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Massage and the Importance of Medical Input

by Su Fox(more info)

listed in massage, originally published in issue 124 - June 2006

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.


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About Su Fox

Su Fox BSc PGCE UKCP Reg MTI Reg CSTA Reg has worked as a complementary therapist and psychotherapist since 1988. For over twenty years she taught massage and related skills in day care centres for the elderly, people with learning difficulties, and mental health issues as well as professional massage qualifications at Hackney Community College. She was director and chair of The Massage Training Institute between  1991 – 2000 and during that time co-authored, with Darien Pritchard, Anatomy, Physiology and Pathology for Massage and authored The Massage Therapist's Pocketbook of Pathology, which has just been revised and reissued as The Massage Therapist’s Pocketbook of Pathology  published by Lotus Publishing.

During this time she was also running a successful private practice in psychotherapy at The Burma Road Practice in North London, focusing particularly on trauma work. She is a trained EMDR practitioner. Su has always believed that the talking therapies need to address the body, and that alternative therapies often failed to consider mental and emotional health, and this led her to write Relating to Clients. The Therapeutic Relationship for Complementary Therapists, published in 2009. In 1993 she added craniosacral therapy to her qualifications and has been a regular contributor to Fulcrum, the journal for the Craniosacral Therapy Association, including a series entitled ‘In The Supervisor’s Chair’. She currently serves on the supervision committee for the Association.

Her current interests are spirituality and its contribution to well being, and the psychology of the ageing process and end of life issues. Su can be contacted via

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