What is Massage?
For as long as people have been on the earth, they’ve been using different forms of touch to soothe and relieve pain, as well as promote healing and relaxation. As if by reflex, our hands go to a part of the body in pain, trusting that rubbing, kneading, stroking or simply touching it will help to relieve the discomfort. The recorded use of massage goes back at least 5,000 years.
Modern therapeutic massage is that same reflex, applied with a scientific basis and in a systematic manner. Most massage therapists in the US use “Swedish” massage, which uses several basic strokes on soft tissue and muscle.
Massage is the use of rubbing, stroking, kneading, tapping, and pressure on various muscle groups, systematically working the entire body to achieve relief from aches and pains and promote a general feeling of both physical and mental relaxation. A sturdy, specialized massage table or a special chair with a head rest typically is used. Massages are normally given in quiet room, free of bright glaring light or distracting noises. Massage therapists usually lubricate the skin with various oils, or lotions, sometimes scented, to decrease friction and promote relaxation.
What are the Benefits? How does it Work?
By enhancing circulation, it is believed that deep tissue massage helps in the removal, excretion, and release of various waste products which cause soreness and tightness in the tissue. Increased circulation
helps to reduce inflammation and generally speeds up the body‘s natural healing processes, as well as compensates for changes in circulation due to decreased use.
Massage is used for pain relief, stress reduction, passive exercise, and for relaxation. Research indicates massage:
- Enhances circulation and increases blood flow to and through the muscles, which means more oxygen and nutrients to tissue throughout the body
- Relaxes muscles and relieves tension
- May help with digestion
- Increases the elimination of metabolic waste products and toxins throughout the body by stimulating the lymphatic system
- May reduce swelling from fractures
- Decreases scar tissue, adhesions and fibrosis from injury or immobilization
- Stretches connective tissue and disperses edema (swelling) following injury to ligaments and tendons, decreasing pain and increasing movement and mobility
Massage seems to maintain general skin health and elasticity. The touch associated with massage often helps to promote general body awareness, and helps people realize and recognize tightness and tension in various parts of the body. Massage usually triggers overall body relaxation, including a temporary lowering of blood pressure, heart rate and respiration rate, as well as the possible release of endorphins, the body’s natural pain relievers.
Major psychological benefits of massage include feeling nurtured, cared for, and connected, as well as experiencing comfort that comes from being touched by another person in a gentle and healing way.
What about Spinal Cord and Brain Injury?
Therapeutic massage may be especially helpful for people with spinal cord or brain injury and other types of paralysis for the following reasons:
- It helps return blood to the heart, partially compensating for lack of movement, decreased activity, and decreased muscle contractions that would normally do this task.
- It helps to reduce swelling in the extremities, often common among people with mobility impairments.
- It can be helpful in treating the effects of muscle overuse and compensation due to injury.
- It serves as a thorough skin monitoring process, promoting skin health, and helping to recognize and prevent skin breakdown.
- It relaxes muscles, and may result in decreased contractors.
- It can increase range of motion and flexibility.
- It can help manage pain and reduce overall pain level.
- It may help promote better sensation awareness, and may promote more function by reducing spasms.
Are There any Risks or Dangers?
Complications from therapeutic massage are rare. However, a few precautions or warnings are in order:
- Massage is not recommended for individuals with diabetes, varicose veins, phlebitis or other blood vessel problems, as blood clots could be dislodged. Therefore, caution is appropriate for individuals with new injuries who are using anti- coagulants or experiencing circulation problems below the level of injury.
- Because it stimulates muscles and sensation, massage may trigger autonomic dysreflexia and severe spasms, which can be quite unpleasant and uncomfortable. As a result, massage should begin with light touch and progress to deeper massage.
- Deep massage may further damage muscle fibers in paralyzed or atrophied muscles.
- Aggressive range of motion work, especially in areas without sensation, can cause muscle pulls and tears.
- Because massage therapists depend on client feedback and direction, caution is advised whenever working in areas where there is no sensation, as tissue damage and bruises could result.
