Header for Alicia Mutch | Poppies Reaching Towards the Sky | Hypnotherapy and Massage Therapy | Healdsburg, California

Receiving Massage Therapy after COVID-19

Massage after COVID-19The Omicron wave of COVID-19 in the spring impacted so many people that an estimated 70% of the population has caught it now in one form or another (here’s an article on WebMD with that information). Ok, so you’ve just recovered from a COVID-19 infection. Maybe it was mild, like the sniffles. Maybe you felt terrible for several days and you’re feeling better now. Either way, you’re ready to schedule your next therapeutic massage. So, when is it safe to receive a massage after COVID? Based on what we know about COVID-19 and how it impacts the body, even in the mildest cases, a conservative approach is to wait a full 90 days after you recover to schedule your next massage. Wait, what? 90 days???!!!! I know, that’s three months. It seems like a long time, doesn’t it? Well, bear with me while I explain the reasoning.

COVID-19 Increases Your Risk of Heart Damage

COVID-19 has been shown to have an inflammatory effect on the heart, even in mild cases. Actually, it impacts all of the organs, but for the sake of massage, I’m most concerned about the heart and the blood vessels. In an article published in Nature Medicine on September 5, 2022 and titled, “Long-term cardiac pathology in individuals with mild initial COVID-19 illness,” 73% of the 346 participants in the study who had contracted mild COVID-19 reported cardiac symptoms that weren’t present before their illness. 38% had mild cardiac symptoms, 33% had moderate symptoms, and 3% had severe symptoms. These symptoms included shortness of breath, heart palpitations, atypical chest pain, and fainting. Anywhere between 274 and 383 days later, cardiac symptoms were still present in 57% of the participants. Yikes!

Here’s another research study published in Nature Medicine on February 7, 2022 and titled: “Long-term cardiovascular outcomes of COVID-19.” This was a research study conducted by the US Department of Veterans Affairs. The participants in the study suffered from mild to severe COVID-19 infections, and the abstract of the study states that: “Our results provide evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial.”

Why does this matter for massage? Well, an hour Swedish massage has the same impact on the circulatory system as going on a 5-mile hike. It moves blood and lymph from the extremities back up to the heart very effectively. If I were concerned about possible heart damage, I wouldn’t go on a 5-mile hike and I would certainly avoid a full-body massage for a while. You want your heart muscle to rest and recover after COVID. And your heart and other organs could take up to a year to heal. Take your time returning to activities that will place a greater workload on your cardiovascular system. No massage therapist wants to be the one with a client experiencing a heart attack on their massage table. That would suck.

COVID-19 Increases Your Risk of Stroke

Here’s the other scary bit. Having a mild case of COVID-19 (meaning, you weren’t hospitalized) increases your risk of blood clotting disorders. On page 16 of the Washington State Massage Therapy Association’s Interim Guidance on Practice Guidelines, it states that “blood clotting can occur in people over 30 days past the point of when they were deemed COVID-19 free and can cause a stroke, heart attack, pulmonary embolism or thrombosis anywhere in the circulatory system.”

Here’s an article from WebMD about blood clots with mild COVID-19 cases. Those post-COVID blood clots could be lurking anywhere in your body after a COVID-19 infection. They might be silent, with no symptoms. You have the greatest risk of throwing a blood clot for the first three months after your COVID-19 infection. That’s where the 90-day massage avoidance recommendation comes in. Yes, you can throw a clot for up to a year after the COVID-19 infection, but the risk diminishes the further away you get from the illness.

The areas of the body where a massage therapist is most likely to loosen blood clots include the legs, arms, armpits, and iliopsoas region (read this for more information about the psoas).While we’re still having COVID surges, a massage therapist should be cautious around those regions and avoid deep tissue work for post-COVID clients.

Symptoms of a Possible Blood Clot in a Vein or Artery

Before you schedule that massage, pay attention to your body. The most common symptoms of a blood clot in a leg or arm vein are swelling or cramping, pain, warmth, and change of color in the area that contains the clot. You might also experience itchiness or notice a skin rash in that area. And you might not notice any symptoms at all. Deep vein thrombosis can be a silent killer. Let your massage therapist and also your doctor know if you notice any of those symptoms.

This article from WebMD is incredibly informative about all the possible symptoms of blood clots that could be anywhere in the body, not just the arms and legs.

Recommendations for Massage Therapy After COVID-19

Some of these recommendations were taken from page 22 of the Washington State Massage Therapy Association’s Interim Guidance on Practice Guidelines. Others are common sense. My hope is that both massage therapists and massage clients will read this and increase their awareness and mindfulness around post-COVID massage therapy.

