In general, most massage therapists have had little experience working with clients with physical disabilities, especially spinal cord injury (SCI). However, with a commitment to communicate openly with your client and being knowledgeable about clinical applications of massage, working with this population can be incredibly rewarding.

The most important advice is to work from a well-grounded, non-judgmental position and with an open heart. Feel at ease to ask your client questions that relate to the massage that you wish to perform.

Questions concerning how the client was injured are appropriate if the client is a recent injury or if they relate specifically to the symptoms directly associated with their injury site. However, accident history is probably not relevant to treat many conditions, for example, an overuse syndrome of the shoulder. A few common questions and issues are noted below:

·        Ask your client if they need assistance getting on the table. Many times it is not necessary to change the table height. If your client is paralyzed, ask them about their sensation level and movement ability. This can vary considerably.  For example, some individuals have intact sensation and impaired movement while the converse is sometimes true for others.

·        Ask your client if they would like their full body worked. Although some clients would prefer massage only where they can experience sensation, others enjoy and appreciate the benefit of a full-body massage. Educate your client about the benefit of movement and massage over paralyzed limbs, yet at the same time, respect their decision.

·        Bolster, Bolster, Bolster. Tell the client you will be placing a bolster under knees or ankles and then ask if it would be all right to lift their legs.

·        Spasticity may be stimulated by passively moving joints, moving linens over the skin, light touch, or when the client turns over on the table. Ask the client if there is anything you can do. If there is, they will usually let you know. Compression often works well. Avoid quick movements.

·        When the client is bolstered or in a prone position, be aware of colostomy bags, catheters or leg bags. A drainage constriction may allow urine to back into the kidneys, a potential life-threatening situation.

·        Encourage water intake especially if working paralyzed limbs that have been immobile for some time. Cellular debris, metabolites and inorganic substances will all be mobilized.

·        Observe your client’s posture. Pectoralis work, anterior shoulder compartment, intercoastals and abdominals can open up the front of the body with tremendous results. Educate your client in stretches for these areas. Remember: lengthen, then strengthen.”

·        If you know ahead of time that your client uses a wheelchair and you do not have an accessible bathroom in your office, inform them ahead of time. Measuring your door width will also be helpful.

Authors: This article was adapted from an insert appearing in an article appearing in Massage and Bodywork, February/March 2000 authored by Laurance Johnston and Lynn St. Denis. Lynn St. Denis, a massage therapist and occupational therapist, practices in Boulder at the Center for Integrative Therapies and is on the faculty at the Boulder College of Massage Therapy.

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