Medications and Side Effects
There are common conditions that can sometimes require massage therapists to alter their treatment plans—either because of the symptoms of the condition or because of side effects of the medications.
In my own practice my biggest concern is always blood thinners. A person who is taking these medications or have hemophilia lets say may bruise and bleed easily.
Second concern for me and other massage therapists that I know is muscle relaxers and pain killers. A person who is on pain medication can’t report the pain or feel it at the time of treatment, which can lead to over treating if let’s say they are asking and expecting for more pressure.
Following, you’ll find information on some common diseases that require medication, as well as some of the side effects and how a massage therapy session may need to change to accommodate clients taking medication.
Common Conditions that Require Medications
Arthritis is a condition that affects the joints. There are many types of arthritis, but the most common types are osteoarthritis and rheumatoid arthritis. The main symptoms of arthritis are joint pain, stiffness and swelling, redness, and a decreased range of motion. Arthritis is typically associated with age, but younger people can suffer from arthritis, too. Age, joint injury and obesity are all risk factors for developing arthritis.
The most common treatment for arthritis is medication. Pain relievers, such as analgesics (acetaminophen, tramadol, and narcotics) and non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen and naproxen) are often prescribed for arthritis. Some people with arthritis also take corticosteroids (like prednisone and cortisone) or disease-modifying antirheumatic drugs (DMARDS) and biologics (including etanercept and infliximab).
There should be consideration in altering treatment plans for anyone taking pain relievers. When people take pain relieving medications, they may experience altered pain perception, low blood pressure, dizziness, and bleeding or bruising.
Corticosteroids, too, can cause swelling of the legs, thinning of the skin, tendency to bruise, high blood pressure and a weakened immune response. Long-term use of corticosteroids can cause osteoporosis, which increases risk of bone fractures. If your client is taking corticosteroids, avoid the injection site during massage (if medications are injected), and avoid deep tissue work, opting for more gentle strokes instead.
Diabetes is a condition caused by too little insulin in the blood or an inability of the body to use insulin. Type 1 diabetes often begins in childhood. Type 2 diabetes most often begins during adulthood, but children can develop Type 2, as well.
Uncontrolled diabetes can cause excessive thirst and urination, fatigue, wounds that are slow to heal, frequent infections, blurred vision, and tingling in the hands and feet. Most people with diabetes will take some kind of medication.
Before beginning massage therapy on a person who is being treated for diabetes, a physician’s referral for massage should be give. You may also want to start with shorter massage sessions to see how therapy affects client’s diabetes or the side effects of medication. When scheduling massages, make sure to do so during peak availability of the medications, and make sure the person has eaten prior to the session.
Some of the side effects of diabetes medications are numbness and tingling, especially in the extremities, easy bruising, swelling, muscle pain, back pain and abdominal pain. When performing massage on a person with diabetes, we look for any wounds, and we need to ask whether a client is experiencing any sensory loss or alterations, tingling or numbness, leg cramps, fatigue and muscle weakness.
People with diabetes are at risk of hypoglycemia (also known as insulin shock), which can be life threatening. Clients who are insulin dependent should always have a source of sugar (glucose) available. In case your client forgets, you should keep fruit juice or regular (not diet) soda on hand in case your client’s blood sugar drops. Call 911 if a person is drowsy or confused, or is difficult to rouse after massage.
Fibromyalgia is a musculoskeletal condition that causes many symptoms, including widespread pain all over the body, points on the body that are painful and tender to touch, joint and muscle stiffness in the morning, and fatigue. Clients with fibromyalgia might also experience numbness and tingling in the extremities, as well as other uncomfortable and even debilitating symptoms.
Fibromyalgia can affect anyone, but it affects women far more than men, and it is more common in women who have gone through menopause. The most common first-line treatment for fibromyalgia is antidepressant medication because it can help relieve pain, reduce fatigue and improve sleep problems. Pain relieving medications (generally analgesics) may also be prescribed, as well as muscle relaxants (such as Soma, Parafon, Forte, Flexeril, Skelaxin, and Myolin) or anticonvulsants (often Lyrica is prescribed for fibromyalgia).
