When you think of physical rehabilitation, your mind might naturally associate it with athletes with sports-related injuries and people recovering from accidents. However, physical rehab is a much larger umbrella, not only including physical therapy but also occupational and speech/language therapy.
So, where does massage therapy fit into physical rehab patients’ recovery? Often, it will be part of a physical therapist’s plan of treatment, which will typically be part of a physician’s plan of treatment. While some physical therapists give their own massage, others will refer it out; but in this article, we focus on a specific arrangement in which physical therapists and massage therapists work together under one roof, in the same clinic.
Providing massage to this diverse clientele is very different from giving massage in a spa or studio environment. MASSAGE Magazine sat down with a couple of massage therapists who specialize in massage for physical rehab to get a better idea of how it is unique, who you can help and what skills you need to succeed in this niche market.
Who Are Rehab Clients?
Just as in massage for the general population, you will see a wide variety of clients in the physical rehab space, and a wide variety of injuries and issues. A lot of the time, clients will have been prescribed, by their medical doctor, a certain number of physical therapy sessions after the acute stage of their injury or illness has subsided; for example, you might see an auto accident victim after doctors have set a broken limb, someone in need of recovering balance and movement after a stroke, or people looking for relief from repetitive stress injuries such as carpal tunnel syndrome or plantar fasciitis.
You may also, says the American Physical Therapy Association (APTA, choosept.com), see survivors of COVID-19 who have developed “long-haul” symptoms, now referred to as PASC: Post-Acute Sequelae of SARS-CoV-2. These individuals are sometimes left with fatigue, pain and other symptoms that may land them in a physical therapist’s care.
“I’m drawn to physical rehabilitation because it’s both interesting and rewarding,” said Brittany Barnes, RMT, who is also a sport trainer and a supervisor at Alberta College of Massage Therapy (acmt.ca). “This is why I’ve sought out my practice to be in clinic settings, where I specialize in therapeutic treatments. I have niched down to what I love most: deep tissue, sport massage and cupping.”
Rehab vs. Relaxation
The massage session itself, in a physical rehabilitative environment, may look very different from a studio session, said Amy Montia, PhD, LMT, who works at Physio Logic in New York, New York (physiologicnyc.com). For one thing, the setting can have a whole different feel; where Montia works, no background music plays during sessions, and clients don’t always remove their clothes. The focus is typically on one specific body area, and “we incorporate deeper techniques—muscle stripping, active release technique, myofascial release.”
Montia also points out the therapeutic value of stress-relief massage for those undergoing physical rehab. “Sometimes what is required for a patient might actually be relaxation massage,” she said. “Sometimes a patient has chronic headaches or chronic tension, and what they actually need is the manual input to help them to relax. So the techniques that you would get in a spa may be incorporated.”
While the techniques used may be similar in many cases, the plan of treatment in physical rehab may vary a great deal from a plan of treatment for a client who’s seeking massage purely for stress relief or chronic pain management. Usually, the client, as well as their doctor, has a specific goal in mind to accomplish during their physical therapy journey.
“Massage for physical rehabilitation is different from relaxation; it is results-driven!” Barnes said. “A specific treatment plan and homecare is essential for optimum recovery from injuries and accidents.”
Your assessment and intake skills are critical with these clients, too, as you will need to note contraindications (which may change visit to visit) and track clients’ progress, she added. And, since you are part of a team of caregivers, remember that your notes will be reviewed by other providers, as well as by insurance companies if they are paying for the therapy.
Most of Barnes’ clients are athletes and other active people, so she typically is working toward a common goal of restoring functionality after an injury so that clients can return to their respective sports. Goals of other types of clients might include being able to perform tasks of daily living, recovering range of motion after surgery, relieving pain or dealing with a chronic illness such as arthritis.
“I also work with those who are looking for ‘pre-habilitation’,” Barnes added. “This can range from a client who has an upcoming surgery to a client that just wants to take preventative measures to be well and move well.”
Joining Team Rehab
If you’ve sought appropriate continuing education and understand the scope of your work with physical rehab clients, you may be well on your way to success in this field—but this line of work entails some additional considerations, especially if you will be working as an employee.
First, you have to talk the talk. “You need to have a really good understanding of anything that would come out of a PT’s mouth,” Montia noted. “So, you have to understand all the anatomy, all the physiology; you have to have a few different tools in your toolbox to be able to do what the PT wants you to do. So you have to be flexible, versatile and understand the language.” Continuing education is important for keeping your knowledge current, as well as for learning new techniques for addressing clients’ needs.
Working well and collaborating with other health care professionals is also a critical skill in this type of massage. “I went into massage therapy knowing that I wanted to go into this field specifically, knowing that I wanted to be part of a team and not work on my own,” said Montia. “You definitely need to be a team player.”
“To me, being a good employee at a place that provides massage for physical rehabilitation takes patience, collaboration and simply striving to be the best you can be,” Barnes added.
Finally, you need outstanding people skills and plenty of empathy.
While it’s certainly out of your scope of practice as a massage therapist to offer any kind of emotional counseling, understanding the emotional component of people’s injuries is an invaluable skill when giving massage therapy in a physical rehab setting. For example, a client may have lost a loved one in the car crash in which they were injured, or had to give up living independently as a result of their condition. For that reason, it is especially important, said Barnes, to bring a hopeful, encouraging attitude to your table.
“In my experience with athletes, their sport is what brings them joy and purpose. Not being able to participate may feel devastating and they can put an incredible amount of pressure on themselves to heal,” said Barnes.
“I acknowledge this is a setback for them—but together our focus is on the comeback.”
About the Author
Allison M. Payne is an independent writer, editor and proofreader based in central Florida. She has written many articles for MASSAGE Magazine, including “What’s Behind Your Massage Technique? A Look at Assessment, Fascia, Movement, Stretching & Research” and “Enrich Your Massage Sessions with Sound Healing” (both, massagemag.com).