[the
Hidden Risks]
MASSAGE
UNCOVERING[the
Hidden Risks]
MASSAGE
While massage therapy is gaining increasing popularity and credibility in our communities, it is also bringing into sharp focus new safety concerns for practitioners.
You might not think about risks on a daily basis, but they slip into your practice in a range of ways on any given day. Perhaps your Natural Therapies Centre announces that the Centre will be running a “time-out of cancer weekend,” with special therapy packages offered to clients with this disease. Maybe you a prospective client walks in off the street asking about massage services and there is something distinctly distasteful about the way he is approaching you. Perhaps you are a new therapist starting your first job at someone else’s practice. How can you know if the environment and equipment are safe?
These kinds of scenarios go on and on and become more sobering. .You do intake with a new client and find out that she is on Glucophage®, as a treatment for diabetes. How will this influence your planned treatment? Or a client comes in for a Swedish massage and you find out that he has heart disease. What implications does that hold for patient safety?
Regardless of the physical setting, there will be always be people who walk in for a massage, thinking that “It’s just a massage.” What are the risks that lie behind this thought and what is your duty of care in such a situation?
Even from the perspective of a long-time massage client, the experience does not necessarily alert them to the significance of their ongoing health with regard to the implications for the type of treatment to take up.
We begin our exploration into these risks by facing up to four risks and suggestions for management. As always, we caution that your common sense can go a long way to helping manage the risks in your practice. It should not take the sensationalism of bad or beefed up press reports to remind practitioners that client safety and risk management rest on the shoulders of each therapist irrespective of who owns or manages the clinic/treatment centre.
Risk 1: More massage clients than ever carry health issues of significance.
As massage therapy becomes more mainstream as a complementary and alternative therapy, it has become less relaxation-oriented and more problem-oriented. Even though massage therapists may envision working with healthy people doing relaxation massage, the reality is that they see clients who bring complaints, as well as other medical conditions that they don’t realize will impact on their treatment.
[factor] How Adequate Are Your Client Histories
This issue is a critical and one which educators in bodywork keep coming back to – the importance of gathering and recording good client histories, most especially with regard to issues surrounding heart disease. This becomes even more problematic in settings where patients are in and out quickly, and where the intake process has not been well
developed. In some cases practices where there is high degree of ‘street walk-ins’ an intake process does not exist.
.[factor] High Blood Pressure and Diabetes
This is another very important area with a growing adult population suffering high blood pressure and/or diabetes. In many cases clients are unaware they suffer from either of these conditions, and of those that do, they often mismanage their condition(s).
High blood is exceptionally dangerous where plaque build up in veins and arteries can potentially erupt with the pressure of massage. High blood pressure makes the heart work harder, eventually placing strain on veins and arteries. This may lead to a loss of elasticity and build up of plaque, sometimes accompanied by the formation of clots. The eruption of plaque during massage may potentially release the clot into the bloodstream where it could travel to the heart or the brain.
Diabetes is another health condition that presents special concerns for therapists. For instance, diabetes can cause increasing peripheral neuropathy in limbs, leading to numbness in the extremities. Therapists rely on patient/client feedback regarding pressure and touch – when the client cannot provide reliable feedback opens them up to a range of potential injuries.
[factor] Prescription Drug Use
Many clients are taking prescription drugs that impact on their pain tolerances. Many therapists lack the knowledge required to judge the interaction between bodywork and medication. Indeed, it would be fair to say that the use of anti-inflammatory and other pain relief drugs, masks the clients ability to determine pressure and heat/cold tolerances, leaving them open to a range of injuries.
[factor] Your safety
Few therapists consider their own safety when providing treatment. Whether working in your own clinic or alone in a shared practice, therapists must consider the implication of working one-to-one in bodywork. Ensuring that the intake process for ‘first-time’ clients is thorough, and the timing of appointments can be a critical step in building client knowledge. No therapist should find themselves alone with a new client, vulnerable and unaware of any health and safety implications for self and client.
Risk Prevention Tip: Protect yourself with a careful intake process, continuing research into the interaction between massage and medications, practice conservative treatment, and be aware of the health and safety ratings of products in use.
Risk 2: Many people will not know if the treatment they ask for is appropriate.
When we consult with a general physician, we usually do so under the pretext that the doctor knows more than you. Consequently, we have some idea of the kind of questions we might ask concerning our condition and treatment.
In massage therapy, this practitioner/patient balance is less obvious. In fact, the average massage therapy client may not have any idea that risk may be involved in their treatment. They also may be oblivious to differences that may exist between a massage therapist who works primarily with relaxation and one whose approach is more therapeutic. This means that a client who’s had a heart attack might misinterpret symptoms of re-occurrence as stress and seek same-day relief through massage without any idea of the harm this might cause him or her.
[factor] when to say no when clients say yes
You need to make a decision on the appropriate modality for treatment that reflects the clients lifestyle and activities. This must take in all facets from health, recreation, work and personal lifestyle. A diabetic that is training for the Great Victorian Bike Ride will require a therapy that will not place more stress on the cardiovascular system than what
he or she does every day. This would be quite different to the pressures applied for a diabetic with renal failure and current dialysis treatment. This attention serves to highlight the difference in therapies relating to ‘fluid movements’ and ‘energy movements’. Obviously the massage modalities that move fluids or exert significant pressure present more risks.