Antidepressants can cause dizziness, drowsiness, and fatigue, along with a tendency to bruise, depressed stretch receptor response and altered temperature perception. Watch for bruising, and avoid deep tissue work if bruising is present or occurs during massage. Also, be aware of the potential for over stretching muscles. Watch for signs of dizziness, drowsiness, altered consciousness and fatigue, and adapt your massage therapy session as necessary.
Parkinson’s disease is a nervous system disorder that affects movement, often developing gradually and beginning with a small hand tremor and progressing over time. The most common symptoms are tremors, rigid muscles, slowed movement, impaired posture, balance problems, loss of automatic movements (such as blinking and arm swinging), and speech changes. There is no cure for Parkinson’s yet, but medications can improve symptoms.
Some symptoms to look for if your client is taking drugs for Parkinson’s are dizziness, drowsiness, disorientation, nervousness, and low blood pressure when changing position (orthostatic hypotension).
To help muscles relax, we would use effleurage and rocking strokes, and possibly some petrissage. If your client is too relaxed or sedated, use some stimulating strokes toward the end of the massage, such as tapotement and fast effleurage. If the client is dizzy, drowsy or disoriented, we offer to help him or her get up from the table.
Cardiovascular disease is a term that encompasses a number of diseases and conditions of the heart and blood vessels. Coronary artery disease, heart failure, vascular disease (disease of the blood vessels), heart valve disease, and other diseases of the heart all fall under the category of cardiovascular disease.
Symptoms vary depending on the type of disease, but angina (chest pain), chest discomfort, shortness of breath, heart palpitations, dizziness, fatigue, weakness, and swelling are common symptoms of most forms of cardiovascular disease.
Medications are a common way to treat cardiovascular disease, and there are many types of medications used by doctors today. These include beta blockers, antihypertensives, anticoagulants/blood thinners, calcium channel blockers (CCBs), sodium channel blockers and ACE-inhibitors, among others. The drugs can cause low blood pressure, easy bruising and bleeding, swelling in the legs (that can lead to deep vein thrombosis), cough and heart rhythm problems, among other symptoms.
Low blood pressure, dizziness, and drowsiness are common side effects of a number of drugs used to treat cardiovascular disease. If your client is taking any of these drugs, we would consider limiting long sessions of effleurage or ashiatsu because it can add to the effects of the drugs.
Common Side Effects of Medication
In order for us to ensure safety, we need to understand how some of the common side effects of various medications can affect clients and, in turn, how you proceed with a massage therapy session.
Low blood pressure and/or orthostatic hypotension
There are a variety of medications that can cause these side effects, including, but not limited to:
- Muscle relaxants
- Narcotic pain relievers
- Antihypertensives (sympatholytics, ACE-inhibitors, and vasodilators)
- Beta blockers
- Calcium channel blockers (CCBs)
If a client is taking one of these medications, we suggest that they move slowly from position to position, and offer helping them up from the table when the massage therapy session is over. During massage, especially toward the end of the session, we use strokes that are faster and more stimulating. However, avoid deep tissue work if your client is experiencing numbness or tingling.
Dizziness and lightheadedness are common side effects of a number of medications, including, but not limited to:
- Medications used to help treat Parkinson’s, including dopaminergics
- Narcotic pain relievers
- Cardiovascular drugs (beta blockers, calcium channel blockers, antiarythmics and vasodilators)
If a client feels dizzy or complains of lightheadedness during or after a massage, we have him or her lie flat until the feeling passes.
Bruising can occur for a variety of reasons, including thin blood, blood vessel problems, anemia, and thin or weakened skin. There are some medications that make bruising more likely, so you should be aware of the potential of bruising and alter strokes and modalities accordingly.
Some common medications that can cause easy bruising are:
- Anticoagulants (blood thinners)
- Non-steroidal anti-inflammatory drugs (NSAIDs)
If a client is taking any of these medications or we notice any bruising, we avoid deep tissue massage and strokes such as deep kneading, muscle stripping and trigger point compressions. Instead, we would use gentle compression, friction and pertrissage.
