part0011

A s with an aging vehicle, parts of our body deteriorate over the years. Some parts can be replaced, some can be supported or made to last longer, some can be removed. But eventually all actions lead to the same place. For therapists and caregivers, it is important to know how replacement parts, drugs, supports, and removal of poorly functioning parts affect our clients and our work.

For example, a massage customer comes in who has had an organ transplant. To avoid rejecting that organ or having that organ reject him, he is given drugs that suppress the immune system. It is vital to know which organ, how long ago the transplant was, how heavy a drug regimen he is now on, and what drugs they are. Ideally you should not work on him if his surgery is recent, unless you are very familiar with the procedure and the aftereffects your client may experience.

As with all sections of SPIRIT, “Physical Issues and Pathologies” is designed to bring up discussion questions for learning beyond what is presented here. Finding others who are as curious as you offers potential partnerships and growth opportunities. Learning from and working with others can build relationships and memories that last a lifetime.

Physical issues experienced by seniors—the surgeries, the medications, old injuries, etc.—are all things you need to know. Older bodies have decades of history that can affect both your client and your work.

Use interview forms for medical information where possible. Some clients will be able to fill out their own. For others, you will have to interview them personally and record the information. Nursing staff or family members may be able to help if the client cannot. Get the answers where you can.

If the client fills in the form, question anything you are unsure about, and don’t be afraid to ask for more information when needed. Don’t be too surprised if the person cannot answer your queries themselves; many older people let their doctor handle their health matters and do not question the professional diagnosis. I have worked with many seniors with osteoporosis, yet I cannot recall even one who knew how bad their bones really were. Some are just over the line from osteopenia, while others may have severe osteoporosis. The more severe the case, the more careful we must be when working on the person. But you need to know, so you may need to contact the doctor for clarification.

If your work with the client requires any disrobing, observe their body. Seniors often forget about older injuries or surgeries. You may see scarring or other oddities and discover more history. Pacemakers are often not disclosed. Some clients have forgotten to mention it when asked about general health concerns.

I had a client who wanted work on her stomach. I felt several hard lumps under the skin, one of which was visible and somewhat discolored. A bit of detective work was done, and I learned it was safe to work on them. She had been getting frequent shots in her abdomen, and scar tissue had developed at those sites. Memory issues kept her from recalling that information, but her facility nurse knew her history.

Family members may be able to fill in some of the information you need. Ask politely. You may have to educate some people on why you need the information. Many don’t understand the interplay of massage and the body’s many functions.

Make friends with the nurses at each facility you work with. They can answer many questions if you respect their time and the limits on what they can tell you. And, as an aside, many nurses also get massages. They can be a good referral source.

I got a call from a new client one day. He wanted deep tissue work and had been referred to me. Pain had him desperate. I made an appointment with him to go see what I could do to help. Once I learned a bit about his health, I told him never to ask for deep tissue work from a therapist. He has chronic obstructive pulmonary disorder and is on the blood thinner warfarin, which was originally a rat poison that makes rodents bleed out internally and die. His weakened, leaky circulation pathways would have been a dangerous combination with deep tissue massage work. Clients don’t always know what they need or can handle safely. You are the expert. You must make the appropriate call for the safety of the client and your practice.

Say you get a call from a potential client with conditions you know nothing about. Just saying yes because you need the money could prove problematic. So, what do you do? Your goal is to make both of you comfortable. To help with that, you will need more information. Ask questions about the client’s conditions and how they affect her life. Has she had other massage work? How long ago? Were any special accommodations necessary at the time? What medications is she taking?

You may also need a doctor’s release for a massage, and that may take roughly a week to obtain. During that period, learn more about the client’s conditions. Search engines and YouTube can be helpful for gaining information about safe massages for various conditions, as can your massage association website.

Most potential customers and their caretakers will appreciate your caution and your desire to do right by them while protecting yourself. There will be those few who don’t understand. Try to explain, but don’t be afraid to let them go if they object to your requests. You don’t want to be the person they eventually sue. Remember that you are there to provide both comfort and safety to all concerned. Do what you have to do to meet that goal. And remember that you are the expert in massage. You are responsible for your choices. Assess the situation, gather the information that you can, and make your decision to go ahead or to end your relationship with that potential client.

