Archives for posts with tag: Contraindications
In RA, the synovium, the tissue that lines the joint, mistakenly becomes a target for the immune system. The immune system cells release inflammation-causing chemicals which cause inflammation in the synovium. The synovium creates a fluid called synovial fluid, which lubricates the joint allowing for smooth movement. When the synovium becomes inflamed and damaged, it fails to produce this lubricant and the joint does not move as freely. If the inflammation of the synovium continues over time, the cartilage and eventually the bone become damaged. The joints can then become deformed and misshapen, and movement becomes limited.

RA affects more than just the hands and other smaller joints; it can affect the entire body making it a systemic condition.

Symptoms

  • pain in multiple small joints for six weeks or longer,
  • morning joint stiffness lasting longer than 30 minutes,
  • bilateral pain,
  • loss of energy and appetite,
  • low grade fever,
  • dry eyes and mouth (Siogren’s syndrome),
  • and rheumatoid nodules, or lumps, which can grow beneath the skin.

Trouble breathing, anemia and inflammation of the blood vessels can also be symptoms of RA.

Joints affected by RA may be tender, warm and swollen, typically in a symmetrical pattern – meaning if one side is affected the other side usually is affected as well. RA shows up in the smaller joints first, so wrist and finger joints are affected most often, but other joints such as the neck, shoulders, elbows, hips, knees and ankles along with the feet can be affected. While there is a great deal of variation in symptoms, once someone shows signs of RA, those symptoms usually last for years.

Drug treatment for RA involves drugs called disease modifying antirheumatic drugs (DMARDs) that relieve symptoms and slow the progression of the disease. Analgesics like non-steroid anti-inflammatory drugs and NSAIDs may also be used to reduce swelling, pain and fever.

Massage and Rheumatoid Arthritis

While massage can aid in increasing mobility and alleviating muscle tightness resulting from chronic pain, it cannot do much to alleviate pain from deformed or degenerating joints. Moderate pressure Swedish massage and myofascial release are the two types of massage that research has proven offer benefits for those with RA, but there may be other techniques that reduce pain and increase mobility as well.

Massage therapy has been shown to reduce pain and increase joint mobility as well as decrease depression and anxiety in clients with RA. In one study, those with RA who received moderate pressure massages enjoyed less pain and greater mobility and grip strength than those who received lighter pressure massage therapy (Field, et.al., 2013). Another study showed that the stress hormone cortisol decreased immediately when RA patients received massage therapy (Field, et.al., 1997).

A 2011 study showed that myofascial massage, applied three times per week for two weeks, provided significant pain relief from RA symptoms. Myofascial release works through the application of sustained moderate to deep pressure, which allows the muscle to lengthen, reducing strain on the joints from muscle tension (Cubick, et.al., 2011).

Deep tissue massage techniques or trigger point therapy on clients with RA, should be limited, as these techniques might trigger a flare up of inflammation, especially near joints affected by the disease. When employing these techniques, it is important to work slowly, giving the client time to react, and to not overdo it. Let the client “live with” the work after a short, limited amount of deep work to see how their body reacts. If they are okay and do not have an increase in inflammation in RA-affected joints after the session, you can do a little more deep work at the next appointment. If they have a flare up of symptoms, avoid deep tissue techniques. Communication from the client is key. Massage should never be more painful than a good workout. Discomfort is one thing, but especially when dealing with RA, pain is not optimal.

Contraindications

Basic contraindications for massage therapy apply to those clients with RA as well; avoid massage when there are open wounds, fever, skin rashes or irritation, or deep vein thrombosis. Clients with any significant health concerns should be cleared by their physician before getting massage therapy.

When working on clients with RA, joints that are in an acute stage of inflammation and are warm, red, or extremely painful should be avoided. The therapist should check in with the client regularly to ensure that the pressure is not too deep, as it is important to ensure the massage does not trigger muscle contraction and cause more tension and pain. If a client is having a significant flare up of symptoms, massage should not be performed until symptoms calm down. Joint mobilization and stretching should be performed with care, as joints may be damaged or compromised.

Massage therapy has been shown to significantly reduce pain, increase mobility and reduce stress and anxiety for clients with Rheumatoid Arthritis. Massage therapy should be light to moderate, and care should be taken with inflamed and potentially damaged joints. Clients with RA live with pain as a constant companion and truly appreciate any intervention which offers relief from that pain.

