Massage therapists help clients through the physical work of massage relieving the traumatic stress that shows up somatically in the body.

Hurricane Harvey made landfall on the Texas Gulf Coast on Aug. 25. Since then, U.S. citizens have been walloped with one catastrophic event after another: hurricanes Irma, Jose and Maria in September, the mass shooting of concert goers in Las Vegas in October, and wildfires still devastating lives in California. These types of events can cause stress and trigger post-traumatic stress disorder (PTSD) in some people—even people who aren’t first responders or victims of an event. Here is information to help you support your clients following such disastrous events as these.

On the night of Sunday, Oct. 1, a shooter opened fire on a crowd attending a music festival on the Las Vegas Strip, killing 59 people and wounding more than 500, according to multiple news reports.

On duty at MedicWest Ambulance in Las Vegas was 45-year-old paramedic Heath Palmer.

Palmer and dozens of other first responders rushed to the location but because it was an active shooter situation and a crime scene, they couldn’t go inside the concert area.

“Having to hold and not go in,” Palmer said, “it was an emotional challenge.”

He and his colleagues did what they could by transporting to the hospitals those concertgoers who had fled the concert area and were out on the streets.

For Palmer and many of his first responder colleagues, the stress of that evening, as well as the stresses of the hundreds of individual traumas he witnesses during each of his shifts, results in difficulty sleeping, headaches and neck and lower back pain.

“The body stores things,” said Palmer, who is also a former licensed massage therapist and massage therapy instructor who gets massage at least every other week.

“It doesn’t just store injury like physical injury,” he added. “Your body remembers, and as you’re getting bodywork those things can get released, whether it’s something exciting, whether it’s something scary, whether it’s something you’re holding back.”

Massage, said Tiffany Pugh, L.M.T., both a massage therapist and instructor at Cortiva Institute (formerly the Nevada School of Massage Therapy) in Las Vegas, helps people release the trauma they store in their bodies.

Massage can lower cortisol, which increases when people are stressed, and increase levels of serotonin and dopamine, which relax the body’s central nervous system, allowing people to start processing what’s happened, she said.

When news of the shooting at the music festival spread through the Las Vegas community, the instructors and students at the massage school wanted to help.

The weekend following the shooting, a group of instructors and students showed up at MedicWest Ambulance, where Palmer works, and set up their massage chairs to provide free massage for the first responders there.

The school also planned to offer free massages to first responders and their spouses on Friday evenings through the month of October.

The first responders who have participated in the free massage sessions have been grateful, said Pugh.

“A lot of them were very emotional, especially [when] starting to receive the work.”

As their bodies relaxed, they talked through what happened, she said. “It was a really good opportunity for them to start releasing some of those things they were holding onto.”

The Problem of Traumatic Stress

First, to effectively work with clients following a traumatic event, it is helpful to understand the difference between stress and post-traumatic stress disorder (PTSD). These are not the same, says Debra Kaysen, Ph.D., a psychiatry researcher at the University of Washington and vice president of the International Society for Traumatic Stress Studies.

In the first weeks following a traumatic event, it is common for those people directly impacted by the event as well as those people witnessing it and the general public to have stress symptoms, she said, such as nightmares, having images they can’t get out of their minds, trouble sleeping, feeling irritable or angry, depression and becoming easily distressed.

For most people, these symptoms gradually go away over a few weeks. “For a subset of people, those symptoms get a little bit better and then they stop improving,” Kaysen said. “Those are the people who we eventually might see as having developed PTSD.”

People not directly impacted by an event are unlikely to develop PTSD, although those previously diagnosed with PTSD could be triggered by a traumatic event even if they were not there—especially as news is on a 24-hour loop on cable and social media.

If it’s been more than three months and your clients are still struggling, or if a client presents with a very strong emotional reaction to an event, it is time to recommend to them someone in your referral network who can provide additional support, Kaysen said.

Massage therapists help clients in two ways: through the physical work of massage relieving the stress that shows up somatically in the body and by encouraging clients to attend emotionally to what they’re experiencing, which can facilitate the processing of emotional trauma, said Cynthia Price, L.M.T., mind-body health researcher at the University of Washington School of Nursing and director of the Center for Mindful Body Awareness in Seattle, Washington.

Clients who have experienced or witnessed trauma may not be aware that they are holding trauma in their bodies, so when working with them the therapist may have to collect information from them in a variety of different ways in order to get a better picture of how you can be most effective in therapy with them, Price said.

Ask questions about how they’re feeling, what they are experiencing in their bodies, if there are any physical sensations in their body that are new or more intense than before. Let their bodies talk to you, she added, and note the places someone is holding tension or where they may be having discomfort or increased sensitivity.

It is not unusual for massage to allow for the emotional as well as the physical release of trauma, so if your clients begin crying on the table let them be with their feelings.

Keep the physical connection you have. Leave your hands resting on the area you were massaging, but don’t make any distracting moves, such as moving to massage another part of the body.

“Just (hold) the place where those emotions are coming from and (let) the person release them,” Price said. Tell your clients that it’s OK to cry and to take the time they need, she added.

Continue the massage when they’re ready.

Don’t Forget Yourself

It is easy to focus on your clients after a community trauma such as the Las Vegas shooting, but don’t forget to take care of yourself, too, especially if you live in the area where the trauma happened, Price said, offering this advice:

Don’t overwork yourself. Take the time to get centered and energetically maintain boundaries so you don’t take in more than you should.

And talk to your colleagues or seek out other resources to support you and help you in your work with traumatized clients.

About the Author

Stephanie Bouchard is a freelance writer and editor based on the coast of Maine. She wrote, “It’s Tick Season—Do You Know What to Do?” for


If you enjoyed reading this MASSAGE Magazine online article, subscribe to the monthly print magazine for more articles about massage news, techniques, self-care, research, business and more, delivered monthly. Subscribe to our e-newsletter for additional unique content, including product announcements and special offers.