A while ago, I had a client who was obese and had lower back scoliosis. She was difficult and bossy. On my last day with her, I was working on her back; she was in a seated position. She was unhappy and felt I should do more to help her. Then, in front of the cleaning staff, I found out why when she suddenly came out and asked me how many more sessions it would take to fix her. I told her it wasn’t my job to fix her; it was my job to make her more comfortable in her condition. I also explained that I could not fix scoliosis. That is when she started yelling at me. She had very unrealistic expectations, and when she found that I couldn’t meet them, she was upset. She told me she would instead go to the Chinese group in town. I was okay with that change because I knew I wasn’t coming back. But knowing that this group has a barrier due to communication and language and had harmed another of my clients because they didn’t know what they were treating, I had my doubts that they would please her. I haven’t seen or heard from her since.

Think about your body and the changes it has already undergone. If you are under thirty, you may not have experienced much painful change. But right around this age, we lose a large number of our systemic enzymes, and aging begins in earnest.

Older people need more assistance to make them comfortable, not only on your table, but with you. Empathy and thoughtfulness are a start and an art. Drawing from your own experiences with pain and suffering can help make you more aware of what you are doing and how you are doing it with your client.

Heat can be particularly important. Blood circulation in seniors is often compromised as activity slows. Blood thickens with fibrin, and circulation is impaired. Warmth can relax tight muscles and allow blood flow, which eases pain.

If you have ever been in some elders’ homes, the thermostat is set at seventy-five degrees or higher. If they have fibromyalgia or myofascial pain syndrome, the heat range can be in the eighties or nineties. These individuals will also likely dress in layers.

When working with these conditions, be ready to sweat to keep your customers warm. On your table, seniors are still and can get cold quickly; you will need to adjust heat to the individual’s comfort level. Once you know the person’s temperature preference, you can be ready to delight them.

Some seniors like their massages with several small heated pads or one larger one. When I can, I use Hot Cherry Pillows heated in the microwave. My fibromyalgia client loves that. You can find more information at https://www.hotcherrypillows.com/ . I put it on her lower back and give pressure through the warm pad to painful or uncomfortable areas. It helps keep her warm and keeps her thermostat down. It is also great for winter days when my hands may not be warm enough to start a comfortable massage.

Older bones love warmth and may also need special supports. Headrests may have to be adjusted for hyper kyphosis, more commonly known as hunchback. Small pillows may help support and separate knees in side-lying positions. This separation may also help eliminate hip pain while they’re on their side.

Clients may have fallen and have recently had a cast, or they may have had surgery and are still healing. Injuries, old and new, can be anywhere on the body and may require some extra thought and support while receiving massage work. During the massage, don’t forget to ask them about their comfort and what more might they need.

If a client is on their bed for the massage, before I begin, I ask them to get comfortable in a position that allows me to access the area we’ve decided to work on. One lady prefers to lie on her stomach while I work on her back and legs. She looks uncomfortable, but invariably she purrs before she falls asleep.

Seniors need to be heard. They have lived in their bodies, they know where it hurts, and they often know what it needs to feel better. Some have no one to converse with them, so your one-on-one time may be their chance to tell their story. Listening is part of the partnership.

Mobility devices help our seniors get around and do more things with less risk of falling. But using them can cause additional issues that massage therapists will see and feel. Sometimes, caregivers can help clients between sessions use the devices correctly, but that help isn’t always available.

Canes can help stabilize a weak gait, but you’ll see the whole body lean to the side on which the cane is used. This can compact the muscles down the entire length of the body on that side, while the opposite side is overstretched. The gait is off, so the proper alignment of muscles is also off, and compensatory patterns flourish. Cane usage causes wrist and shoulder issues as well. A cane should ideally be adjusted to the person’s height, but sometimes people buy canes and use them without a proper adjustment. They don’t know they need adjustment, let alone how to do it. The top of the cane should come to the person’s wrist when they stand tall and relaxed. The handles on walkers should do the same and meet the person comfortably at the wrist.

