military man sitting on the sofa and talking to his therapist while discussing his problemsVeteran massage is an emerging field of focus that many massage therapists are choosing to enter. Serving veterans through massage can be highly rewarding and provides therapists with some of the most fulfilling experiences of their careers.

Prolonged Disruption

It is essential to receive proper training specific to the military population before promoting oneself as a practitioner massage for veterans. An understanding of military and warrior culture will inform therapists of the unique approach they will need to provide compassionate client care and help them consider how to best modify their technique to help each client feel comfortable.

Many men and women who return from deployment will experience combat stress, which is a very normal period of processing a collection of events and re-establishing physical health and overall physiological balance.

This process of decompression is similar to what many of us go through at various points of our lives; perhaps at the conclusion of a busy season at work, after a time of supporting a family member through an illness or coming out of a period of financial stress. With time, rest and a little self-care, we feel like ourselves again.

Yet other military members will experience acute combat stress, which can arise from one specific traumatic event that can cause behavioral, mental and physical distress.

In this case, time has passed and rest has been possible, yet decompression has not occurred. Returning to one’s old self is not happening. Experiencing prolonged disruption can lay the groundwork for post-traumatic stress disorder (PTSD).

Man And Woman SoldiersVeteran Trauma

Statistically, PTSD affects one in five Iraq war veterans; up to 10 percent of Gulf War veterans; 11 percent of veterans of the war in Afghanistan; and almost 31 percent of Vietnam veterans, according to the U.S. Department of Veterans Affairs (VA)

Military sexual trauma (MST) from sexual assault or repeated sexual harassment is another condition that presents with similar symptoms and affects an estimated one in four women and one in 100 men, according to the VA.

Most experts in the field of veteran care suspect that both of these estimates are low, as many cases may go undiagnosed. It might be because of lack of available services, a lack of desire to get help, or a fear or inability to disclose what they have experienced.

One of the most succinct explanations of how trauma impacts the body comes from trauma specialist Bonnie Owens, L.C.S.W., who says “neurons that fire together wire together.” She explains that in the wake of a traumatic event, the brain is assaulted and many, if not all, systems of the body fire rapidly in an attempt to protect and survive the event.

“After the event has passed, the brain and body attempt to regulate and put things back in order, but new connections have formed and people can get stuck in patterns of thought or behavior and may be unable to overcome neurobiological disruptions.

Those with PTSD or MST often experience flashbacks that may cause them to go to great lengths to avoid facing reminders of a specific experience. In an effort to avoid a trigger, they may withdraw from family, friends or public places. They can feel like they need to be on guard or hypervigilant. In this state, they will survey a room upon entering, and keep their back to the wall with their eyes on others. Not surprisingly, this can lead to poor concentration, irritability, mood swings and lack of sleep.

As symptoms compile, veterans can end up feeling disconnected and numb. Many who fought in modern warfare also wrestle with moral injury, which is the belief that the acts they performed in combat violate their personal belief of what is right. These symptoms manifest in any number of combinations, but in all cases, the body as a whole carries the burden of the condition.

massage for veteransMassage for Veterans

It is encouraging to know that our brains and bodies have the ability to form new pathways after trauma, which means that healing is possible. This notion creates a strong argument for incorporating massage into a veteran’s overall treatment plan. Just as the initial trauma arose from an intense output of physical and mental energy, eliciting a controlled neurobiological response through bodywork can help to re-wire the brain and relax the body.

Additionally, the social engagement aspect of each visit can in itself be healing. In a massage session, nurturing, soothing touch is offered unconditionally. The therapist is there to help the client feel good, with no expectation of anything in return. This helps the client to learn trust and to experience human touch again. These experiences contribute greatly to the healing process especially for victims of MST.

It is important to understand that not all veterans have PTSD nor have they all sustained significant injury. But for those who are injured, it is crucial to be knowledgeable and to be prepared for anything.

The phrase “embrace the suck” is commonly touted in military culture. Service people can be led to believe that in the face of pain and discomfort, they have no choice but to deal with it. Injured veterans often work with a team of doctors at their VA hospital, which usually means they are embracing the suck of a lot of painful treatments as a part of their plan.

Practitioners should know that they become a part of that team when they provide massage to a veteran. Those who take the initiative to tell the veteran that massage does not have to hurt and empower them to voice their preferences will contribute to a much more successful session.

Build Trust

More frequently than not, veterans will not provide the information asked of them on their intake forms. Injuries and surgeries will likely not be explained in detail. If asked how they can be made comfortable before the session begins, most will not have an answer.

Practicing patience and being pre-emptive with suggestions to the veteran will help to build trust. Many therapists have learned to read veterans’ bodies as they pull back the sheet to begin work, looking for obvious indications of wounds from knives, bullets or shrapnel. Leading with kindness and understanding, practitioners remark that clients open up as work begins. After a couple of meetings, veterans feel safe.

One practitioner described a client who came to her after a series of appointments at the VA. He was quiet and nervous, and she suspected that what he needed from her was simply to relax and feel good.

He did not explain what his treatments were for, but shortly after she began, she heard him say, “I was hit by an IED.” He then told her that he had chronic, burning pain in his shoulder. It was so bad that he couldn’t take it. He went into his room at his barracks and put a gun to his head. He began to pull back on the trigger when suddenly his commanding officer burst into the room and knocked the gun out of his hand.

Experienced practitioners of veteran massage easily read small movements and behaviors in their clients and can usually tell when they are working with a victim of MST. To help clients feel respected and in control, therapists will not move their arms and legs for them, but will instead ask the client to move his or her own body.

Soldiers at rifle drill on training grounBe Informed

Knowing the demographics of your area will shed light on what you might expect in your military clients.

For instance, a unit that specializes in going through mountains on foot in desert climates engages in a lot of running, moving and carrying heavy bags and equipment, so you can expect to see a lot of compressive force injuries.

A post where active military are deployed at home will present with neck, shoulder and low-back issues. Each base, post and branch has a unique pattern, and understanding them can help you prepare.

Educated veteran massage therapists will remain current on contemporary warfare, fighting styles, the nature of injuries sustained and what kinds of experiences are most typical for today’s warriors.

Now more than ever before we are welcoming home wounded veterans from contemporary combat who are surviving loss of limbs, severe burns and traumatic brain injuries. Medical care advances because of war, so too should massage adapt in practice.

Stay Flexible

One of the best skills you can have is to be completely flexible. Individual clients will present differently, emotionally and physically. The same person can be different each time they see you. Don’t do just what is comfortable for you as the practitioner; make it clear to the patient that they have choices.

Veterans with PTSD may want to remain supine with their eyes open. Those with MST might prefer to remain face down and have you work only on their back. Acknowledge that some will be more comfortable by a window or with the door open.

Be sure to take time for yourself to pursue your own avenues of health and wellness practices. Caring for yourself properly will allow you to deliver better care to others.

Serving active military, guard, reserve and veteran clientele requires effort on the part of the practitioner to become well-educated in warrior culture, to practice patience, kindness and adaptability.

Many, like massage therapist Carol A. Schneider, L.M.T., M.M.P., see the effort as well worth it, and, as she said, “I have personally seen dramatic changes in the quality of life in the veterans that I have had the good fortune to massage.”

About the Author

Kayleen Wilkinson works in the Wellness program at Clear Path for Veterans in Chittenango, New York. Clear Path partnered with Crouse Hospital to establish Caring Hands, Caring Hearts, the nation’s first National Certification Board for Therapeutic Massage & Bodywork-approved veteran massage continuing education credit program. The Wellness program offers numerous integrative medicine modalities to active military, reserve, guard, Veterans and their families and caretakers.