Every MT, no matter how experienced in practice and study, is a lifelong learner. We create new knowledge by integrating previously-separate information.
Here's an example of the process, leading to a change in what I practice and accept as a client, based on new information and recommendations from Susan Salvo at her blog:
Thrombocytes, or platelets, are the blood cells used to form clots. Thrombocytes have a life span of about 10 days.
If your client has had surgery, avoid massage on lower extremities for 10 days starting from the time the client is ambulatory and no longer confined to bedrest.
Salvo reasons in the following way:
Inactivity and bed rest, such as that following surgery, can lead to stasis, which in turn can lead to blood clots.
Thrombocytes formed before the client/patient is fully ambulatory are at a higher risk of clotting, due to that stasis.
That stasis and the resulting clot may not show up immediately, but may even happen late in the life span of the thrombocyte.
Thrombocytes have a life span of about 10 days.
Therefore, even a few days after the client/patient begins walking again, the thrombocytes circulating in their blood are still potentially at some risk for thrombosis, due to their earlier inactivity.
The safest way to lower the risk of thrombosis is to wait for those potentially at-risk thrombocytes to be replaced by brand-new ones that were never exposed to inactivity and potential clotting.
That is the source of the 10-day recommendation: approximately 10 days after the client/patient becomes ambulatory again, the thrombocytes exposed to inactivity and clotting risk should pretty much have been replaced by thrombocytes that have always experienced activity, and thus are less at-risk.
Her reasoning is solid, and the recommendation makes sense.
But are clients/patients in hospital to be deprived of massage during the post-surgical and pre-(ambulatory + 10 days) period? That, in the experience of the client, is potentially a tremendous loss.
I've written about it myself here at POEM, when I described what it meant to me when I spent a month in the hospital for surgery following a blood clot that led to the loss of 3 feet of my small intestine:
It's hard to describe what it feels like to come so close to death, and then to have to work my way back slowly away from the edge of the cliff. "Alone", "frightened", "vulnerable"--these certainly all were part of it, but they're insufficient to depict the experience. My family, friends, and graduate program were wonderfully supportive, but no matter how much they were there for me, there are some things you just have to go through alone.
While I was in the hospital, I was moved to a floor that had a volunteer MT come in once a week to offer patients a massage. I remember it was Wednesdays when she made her rounds.
The first Wednesday, she came around and offered a free hand and foot massage, which I gratefully accepted. It's not that I was touch-deprived, not exactly--but the touch I was getting in the hospital was almost universally invasive touch--blood draws, infusions of dye for CAT scans, IVs for feeding and painkillers. Although there was lots of touching, I was definitely "good touch"-deprived. Her simple offering of a hand and foot rub turned into one of the best experiences in my life.
The next Wednesday, she returned, and once again, it was the high point in a week that had very few other good experiences.
The next Wednesday, I waited eagerly, my anticipation heightening from minute to minute for another of the massages I had grown to love. When it finally dawned on me that she wasn't coming this time, I cried and cried inconsolably.
When something has that much meaning to a client/patient, how can we deprive them, even in the face of risk?
Fortunately, we don't have to totally deprive them: a head/neck rub or a back rub, depending on their tolerance for it, should be perfectly safe (unless there are other factors for a particular client/patient that you need to consider). And although a hand rub is technically "massaging an extremity", arms have not been shown to run the risk of blood clots (deep vein thrombosis) that legs do.
Based on Salvo's recommendation, if I am ever a hospital patient again (and I hope that never comes to pass!), if an MT offers me a foot rub, I'll ask for a back or head rub instead, until I have been fully ambulatory for at least 10 days.
And when I am offering massages to bedridden hospital patients, I'll make a point to offer head, neck, back, and hand rubs--but until they're up and walking, and have been for at least 10 days, I think I'll pass on the foot rubs as well.
As small or as large as the risk may be in any particular case, I have no way of judging it, and I have perfectly good options to offer instead that do not carry any particular risk of thromboembolism.
cheers, to Susan Salvo!
Source: http://upload.wikimedia.org/wikipedia/commons/7/73/Aterialthrombosis.jpg accessed 18 october 2011