  1. Wait for at least 90 days after recovering from COVID-19 before you schedule a full body massage. If you’re experiencing any cardiac symptoms, go see your doctor. You’ll need a doctor’s clearance before you get that massage. And the cardiac symptoms need to be resolved.
  2. If you can’t wait 90 days for your next massage because of injuries, surgeries, or chronic pain, here’s what you can do:
    1. Spot massage treatments here and there are ok. Just avoid full body massage.
    2. Especially avoid receiving deep massage on the legs, arms, armpits, psoas and neck (where the risk of throwing a clot is the highest).
    3. Energy work, like Reiki, is fine. And lighter massage on the arms and legs and neck should be fine, too.
  3. If you’re a massage therapist, treat all post-COVID massage clients with caution, and act like every single one of them has a hidden blood clot that you might dislodge with the work you’re doing.

Here’s to your health and continued well-being! I know that this is an uncomfortable and scary topic (and I don’t want to scare you away from massage!), but knowledge is power. And therapeutic massage has incredible benefits that accelerate your healing and alleviate stress (here are the top 10 benefits of massage). We’re all doing the best we can to return to a sense of normalcy after this pandemic. Let’s do it mindfully.

Massage Therapy and Vaccinations

Vaccinations and Massage TherapySo, you just received your annual flu vaccination or your COVID-19 booster shot. Now what? When is it safe to get your next full body therapeutic massage? I have some thoughts about it that I’d like to share with you. First of all, plan on getting a massage BEFORE your vaccine, rather than right afterwards. A day or two beforehand is great. This will stimulate your immune system and set you up well for your body’s response to the vaccine. Next, please avoid massage for about two days after a flu vaccine and nine days after receiving a shingles or COVID-19 vaccination. I made up that number. You won’t find it online. I looked. But here’s where I got it. The Center for Disease Control (CDC) states that side effects for the COVID-19 vaccine show up within seven days. I added two days to make sure your massage is well out of the side effect time period. Read an overview of COVID-19 Vaccinations here.

Don’t Get a Massage Right After Your Vaccine

Over the years, I’ve had numerous clients show up for their massage appointments and announce that they just stopped by the pharmacy to get a vaccination right before coming in to see me. For each of them, I apologize and ask them to reschedule their massage. This issue is becoming more and more prevalent as we’re stepping into both flu season AND the beginning of the next COVID-19 surge. When you receive a vaccine, your body perceives the contents of the vaccine as an invader and mounts an immune response. The more robust the response, the more your body is producing antibodies against the illness. It can take a few weeks for your body to make all of the T-lymphocytes and B-lymphocytes needed to fight off an illness. Right after a vaccine, treat your body as if you have the illness you’ve been vaccinated against. Keep in mind that an hour Swedish massage has the same effect on your circulatory system as going on a five-mile hike. Massage moves a lot of blood and lymph around the body! If you had the flu, would you go out and get a massage? I hope not! Here’s an article from the Center for Disease Control on how vaccines work in the body.

Don’t Get a Massage While You’re Having Negative Symptoms from a Vaccine

Ruth Werner is a highly respected massage professional who wrote “A Massage Therapist’s Guide to Pathology.” In an article she wrote for the Associated Bodywork and Massage Professionals (ABMP) on January 1, 2021, she recommends waiting at least two days after each COVID-19 vaccine injection to make sure you don’t have a negative reaction to the vaccine before receiving massage. If you have a negative reaction to the vaccine, wait until your symptoms are gone before you get the massage. Read the entire article here. I prefer to err on the conservative side, which is why I added an extra week to her recommendation.

Wait Until Your Risk of Blood Clots Has Decreased

The Johnson & Johnson and AstraZeneca COVID-19 vaccines have a window of time for four to twenty-eight days after the vaccination where a very small percentage of people develop blood clots (vaccine-inducted thrombotic thrombocytopenia). Read the article here. Although this risk is very small, massage increases your risk of throwing a blood clot within than twenty-eight day time window. I definitely don’t want to be the massage therapist that sends you to the emergency room. So, if you’re using the Johnson & Johnson COVID-19 vaccine, please delay your next therapeutic massage for twenty-eight days.

Massage Can Slow Down Your Immune Response to Vaccines

It’s really hard to find research studies on vaccinations and massage! But here’s one I found on PubMed. A 2012 research study looked at massage therapy and antibody responses to a Hepatitis B vaccination. In the study, the group receiving the massages after the vaccine had a lower antibody response to the vaccine than the control group. Since we really want the vaccinations to kick up our antibody responses to the illness, it appears from this study that massage interferes with antibody production. Since we want a robust immune response to vaccines, this study seems to indicate that delaying massage after vaccines is beneficial. Read the PubMed article here.

