the draping is moved, not working underneath draping, reassuring clients that they are allowed to remain clothed, and reassuring clients that they are empowered to stop the massage if they feel uncomfortable during the session. By respecting and adhering to such protocols, particularly with new clients, therapists establish the boundaries for future sessions (Fritz & Fritz, 2020). ● For clients taking multiple drugs for multiple or chronic conditions, complete a new health history form every 3-4 months. ● Accept the limits of your knowledge and avoid comments or questions about drugs that have been prescribed for a client and refer client questions back to the prescriber. ● Do not offer personal opinions regarding immunization, herbal supplements, pain medication choices, or any other choices made by the client. Interview guidelines for drug use Discuss the following questions for each drug: ● Why was this drug been prescribed? ● How do you take this drug? Identify IM, IV, implantation, or transdermal patch sites and avoid by at least a hand width. ● How often do you take this drug? ● Have you taken this drug today? ● Have you noticed anything different since you started taking this medication? ● If the client does not know the answers, ask who/which doctor prescribed it and seek further information is necessary. ● Keep inhalers handy. ● Keep emergency medications handy. ● Be sure to identify symptoms that may indicate a medical emergency in relation to the client’s condition, for example seizure or angina, and have an emergency plan in place. ● Clarify that providing service in case of known non- compliance may compromise client safety and your licensure. ● Advise that certain modalities/techniques maybe contraindicated, and that treatment may not be safe without compliance. ● Reports of pain, muscle, or joint stiffness unsupported by objective assessment indicate deferral of massage, and referral to the prescriber. ● Alert client that drug-related side effects alleviated by massage may return after massage, for as long as this drug is taken. Care for specific medical conditions and pharmacology effects Always be sure to remain within the scope of practice and consult supervisors, state regulations and other healthcare providers if uncertain about treatment related to medical or pharmacological cases. Never proceed if uncertain about the health, safety or best practice for the client. Integumentary issues of the skin and appendages may present as: bruising, rash, lesions, dryness, epidermal fragility, hypersensitivity, or a lack of touch sensitivity: ● Keep touch a hand-width away from a bruise, rash, or lesion. ● Gently palpate to assess perception of sensation on the skin. ● Assess skin turgor (elasticity) by gently pulling up a fold of skin; if it remains raised, skin is dehydrated and fragile. ● Ensure sufficient lubrication.
The focus of both parties should be on therapeutic goals that are established in part by standard protocols for physical safety. Such protocols include but are not limited to consent for working sensitive areas such as the abdomen, gluteals, and female pectoralis muscles, what part of the therapist’s body touches the client, not touching the client inadvertently with loose clothing or hair, keeping a client draped in accordance with local laws and regulations, how Treatment planning and pharmacology An important element of safety, informed consent, and client welfare is the consideration of medical conditions and pharmacology when determining the plan for massage and bodywork care. The increasing demand for massage and bodywork for a variety of physical and medical conditions through integrated, multi-disciplinary approaches to health care requires competency in the area of pharmacology. The following Centers for Disease Control and Prevention statistics outline the prevalence of prescribed drug use in the U.S. today (Centers for Disease Control and Prevention, 2019): ● 48.6% of Americans have taken a prescription drug in the past 30 days. ● 88% of those 65 years and older have taken a prescription drug in the past 30 days. ● 24% of Americans have taken three or more prescription drugs in the past 30 days. ● 12.8% have taken more than five prescribed drugs in the past 30 days. The massage and bodywork professional must realize that many clients are taking prescribed medications that may impact the type of modalities, procedures, positions, duration, and frequency of care they plan. The professional must have information on drug administration routes, drug interactions, dosages, adverse reactions and allergies, safety considerations, medical conditions being treated, and other health care providers to contact for further information. Treatment planning guidelines related to client drug information include the following (Goodwin, 2016): ● Carefully review the health history form during the interview with the patient. ● Request that the client bring the prescription drug bottles to the initial appointment and list the condition each medication treats. ● Note dosage and frequency for each drug. ● Include the prescribing physician’s information for each drug. ● If the client has pills they cannot identify, in pill organizers for example, the website www.drugs.com provides pill identification. ● Be sure to get information on over the counter medications, supplements, and vitamins being taken. ● Establish the level of compliance for each drug. List the side effects experienced by the client. Discuss whether side effects are discouraging compliance. Ask if client has consulted prescriber or dispensing pharmacist about side effects. The client may not realize that other drug options in same class may not cause similar side effects. ● Inquire about any medication changes before each session, document drug and/or dosage changes. ● Have you noticed anything different since you started taking this medication? The client may not connect emerging signs or symptoms with this or another drug: ● Reinforce the importance of accurate information for client safety and comfort.
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