Muscle cramping or weakness
Antidiabetics, calcium channel blockers (CCBs), beta blockers and diuretics can all cause muscle cramping or weakness. If your client is experiencing these symptoms, you may want to postpone or reschedule massage therapy, or ask for a physician’s clearance before beginning or continuing therapy.
Weakened body tissue
Corticosteroids can cause weakened body tissue. If you notice any clinical signs of tissue weakness or damage, avoid massaging those areas. If your client is taking corticosteroids deep tissue massage is not recommended.
Some medications, including corticosteroids and calcium channel blockers (CCBs), can cause deep vein thrombosis (DVT) and thromboembolism.
Avoid using deep, kneading strokes, especially on the legs, and we need to monitor client for signs of DVT (pain, redness and warmth) or embolism (including sudden pain in the chest or head).
Drugs given by injection or patch
If a client receives any drugs by injection, such as corticosteroids, hormone replacement or insulin, avoid the injection area. We do not perform any deep tissue work near the injection site.
If your client wears a medication patch, avoid massaging the area around the patch, and do not remove or move the patch at any time.
Similar precautions should be taken with any hormone cream or topical medication.
Of course, not all people who take a medication will experience side effects. But it’s important to be aware of what the potential side effects are so we can monitor clients for signs of problems. If you’re ever concerned that massage therapy might not be safe, request a physician release for massage.
Getting the Information We Need
Doing a thorough intake is a necessary part of any massage therapy session, but especially so when there are clients who may be taking medication for acute or chronic health conditions. Having important health information, like what medications your clients are taking—as well as knowing the possible side effects of medication—helps us ensure client safety.
Verbal Intake: Questions we ask New Clients and recurring clients because things change
- Are you taking any medications, including over-the-counter drugs, vitamins and supplements?
- If so, why do you take the medications?
- If you take medication, how often do you take it, and what time of day do you take it? (This is especially important for medications like antidiabetics, pain relievers and cardiovascular drugs.)
- Do you experience any symptoms or side effects, such as dizziness, fatigue, pain, tingling or numbness, low or high blood pressure, skin problems or bruising?
- Are you taking the medication long-term or for a limited time?
Having all of this information will help you better assess what, if any, adjustments need to be made to the massage therapy session.
For example, a client who is taking medication long-term versus for a limited time may have different needs and considerations, especially for, say, corticosteroids, where long-term use may cause muscle weakness and edema.
Visual Assessment: Things We Look and Feel For
Along with clients answering online or paper health questions or performing a verbal intake, massage therapists can learn a great deal about a client through visual assessments, as well.
Some medications, for example, may cause swelling or differences in gait or movement patterns that need to be investigated prior to a massage therapy session to ensure the cause isn’t one that would contraindicate massage.
Some of the signs and symptoms you should look out for include:
- Unsteady gait or changes in gait
- Apparent dizziness or drowsiness
- Change in skin color (Is your client pale or flushed?)
- Swelling of the face, legs or ankles
- Facial expression
- Physical deformity or irregular posture
- Changes in speech
Additionally, we may be able to detect some symptoms and side effects by palpating client’s skin:
- Increased perspiration and cool or clammy skin can occur when people take non-steroidal anti inflammatory drugs, which might require you adjust a massage therapy session.
- Loose muscles that are easy to maneuver can be a side effect of muscle relaxants and central nervous system depressants, which can lead to overstretching.
- Fragile skin and soft hypotonic muscles can be a sign of tissue breakdown, which can happen when people take corticosteroids for a long period of time.
- Nodules or fibrous tissue can grow near injection sites, especially when the same site is used over and over again. Avoid these sites, especially after recent injections.
- Swelling (edema) can often be felt as well as seen.
Many medications can cause swelling, as can a number of conditions. Watch for swelling, and if you encounter it, talk with your client. Swelling, warmth and redness in the legs may indicate deep vein thrombosis, which may contraindicate massage. If you notice warm, red spots on the legs, avoid deep tissue massage, and consider asking your client to get a physician’s referral.
Concussion: When in doubt if massage is right for a specific client at a certain time a consultation with a doctor should be made.
Brilliant Massage Therapy