Unique Circumstances and Adjunct Therapies

Chapter 14


Unique Circumstances and Adjunct Therapies




Objectives


After completing this chapter, the student will be able to perform the following:


1 Alter massage application to work effectively with a sleeping client


2 Alter massage application to adjust to unique draping concerns, hairstyles, and clothing


3 Provide massage in various environments and in the context of typical sports schedules


4 Adjust massage to respect habitual behavior


5 Use simple and safe application of adjunct therapies to support the massage outcome



Key Terms



























This final chapter of Unit Two discusses some of the specific circumstances often encountered while working with the sport population. The information is based on years of professional experience. I hope the suggestions will help you understand athletes a little better, and that they provide ideas to address these issues.


This population can present unique situations that require ingenuity, flexibility, creativity, and a sense of humor. As mentioned at the beginning of this textbook, many different situations arise that can stretch one’s ability to carry out an effective massage. The main challenges are the sleeping client, draping considerations, clothing and hair, distractions, restroom needs, body size, the massage location, scheduling, and habitual behavior.


The sport and fitness community is open to using essential oils, homeopathy, and magnets. The massage therapist needs to be ethical and informed about these approaches. Many of these products are expensive and may have little value beyond placebo effect. The methods provide possibilities for self-help treatment or to support or extend the effects of massage.


This chapter provides information on adjunct therapy such as aromatherapy, hydrotherapy, and magnet therapy. Hydrotherapy is well researched and is used extensively by those involved in sport fitness and rehabilitation. Aromatherapy (essential oils) is also a useful method; more valid research is providing insight into its mechanism and effects. This chapter describes the oils that I have found most useful and that are generally safe.


Magnet therapy and other energetic methods such as homeopathy are less solid in their research base, but many athletes use magnets, so it is important to understand current theories. My own personal experience indicates that several homeopathic remedies are helpful, especially arnica. Rescue Remedy is a Bach flower remedy that seems to help with the ongoing trauma and shock that these clients experience.



The Sleeping Client



Objective




Athletes commonly fall asleep during the massage. Because restorative sleep is so important, the ability to adapt massage application to accommodate sleep while continuing to achieve outcomes is important. The most obvious challenges are active assessment and use of methods that require active participation. Altering the flow of massage application so that these methods are used at the beginning of the massage and after massage usually will solve the problem.


Extra blankets and pillows and bolsters usually are required. Clients’ circulation alters during sleep and massage, and they become cool. The position of the client needs to be changed gently and smoothly so that he or she is disturbed as little as possible. Instruct the client to keep the eyes closed while changing position. Use rhythmic rocking to settle the athlete if he or she is aroused a bit from sleep. This usually will allow the client to go back to sleep. This can occur during position change, with passive range of motion, and during stretching methods, or if the method applied is unexpectedly painful.


Attempt to do most of the massage with the client in the side-lying and supine position. The prone position can cause sinuses to clog up and strains the lower back. Use it when the client is most wakeful, and bolster the lower legs and under the abdomen to reduce lumbar strain.


The massage needs to be given in a confident rhythmic manner. All movement should be secure and stabilized appropriately. The massage professional must be focused, observant of client responses, and quiet. Passive methods, such as lymphatic drain and other fluid dynamic methods, are easy to apply during sleep.


Some of the more active applications and assessment procedures can be altered and applied passively by the skilled massage therapist.


In general, assessment consists primarily of observation and palpation. For more active assessment methods, such as assessing firing patterns, alter the process and perform these assessments at the beginning of the massage. During the massage, when you sense heat and muscle tension, note the synergistic dominance pattern. If in doubt, assume that the firing pattern is synergistic dominant. Methods applied can be focused to reduce tone in the misfiring muscles while more stimulating methods are applied to the inhibited muscles.


To address gait patterns with the passive or sleeping client, work opposite arms and legs in sequence as follows:



Joint play is restored by applying traction to the joint and moving it passively within the normal range of motion.


Passive application is usually less effective than active participation of the client, but benefits still are achieved when sleep is also an important goal. Indirect functional techniques become a primary treatment method. Passive application of the ease/bind tissue movement method replaces more invasive connective tissue methods and trigger point application. Pay attention to the sleep cycle, which naturally fluctuates about every 45 minutes, and time the massage to end about when the client would begin to wake up.



Draping, Clothing, Hair, and Environment Considerations



Objective




Ideal draping procedures are presented thoroughly in Mosby’s Fundamentals of Therapeutic Massage, and certainly the skilled massage practitioner has been able to incorporate effective modifications based on need. The athlete does present some draping challenges that can go a bit contrary to typical draping recommendations.