In Conclusion

If you choose to get vaccinated, go get your vaccine! Schedule your regular massage for a day or two before your vaccine and then avoid massage for two days (after a flu shot) to nine days (after a COVID-19 vaccine) afterwards. While you’re waiting for your body to mount an immune response to the vaccine, take great care of yourself. Drink plenty of water. Ice your arm, massage the injection site lightly and make sure you’re moving that arm around. Get plenty of rest. Avoid hard core, strenuous exercise for a few days. And then schedule your next therapeutic massage.

Here are 9 things to do after receiving your COVID-19 vaccine



The Iliopsoas Muscle — an Under-Appreciated Cause of Low Back Pain

Low Back Pain — The Three-Dimensional Picture

Iliopsoas MuscleI would estimate that seventy percent of the clients who seek me out for massage have low back pain as either a main or secondary complaint. Maybe they’ve injured themselves or maybe they’re just getting older and experiencing their bodies breaking down slowly. If I just work on their low backs and hips, I’m not getting at the whole picture. You see, we live in a three-dimensional body. The low back has a front, two sides, and a back to it. Most massage therapists work on the back of the low back and hope for the best. But let’s look at the front of the low back.

The Iliopsoas

Meet the iliopsoas – a two-part muscle made up of the psoas major and iliacus muscles. It lives in the front of the back on both the right and left sides of the body. The psoas major originates between the last thoracic vertebra and every single lumbar vertebra. The iliacus begins in the front of your pelvic bone. Both of them weave together at your hip and attach to the front inside of your upper leg. The iliopsoas is a powerful hip flexor, meaning that it helps you bend over to tie your shoes or bring your knee up to your chest. However, when it’s tight, it pulls down and forward on your low back vertebrae, making them feel tighter and tighter, until you’re walking around with a chronic low back ache and a feeling like you’re wearing a belt of tightness and pain around your waist. How does it get tight? Oh, the usual things that we do way too much of: sitting in front of a computer, sitting and watching tv, and more sitting in the car. The iliopsoas hates couch (and desk) potatoes.

Massage Techniques for the Psoas

Psoas massage is an advanced technique. If you’re looking for this for yourself, seek out an orthopedic massage therapist or a physical therapist. I sink right down into the abdomen when I massage the psoas. The intestines and mesentery move reflexively out of the way, so I don’t worry about compressing them. There are some serious endangerment points, like the aorta, the vena cava, the colon and the ovaries, so you shouldn’t do this on yourself. I’ll do a combination of cross fiber friction and pin and stretch technique along the length of the right and left psoas, as well as trigger point massage and pin and stretch technique on the right and left iliacus. Then I ask my client to straighten their legs fully on the table and tell me how their low back feels. Iliopsoas massage done well should make the low back feel like it has relaxed. The low back curve will be straighter and you will actually get the feeling that your low back has dropped down and is contacting the massage table more. For clients with chronic low back pain, the lengthening and straightening of their lumbar spine can feel like a miracle and give incredible pain relief. Results can be long-lasting, but unless you stop your sedentary lifestyle, the iliopsoas will generally tighten right back up again.

A Visual Description of the Psoas

Here is a great descriptive video of the iliopsoas from Kenhub:

For more information on the iliopsoas, here is another helpful link from Dr. Christiane Northrup’s website:

Why Your Psoas Muscle Is The Most Vital Muscle in Your Body, by Christiane Northrup, M.D.

Therapeutic Massage – the Top 10 Benefits

Foot MassageFace it, some of us have a hard time justifying splurging on the expense of a massage. The cost of living can be extremely challenging right now, and many people are holding out for special occasions like birthdays to receive a massage. Since an hour massage runs anywhere from $60 to $150, many of us can think of many other ways to spend that money. Rather than thinking of massage as a luxury, I invite you to think of it as an investment in your health. How often does your body need a tune-up? Once a month? Twice a month? Once a quarter? Think about what your body needs and schedule some sessions for yourself.

Top 10 Benefits of Receiving Regular Massage:

  1. Reduces or eliminates pain and muscle tension from chronic or recent injuries
  2. Reduces stress and fatigue
  3. Alleviates headaches and lowers the need for migraine medication
  4. Accelerates your recovery from muscle injuries and surgeries
  5. Improves poor posture
  6. Increases joint flexibility and muscle range of motion
  7. Increases circulation and lowers blood pressure
  8. Improves immune system function
  9. Alleviates symptoms of depression
  10. Enhances attentiveness and focus

For more information on the scientific research being conducted on the benefits of massage, visit the website for the Touch Research Institute.

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