Is It Safe to Get a Massage Right Now? | Elemental - Elemental

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What you should know as physical therapists, acupuncturists, and massage therapists are starting to see clients again

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Almost every week, 46-year-old Nina Strommen, a Minneapolis-based nurse, got a massage to manage muscle spasms and pain caused by fibromyalgia. But that was before the pandemic.

While some medical care has been able to pivot to telehealth, many patients haven’t received the hands-on treatments they rely on for conditions like chronic pain, headaches, or injuries.

For Strommen, that meant her fibromyalgia worsened. “Without these treatments, and with the added stress of the pandemic, my symptoms aren’t well controlled,” she says. “I’ve had to take muscle relaxers, which make me sleepy and makes it hard to work.”

Strommen’s massage therapist and other practitioners around the country are starting to see clients again. But the decision to go back to receive care isn’t simple. When is treating a health condition with hands-on therapy worth the risk?

It depends, says Irina Todorov, MD, an integrative medicine doctor at Cleveland Clinic. In general, even before the pandemic, she suggested people focus on nutrition, exercise, and getting ample sleep to treat the root cause of many health conditions, rather than relying only on hands-on therapy. Therapies like massage and acupuncture are “add-ons,” according to Todorov.

“I always stress to patients what you can do at home, versus seeking outside care,” she says. “Other therapies should be in addition to you taking care of yourself — self-care can improve your overall health and help manage symptoms.”

Wondering if you can and should resume hands-on therapy? We talked to practitioners to find out.

Until it’s safe for all patients to come back for physical therapy, many providers are using a triage system to determine who needs to be seen in-person immediately and who can do therapy from home.

“We… are all working hard to take a look at patients and decide who is most necessary for an in-person visit because we don’t want to put people in a high-risk situation if waiting a few weeks won’t hurt,” says Karen Mattie, Boston Medical Center’s director of rehabilitative services.

If you have chronic pain that doesn’t threaten your overall health or you’re progressing in your healing from an injury, your PT may recommend you wait to come in. It may seem counterintuitive, but many hands-on providers, including physical therapists, can do a lot for patients over telehealth visits. Joe Majercik, director of rehabilitation services at Northwestern Medicine Woodstock Hospital, says PTs can easily offer at-home exercise ideas and monitor patient progress through video appointments.

If you recently had surgery or you have a health condition or injury that could get worse without therapy, your physical therapist will probably want to see you in person. People who stop making progress following at-home exercises might also need to go into the clinic.

“In most surgeries, a patient’s outcome will be negatively affected if they don’t receive physical therapy on a timely basis,” says Majercik. “If someone had a knee replaced, the knee won’t move unless the therapist is helping them move it.”

Majercik says physical therapy clinics, like other medical settings, are following stringent guidelines to keep in-person patients safe during the pandemic. Staff screen for Covid-19 symptoms and take temperatures before a patient is allowed into the clinic, and appointments are spaced out to avoid patient overlap. Staff disinfect more surfaces more frequently, all staff and patients wear masks, and clinics enact a more limited visitor policy.

“If you look at all the things we are doing, it’s so much safer than if patients go pick up carry-out or go to the grocery store,” says Majercik. “We don’t feel like they are putting themselves at risk when they come in.”

Want to maintain your mobility at home? Mattie emphasizes prioritizing physical exercise after consulting with your doctor. “Most people are staying at home, so they have limited motion and activity,” she says. “Go for a walk up and down your street, or up and down your stairs if possible.”

Unlike physical therapy, massage doesn’t come with an easy telehealth option. If you’re dealing with physical pain, you might be counting down the days until your massage therapist opens their doors. Maybe your doctor even prescribed medical massage to help you manage a health condition.

If you regularly receive massage for medical reasons, check in with your doctor to see if you should resume in-person appointments. Sue Kim, MD, an internal medicine doctor and medical acupuncturist with Stanford Health Care, says she recommends massage therapy to patients with pain or injuries that interfere with their daily functioning.