The reasons for draping are to respect the boundaries and modesty of the client, and to provide warmth. Many athletes are hypersensitive to skin stimulation and find the drape irritating. They can wear loose shorts and/or a tee shirt instead. Other athletes cannot stand to feel wrapped up, so a very loose draping style is necessary. Athlete clients seem to be hot or cold and usually end up cold before the massage is over. It is common for athletes to not want a drape to start and to prefer to wear some sort of loose shorts, and by the end of the massage to be buried in sheets and blankets. Make sure you have extra draping materials and blankets available. Continually monitor skin temperature and add draping as needed to keep the client warm. This is especially important if the client is fatigued and tends to fall asleep during the massage.


Typically, each area to be massaged is undraped, worked with, and then re-draped. However, with a cold client, it may become necessary to work under the drapes. Pay attention to where your hands and forearms are, and if by mistake you touch the genital or breast area, acknowledge it and apologize.


Athletes commonly are very modest and not only want precise draping but also wear restrictive undergarments. Most common are sports bras, compression shorts, and athletic supporters. Many athletes leave their socks on because they have athlete’s foot, their feet get cold, or they think they have weird feet. Some athletes wear elastic-type hats that protect or control their hair, and others just want to leave their hats on. Massage needs to be altered to work through these garments, and the massage therapist needs to understand that the client derives some sort of benefit from wearing these clothing items.


Just as common are athletes who are not modest because of ongoing focus on their body or even the type of sport (e.g., bodybuilding) for which they regularly display their body. This usually manifests as disrobing while the massage practitioner is in the area, or showing the massage therapist the location of some area that the athlete wants addressed during the massage. The massage therapist should not interpret this as sexual and should maintain a matter-of-fact, anatomy-is-just-anatomy approach. Because groin injury is common, the massage professional needs to become comfortable with working in this area.


During work with male clients, the genitals can get in the way of accessing the area that needs treatment. Use the drape to move tissue around, or ask the client to reposition the genitals. Male clients often get partial erections while receiving massage because of the increase in circulation and the parasympathetic response. Young athletes are more susceptible and are more embarrassed by this physiologic response. The drape moving in the area can stimulate the erection response, as can working in the groin, buttock, and low back area. Athletes often sleep during massage, and it is common for an erection to occur. Do not use a draping method that would increase awareness of this response and increase the embarrassment of the athlete. This is one of the reasons why male athletes wear athletic supporters and compression shorts during massage.


Keep the drapes loose in the genital area, and use an extra towel over the groin if necessary. Be prepared to discuss this issue in a matter-of-fact and physiologic way. If the massage therapist is embarrassed as well, the situation is even more difficult for the client. One of the reasons that young male athletes prefer middle-aged (40 years and older) female massage therapists is that they are most comfortable with these types of physiologic responses with the “mother-aged” person. The author’s experience is that young male athletes tend to avoid younger female and male massage practitioners because of concerns about and misinterpretation of this natural body function.


The buttock area needs effective massage for all clients, but anyone who runs or jumps will especially require effective work in this area. Being comfortable working in this area is absolutely necessary for the massage therapist.


During work with female athletes, the breasts are literally in the way of accessing the anterior thorax. Because this is such an important area, especially for supporting effective breathing, the massage therapist needs to be comfortable working in this area, both with positioning the client and with moving the breast tissue so that it is out of the way. Do not use the hands to move breast tissue. Use the sheet or forearm. No therapeutic reason exists to massage the actual breast tissue if it is normal.


Because athletes drink a lot of fluid, they may have to urinate frequently. They may be embarrassed to ask to use the restroom. The massage therapist should ask whether the client needs to use the restroom at least halfway through the massage. A good time is when changing positions. It is impossible to relax with a full bladder.


Athletes also consume food and supplements that produce intestinal gas. The sports massage professional cannot react adversely if the client passes gas during the massage. High-protein and soy-based sport drinks can make the gas particularly odoriferous (smell strong), so if a person finds intestinal gas especially disgusting, he or she may have difficulty with this population.



In My Experience


I cannot resist telling the following story. One of the athletic clients with whom I work has a precocious young daughter. At the time this event occurred, she was about 6 years old. She was in the massage area with me, helping me set up. She asked me if her daddy passed gas when he got a massage (her term was “make fluffies”). I asked her why she thought this might be so, and she said, “My daddy passes gas when he is asleep. He sleeps when he gets a massage, so he must pass gas when he gets a massage.” How can you argue with this logic? Every time I think of this conversation, I smile. I could not resist disclosing this conversation to my client. We both got a good laugh. A while later, he asked me if he did indeed pass gas when he got a massage. My answer was, “Who doesn’t? I am gas tolerant.”


Athletes sweat, and although the author’s personal experience is that most athletes are meticulous about hygiene, the massage therapist at times may have to work with perspiring clients. Keep a towel available to dry the skin.


