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
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
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
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
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
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