Tag Archives: Scope of Practice

When NOT to Massage

The following are examples of times in which we should NOT massage or at the very least modify the massage and inform the client as to why…

Client has not seen a doctor but believes he or she may have “torn” a muscle or “thrown out” their back lifting something:

As you begin to massage the area in question the pain becomes intolerable.  At this point STOP working on that area, we do not want to do anything that may make the condition worse.

We unfortunately do not have x-ray eyes and cannot see if a muscle is torn or a disc has been herniated or if there may be a bone spur pressing on a nerve or any of the many things that could possibly be going on.

This is when we really need to tell the client to see their doctor just to be sure that the injury is not worse than what the client believes it to be.

Many people are hesitant to see their doctors for a variety of reasons, I will admit that I seldom go to the doctor unless I am absolutely sure that I cannot manage whatever is wrong with me on my own so I understand this. Many people are more inclined to schedule a massage or stop by their local chiropractor before ever seeing a physician.

You are giving a massage and come across an area that is red, swollen, and hot to the touch:

Avoid that area, not only for their safety but for yours as well, there could be a staph infection or other condition that not only could you make worse but could contract and or spread to other clients.

I had this situation happen with a walk-in client, the first part of the massage, neck, shoulders, and back was uneventful, but when I exposed one leg to work on it that was when I saw the problem. I did not touch the area in question, I held my hand slightly above it and could feel the heat coming off of it, everything in me was telling me this man needs to see a doctor ASAP.

I told him that based on what I was seeing I cannot massage his legs and I strongly urged him to have it looked at by a doctor, his leg looked so bad that I added that he should not wait to have it checked out. I honestly hope that he did, because what I was seeing was very concerning.

Prenatal client states to avoid one of her legs:

As I was massaging her I noticed that the leg in question was more swollen than the other, she later tells me that she had recently had a blood clot in that leg but that it was gone now. She went on to tell me that in the past she had a blood clot that had gone to her lung when she was not pregnant. Later she tells me that she is on blood thinners.

I documented this in her chart and told the receptionist that she is very high risk and we cannot continue to massage her during this pregnancy for her safety and the safety of her baby.

Client Comes in Requesting a Deep Tissue but has a lot of bruises:

When you see a lot of bruises on a client that should caution you that deep tissue techniques should be avoid.

The client may be on blood thinners or an aspirin regimen to reduce potential blood clots. Often times the client will fail to disclose daily use of aspirin  because they do not consider over the counter medicines as being medications that we should be aware of.

When I see a lot of bruises on a client I ask them if they are on blood thinners or an aspirin regimen, if they are not on either of these things the bruising may be caused by anemia or a vitamin deficiency, but regardless of the cause of the busing  we need to avoid causing further damage.

Avoid suspicious skin rashes:

There are many skin conditions that are not contagious such as eczema, psoriasis, vitiligo, and ichthyosis. Such areas we can massage without concern, however, suspicious rashes, especially if red or itching should be avoided.

If you see redness or marks from fingernail scratching this should alert you that the area may be contagious. Any strange lesions or open sores should be avoided.

If a rash or other skin condition seems questionable you can choose to use gloves for the massage but make sure that the client does not have a latex allergy.

Do not be afraid to refer a client to their doctor:

Your clients trust you, if you see something that is concerning please don’t hesitate to suggest to the client that they may want to have their doctor take a look at something. It is better to be cautious than to let a potential condition worsen or go untreated.

Yours in Health and Wellness,
Kristeen Smart AKA Kristeen Kish
CAMTC Certified Massage Therapist
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What is Complementary Alternative Medicine?

http://www.medicinenet.com/alternative_medicine/article.htm

What is complementary medicine?

Complementary medicine is a group of diagnostic and therapeutic disciplines that are used together with conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient’s discomfort following surgery.

Complementary medicine is usually not taught or used in Western medical schools or hospitals. Complementary medicine includes a large number of practices and systems of health care that, for a variety of cultural, social, economic, or scientific reasons, have not been adopted by mainstream Western medicine.

Complementary medicine is different from alternative medicine. Whereas complementary medicine is used together with conventional medicine, alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a physician.

Complementary and alternative medicine (CAM) can include the following:

acupuncture,
Alexander technique,
aromatherapy,
Ayurveda (Ayurvedic medicine),
biofeedback,
chiropractic medicine,
diet therapy,
herbalism,
holistic nursing,
homeopathy,
hypnosis,
massage therapy,
meditation,
naturopathy,
nutritional therapy,
osteopathic manipulative therapy (OMT),
Qi gong (internal and external Qiging),
reflexology,
Reiki,
spiritual healing,
Tai Chi,
traditional Chinese Medicine (TCM), and
yoga.

Complementary Alternative Medicine is used in cooperation with Western Medicine  and is not in opposition to Western Medicine, although many of the approaches focus on reducing the need for pain medications through alternative approaches such as stretching, acupuncture, trigger point therapy,  massage, and other therapies our treatments are intended to work with not against Western Medicine.

A good therapist will always tell a client to speak with their existing doctor if they have any medical concerns. I personally have referred some of my clients back to their doctors and encouraged many to see a doctor about their conditions. It is always best for both the client and the massage therapist to have a good understanding of the condition the client has and any contraindications that may alter the course of treatment for the client.

A massage therapist is not allowed to “diagnose” a client, so if we do see something of concern we may suggest that the client should talk to their doctor about it, we can tell them that many conditions present with similar symptoms and that it is always best to ask the doctor to be sure.

 

I always make sure to note if I recommended the client see a doctor in my client notes along with a description of what I observed. We should always make careful notes when we observe anything that seems unusual, such as excessive bruising, and make note of our approach such as “I avoided contact with the area in question.”

If we see something that we feel needs to be addressed by a physician it is our responsibility to say something to the client. There have been cases of melanoma that would have gone unnoticed by the client if their massage therapist had not noticed it and voiced concern that the area should be looked at by a professional. We are in a unique position to see  areas of the body that even the client cannot adequately see and are often covered by clothing and could go unnoticed.

What we do is often times more than simply massaging and stretching a body, our focus is on  the clients overall health and wellness, they trust in us, and we owe it to them to be honest with them if we believe they should see a doctor. The doctors, physical therapists, chiropractors, and osteopaths are not our competition, they are our allies in health and wellness.

If a client has or has had cancer it is always best to get a release from that doctor that states the client is able to receive massage therapy.

Yours in Health and Wellness,
Kristeen Smart AKA Kristeen Kish
CAMTC Certified Massage Therapist
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