How to Accommodate Massage Clients with Health Conditions

Massage therapy can help clients better manage a variety of health conditions, from arthritis to chronic pain.

By Christian Bond, August 18, 2014

Helping clients deal with these conditions, however, requires you not only understand the health condition and its symptoms, but also what adjustments you might need to make to the massage session and your practice environment. Following are a few important tips.

Massage and Chronic Pain

More and more research is confirming the benefits massage therapy offers people dealing with chronic pain, whether because of injury or as a symptom of another condition. Some people who come to you for help managing pain once they’ve been cleared for massage therapy by their physician, however, may need you to make some adjustments to both how your practice is set up, as well as the massage therapy session—including those who have fibromyalgia, chronic myofascial pain syndrome and arthritis, to name just a few.

Fibromyalgia and chronic myofascial pain syndrome (CMPS). According to the National Fibromyalgia Research Association, more than six million Americans suffer from fibromyalgia—90 percent of whom are women. Fibromyalgia is often characterized by numbness in the upper and lower body, joint stiffness in several areas of the body, and widespread musculoskeletal pain.

The condition is diagnosed when 11 out of 18 tender points are painful to the touch, and some clients might also experience other symptoms, including headaches, anxiety, depression, and sensitivity to environmental stimulation such as bright lights, loud noises and strong odors.

CMPS typically occurs when a muscle has been contracted repetitively, often due to repetitive motions (usually from a job or hobby) or stress-related muscle tension. Those with CMPS tend to have a persistent, deep aching pain in their muscles, and may have difficulty sleeping. Unlike fibromyalgia, CMPS tends to affect both genders equally.

Arthritis. Arthritis is characterized by an inflammation of one or more joints. The most common symptoms of arthritis are joint pain and stiffness. There are more than 100 different types of arthritis, so understanding your client’s individual pain is essential.

Adapting Your Practice and the Massage Session

Different clients are going to manage chronic pain in different ways. Some may have self-care routines, for example, that keep the pain under control between massage therapy sessions. Or, perhaps they are working with other health care professionals to manage pain and deal with other symptoms of disease. Additionally, all clients are going to experience pain differently, meaning my pain isn’t your pain isn’t somebody else’s pain.

With these things in mind, think about some of the following considerations when scheduling appointments with clients who are looking for you to help them better manage pain.

Accessibility. Try to imagine your practice from the point of view of someone whose pain might limit their mobility or make holding a pen difficult. How easy can a client get into your practice? Does your practice have stairs a person has to negotiate, and is there room enough if someone uses a wheelchair or walker? 

Think, too, about clients whose arthritis might make filling out an intake form difficult, or someone whose pain might make getting on and off of your table difficult. Are there ways you can adapt your practice to accommodate their needs, such as providing chair massage for people who can’t get on a table, for example?

Good communication. You know the importance of good communication skills, but when you’re working with people who are in pain, these skills are imperative. You need to know what pressure works and when the client wants you to go deeper and when they need you to back off. Clear communication will also help in figuring out what techniques and modalities are most helpful, and which might not be working for them.

Additionally, because fibromyalgia clients might be experiencing sensitivity to environmental stimulation, you should discuss things like music, lighting and scents before each session.

If you need more information on how massage can benefit clients suffering from some of these conditions, have a look at Massage + Chronic Pain and Massage + Arthritis.

Massage and Lupus

Lupus is a chronic inflammatory disease that manifests in a variety of ways. Some common symptoms include fatigue, fever, joint stiffness and pain, shortness of breath, chest pain and dry eyes, to name a few.

As with most disease, how a client is affected will be as individual as the symptoms they experience. Ruth Herold, owner of Ruth’s Massage Therapy in Staten Island, New York, believes the key to providing care is to emphasize the calming nature of massage therapy. “They have so much pain already, so massage needs to be tolerable and, hopefully, pleasant enough that they can relax,” she says. 

Adapting Your Practice and Massage Session

Good communication. As with managing pain (which will also be part of working with clients with lupus), good communication skills are necessary when working with this population. Because of the episodic nature of lupus, it is important to listen to your client’s needs, creating an open dialogue that will help both you and the client find what works best. “You will then be able to focus on the areas that they feel need attention,” Herold explains. “They should let you know if they feel you are helping or if there is any pain. Any pain is not well tolerated and doesn’t lead to good results.”

Adjustable equipment. These clients may have a hard time getting on and off a table, so if you have an adjustable table, make sure you ask a client with lupus if they need the height of the table changed when getting on or off. Or, consider whether chair massage may be more appropriate. Herold, for example, works with a client with lupus who prefers a massage chair or couch for back massage rather than climbing on a table.

Accessibility. Though perhaps not possible for every massage therapy practice, Herold recommends making your space as handicap accessible as you can, suggesting some of these clients won’t come otherwise. Again, look at your practice from the perspective of someone whose pain may limit mobility. How are the widths of your doorways? Is your treatment room large enough for someone in a wheelchair to access and move around in?

Americans With Disabilities Act

When setting up your practice, consider having a look at the design guidelines set up by the Americans with Disabilities Act (ADA) so you can ensure your practice is accessible to every client. Ramps, easy to use doorknobs, and large, clear walkways are essential when providing care to consumers who may have limited mobility or need assistance.

