In the language of massage contraindications, therapists are often cautioned to “avoid the area.” This is a broad guideline that can easily be misinterpreted. Sometimes “avoid the area” means stay away completely, avoiding all contact. At other times, it just means to use gentle pressure at that site.
Modifying pressure for oncology massage
Pressure is one of the most common ingredients of massage that we might adapt for a client with cancer. There are many situations that would call for pressure restrictions, among them:
- Over a tumor site.
- Over confirmed or suspected bone involvement.
- In an area where the tissue is unstable.
- In an area where there is risk of or history of lymphedema. (These are common scenarios, and lifelong massage precautions are typically in force, long beyond cancer treatment.)
- In an area where there is risk of or history of deep vein thrombosis. (In this case, again, massage precautions for deep vein thrombosis persist beyond cancer treatment, and are followed for six months post-treatment at minimum.)
What is gentle pressure?
Given that some oncology massage pressure precautions are for active cancer or treatment, and others post-treatment or indefinitely, it’s especially important to define “gentle pressure.” What does gentle pressure mean? It can be as broadly interpreted, and as confusing, as “avoid the area.”
One therapist’s or client’s gentle pressure is often another’s deep pressure. Absolute massage pressures are tricky to measure, but you can describe commonly used massage pressure in plain language, as in this pressure scale often used with oncology clients in hospitals and outpatient settings.
Some years ago, there were few specific guidelines about massage therapy for people with cancer and cancer histories. Today, appropriate guidelines, including pressure guidelines, are well-described for oncology clients. Gayle MacDonald was the first to present oncology massage in terms of pressure, site and position restrictions in her book, Medicine Hands: Massage Therapy for People with Cancer, now in its third edition. A textbook I wrote, Medical Conditions and Massage Therapy: A Decision Tree Approach, offers specific pressures for specific cancer presentations, along with interview questions for each client. You can take a look inside the book, including the pressure scale, by clicking here.
These resources, along with many articles and books on the topic, are essential reading for anyone working with persons with cancer and cancer histories. Even experienced oncology massage therapists still read everything they can on the subject, as information grows and changes.
In-depth understanding is important, because even the pressure guidelines do not conform to a sound bite. Despite the many massage therapists asking for oncology massage advice on social media, and the many other therapists advising them to “just work gently,” and everything will be okay, the reality of oncology massage is more nuanced than that.
Moreover, pressure modifications are not always intuitively obvious, and it takes good interview skills to find them. These skills typically come with good oncology massage training. At minimum, such skills require familiarity with the oncology massage literature; experience adapting massage for medically complex situations; gentle, sensitive hands; and a heavy dose of common sense.
Tracy Walton & Associates LLC provides online and face-to-face training in oncology massage therapy and in massage for medically complex presentations; 2015 trainings are in Boston, Massachusetts; Siler City, North Carolina; Austin, Texas; Omaha, Nebraska; Eau Claire, Wisconsin; Miami, Florida; Hoboken, New Jersey; and Rome, Georgia. Explore their website to learn more about Walton’s textbook, an instructional massage DVD for caregivers of people with cancer, and the pressure scale used in courses and clinics. Walton authored the Expert Advice column for MASSAGE Magazine’s February 2015 issue, answering the question, “How can I get a job providing oncology massage?”
Neither the author/s nor MASSAGE Magazine assumes responsibility for the application of any technique. Readers must ensure they have completed the training necessary to safely and effectively perform any technique mentioned on www.massagemag.com.