Both devices are meant to support an upright body, whether standing or in motion. If the cane or walker is too short, the person leans on the device more than necessary. Too high an adjustment doesn’t support well and can cause damage to the arm and shoulder. Personally, I once left a hospital with crutches that were never adjusted to my body, and I fell constantly until I got a walker instead.

If your client is looking for a mobility device for walking, encourage them to ask the store if they will adjust the device appropriately. Many stores send clients out with no adjustment, and the client, unaware of the necessity, uses it “as is.”

One of my clients, a very tall woman, bought a walker, and the store sent her home with one that only fit my shorter frame at its highest possible adjustment. She was almost doubled over the walker. I was appalled. She and I did research to find one that would fit her larger build, and we found a good one that was more suited to her needs.

Walkers, if height-adjustable, often aren’t adjusted. People end up leaning or bending into the handles. Problems that weren’t there before begin to emerge. Shoulders round, necks protrude and descend, and posture may never be recovered. Back muscles get stretched too tightly. Front muscles get contracted, and pain is the result. Over time, this forward contracture will impede organ function. This may be preferable to complete immobility, but it is possible to avoid many of these complications.

Electric wheelchairs and scooters are a necessity for many seniors. That may be the method they need to be as independent as possible. However, muscles and joints still need to be moved, and blood needs to pump. Sitting in chairs, wheelchairs, and scooters accomplishes little movement. But there are options. Vibration machines can assist in leg muscle relaxation. Massage and physical therapy can help loosen compensation patterns and get the body the movement it craves.

Posture is so critical to the comfortable aging of the body. Bones should be in their proper place, aligned, and joined correctly to their joints. Good posture begins with the feet and travels up the body. We are meant to stand erect with our head held high.

But poor posture deforms the body. Joints meet their bones out of position, which causes wear and loss of function. The muscles attached to those bones are then forced to work with weakened skeletal support. This resultant poor posture cannot support the body’s health as a whole. Posture is especially important to overall stability, range of motion, and strength.

All it takes is one wrong move, and a healthy senior can fall. For some, this is the end of self-propulsion and the beginning of device use. Emotionally, it can mean a loss of confidence and a fear of moving without assistance. Have you seen those seniors who constantly look down at the ground while they walk? Chances are they have fallen before and now are scared to take each and every step. This downward-facing posture wears down the skeleton, especially in the neck.

Loss of the ability to transport one’s own body can be a sign pointing toward life’s end. There are many markers that tell an elder that time is closing in on them. Be understanding of the fear and anxiety that may come with this loss.

Referrals are just as much a part of your work with senior clients as with anyone else. Even in my work with Alzheimer’s patients, I have often requested they get physical therapy or passed on to caregivers symptomatology that might need attention by a doctor or nurse.

I may suggest to more cognizant clients that they might want to talk to their doctor about questionable growths or moles, wounds, or bites that seem to be inflamed or slow to heal. One client told me he has fibromyalgia, but we talked often about the potentially different diagnoses of myofascial pain syndrome and why I thought his condition should be reassessed. To date, that hasn’t happened; I don’t expect it ever will. But the client, a nurse, and a supervisor at his residency home all know what I suggest and my reasoning behind it, so I have done all I can do.

I also refer clients to take yoga or tai chi, or swimming classes, to chiropractors or nutritional advisors, or for some additional testing—and to an endless number of specialists. Like with my previous example, I don’t expect that anything will be done, but I know I have done my job. It is always a pleasant surprise when someone does try something you have suggested.

Few chiropractors will work with the elderly, but there are a few. The weaker the bones, the less can be done by chiropractors without additional skill sets. Medicare will pay for up to twelve chiropractic sessions a year. Unfortunately, it is the only alternative therapy Medicare covers. If your seniors have decent bone health, this could be an option for them.

Just as with massage therapists, chiropractors are each a bit different in what they do and how they do it. There are force and nonforce practices. Find them through your professional network. Get to know a few chiropractors of each kind for referral purposes. One client that I am aware of has gone to my referred chiropractor, but I have also referred to osteopaths, naturopaths, dermatologists, and more. I helped catch one patient’s skin cancer through referral years ago.

