Massage Therapy Journal Summer 2024

Summer 2024 • 67

“The findings indicated that dose-escalation increases the efficacy of massage for pain-fatigue sleep syndrome cluster,” researchers noted. “Although the 60-minute doses were found to be more effective, the 30-minute doses can be considered more practical because they are less costly and time-consuming.” The usual contraindications for massage, such as fever and contagious disease, still apply when working with palliative care clients. Because massage during these session is typically much lighter, slower and often only applied to the extremities, however, contraindications most often depend on the comfort of the client. Good reminders are to be aware of and avoid any medical devices or tubing, or open wounds. Intake and Massage Sessions: What Massage Therapists Need to Know Information you need. Intake is always important, but especially so when working with clients who are seeking massage for palliative care. Massage therapists need a good understanding of the client’s medical history and current health status to best tailor a massage session to client comfort. Some information on how a client is dealing with their condition can also help, though massage therapists need to ensure they’re clear about their ethical boundaries. “I still need to know about their medical conditions in a traditional intake, but the emotional component of how they relate to their condition or how it has affected them emotionally is particularly relevant,” Patrick says. “Remember, the aim isn’t to fix anything in the therapeutic sense, but, at least for the time of the session, to shut down the stress response so that the body’s natural processes can get some airtime.” Massage session basics. The very nature of this work means that massage sessions can vary greatly in length, anywhere from 15 to 90 minutes, depending on how the client is feeling. Typically, shorter sessions (20 to 30 minutes) are preferred, and decisions around positioning and massage techniques used should be decided upon based on both a client’s preferences and a massage therapist’s best judgment.

“The massage table may be impossible for the client to lay on due to their illness, muscle soreness or disability,” says Erica Johansen, LMT. “Being flexible is key. Bolsters and pillows may be used to help prop the client into a comfortable position.” Additionally, massage therapists working with palliative care clients need to be adaptable and willing to meet the client where they are, both in session and location, as many times massage will take place in a person’s home or medical facility, whether hospital, rehabilitation center or assisted living environment. A typical session will include some type of guided mind and body relaxation practices, gentle touch (such as reflexology or acupressure) for parts of the body, such as the hands or feet, and comfort-focused effleurage and/or manual lymphatic drainage. Massage sessions can be done with or without lotion, and many clients will remain clothed. When it comes to technique, the key is to be slow and gentle. “Slow, slow, slow,” says Patrick. “If you think you are going too slowly, you probably could still go slower. Think of it as a snail’s pace, and just as much pressure.” When working with clients outside your massage practice, remember to return the client’s bedrail heights, bed heights, meal trays—anything you might have moved during the session—back to the position they were found in once a massage has ended. Self-Care: How Massage Therapists Can Care for Themselves One thing for massage therapists to consider about this slow pace is that it can actually feel more strenuous on their own bodies than giving a regular massage or even a heavy-pressure massage. This is due to the sustained muscle control necessary to perform the very slow, controlled movements. The oftentimes awkward accessibility sometimes found in these client’s homes or hospital rooms can also add to the strenuous nature of the work. “Massage feels so good for palliative care patients,” says Patrick. “However, it draws on my resources as a therapist differently than Swedish massage does. If I don’t replenish those resources, I have nothing to give.”

DEEPER DIVE Because many clients who are receiving palliative care may also be taking medications as part of treatment for a chronic or acute condition, massage therapists should be aware of medication side effects, as well as when massage may be contraindicated. Stay updated on guidelines by taking AMTA’s “Massage and Medications When Is Therapy Dangerous?” available at amtamassage.org/learn.

amtamassage.org/mtj