery?” she asks, noting that some clients may not associate ongoing discomfort with previous surgery. Before working with a client who’s undergone surgery of any type, Mattek advises seeking medical clearance if they’re less than six weeks post procedure. “Also, if there’s an infection or redness present, or a wound is not healing, do not work directly on that area,” she advises.
Anxiety, Stress Also Targeted
Regardless of the type of surgery a patient has received, pain, anxiety and stress are often byproducts of the experience, and research indicates massage therapy significantly targets these after-effects. Dr. Bauer co-authored 2010 research indicating statistically and clinically significant cuts in pain, anxiety and tension scores in patients receiving a 20-minute massage sometime between two and five days after surgery compared to patients receiving standard care and 20 minutes of “quiet time.” He co-authored similar research showing comparable results in cardiac surgery and colorectal surgery patients as well.
“Even the best surgical experience is still a highly stressful experience both on the physical and emotional level,” he says. “Thus, anything we can do to help the individual manage their stress and sometimes, the stress of their loved ones—may in fact improve outcomes. There’s a good deal of literature suggesting that high stress levels reduce our wound-healing abilities and also dampen immune function. Neither of these are things we would like to have happen during the postoperative period.”