Originally published in Body Sense magazine, Autumn/Winter 2007. Copyright 2007. Associated Bodywork and Massage Professionals. All rights reserved.
As massage has entered the mainstream of healthcare options, more and more people consider this intervention as part of an overall health plan. Massage has gone from being an occasional treat to being part of how we take care of ourselves. This may be especially true of people who live with chronic conditions that decrease quality of life: people with fibromyalgia, chronic fatigue syndrome, arthritis, depression, anxiety disorders, eating disorders ... the list of those with medical conditions who find that massage is a valuable part of their healthcare is expanding daily.
All of this is good news: massage is a low-tech intervention with high benefits. While an hour of one-on-one time with a health professional can feel expensive, it is ultimately more cost effective than many other options like surgery, long-term physical therapy, or serious complications of various health issues. But the movement of massage into a medical setting comes with a cost: massage therapists are often put in the position of weighing whether their work will be beneficial or detrimental to the health of their client. The only way to preserve public safety is to get information about a client's health status in general, and in particular for the day of the massage.
Some massage therapists take long, elaborate client histories. They may require clients to fill out forms before they come for a first appointment and schedule extra time to go through the forms together in a client history interview. Typically this occurs in settings where a client and practitioner may be planning on a long-term therapeutic relationship. In other settings, like an on-site massage or a visit to a spa, a client may never see this therapist again. Then short-term goals are at the top of the priority list, and the practitioner may not have the inclination or the time to take an extensive history. Nonetheless, it is important to share some key pieces of information so that everyone can derive the best benefits from a bodywork session with the least risks.
What follows are some questions your massage therapist may ask you, with explanations for why that information is important. Massage is more than just a rub; by creating a stimulus (even a welcome and wonderful stimulus), massage requires that the body be able to adapt. Some people are better able to do this than others, and your massage therapist has to figure out where you fall in this continuum. As you read this, you might make your own list of health issues you want to be sure to share with your therapist, whether this appointment is a one time only or part of an ongoing project.Basic Questions For A One-Time Session With A New TherapistHow is your health today?
This may seem obvious, but people sometimes seek massage when they are fighting a cold, dealing with an internal infection, or even just suffering from a bad headache. Massage therapists may change the way they work or decide it is not in the best interest of the client to work in some situations.Do you have any skin conditions?
Again this may seem obvious, but it is amazing how often people forget about that mysterious rash on their abdomen until they are on the table. Obviously, if you have an active contagious skin condition (herpes, boils, impetigo), then massage may not be your best choice for today. If you have a chronic, non-contagious skin condition (eczema, psoriasis, allergic reactions), then your therapist can make appropriate adjustments. But if your condition is undiagnosed, your therapist is at risk for three bad things: spreading a rash further on you; spreading a rash on the therapist; or spreading a rash to another client.
Even if your undiagnosed rash or contagious lesion is in an area that the therapist doesn't touch, it is important to share that information with him or her for safety reasons.Have you had any accidents or surgeries that affect your health now?
This is particularly important if any accident or surgery currently affects your ability to get through your day. Scar tissue, headaches, limping, jaw-clenching, or other leftovers of trauma may be addressed with massage with good effect.Do you have any chronic conditions that affect your health?
The answer to this question for most people is probably yes, even if that chronic condition is caffeine addiction or a boss who drives you crazy.But if you are under treatment for something more serious, it is especially important to share that information with your therapist. Common examples might include arthritis, depression, or high blood pressure. Clients with chronic conditions can derive wonderful benefit from massage, but some situations require adjustments in timing, pressure, or positioning.Are you taking any medications?
Massage therapists must consider the possibility of interactions between bodywork and medications that clients take. For instance, if a client uses insulin and then receives a massage, it is possible to have an uncomfortable or even threatening double-dose of glucose-lowering interventions. High blood pressure medications or drugs that alter body fluids may also require some adjustments.
If you take a painkiller or an anti-inflammatory on the day of a massage, your massage therapist will have a harder time reading your tissues to give appropriate pressure.
None of these medications categorically contraindicate massage, but they all may require some modifications from your therapist. This is why you should share what medications you take, what conditions you take them for, and when your last dose was.Are you under a doctor's care?
This question can bring up any conditions or situations that might be a red flag that haven't already been discussed.Are you pregnant?
Clearly this is not a question for every client, but for women of child-bearing age this can be an issue. Pregnant women can reap wonderful benefits from massage, but certain risks must be respected.Do you wear contacts?
Many varieties of contact lenses are perfectly comfortable to wear during a massage, but you may appreciate the option to take out your contacts before you begin.What would you like to accomplish today?
This may be the most important question of all: if you can clearly communicate your goals to your therapist, then he or she will be better able to give you a wonderful, satisfying (and safe) session.Additional Questions For A Long-Term Relationship With A TherapistWhat preexisting conditions do you suffer from?
Your therapist may give you a list of conditions and ask you to indicate which ones you have had in the past. This gives some general insight into long-term repercussions that you may experience.What activities make your pain worse? What activities make it better?
These questions are for clients with specific injuries or weaknesses they would like to address. In addition to helping the therapist understand your situation, he or she can form a baseline to watch how improvements grow over time.What is your diet like? How well do you sleep?
These questions provide insight into your general lifestyle. While massage therapists don't diagnose or prescribe, they may be able to offer some well-informed advice about how some lifestyle habits support or interfere with health-related goals.What are your long-term goals for our work together?
The most fruitful client-therapist relationships are those where both people work together in an active partnership to make good things happen. While long-term goals for massage may change, working together to make them happen can be a satisfying and ultimately successful experience.
Once in a while an issue comes up in a client history interview that makes it clear that some kinds of massage may carry unacceptable risks. A good example might be this situation, based on a real-life scenario: a client who was recently in a car wreck, and who is taking high doses of anti-inflammatories and painkillers, wants his therapist to "really work out the kinks: just get in there and dig'em out."
This client has a legitimate wish: to reduce his pain and limitation. But this therapist cannot ethically do what he asks, because of the risk for further injury with the kind of bodywork he is requesting. In this case the therapist may offer alternative forms of massage. It might not be what the client had in mind, but it is a session designed to give the best possible benefits bodywork can offer, while minimizing risks.
One final wrinkle that may come up during a client history interview is the need to communicate with a primary care physician. It is important for you to understand that your therapist may not talk to any other health professional about you without your permission. He or she may request that you fill out a HIPAA (Health Insurance Portability and Accountability Act) form to give that permission. Therapists may wish to communicate with doctors to identify specific information about a certain condition, or to discuss the risks of certain kinds of modalities, or simply to inform the rest of your healthcare team that you are receiving massage in addition to whatever else you do to take care of yourself.
The overall point is that in a client-therapist relationship, more information is better than less information. Open, clear communication between you and your therapist helps to preserve your safety, but also helps you to get the very best out of your time together. Ruth Werner is a writer and educator for massage therapists and clients. Contact her at www.ruthwerner.com or werner firstname.lastname@example.org.