Massage Therapy What is a Contraindication / Modification? When a symptom, incident, or circumstance creates…
1. Types of Medications
A common cause to modify treatment, or at the very least monitor it, are due to medications and their effects. Many aspects vary from patient to patient and they can depend on factors such as the type of medication, how often it is being taken, whether or not it is being taken with other medications, whether or not the patient has experienced massage therapy since taking the medication, side effects of the medication, and many more. Lifestyle factors of the patient can vary depending on their general routine, if they are properly following the medication requirements, if they are refraining from things such as alcohol, whether or not they have other conditions which interfere, etc.
The amount of time that it takes medication to affect the body can prompt the RMT to ask more questions. Typically, medications in tablet form can enter the bloodstream within thirty minutes, while liquid oral dosages require less than that. There is an instantaneous effect with injections and inhalations. It takes about one to three hours after ingestion for muscle relaxants to peak, lasting six to twelve hours. However, aspirin takes two to four hours to reach peak blood levels and it may take twenty-four hours until it is present in reduced quantities.
Multiple-use medications, such as Diazepam and Aspirin, include one medication with multiple targeted effects and uses. Diazepam works as both a muscle relaxant and antidepressant, while Aspirin has both analgesic and anticoagulant properties. Additional and complicated massage therapy contraindications can be due to patients having to take several medications for several medical conditions.
Analgesic drugs – commonly known as painkillers or pain relievers – aim to ease pain symptoms. This type of medication is not to be confused with anesthesia, which can be used during surgery by neutralizing the nerves. Analgesics, however, don’t turn off the nerves, alter consciousness, or change the ability to sense your surroundings.
There are two major groups of Analgesics called anti-inflammatory and opioids (narcotics). Anti-Inflammatory Analgesics work by reducing inflammation/swelling at the site of pain and the include medications such as Acetaminophen, Aspirin, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Anaprox, and Motrin. Opioid (narcotic) Analgesics work by altering the brain’s perception of pain and some examples include drugs such as Codeine and Oxycodone.
Patients who are on these types of medications may lose the ability to provide concise and accurate feedback regarding their perception of pain during the treatment. Registered Massage Therapists will avoid deep pressure and extreme range of motion movements in patients who have taken Analgesic medications.
Anti-Asthmatic medications may cause an increase in sympathetic nervous system response, including increased heart/respiration rates & blood pressure levels. RMTs will avoid deep, vigorous, or painful techniques, as well as hot hydrotherapy applications in instances of elevated blood pressure. An example of this type of drug is Ventolin.
These types of medications aim to decrease the body’s clotting ability by thinning the blood. Anticoagulant medications work by allowing the breakdown of existing blood clots, or by preventing the formation of new clots. This type of medication can be administered in several forms including intravenously (IV) and orally. Due to the possibility that bruising can be caused by repetitive muscle stripping or frictions, deep techniques are generally avoided. Some types of anticoagulants include Aspirin, Coumadin, and Heparin.
Antidepressant medications exist in various forms and are available for prescription use, depending on each individual’s symptoms and needs. The normal response of the vasculature to temperature changes is altered by antidepressants. Chemicals that are usually responsible for communications between neurons in the brain are usually balanced by antidepressants. These chemicals – called neurotransmitters – include serotonin, dopamine, and norepinephrine. There is a correspondence with a decrease in depression intensity when these neurotransmitters are found at higher levels.
The effectiveness of the type of antidepressant medication, as well as the duration it will be effective in the body, varies from patient to patient. Registered Massage Therapists should avoid full body hydrotherapy applications, as well as ensure local applications are kept at a moderate temperature with sufficient visual and palpatory monitoring for adverse reactions. RMTs will also be able to assist patients with referrals to Psychological medical specialists, when necessary. Diazepam (Valium), Prozac, and Paxil are examples of antidepressants.
An inaccurate assessment can be the result of inflammatory process suppression by the use of anti-inflammatory drugs. Unfortunately, deep techniques such as frictions are highly indicated for this type of response. As a result, such techniques become a contraindication and are not able to be performed during the treatment. Aspirin, Tylenol, and Clinoril are a few types of anti-inflammatory medications.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) work by blocking the production of certain body chemicals which cause inflammation. NSAIDs can work well with general symptoms such as menstrual pain, headaches, and backache, or by treating pain caused by slow tissue damage. These types of anti-inflammatory medications work similarly to corticosteroids (steroids), however, they don’t possess many of the same side effects that steroids typically have.
Corticosteroids are a commonly used, specialized type of anti-inflammatories that come in numerous forms including tablets, injections, and topical creams. There is a 14-21 day waiting period where injection sites are avoided completely during this time. Prolonged use of corticosteroids can give rise to several complications including delayed tissue healing and decreased bone formation (leading to osteoporosis). With repeated injections, there may be muscle and connective tissue breakdown, as well as tenderness and a palpable gap at the injection site. When corticosteroid creams are used for long periods, they can lead to skin and subcutaneous tissue atrophy, as well as exhibit an inelastic feeling of the skin and muscle upon palpation. An RMT would avoid any techniques which would put stress on the tissue including fascial techniques, frictions, and joint play. A few examples of this type of specific anti-inflammatory drug are Topicort, Cortisol, Corticream, and Aclovate.
The stretch response of muscles become altered when Muscle Relaxant medications are taken, as they act on the neuromuscular junction. Upon palpation, the muscle may feel loose or stretchy. Since dizziness and postural hypotension can be present with this type of medication use, the therapist should advise the patient to get off the table slowly. An RMT should avoid deep techniques, full-body hydrotherapy applications, and extreme stretches. Any hydrotherapy application should be strictly local and moderate in temperature. A few types of muscle relaxants include Flexeril, Diazepam (Valium), and Norflex.
Although the daily use of a medication may not appear to affect the body, it can prompt an RMT to modify a treatment plan. Furthermore, sometimes it may not seem to be important to mention common medications, such as Advil, in the health history form. It is important to list any medications that are taken, along with supplements and herbal remedies, as a precaution. In instances, such as when a patient is taking anti-inflammatories while seeking massage therapy for a recently inflamed tendon, the RMT will have to modify the treatment plan as the most intended technique for tendonitis is not indicated while on this type of medication. However, if it is not listed on the health history forms, the therapist will inquire about the use of medications during the pre-treatment assessment.
Christina Sharma, RMT