Seniors face conditions that may be indicators of how much time they have left. But there is only so much we can do to keep human bodies running, and spare parts are seldom an option. Quite often, medications are how many people keep their body going.

Medications are designed to have various effects on the mind or body of the user. Understanding our client’s medication delivery systems and effects can help us modify our sessions for better client safety. Patch delivery systems release their dosage over a certain period through the patient’s skin. Rubbing over a medicated patch can speed up the medication’s absorption, disturbing the intended prescription dosing. Injections and medicinal creams are also subject to an accelerated absorption process if massaged into the body. To be safe, leave these areas alone for twenty-four hours from application, unless you wish to research and understand the half-life of various drugs.

Drugs that lower the response time of the central nervous system, like medications for anxiety or pain, can also delay the pain response during a massage. Be aware of the depth of your work; the central nervous system (CNS) may be unable to alert the client quickly to any pain we may be causing.

It is important to have a general idea of the classifications of drugs, or what they are designed to do and how they do it. The previous example indicates that some drugs for pain and anxiety work on the CNS to slow it down. When you understand just this, you can more easily understand what it means to your massage techniques.

Medications also have side effects. Often, supplemental drugs are prescribed to deal with the side effects of a primary medication. Some supplements and foods interact with drugs and the body’s systems, as do hemp and marijuana products. More information on potential adverse drug events and drug–drug interactions with medical and consumer cannabidiol (CBD) can be found at http://scholar.google.com . You will have to do a search.

Nutritional depletion can also be a consequence of using certain drugs. Greater quantities of medication lead to greater overall health problems. Not many people consider the nutritional depletion of the drugs they take and then use supplements to compensate. There are many resources for further research, including Integrative Rx Pharmacy on the internet.

The best defense is a good offense, and a good offense here is to take excellent care of yourself in order to limit your exposure to medications. Set a good example for your clients. If you must take a medication, know its side effects. Know what it takes from the body and how to replace those nutritional support items. You may even choose to detox after a hospital visit if you take any medications while you are there.

While we are not medical experts, we need to understand as much as we can about our clients, their problems, their solutions, and how to best serve them, whatever their state of health may be. We are here to care for those who honor us with their trust.

Depression is common in seniors, whether it is clinically diagnosed or not. Energy is low. Interest in activities is low. The will to interact is low. Pain can be more intense. Grouchiness is often a result. Social withdrawal is common. And substance abuse often goes hand in hand with all these symptoms of depression.

Remember that massage is a form of self-care. Depressed individuals may be poorly groomed. Their homes may be messy and unkept. You may only see those clients with intermittent mood swings or when they are feeling better, since those with more severe depression may not consider a massage.

Changes in sleeping patterns and appetite can be a sign of depression. Some might lose interest in favorite people and activities and withdraw socially, physically, intellectually, and spiritually. And as seniors stay in a negative cycle, other illnesses can find an opening. Immunity lowers, and recovery time increases.

A massage can help balance moods by influencing an increase of dopamine to the brain. Dopamine serves as a vital messenger to the brain and is critical for motivating behavior. It also helps with body movement. Parkinson’s clients in particular have movement and balance problems partly due to reduced dopamine levels.

Serotonin levels are also affected by massage. Higher levels of serotonin can help with sleep, mood, and behavior—and getting enough sleep can also help stabilize mood and behavior. Serotonin also aids digestion and pain response. Depression can result from lowered levels of this neurotransmitter.

Sometimes, depression manifests as anger turned inward and aimed at the self. Sometimes, someone with depression may lash out at you. Your client may not normally make derogatory comments to you or about you, but they may just surprise you one day. Try not to take it personally. Understand that depressed or depressive people bring their mood to your massage sessions. Their negative thoughts can even negate your efforts to help. If they don’t want to feel better, they won’t. You have no control over how someone feels inside their own skull.

It is said that fibromyalgia is a chicken-and-egg problem. It is unknown which comes first, the depression or the disorder. What is clear, though, is that constant pain can cause mood swings. How would you feel if pain were your constant companion?

