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Injury Contraindications for Massage Article by Sarah


Contraindications for Massage Clients with Spinal and Ligament Injuries


In the world of Massage and Bodywork, there are some massage movements that are not suitable and even dangerous to some people who are not stable in their spines due to past injury. The goal of this article is to prevent injuries from occurring on massage tables world wide.

This is for the safety of the public and the further education of practitioners.

 First, I would like to introduce myself. There is a reason for you to pay attention to what I have to say on the subject. My name is Sarah Marguerite Pennington. I have been doing massage for 40 years, and training in continuing education for the NCBTMB for 17. I own a Massage School and Spa business.

 I have had seven car accidents, and several major falls in my life. I know what it is like to be normal and experience massage, and I know what it is like to be injured and receive massage. The primary reason I am writing this is due to the massive amount of people who are injured on massage tables. This occurs, I believe, because they have a past injury that causes them to be weak or unstable in an area of the body.  This leaves them vulnerable to misalignments happening by very simple and normal massage moves that are taught worldwide in massage schools. 

This may sound fantastic to some, but unless one is injured it is hard to fully understand. The reason I am writing this is not to put down or in anyway discount any form of massage.

I have, however, seen with my own eyes on too many occasions, massage therapists injure clients. Not my students, but ones practicing normal recognized massage styles. My goal is not to attack, but to educate further in the area of contraindications to certain moves that may be from several styles of massage.  Again, I would emphasize that I am not implying that any particular style is wrong. It's just that some massage moves are not appropriate for all people.

In 2007, I was informed by my Massage Schools insurance company that the liability insurance had skyrocketed due to the amount of claims being made by massage clients of students of schools.  I have recently done a few couples massages with therapists not practicing my modalities, and was horrified at the moves being used on people who could, possibly be seriously injured by them.

 About a year ago or so, I got a call from a past client that had returned on holiday here. She had not been able to find me, so she got a massage from a spa therapist. Then she hunted further and located me because she was severely injured in one hour by this therapist. The injuries including a dislocated neck and rib cage, he threw out the lower back, and the list went on from there. On more than one occasion, someone who knew my reputation has referred a client to me. Not just for a massage, but to fix a person who had been injured by some other therapist and needed un-tweeking. Since therapists have injured me personally, I know how frustrating it is to seek help and get hurt instead.

It is that experience, and the recent ones that cause me to write this article. I need to light a candle instead of cursing the darkness.

 So here goes. Once again, if you do this kind of move in your massage you are not wrong. It is just not safe for some people. I do not want to step on anybody’s toes here, but I am sure you do not want to be sued either for hurting someone you are trying to help. So please listen with an open mind to this instruction.

Understanding the underlying root of ligament laxity is critical to know who is at risk on your table. If a person has had any high impact injuries in their life they have injury to the ligaments and tendons surrounding the joints. The spine is kept in place by the connective tissue. However, when the spine receives a jolt, even as small as a fender bender accident, the integrity of the connective tissue is damaged. The person is then vulnerable to that area going out of alignment. This is the root of most injuries that occur on a massage table. If your client has fallen or been in a car accident, they are possibly loose in the connective tissue regions of the spine. This means it moves further than designed to, and cannot hold the vertebra or joint in alignment if certain massage moves are applied.

 I myself have seen the difference in my own life. Before my serious car accident, I used to tell my students to treat me like I was a big weight lifter. I can take it, I said. Afterward, there were many things my back could not tolerate without going out of alignment completely. Very toned people can be less unstable, but even weight lifters that are very buff have expressed a feeling of weakness in the lower back area due to the injury they experienced.

What this means, in practical terms, is that the spine is not to be jostled. This would include any movement from the spinal area out laterally without the exact balanced move being applied on the other side at the same time. Pushing down on a hip with one hand and then pushing on the other hip alternately is extremely dangerous to a person with an unstable sacroiliac. This can throw the lower back out of alignment. The deep pressure moves on the sacrum can push down a sacrum and tail bone, pushing it under. This will cause an inability for the person affected to receive nerve impulse to the lower legs and feet. In extreme cases one cannot walk after this. Other side effects include extreme depression, lack of sex drive, the inability to go to the bathroom from the coxis obstructing the rectum. Pushing down on the sacrum at all is contraindicated. Rocking the body or twisting the body is also very dangerous for theses people. Alternating pressure in massage moves on opposite sides of the back can cause the spine to be thrown out of alignment.

It is easy to know if the coxis is unstable. If the person has had a fall directly onto the bottom, sitting down so to speak, as they fall.  Also a whiplash will cause it. Sometimes it is a combination of things that result in the body loosing the ability to be stable in a certain region. Then, as we age, the body loosens up in places that have never bothered us. Areas that were injured years ago lose the strength they once had. They can loosen up to the point of dislocations in joints and other areas. The use of any movement that pulls on the legs or arms, one at a time, is dangerous to those with ribcage issues, shoulder injuries, and sacroiliac instabilities. In addition, clavicle injuries are also situations causing contraindications to the injured person. In this case, pulling on the arm during massage. Also, movement that touches the clavicle while massaging the neck should be avoided. Clavicle issues can be recognized by tension on the side of the neck, and commonly are related to the seatbelt restraint in a car holding the person while in an accident.

Any massage movements away from the spine are not wise.  Moving up and down the body doing alternate pressing is dangerous to unstable backs. Gliding from the leg into the buttocks or the side of the hip can throw out the lower back of an unstable client.  Some ribcage injuries are affected by moving against the injury pulling the ribs out of alignment. If the ribcage has been injured the problems are usually individual and the person may know what causes them problems. Listen to them and avoid doing anything that would hurt them. We are in the healing field and we need to be very aware of our clients individual needs to serve them best.

 Another area I have found injuries that were created by a therapists hands is in scar tissue. As a therapist, it is important to know when enough is enough. Too much working of an area can cause the body to react and cause scar tissue.  I teach how to remove scar tissue from injured regions and the task is very gentle and ginger. Many therapists believe that if you encounter a knot you have to work it out. The knot they are usually referring to is a very sensitive area that is harder than the surrounding tissue and sometimes very painful to the person. This is an adhesion or scar tissue, and it cry’s to be touched. However, when it comes to scar tissue the body can easily react to your touch and make more, in some kind of defense mechanism to ward off the attack so to speak. Now the scar tissue needs to be removed, but in all my years of teaching students from schools world wide I have never learned of any teaching how to remove this menace from the body.

Above all, do no harm! If you would like to learn how to treat these conditions, I offer a course that is designed to bring the body into balance and treat dislocations and spinal curvatures. How to remove scar tissue from the body is central to this work. It is called Body Balancing for Scoliosis Therapy received by Sarah Marguerite Pennington.

 The course is a one-week intensive and teaches how to deal with these problems.

Body Balancing for Scoliosis Therapy is NCBTMB approved for 50 hrs of NCBTMB continuing education credit hours.

 Sarah Marguerite Pennington LMT

Associated Bodywork & Massage Professionals
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