Positive Health Online

Aftercare doesn’t mean after thought. And yet, this is very much the impression I’m left with, having recently assessed students taking their final practical exams. Client aftercare was tacked on at the end of the session because it’s on the syllabus, a GCMT (General Council for Massage Therapy) requirement. But shouldn’t we be offering more than the advice to ‘drink lots of water because the massage will have released toxins and you should flush them out’?

Why do aftercare? I’ve had many a massage, and been left to get dressed and pay on the way out. It’s as if someone said hello to me but forgot to say goodbye. Aftercare balances the initial consultation, and re-establishes the relationship that was set up while asking why the person wants a massage, taking a medical history, and so on.

Holistic massage claims that title on the grounds that it suits the individual and her massage needs within the context of her whole life. The first part of the session invites these factors into the room and good aftercare enables the client to take something away with her, other than the feeling of wellbeing or relief from pain, something that she can take into her everyday life and use there. Andrea, manager of an IT company, tells me how much she appreciates being able to slow down when she has massage. I write ‘slow down’ on a post-it to put on her bathroom mirror to remind her.

Shared responsibility is one of the differences between the complementary and the medical models. Recently, I saw a physiotherapist for a number of sessions. After each one I went home carrying pictures of little stick people illustrating the exercises she’d showed me. There was an assumption that I would do my bit by doing the exercises at home. We don’t have to be physiotherapists or yoga teachers in order to offer exercise advice. All the joint manipulations, all the stretches we do during a massage, can be adapted for individual use, to help the client help herself. Lois has lower back stiffness. At the end of the massage, before she gets off the couch, I ask her to bend her knees into her chest, hold them there for a while then rock gently from side to side. When she’s dressed, I remind her of this exercise, and suggest she does it before getting up every morning. The model of shared care also applies to sharing of information. During the massage we palpate areas of tension not mentioned previously, come across rashes or bruises, discover joint restrictions, feel energy stagnant or moving. Now it may be appropriate to share some of this at the time, depending on the level of alertness of the client – not a good idea if he is asleep – and the extent to which you talk during the massage, but surely he is entitled to know what you discovered? Sharing information isn’t just for the sake of it though; it may reinforce the suggestions you give for aftercare, or be grounds for referral. For example, a mole on Andrew’s back seemed to be growing, so I suggested he might like his doctor to take a look at it.

Good aftercare advice ensures the client’s health and safety and, especially if it has been recorded in the notes, is a sensible precaution against potential litigation. Massage can make people drowsy or spaced out and it’s important to establish that your client is fit to negotiate stairs, or drive home. And suppose you notice an unmentioned skin disorder and fail to mention it, the client later goes to the doctor, is diagnosed with an infectious condition, claims to have caught it from you? This kind of worst-case scenario would be prevented by good aftercare practice: sharing information, suggesting referral and making a note of the conversation.

Aftercare doesn’t have to be after the massage. Very often the obvious time is when engaging with the client at the beginning. Questions about pain or stiffness lead naturally to questions about habitual movements or body use and then to considering what could be done differently. John, over six feet, came to me because his girlfriend said he was beginning to stand like an old man. We tracked his incipient kyphosis to his proofreading job, and before he got onto the couch, we’d worked out that he needed a lower table, and also to take regular stretching breaks from his work.

And finally, aftercare needs to be relevant to the individual, and take into account her knowledge and skill level, lifestyle and health. When Dolores told me she’d been getting cramps between her shoulder blades, I began to remind her of the shoulder rotation exercises, but on noticing her wince as she tried them, quickly remembered that she has two frozen shoulders (probably also the cause of cramping in her rhomboids and mid trapezius), and instead suggested a hot water bottle for her upper back when she watches television at night.

Consultation, massage treatment, aftercare – beginning, middle and end. All three have a valuable place in good holistic massage practice.