“I froze when she started having a seizure. What flashed through my mind was, ‘She’s going to fall off my massage table!’ so I threw myself across her body and held on for dear life.”
That’s the summary of a phone call I received from a massage colleague with whom I’ve waged an ongoing battle over whether massage therapists should ask clients about their medications. This colleague is a very successful relaxation therapist who has maintained for years that she “gets people on the table, makes them feel good, and does no harm.” She saw no reason to ask about medications, which she viewed as “beyond our scope” and “nonessential information.” After this upsetting experience, she changed her mind.
An oversimplification, or rigid interpretation, of the massage therapist’s scope of practice might lead therapists to believe that the medications our clients take should not concern us. In the case of my colleague, knowing her client was taking antiseizure medication would have led her to avoid abrupt, overstimulating, or percussive modalities. In a second possible situation, a therapist whose client is taking anticoagulants would decrease the pressure of the massage, knowing the blood-thinning effects of these medications can cause the client to bruise easily. And a client who takes medication to manage blood pressure may need extra care when changing positions on and off the table.
In all these cases, knowing a client’s medications affords the therapist an opportunity to devise a plan of action in case an adverse reaction occurs. Medication knowledge translates into safe care.
Avoid Chasing Symptoms
Early in my massage career, I had a client with a lot of medical challenges. Her diagnoses ranged from fibromyalgia to clinical depression, insomnia, polymyalgia, and postpolio syndrome. She was a “doctor-hopper”: after becoming disappointed or disillusioned with one doctor, she’d find another, maintaining the prescriptions she had received from each physician. She was taking no less than 23 medications. When I asked her to bring them in so we could make a list, she brought in two huge plastic bags filled with bottles: antidepressants, antipsychotics, muscle relaxants, narcotic pain relievers, sleeping pills, and more, all topped off by huge doses of multivitamins. Even as a new massage therapist, I realized something was seriously wrong with this picture.
I made a list of all her medications and, over the following week, compiled a chart with information about each one’s purpose and potential side effects. I found exactly what I was looking for: she had come to me for relief from dizziness, muscle soreness, and anxiety, and it turned out those symptoms were all side effects of her daily medication intake! If I continued to see her, I’d only be chasing the symptoms.
I was not going to win this battle. I explained what I had found out, saying I’d be glad to see her but I seriously doubted I could offer her much relief. I strongly suggested she take my chart to her doctor for advice about her medication use. She took the chart and I never saw her again.
The moral of this story is that you not only want to know the medications your client is taking, you also want to know about possible common side effects. Otherwise, you could be working your heart out to address something that cannot be fixed. A quick glance at the table on the following pages reveals that many medication side effects are similar to common complaints for which clients seek massage therapy—for example, headaches and constipation. As long as the client takes medications that cause these side effects, you will reach no resolution, no matter how stellar your technique. In some situations, of course, temporary relief may be very beneficial and welcome to the client. The key is to be aware and honest about what is possible.
Check Medical History During Intake
Learning about your client’s medications is easy, and it’s essential, whether your practice focuses on relaxation or has clinical goals. The questions can be incorporated into your first-session intake. Simply say something like, “May I ask about any medications you’re taking regularly?” Be sure to document what the client reports. If your client doesn’t know the name of the medication, ask what the medication is for. You might get a response like, “Oh, something for my blood pressure, something for my heart, and oh, yes, I had a small stroke last year so I take a pill for that.” This brief exchange gives you a significant amount of relevant knowledge and can guide your session and inform any precautions you might take.
Know How Medication is Administered
The method by which a medication is administered—whether injected, delivered by patch, or rubbed on the skin, for example—directly affects your massage. A corticosteroid injection in the elbow joint within the past 24 hours to reduce tennis elbow inflammation would be a local massage therapy contraindication. The medication’s effectiveness is intended for a very localized effect and massaging the area might cleanse the joint of the much-needed medication. Similarly, a Betaserone injection into the belly fat of a multiple sclerosis (MS) patient must be left undisturbed because the injection site can be easily irritated and will be sore. Knowing about an adhesive patch containing pain-relieving medication is another example of the therapist’s “need to know” stance regarding drug administration methods, as these patches are easily dislodged and touching them should be avoided.
If you open the door to discussion by asking your clients about their medications, they will often offer drug administration information. For example, “My doctor injected my left knee with a steroid this morning. Can you still massage it?” Or, “I took my MS medication last night—just wanted you to know.” Again, knowledge of the intended effects of the medication, as well as the method of administration, establishes a foundation for safe care.
Understand the Names
When you research your clients’ medications, be aware that every drug has several different names:
1. The generic name is the scientific name assigned to a formula during its testing phase and throughout its final clinical trials. This name is generally not used by consumers.
2. A trade name (or brand name) is the name used to market the drug, and is assigned by the pharmaceutical company once the drug is approved for use. For example, the drug with the generic name naproxen is sold under the trade names of Aleve, Anaprox, and Naprosyn.
3. The class name is the name that categorizes the drug’s actions. There are just a few dozen class names, each covering many medications. For example, the class of nonsteroidal anti-inflammatories includes Actron, Advil, Aleve, Anaprox, Motrin, Naprelan, and Orudis; the class of skeletal muscle relaxants includes Flexeril, Lioresal, and Valium; and the class of antiparkinsonian drugs includes Comtan, Eldepryl, Mirapex, and Requip.
Understand Off-Label Use
Some medications were designed, researched, and trialed for one purpose, and were later found to be effective for another purpose. Prescribing a medication for that other purpose is called off-label use, and is common and ethical. Discovering off-label uses for a drug is one of the benefits of long-term clinical trials. One example is Lyrica (pregabalin). This medication is clinically an anticonvulsant but also relieves multiple symptoms of fibromyalgia and neuropathy, so it is often prescribed off-label for those conditions.
Keep a Reference Chart Handy
Once you do your research and practice long enough, you’ll be very familiar with the most common medications your clients are taking. There are some excellent reference books written specifically for massage therapists that can serve as quick guides as well.
Please ask your clients about medications during your massage therapy intake. It shows a deeper level of care, raises your professionalism to a higher level of involvement, and can ultimately help keep you and your clients safe from harm.
Charlotte Michael Versagi is a national presenter and author of Step-by-Step Massage Therapy Protocols for Common Conditions (Lippincott Williams & Wilkins, 2011). Contact her at charlotteversagi@gmail.com.
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