Fibromyalgia is basically scar tissue that builds up in muscle tissue, causing pain—fibro-my-algia. Fibro is fibrous (scar) tissue, my(o) is muscle tissue, and algia is pain. Sensitivity to touch is a real phenomenon, and the degree of pain can vary. A very gentle touch is tolerated by some. Others will be able to take and sometimes want more pressure. To break up the scar tissue, more pressure may be necessary, but the pain may be intolerable. Work at the individual’s current threshold, and you may see gradual changes that allow you to work at a deeper level later on.

Fibromyalgia and several similar conditions also have many layers of potentially contributing factors. That is why it can be so difficult to alleviate their suffering. There may be food sensitivities, allergies, bacterial or viral infections, exposure to mold, nutritional needs, etc. all playing a role. Most doctors don’t have time to play detective. Others may still believe the problem is in the patient’s head.

You may also run into the differential diagnosis of myofascial pain syndrome (MPS). With fibromyalgia, pain areas are right under your fingers, but MPS gives referred pain as well as local pain when pressure is applied. As mentioned before, I suspect one client of mine has MPS rather than fibromyalgia. I can touch a point by his spine, and his toe—or some other part—will hurt along with the point touched. For someone with MPS, pressure at one spot is referred to different areas of the body, causing referred pain at a distant point.

Muscle cramps and spasms in legs and feet are somewhat common for seniors. Medications, poor digestion, lack of electrolytes or iron, and lack of magnesium or potassium are just some possible causes. When these spasms occur in my own body, I often use Hyland’s Leg Cramp, a homeopathic solution.

Over the years, muscles are repeatedly repaired with scar tissue. Older adults may have shortened and stiff muscles because they lack the natural systemic enzymes of youth. Joints are in turn affected by shortened muscles and can be pulled out of place, causing them to wear down. Inflammation and pain can result. Stiff, shortened muscles also restrict circulation and nerve conduction. Supplemental systemic enzymes won’t stop this progression but can slow it down by eating away at excess scar tissue. They also work to rid the body of inflammation, another issue that can cause overgrowth of scar tissue and disease. I have taken these supplemental gems for many years.

In my years of practice, I have also run across Dupuytren’s contracture several times. A nodule forms just below the palm knuckles, pulling fingers down toward the palm. In later stages, the shoulders may round, and the side with the contracture becomes severely deformed.

I once had a client that I suspected had this contracture. The doctor had told the family it was arthritis. Knowing that Dupuytren’s is an inherited condition, I asked the family to approach the doctor again. Arthritis was surely a result of the condition, but I didn’t believe it to be the condition itself. The family deserved to know more, since it could one day affect them too.

You don’t have to be a doctor to know how the body works. Tread lightly, as you do not want to be out of your area of expertise but be an advocate for your clients. Tell others what you suspect and why. In this case, I told the family. In another case, it might be a nurse or administrator who needs to know. The client should also be told, of course, especially if they have the awareness to understand.

In general, I spend far more time with a client than their doctor spends with them. I see them in their home environment, listen to their stories, and actually see and spend time with their bodies. This time allow me a different perspective of the person, as does my therapeutic training and experience. I do expect doctors to take my concerns seriously, for the sake of our mutual client without the interference on either side of egos.

Movement of muscles pull on bones and joints. If bones and joints don’t line up as they should, neither do muscles. Muscles can become shortened or lengthened, depending on the posture and alignment of the body. Conditions and diseases that compromise the integrity of muscles or bones can cause problems to both, such as Parkinson’s, osteoporosis, and accidents and injuries. This improper balance, in turn, compromises blood flow and nerve conduction. The body is one unit, but any part of that unit can impair the functioning of the rest in a variety of ways.

Think of your feet as the foundation of your body, the house in which you live. If the foundation isn’t level, the windows and doors won’t fit correctly. In the case of the body, the joints don’t fit together as they should. And that results in muscles that are out of balance throughout the body.

High arches cause muscle shortening up the center of the legs and upper body. The lateral or side muscles of the entire body are stretched too tightly. This muscular torqueing affects joints from the ankle upward, and the joints then pull on the bones.

