Positive Health Online

When a new client walks into our treatment room, we never know, until we begin to take the medical history, what ailments, temporary or chronic, recent or long-standing, minor or disabling, we will have to take into account as we negotiate treatment options. However much experience we have, there are always the occasions when we aren't sure what to do. And all our massage textbooks and medical dictionaries don't have the answer. I'm in a very fortunate position. I have my own private medical Consultant whom I can call up at any time and who is happy to discuss with me the possible effect of light massage on neuralgia, for example, or how a particular medication acts on the nervous system. He's my brother.

Here's an example of a time when his medical knowledge was very helpful. Mr J was a busy city financier, who would never have chosen to come for massage if it hadn't been for the persistent ache in his shoulders and neck, associated with kyphosis of the spine. He took Ibuprofen orally and locally to ease the pain. He had a complicated medical history: high blood pressure; no known cause but probably stress related, kept under control with medication, monthly injections for low testosterone levels, varicose veins in his right leg that had been stripped resulting in ulceration. The wound was just healed, leaving a considerable area of thin skin around the ankle. The veins in the other leg were also varicose.

He wanted pain relief and better posture. We agreed that I would work with the muscles associated with the curvature in his neck and upper back, to stretch the neck flexors and upper back spinal extensors, while increasing circulation in the shortened neck extensors, shoulder adductors and intercostals. After a while, I was able to persuade him that other muscle groups in his body were also affected, that his pelvis was tilted, the muscles on the fronts of his legs tight and those on the back short, as his body attempted to compensate for the curves in his spine.

And how did I take his medical history into account? On the days when I knew he'd taken Ibuprofen, I modified the depth of the massage, because the drug affects pain perception and is also an anti-coagulant and I didn't want him to be bruised. I remembered to avoid the site of his monthly injection if I saw him within two days. I avoided deep pressure on his abdomen, a contra-indication for high blood pressure. I used draining and stretching techniques on both hamstrings, and holds and energy work on his calves and ankles, taking his varicose veins and thin skin into account. With his permission, I sent a letter to his doctor, informing him that I was massaging his patient, Mr J, and asking the doctor to contact me if he had any concerns. I didn't expect to hear from him – doctors are really busy people – and sure enough, I didn't.

After a year of regular massage, his discomfort had eased considerably, to the extent that he was taking Ibuprofen very occasionally, but, as I'd anticipated, his posture had improved only slightly. Around this time he noticed a small lump in his right groin, which disappeared when he lay down. His doctor diagnosed a Baker's cyst and referred him to a specialist for tests.

My medical dictionary told me that a Baker's cyst is an accumulation of synovial fluid that forms behind the knee. Puzzled, I thought it was time to contact my medical expert. I rang my brother, who also couldn't understand why a cyst in the groin should be a Baker's cyst. He wondered if it was a sac of lymphatic fluid. I described how I was working on Mr J's legs and we decided that it would be sensible to stop using any technique that would affect circulation flow, cardiovascular or lymphatic, in the legs. My mind at rest, I felt confident after this discussion that I could continue to work safely with Mr J. (Several weeks later the cyst was accurately diagnosed as a melanoma. Mr J moved to another city and our work together ended.)

I am lucky to have access to a medical professional, as this story demonstrates. But my brother gets his information third hand, and does not really know the client. I need to be mindful about confidentiality. And if anything were to go wrong, a verbal discussion with my brother would not cover me for legal purposes as would written communication with the client's doctor. In an ideal world, it would be so useful to discuss clients with complicated medical conditions with their doctors, to ascertain how massage could best help and where cautions would be sensible. In the meantime, it is our responsibility as massage practitioners to ensure that we know as much as we can about pathology and contraindications and how to massage safely and, whenever we can, to help medical professionals to be aware of what we do and how we do it.