Perspiration may create a body odor. This is just part of the process, and the massage therapist cannot be disturbed by these types of normal body odors.


Athletes shower and bathe a lot. In addition, they often soak in hot and/or cold tubs and use saunas. Constant exposure to soap, water, and chlorine dries the skin, and more lubricant may be needed during the massage than with the general population. Use only hypoallergenic lubricants. An athlete who has to compete with a skin rash from a reaction to lubricant will not be pleased.


Many athletes shave their heads, keep their hair short, or braid it. The various braid designs can be intricate and expensive, so it is not appropriate to mess them up during massage. Use compression instead of kneading, and remove lubricant from your hands before working in the hair. Shaved heads present unique challenges. Massage only with the grain of the hair. Do not go in a direction where you feel stubble because this will irritate the area. This recommendation also applies to shaved bodies.


Most athletes are of normal size, but some are large and do not fit on standard massage tables comfortably. They usually are most comfortable on a mat. I have used duct tape to connect two massage tables together to make the surface wide enough. If tall (e.g., basketball players), the athletes hang off the ends of the massage table. They often need some sort of support for their arms, and although some massage tables are equipped with armrests, unless the armrests are adjustable, they are not in the right position. Large, round exercise balls work well when placed at the end of the table. A short stool, chair, or ottoman can work. Usually, large and tall athletes will not fit comfortably in massage chairs.


Large athletes need large bolsters. The bolsters that come with most massage tables are too small. Some creative solutions are rolled exercise mats, two king-size pillows taped together, rolled blankets, and sofa cushions.


Various environmental distractions can occur: massage in a public environment, the client talking on the phone, text messaging, listening to music with or without headphones, fellow athletes, or family members in the area. The massage therapist needs to remain focused and flexible.


Many athletes watch television or movies while getting a massage. The massage therapist can adapt to allow them to be able to see the screen. Position the massage table or mat on a diagonal, where the television screen is visible. When prone, the client should be able to turn his or her head to see the television. Then turn the lies on the side so the client is facing the screen. When it is time to massage the other side completely, have the client switch ends of the table, so his or her head is where the feet were. When the client lies on the other side to be massaged, the client still will be facing the television. When in the supine position, the client again can turn the head slightly to see the screen.


When one is working with athletes, massage commonly is provided in locations other than the typical private massage office. Instead, massage may be given in the locker room, the playing field, or whatever corner is available. If athletes can afford it, they often want massage in their home, which presents all the challenges of an on-site massage, that is, privacy; distractions; attention to confidentiality; discretion; arriving, setting up, and leaving efficiently; and many other situations. Hotel rooms are cramped, so if the athlete is traveling, it may be difficult to find enough room for the massage table. In these situations, you just have to do the best you can and have a sense of humor.



Scheduling



Objective




The athlete’s schedule can present unique challenges. Often massage appointments are early in the morning or late at night. Depending on the type of sport, scheduling of massage sessions at the same time consistently may not be possible. On occasion, the massage therapist may have to travel with the athlete. If this population is the massage therapist’s main focus, specific scheduling times will be difficult, for example, most of the football players with whom I have worked want a massage on Tuesday night at 8 pm or 9 pm in their home. Tuesday is the typical day off, and they want to get the children in bed before the massage. Other popular times are Friday night after 9 pm to be ready before the final game practice, or on Saturday or Monday morning early before practice. Football players will settle for late evening appointments on the other nights, but this is not their preference. Given this information, it is impossible for one massage therapist to see more than six to eight football players as clients during the season.


Basketball, baseball, soccer, and hockey are even worse for scheduling because the game schedule changes days, times, and frequency. For example, basketball players and baseball players can play two games in a row, have 3 days off, play an afternoon game, and 2 days later play a night game. They will schedule a massage when they can, which is often at the last minute.


Individual athletes such as tennis players, golfers, and bowlers may have a bit more control of their schedules, but availability is dictated by when events occur. Even if the massage professional is employed by an athletic organization, meetings and practice schedules make scheduling difficult.


Because of these scheduling issues, working with a large population of athletic clients on a schedule of 9 to 5, 5 days a week, is difficult. The most difficult scheduling demands are with the professional athlete, and the least with the client pursuing fitness or involved in physical rehabilitation. The massage therapist needs to consider these issues carefully when targeting this population. A life with a standard routine usually is not possible. Difficult scheduling issues may prohibit a massage therapist from working with professional athletes. They cannot easily alter their schedule and often request on-site massage at odd hours. Working for a fitness or rehabilitation center provides the most stable scheduling options. If your career goals target professional athletes, be prepared for an erratic schedule.

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Jun 22, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Unique Circumstances and Adjunct Therapies

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