Communication with the therapist as to medications taken is important. Depending on the medication considerations will be made pertaining to how the medications affect the body including pain relief, muscle relaxation, nerve reaction, dehydration, time of last dose etc.

 Adapted from an article Written By Leslie DeMatteo, LMT, MS  December 7th, 2016

 

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A couple of days ago, I awoke in a panic with this on my mind and have been simmering on it trying to figure out a way to share this very important information with my clients and colleagues.

How many times have my clients forgotten to tell me what medicines they are taking? OMG a million times over! And this is so very important not only for their health but for mine! Some medicines are contraindicated for massage because while taking it, harm can come to the individual who is on those drugs. Some medicines are contraindicated because while taking it, the massage can be negated rather quickly. Some medicines are contraindicated because they are topical and can cross over to the therapist. Yes, I said that!

I have on my intake form What medicines are you taking for a reason. I have to be able to determine how and where I can work on you. I don’t just rub bodies.

Additionally, I have on my intake the direct question of Are you taking any topical medicines? This is doubly important!

I’m not sure why, but many people feel that if it is a cream or gel, it isn’t really a medicine. That is so not true! Just because it fades into your skin almost immediately does not mean it is not still working, or able to be transmitted to someone who touches that area. ESPECIALLY if that person is doing a bit more than just rubbing it and is actually reactivating the agent using oils and creams and friction!

A few years ago a colleague was having medical issues. She found out that she was overdosing on female hormones because a client she was seeing multiple times a week was using a topical version of the same thing she was taking. When my colleague found out she was ODing somehow I asked her if any of her clients were on hormones and taking them topically. We surveyed and got our answer.

I immediately changed my intake forms to include that.

Fast forward.

How many of you know a man with low testosterone? How much more prevalent is the advertisement of drugs for low T? How many people believe that talking about anything in that region is taboo and should be avoided at all costs? How many people are embarrassed about why they might have to take any kind of drug? If they are hiding it from their spouse or significant other, do you think maybe they might “forget” to put that on their intake massage when they are “just going for a bit of relaxation in a massage?” Absolutely!

Testosterone gel is rubbed onto the body (the insert I saw suggested the pectoral muscles, shoulders or belly) daily. How many male shoulders and pecs do you think I work on? Um every client male or female that comes in to see me gets worked on there! Female hormones are generally rubbed onto the hips or belly, and I work on just about every hip that comes into my office too .. male or female. Bellies I do work on, but not as often.

It clearly says on the package that females are NOT to touch treated areas. In fact some say women are not to touch the treated areas for at least 6 hours. And if so to wash hands thoroughly with alcohol. Others say it is never safe for a female to touch  a treated area and that a shirt should be worn during intercourse. Massage isn’t intercourse, but I’m doing quite a bit of touching.

I would say that massage is much more intense than mere touch.

OK … that’s just the hormones….

I’ve heard stories of clients coming in with pain patches who thought they were not working only to have the therapist have to stop the session because her tongue went numb from all the pain meds on the person’s body. That’s from patches not even creams! Who would have thought? Needless to say, because of this, I will not work on anyone who has a pain patch. Sorry, I don’t need a dose of pain meds. I need to be able to feel what I am doing to work on my clients.

OK … so what about other topicals?

Many people take topical steroids for different issues. Those are also able to be transferred to others. I don’t need steroids either, but thanks!

How many people out there forget that supplements are drugs? How many people forget that topical are drugs? How many people out there think that massage therapist just don’t need to know the medicines they are taking and don’t fill out the intake completely?

Please, I’m begging you. Be honest with your therapists! It’s not just about being able to take care of you the way we need to. It is about being able to take care of all of our clients and also ourselves. Please fill out your intake forms completely. Please be honest. We aren’t asking just to be nosy.

If you are coming in to get a massage and you are taking topicals, IF IT IS POSSIBLE … please apply in an area that I will not be working on. If your low back is hurting, I’ll need to work on your hips. If your neck and upper back are hurting, I’ll need to work on your shoulders and pecs. Bellies are generally safe unless I’m doing abdominal work of course. If it is not possible to put in a different area, maybe try to apply AFTER your appointment instead of before. If that is not possible, we therapists, understand! But we, as therapists will need to work around that area. And if you choose to deliberately withhold that information from us just so you can get an awesome massage, please know OUR health is quite literally at stake in that decision.