Pain & Injury on January 18th, 2011 No Comments

Have you ever doubted your intuition and second -guessed your decision, even though you had an inner knowing to trust your gut?  In today’s litigious society most human beings, no matter how knowledgeable or skilled, sometimes question the validity of decisions they make. In my 22 years of practice as a massage therapist and teacher, there had never been a time when I encountered a circumstance that, in my mind, involved a life or death situation needing prompt action. But a recent incident woke me up and caused me to stop and reflect on the importance of acting on the knowledge and instincts possessed within us all.

My client Matt is an extremely athletic male of 36.  Over the last months, I had been treating specific areas of concern relating to a herniated disc issue, as well as concentrating on various chronically stressed musculature due to his active lifestyle.
On this particular day, Matt came to my office insisting that I look at his “gigantic swelled up calf,” which he described only as feeling “tight.”  He was not upset by this, but almost proud to exhibit this unusual phenomenon.   He couldn’t figure out why it was so uncomfortably swollen, though he did not complain of any discernible pain.  His right calf showed all the classic symptoms of severe inflammation.  When I questioned him about any apparent injury to that lower posterior leg in the last few days, he explained that he could not remember any assault that could account for this present condition.  I became suspicious.

Matt had a session with his trainer that day, who thought the symptoms might be related to an inflamed sciatic nerve as a result of the disc involvement.  The trainer instructed him to stretch the calf and use a styrofoam roller to try to “work out the tightness.”  Upon hearing this story, my mind raced with anxiety, as I had a gut feeling that what I was dealing with here was not what his trainer had indicated.  Though I didn’t want to sound alarmed, I relayed my concern that it might be something else.

When Matt requested that I work on his calf (to work out the tension), my voice became uncharacteristically stern and nervous, as I gave my emphatic negative response.  When he asked me what I thought it was, I explained to him, as diplomatically as I could, that it was not within my scope of practice to diagnose any pathology.  As a massage therapist, it is my obligation to assess the musculoskeletal condition and determine if massage is indicated or contraindicated.

I silently thought things through.  What I knew was that blood clots are often in the calf location and may appear to have redness, swelling, heat and pain, though I also understood that sometimes there are no symptoms.  I knew there had been no previously known injury to warrant the obvious signs of inflammation.  Also in my awareness was the fact that a lodged blood clot was a medical emergency and that one out of three embolisms (traveling blood clots) that are not diagnosed or treated will lead to death.   I weighed my next words with caution and told him the seriousness of the matter if, in fact, the problem was a blood clot.

The self-doubting began.  What if I am wrong about this, maybe hastily overreacting and upsetting my client needlessly?   Do I risk looking like a fool if the client goes to the hospital now, tells his doctor that his massage therapist suspects an embolism, and it turns out to be nothing at all?  On the other hand, if I withheld information from him, massaged the affected area, and something catastrophic were to happen to him afterward, how would I feel then (not to mention a possible lawsuit)? With so much at stake and acting on the courage of my convictions, I told him that if he were my family member, I would insist that he go to the hospital now to make sure that it wasn’t the worst- a blood clot.  Extremely shaken by my words yet trusting my judgment, he promised me that he would stop at the hospital on his way home and get it checked out.  I asked that he keep me informed.

That was a Friday, and my concern lasted through that day and the next.   With no word by Saturday evening, I made the assumption that my fears had been unwarranted, and reassured myself that it was better to be safe than sorry.   Returning home on Sunday evening, however, I found a message from Matt on my machine.  He reported that I had scared him into stopping in the emergency room after leaving my office.  He was diagnosed with a serious life-threatening pulmonary embolism condition, and had been hospitalized ever since that Friday afternoon.   He went on to say that his admitting physician had told him that the advice I had given him had saved his life.  His condition had been such that he might have died had he waited to seek timely emergency care.

We massage therapists at times don’t give ourselves credit for what we know about the body, both scientifically and intuitively.  We can sometimes see and palpate abnormalities that can be overlooked by other healthcare practitioners.  We can share beneficial information and suggestions, and provide a valuable service to our clients. As children we’re taught to STOP, LOOK, AND LISTEN before crossing a street.  As professional massage therapists we’re wise to heed the same advice when we recognize the signs and symptoms of various pathologies that may be contraindicated for massage, and need immediate attention. STOP to notice the warning signs, LOOK at the evidence presented, LISTEN closely to what has been said and, trust your insticts!

Gaye Franklin, NCBTMB, has been a massage therapist and instructor for over 20 years and continues her private practice in Boulder, Colorado.


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