Ideally, Kim says, massage practitioners should follow county or state guidelines for patient safety, such as taking patient temperatures, requiring masks, and screening for Covid-19 symptoms. And because the warm temperature of a small, confined space could cause sweating, which can compromise the efficacy of a mask, it’s also important for massage therapists to use open spaces or airflow systems when possible.

“Most massage places will have to comply with certain guidelines if they are able to operate under the current situation,” she says. “I’d explore what steps were taken and talk with your physician about if those steps are adequate.”

“I don’t think this is the time to show up to a random massage place in a strip mall with lots of practitioners. I’d recommend seeing a massage therapist you have a relationship with.”

If massage is an elective therapy you simply enjoy getting, whether you go back is up to you, and if you feel like the health benefits of a massage outweigh the risk. If your therapist is open, the first step is to check which precautions they’re taking toward client safety.

Kathy Gruver, PhD, a California-based massage therapist, is getting ready to reopen her practice with CDC and state guidelines. So far, her plan is to remove high-touch items from her massage room, disinfect surfaces between clients, and wear a mask (along with requiring the client to do so). She won’t massage faces and won’t touch hands unless requested. She’s also going to screen clients by asking if they have any Covid-19 symptoms when they arrive for the massage.

While massage therapists should do their part, Gruver says you may want to go the extra mile to ensure safety. Wipe down the table with a disinfectant before you get on it, and wear a mask throughout the massage. And, ideally, do all of the above with a massage therapist you know. If you don’t have a practitioner you trust, and you can manage your condition with other measures, it might be better to wait.

“I don’t think this is the time to show up to a random massage place in a strip mall with lots of practitioners,” she says. “I’d recommend seeing a massage therapist you have a relationship with.”

Want to relieve tension at home if you don’t feel comfortable getting a massage yet? Your massage therapist may be able to share at-home self-massage techniques.

Gruver’s favorite method is placing a golf ball under your foot, then gently leaning into the ball so it massages the arch. And to prevent strain associated with excessive sitting, stay hydrated, stretch regularly, and get up about every 50 minutes to shift your posture or walk.

As their clinics reopen in some parts of the country, some acupuncturists are triaging their clients. Elizabeth Sommers, PhD, MPH, a senior acupuncturist and researcher at the Integrative Medicine and Health Disparities Program within the Family Medicine Department at Boston Medical Center, says a practitioner might recommend in-person care for patients who can’t manage conditions with telehealth. For example, patients with chemotherapy side effects or someone recovering from surgery would receive higher priority than someone with a headache.

Other acupuncturists are open to seeing people who don’t have an urgent need. Elizabeth Martin, a New York-based acupuncturist, says most acupuncturists follow CDC and state guidelines like prescreening patients for symptoms, both parties wearing masks, and properly disinfecting surfaces. As for the actual therapy: Martin says practitioners wash their hands frequently and only touch the shaft of prepacked, sterilized needles. They also wipe down the surface of a person’s skin with 70% isopropyl alcohol before penetrating with the needle.

With these protocols in place, the risk of receiving care could have a positive payoff. She says acupuncture and nutritional recommendations from practitioners can help strengthen the immune system.

Receiving acupuncture may also keep patients out of the emergency room, which in turn lowers the risk for contracting Covid-19; studies show acupuncture can manage pain enough to keep people from needing drugs.

“I feel like I’m helping flatten the curve by providing care for patients by keeping them out of the hospital,” Martin says. “That way, doctors can focus on the people who are really sick.”

If you have a condition like chronic pain or headaches that you can partially manage at home, your provider might suggest waiting to visit the office. Sommers says an acupuncture practitioner can use telehealth to guide through acupressure, a type of self-massage that can mimic the effects of acupuncture.

How does that work? Martin recommends a stress- and anxiety-relieving spot between the eyebrows, an inch above the top of the nose. Press firmly with your index finger on the point where you feel tenderness and take five to 10 deep breaths. Then, pat yourself on the back: You’ve just practiced stress-reducing self-care, which can only benefit your health. “There’s so much we can do in the treatment room, but what you’re doing at home is also going to help facilitate healing,” says Martin.