Pulled out of their correct positions, the joints begin to wear and tear. In high arches, the outer ankle and knee are opened, and the inner knee and ankle are too tightly pressed together. In low arches, the knees are torqued the opposite way. Often, joint replacement is the result, and that comes with its own set of issues.

Low or fallen arches create a similar chain reaction up the body. Muscles are shortened on the lateral sides and stretched too tightly in the center of the body. The arch no longer supports balance. The results are similar for joints as well; the only difference is that the joints are pulled out in the opposite direction than in the high arch scenario.

Many problems affecting balance and stability are at least partly caused by the feet. This stability is aided by proper artificial foot support, but few seniors seem to use foot support systems. There are three arches in the foot, but it is rare that a foot support addresses more than the medial arch. I can tell you from experience that the loss of the metatarsal arch is excruciating. I found supports that work for me and have used them for years now; they took away the pain by supporting all three arches. I used FootSmart.com years ago to help me figure out what was causing my issues and what I might need to do about it. Initially, I couldn’t get the podiatrist to agree to my own diagnosis of Morton’s neuroma, so I fixed it myself with a strategically placed cotton ball covered with a Band-Aid. This worked for several months until I moved to a new area, and I saw another podiatrist who agreed with me. We set about preparing a foot support system.

The need for metatarsal support is crucial. Once that arch has fallen, the foot’s knuckles are no longer separated. In this position and crammed together, the nerves in the area become pinched between the knuckles. Walking adds more pressure to an already overly sensitive area. Foot care companies have begun to realize the importance of supporting the metatarsal arch.

I recently had a client in her nineties who had several accidents when she was younger, which caused her left foot to angle away from her body. Her hip, of course, had been affected too. She walked with a cane, and I was always concerned when I’d see her walk. In each session I would work to bring the muscles nearer to balance, so the foot would not angle off so drastically and cause her hip to hurt in turn. I didn’t want to see her fall. We spoke about the fact that she was in an independent living facility, at the very end of a long hallway, where it was unlikely that anyone would find her if she did fall.

One day I showed up at her residence for her appointment and saw several days’ worth of newspapers at her door. The door was locked, and she didn’t answer my knocking. I knew something had happened. I went downstairs to the receptionist to see if they would give me any information—sometimes they will, and sometimes they won’t. I found out that, indeed, she had fallen in her bathroom, and her son had found her long after the event. She was in the hospital.

This is a perfect example of why posture and feet are so important. She was unable to stand in a fully upright posture. She was unable to walk, as we should, from heel to toe. Her whole body was affected by those old injuries that had never been addressed. I am sure that her sideways foot was her downfall.

Joint replacements have good and not-so-good aspects, like anything unnatural that we introduce into our natural system. For a long time, they gave men and women the same knee replacements. Problems resulted for many women, since the Q-angle from hips to feet of a female is wider. Women, therefore, need a slightly different and smaller knee replacement.

After any joint replacement, the patient must be cautious and do exercises that will get and keep things working again. If these are not done regularly, limited joint mobility is likely to result as the scar tissue builds and binds. Keeping the reattached muscles, ligaments, and tendons mobile can be a challenge for older, less active adults. It is important to remember that scar tissue grows more readily in seniors, and their scar tissue is less pliant. If it isn’t broken early by appropriate activity, scar tissue grows strong enough to limit movement. Some people even grow excess scar tissue both internally and externally.

However, surgery has advanced since I first started writing this book. It is now possible to have a small incision operation that replaces only the malfunctioning part of the knee. That is progress and, I imagine, less downtime for the patient; the more invasive the surgery, the more required healing time. There are also stem cell injections now that, for some, can eliminate the need for surgery altogether.

Recently, I had laparoscopic and robotic surgery on my abdominal area. I expected to be in pain and unable to get around for many days. To my delight and surprise, I was up walking by the next day and never had any pain. I didn’t need the pain pills they prescribed. That was amazing progress since my last surgery decades ago. This time I returned to work in two weeks.