In addition, massage is not recommended under the following conditions:
- In areas of acute inflammation (those that are hot to the touch, or exhibiting redness or swelling), or where the skin is cut or has abrasions.
- Fever over 99.4 degrees.
- Skin diseases or rashes that can be spread to self or others.
- Dislocated joints or when no range of motion is present.
- Burned areas.
- While taking Prednisone or Coumadin, as the skin is much more sensitive and likely to bruise.
What Do I Do?
As a client, you’re responsible for communicating any special needs you have. Don’t assume the massage therapist is an expert in spinal cord or brain injury. Be prepared and willing to explain where you do and don’t have sensation and muscle function, and what you can or can’t do functionally, such as transfer independently on to a massage table or chair.
As a client, you need to speak up and communicate. You’re responsible for making your preferences known, such as for lighter touch or deeper massage, which areas of the body require special attention or any conditions you wish the therapist to focus on. It’s your job to communicate whether or not any techniques are causing discomfort or are painful rather than helpful. You may need to bring a friend or family member along to help you explain this to your massage therapist.
Keep in mind that you’re responsible for your own cleanliness. Massage is a very hands-on therapy, usually done skin to skin, and common courtesy calls for personal hygiene and cleanliness considerations.
What If I Can’t Transfer?
People with spinal cord or brain injury who have significant mobility limitations may think the logistics of massage are just too challenging or too much trouble, since massages are normally done on specialized padded tables, and usually require individuals to undress. If these issues are big problems for you, ask about the availability of help for dressing and transferring, or bring along someone to help if possible. Some therapists have hydraulic tables, similar to medical examination tables, which adjust to different heights. A chair massage is also an option, and some people can receive massage in their wheelchairs.
A chair massage is given to a seated client, and can often be nearly as thorough and effective for the neck and shoulders as a conventional massage. Chair massages are often shorter, usually 15 to 30 minutes long, and normally focus on the upper body, (arms, face, scalp and shoulders, as well as stretching).
Check to see if your therapist has a desk-top unit for chair massages, as this unit will allow people to remain in their wheelchairs while being worked on. Because the client remains clothed, chair massages can be delivered nearly anywhere. Because no oils are used, a shower to remove the oils is also unnecessary.
What to Look for in a Practitioner
Massage therapists are licensed, registered, or certified in 42 states and the District of Columbia. Licensing varies according to state, but normally requires a minimum of 500 hours of training from a reputable program, in addition to passing an exam.
A good practitioner should have at least 500 hours of training, graduated from an accredited school and be either licensed, nationally or locally certified, and/or registered in your state. National certification usually comes from the National Certification Board for Therapeutic Massage and Body Work. Most therapists belong to either the American Massage Therapy Association (AMTA) or the American Oriental Bodywork Therapy Association (AOBTA).
Massage is a fairly individual craft, and no two therapists give exactly the same massage. Ask around and get recommendations from friends and professionals that you trust. You want a therapist who will respond to your needs and wishes, whether they are for extra attention to specific areas or for stretching to relieve tightness and spasticity. Experience with spinal cord and/or brain injury is a big plus, and you want a therapist who is flexible enough to meet the special challenges posed by paralysis, mobility limitations, or difficulties with communication.
Because one of the primary benefits of massage is relaxation, the practitioner you choose should be someone with whom you can feel comfortable and safe.
What Does It Cost?
You can expect to pay between $35 and $90 for a massage treatment, which normally lasts 45-60 minutes. Chair massages are often considerably shorter and proportionately less expensive. The cost of a massage may vary greatly, depending on geographical location, as well as the experience and skills of the therapist. Check with several therapists to get a general idea of rates in your area.
Health insurance may cover the cost of massage if prescribed by a physician and if the treatment is due to or connected with an insurance-covered injury. If you do have coverage, be sure that your therapist of choice accepts insurance and is part of your carrier’s network.
Be sure to discuss all the particulars of treatment – fees, length of the treatment sessions, method of payment, insurance reimbursement, wheelchair accessibility of the treatment area, as well as the therapy itself and the type of treatment – prior to beginning a session.