[factor] Stepping Outside Your Specialty
Although clients don’t know your limitations, you should. If you find yourself in doubt, despite client requests, your should choose a modality that moves energy, working only for small, cumulative improvement in function, rather than big immediate change. Choosing the modality, makes you responsible, irrespective of client requests. One of the greatest risks massage therapists can take is to step outside of their specialty. You cannot start taking
the role of a chiropractor and begin manipulating the spine, nor prescribe herbal nor therapeutic remedies as if qualified to offer naturopathic treatments. Such action could easily be construed as practicing medicine without a license.
[factor] Conditions That Present Treatment Risks
Constant research is required to maintain sufficient knowledge to provide treatment for people suffering health issues. Despite the client’s belief that ‘touch’ or ‘relaxation massage’ can only help, they are often unaware of the impact that different massage treatments can give rise to. You are the professional in the relationship, it is your duty of care to not only identify and record health conditions but to advise clients of appropriate treatment or perhaps recommend no treatment on certain occasions. Learning to say “no” to clients can be difficult but you should concentrate of providing as much information as possible to ensure the client is informed and understands the risks involved in treatment.
Risk Prevention Tip: Work for incremental improvement, always err on the conservative side. Only provide the treatment that you’ve been trained and licensed to practise.
Risk 3: Clients who are looking for “extras.”
Unfortunately there are far too many of us who can tell of episodes where clients thought they were going to get more than just a massage. In fact one anecdote from a massage therapist tells of the time she told one client that the massage was finished, to be confronted by the client repeatedly asking “Where’s the extras?” This was not the only occasion the therapist has had to re-affirm that she only provided nonsexual therapeutic massage. Other therapists have had the unfortunate experience of discovering during massage that their client (face down on the massage table) were having a ‘pleasure experience all of their own’.
[factor] Conversation that is Invasive
Clients seeking more than remedial or therapeutic massage generally give some warning signs - something not quite right. It may be that they become more personal than the treatment setting calls for. You can generally gauge how clients should talk with you by asking yourself if they would converse with another medical professional in the same way.
One of the best ways to deal with unwanted behaviours or inferences is to make clear the service to be provided up front. On the first inquiry from a new client, relay that you provide therapeutic, nonsexual massage that addresses the client’s treatment needs – and have them confirm that this is what they are seeking. As a reminder, practice or clinic waiting areas can display inoffensive signage to the same effect. “This practice provides therapeutic massage treatment only – the massage session will be immediately terminated where clients attend under the influence or alcohol or other abuse substances, or who make inappropriate suggestions or conversation.
Measures such as these can not only help protect you from unwanted advances from clients, but also will make your intent clear if a client accuses you of sexual impropriety. It may seem far-fetched to some, but it is astounding the number of therapists who report that they have been victims of sexual misconduct by clients. For this reason, working in an environment that is not isolated, and with a clearly placed phone in the treatment room connected immediately to reception may overcome some of the potential for unwanted behaviours, and assistance in case of medical emergency.
Minimizing Risk
A little common sense can also help reduce risk. For instance, if working on the groin of a male patient, suggest upfront that he keep on his underwear. If working extensively on the hip area of a patient, work through the sheet. Lastly, remember to never leave their purses or wallets in the same room where they are working with clients
Risk Prevention Tip: Listen and watch for inappropriate talk or behavior. When in doubt, terminate the session.
Risk 4: Risks Sometime Emerge from the Most Unlikely Places.
As a massage therapist, the onus is on you to make sure that the environment you practice in and the equipment you use poses no risk to your clients. All practitioners who use equipment or devices that could cause injury should exert extreme caution. In fact, it is up to practitioners to choose the right equipment (tables, heating pads, oils, etc.) and use it as part of the treatment only if confident that the product will not cause injury – something which is very individual according to each client’s condition..
Risk of infection from poorly laundered linens or poorly disinfected surfaces provide further hidden risks. Irrespective of pressing time constraints each client deserves a clean and safe treatment environment. What products are selected and used to
[factor] Burns and Bruises
Practitioners need to be especially cautious about products and/or equipment that generate heat. Patients on blood thinners are very susceptible to bruising. Some people are very susceptible to burns, especially through equipment malfunction. If the client is on a medication that masks pain, she/he could be getting burned and not know it. We must always be mindful to move cautiously with any heat source, to ensure heat packs are wrapped in a minimum of four layers of dry toweling or suitable wrap; and cold packs wrapped in one layer of moist toweling.
As a general practice rule, therapists should never leave the room when hydrotherapy is being applied, and should check with clients frequently, as the situation can change rapidly. Likewise, practitioners who use hot rocks need to understand the risks involved, making sure they have received appropriate training in the use of the equipment and that the equipment in use is reliable. Much of this comes down once again to the use of effective client record and histories and use of intake processes.
[factor] Candles and Sheets
Use of candles will always present a risk of fire. Massage tables that do not meet appropriate safety requirements are at risk of collapse and potential injury. Sheets always present the risk of infection, especially if practitioners take short cuts, like double-sheeting the table (putting layers of sheets that they remove one at a time). If practitioners choose to wash their own sheets are careless, contagions may remain, opening clients to unwanted infections. People come into your clinic regularly with a variety of contagious conditions, and may well leave you with a problem you didn’t count on. These risks need to be managed on a day to day basis with commitment to client and self safety.
Risk Prevention Tip: Educate yourself on using candles safely, buy equipment that has been rated for safety, and screen patients carefully before using heat-related treatments.
Closing thought
Although it can be a little scary, take the time to look at the hidden risks in your practice – you may even find the results more empowering that you though possible. A good understanding of the risks of practicing massage therapy will go a long way to help protect your clients, your practice and the reputation of your profession. Arming yourself against risk is to promote good information and good practice.