But even the most advanced surgeries cause some scarring. Massage can also help scar tissue alignment. As we age, scar tissue grows with less organization, so we make more, and its fibers are laid down in more randomized patterns. Organized scar tissue lays in one direction and is more flexible than randomly laid scar tissue. Think keloids.

Some people are prone to build up more scar tissue than others. In my experience, I’ve found these people also tend to have more surgeries and thus more scar tissue. They even have surgeries to remove excess scar tissue, which then invites the growth of more scar tissue. It’s an endless cycle.

The problems I have personally seen with joint replacements include limited range of motion, an excessively tight iliotibial band from a knee replacement, and a leg turned outward from hip replacement that can no longer support the body. I’ve also seen a few that have worked well but need to be loosened up often. A current client has had hip replacement work but is still sore to the touch several years later.

Seniors need proper therapy after surgery, or they may end up less mobile than before. As massage therapists, alongside physical therapy or restorative yoga, we can help get them moving again. We can also work with a client’s caregivers so that they have more information on how they can support their clients in our absence.

There are many common bone and joint problems for seniors. Osteoporosis is quite common, especially among older females, but males are not free from the disease. Exaggerated kyphosis or rounded upper back can be a sign of osteoporosis. The spine may be crumbling from the inside, thus rounding the outer structure.

Teeth are bony structures. If teeth are weak, bones may be too. Small-framed women are most at risk for thinning bones and should be tested frequently as they age. Despite the fact that osteoporosis is a very common problem, I have had to ask for every bone test I have had. I even had to ask for one when I broke a bone in my foot. I feel that should have alerted the doctors, since I was over fifty at the time. About a year before that, I had to have more dental work than ever before.

Arthritis and bursitis are frequent pain generators in seniors. Arthritis simply means a swollen joint. Bursitis is swollen, inflamed bursa sacs inside the joint. Modern diets can lead to system-wide inflammation, and inflammation equals pain. You can help by informing your clients of anti-inflammation diets that can help them. They are likely eating a large portion of highly acidic foods. Give them the information, but then let go of the results. You only control yourself.

Did you know that there are over one hundred kinds of arthritis? Rheumatoid and similar kinds are autoimmune disorders. Like fibromyalgia, these are multicausal ailments, some with an inheritable factor. Osteoarthritis is a quite common form. It is considered a wear-and-tear inflammation of the joints. These two forms alone have very different causes and treatments. Now you have approximately ninety-eight more to research.

Poor arches, as discussed before, cause misaligned joints, joint wear, and their deterioration, then may require replacement. Other compensating body patterns pull joints into painful positions, as can simple habits of poor posture.

My mother had multiple myeloma, or bone cancer. But she still got massages. Knowing how easy it was for her to simply turn in her bed and break a toe, I would guess the work was done very lightly. Years later, I had a chance to work with another lady suffering this same bone-eating disease. I loved that I could do for her what I couldn’t do for my mother, since we lived in different states.

Years after my work with this lady, someone came up to me almost glowing. When she told me who she was, I almost cried. My multiple myeloma client had had stem cell treatments and was now well and healthy. My mother didn’t get that chance.

We do have some control over how our bodies age. We must do all we can to avoid the ravages brought on by our own ignorance or poor choices. Leading by example, again, is not only good for us, but good for those around us. I have been in a longevity study, and before that, I had my DNA tested, so I could know more about my body. I went beyond that original test and sent the DNA results for a nutritional analysis. It was very interesting information. The more you know, the more you can plan for your health as you age.

Extremities are usually the first to show these signs of aging, as our collagen production declines. Thinning skin means more caution during massage work, so we do not tear the fragile surface. In my experience, I have met only a few whose skin was delicate enough to require close monitoring. But then again, I know how I work. I have not torn any skin and have no wish to do so.

Bruising or bleeding under the skin may be present because of blood thinning drugs, such as warfarin, more commonly known as Coumadin, or because of falls or bumps, or both. If a senior falls while taking blood thinners, the bruising can be substantial. The blood, so thinned by the drugs, has little viscosity and leaks through the walls of the vessels, and it stays there until the body reabsorbs it. