During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and well thought out information and decision-making outcomes. I am happy to share some of their assignments for you to enjoy.
Reason for Choosing: I chose this client because this was one of my more challenging situations in my internship and challenged my creativity to modify massage. The client requested that her legs be avoided and she also requested no oil. I also chose this client because my ultimate goal in massage is to work with patients with chronic diseases.
Client Condition: The client receives massage on a regular basis and was able to communicate her needs clearly. She has had Fibromyalgia for many years and is in touch with her needs in regards to her condition. On the day of the massage she was experiencing good energy but her legs were very sensitive to touch and she requested they be avoided. She also requested deep massage on the rest of her body and indicated that feet and head could be massaged.
Understanding of Fibromyalgia: Fibromyalgia Syndrome (FMS) is a chronic disease that presents as tenderness and stiffness in muscles and joints. There are many clinical manifestations of FMS and diagnosis is confirmed after a 3-month history of widespread pain and other manifestations. It is important to rule out other conditions before diagnosing FMS as many of the symptoms are also present in other diagnoses.
The cause of FMS is a lower pain threshold that may be due to elevated levels of Substance P which is associated with pain signal transmission. FMS may also be caused by psychological trauma, local or generalized infection, medications, physical trauma and excessive use of aspartame. Some people also show a genetic disposition and other family members are affected.
The most common symptom is an aching, burning or gnawing pain in the muscles that begins in a localized area and then becomes more generalized with most women reporting fatigue and pain for 90% of their waking hours. Other symptoms include visual disturbances, mental and physical fatigue, sleep disturbances, morning stiffness, mitral valve prolapse, anxiety, cognitive problems, irritable Bowel Syndrome, headaches, inflammatory bowel disease, hypersensitivity to heat, cold, noise, and odors, depression, urinary frequency or urgency and TMJ dysfunction.
Treatment for FMS includes stress reduction and regular physical activity. Medications may also be used to manage symptoms and reduce pain, assist with sleep and manage depression. Massage can be a very beneficial treatment to manage pain.
Treatment Plan and Justification: The client came in with very specific requests on her treatment plan. She stated that she wanted no oil to be used and that her legs were to be avoided due to tenderness and pain. Her goal of the session was to relax. I reviewed other potential areas to avoid and discovered that her gluteal region and feet could be massaged. I modified treatment to include more gentle compression and focused more on her back with slow, rhythmic effleurage and gentle petrissage. I started with lighter pressure to warm the muscles and skin and checked in as I deepened the pressure. I also focused time on her feet, arms and head.
The reason I chose the treatment plan was to ensure that I did not create any pain and that the client was able to relax knowing her requests would be honored. I started with light pressure and increased slowly allowing the client to control the massage and to avoid the inflammation response. Compression allowed me to offer a variety of strokes and the slow rhythmic strokes allowed my hands to move over the body without oil and provided relaxation to my client. My client was not having any other issues with her condition that day, except for leg pain and tenderness, so no other modification was needed.
Expected and Actual Outcome of Treatment Plan: The outcome I expected from this treatment plan was to provide the client with the massage she requested and leave her relaxed and satisfied without exacerbating her FMS or creating an inflammation response.
The actual outcome met those goals. The client verbally confirmed that she enjoyed the massage and felt very relaxed, She also appeared to be more relaxed than when she came in. The new treatment plant for her next visit would depend upon where the client was at that day with her FMS symptoms. FMS changes daily and the local contraindications would be different on her return. I would need to be prepared to modify my massage to meet her needs that day.
Research Article: I reviewed the article "Massage Therapy for Fibromyalgia: A Systemic Review and Meta-Analysis of Randomized Control Trials." This article reviewed nine randomized control trials that met the criteria set forth for this review and included outcome measures of pain, anxiety, depression, and sleep disturbance. There were a total of 404 patients that met the includsion criteria, which included a diagnosis according to the American College of Rheumatology criteria. The reviewed studies also had to meet criteria of only massage being used as a treatment for Fibromyalgia and had some type of control intervention.
The conclusion of the article is that massage therapy administered to Fibromyalgia patients with duration greater than or equal to five weeks, reduced pain, anxiety and depression but had little effect on sleep disturbances. The authors of this article discussed the physical and psychologial effects of massage therapy on Fibromyalgia patients and proposed that biochemical changes would occur. These biochemical changes would improve muscle flexibility and modulate blood and lymph circulation. The result of these changes may be that local nociceptive and inflammatory mediators may be reabsorbed. Some studies also showed that serotonin levels were increased in patients with Fibromyalgia and may change neural activity at the spinal level.
The article can be found here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706
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