For example, ADA guidelines suggest that entryways and hallways should be at least 36 inches in order to accommodate a wheelchair. Additionally, turning spaces should be at least 60 inches in diameter. Having a better understanding of the needs some of these clients have will better help you adjust where necessary, such as providing massage therapy in a person’s home instead of having them travel to you.

Or, make adjustments the day of an appointment with a client who has specific needs, like moving some furniture in the lobby to make a clearer path to the treatment room.

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Massage and Pregnancy

Massage therapy can help pregnant clients in a variety of ways, like easing back pain. And though there are myriad things massage therapists need to consider when working with these clients, there’s no doubt massage has benefits for expectant mothers.

Adapting Your Practice and the Massage Session

Good communication. As you’ve no doubt noticed, having great communication skills has been mentioned as necessary for all the special populations discussed, and pregnant women are no different. Just as with other consumers who may require special considerations, no two women are going to experience pregnancy the same, and so you have to be aware of how your client feels and what they want and need from massage therapy. “You need to be in touch with your clients’ needs, whatever they may be,” explains Anne Heckheimer, owner of Prenatal Massage Center of Manhattan.

Comfortable environment. Some women, too, may run a little warm while pregnant, so be sure you ask about the temperature of the treatment space and make adjustments if necessary. When providing massage for pregnant clients, positioning is key. Because pregnant women are not able to lie on their stomach or back, these clients will often lie on their side with pillows and wedges used for support.

Alternatively, some massage therapists will invest in a special massage table with hollowed out areas that allow pregnant women to lie on their stomachs. No matter what option you choose, make sure the client is comfortable, relaxed and properly supported.

Scent sensitivity. According to Heckheimer, pregnant women are often more sensitive to smells, so be careful with the oils and lotions you use, as well as any candles that you burn, and give these clients as much control over the scents (or the desire for no scents) during the massage therapy session as possible. Be sure, too, your session room is well-ventilated.

Massage and the Elderly

As with everyone, massaging elderly clients is not a onesize- fits-all endeavor. Elderly clients will have different needs depending on a variety of physical and mental factors, and you’ll have to make some adjustments.

Adapting Your Practice and the Massage Session

Easy to navigate. Julie Goodwin, a licensed massage therapist from Tucson, Arizona, recommends installing exterior and interior signage that is easy to see, along with doorknobs that are easy to use. Make sure hallways are well lit. Bright, non-glare task and ambient lighting can be provided throughout the facility for clients who are more light sensitive.

Breathe easy. Some of these clients, too, may have difficulty breathing—for any variety of reasons. Make sure your practice space is regularly dusted, and again, be careful about what scents you use during a massage session—from lotion and oil to any candles you might use in the treatment room. Be cognizant of other allergens that may make breathing difficult for elderly clients with respiratory problems.

Clutter free. To accommodate less mobile clients, keep the hallways clear of obstacles such as rugs. Also, the bathroom should have grab bars installed where needed, and the sink should be wheelchair-accessible. Make sure products in the bathroom are clearly labeled and non-shatter product containers are used.

Like the hallway, Goodwin recommends the treatment room should be an obstacle-free movement space. Your surfaces should be close together and stable enough to allow the client hand supports for safe movement around the room. Finally, make sure linens are all-cotton, knit jersey or flannel, and in highly contrasting colors.

Good communication. Again, you are going to have to be able to communicate clearly and effectively with elderly clients. You need to ensure they’re warm enough, for example, and are tolerating the massage well. Additionally, you want to be able to communicate with the client about the lotion or oil you’re using, and make sure they understand that if something doesn’t feel right they should let you know immediately so you can make adjustments, whether that’s to the environment or the massage.

Your clients are all unique. They come to you for many reasons, ranging from relaxation and stress relief to help managing symptoms of disease to recovery from an injury. Whether or not they suffer from these health conditions, some clients are going to require that you handle the massage therapy session— and your practice—a little differently. And knowing how to accommodate all of your clients can go a long way in creating loyalty.

Other Accommodations

Your clients are unique and you take the time to get to know them—as well as what they want and need from a massage therapy session. Some, however, are going to need you to take extra precautions, and adjust both your practice and the massage session to accommodate their needs. Julie Goodwin, a licensed massage therapist in Tucson, Arizona, offers some additional tips:

Accommodating Vision Loss

  • Use a top sheet that contrasts with the bottom sheet and withmthe floor
  • Keep the floor clear as the client moves about the space
  • Verbally orient the client to the room
  • Leave your client’s belongings, like eyeglasses and assists, in place within their easy reach
  • Offer your arm in transit and keep traffic paths clear

Accommodating Hearing Loss

  • Face the client when speaking, but don’t yell
  • Agree on communication strategies. For example, a tap on shoulder to turn over, client calls out when ready for you, etc.
  • Eliminate superfluous sounds, like music, if the hearing loss is profound
  • Avoid touching near the ears when hearing aids are in place
  • Install a battery-operated doorbell so client can summon you for any needed assistance

Accommodating Mobility Loss

  • Keep traffic paths clear
  • Be mindful of body mechanics
  • Prevent positional strain on the client by adapting your technique to the client’s needs
  • Return mobility assists at the session’s end
  • Avoid contaminating mobility assists with lubricant
  • Consider treatment in-place, when indicated

Accommodating Cognition Loss

  • Be adaptable
  • Stay flexible and non-judgmental; be in the moment with the client
  • Offer only the degree and duration of touch that is welcomed by the client
  • Adjust treatment planning as the condition progresses
  • Make sure to include an observer in the treatment room during the massage

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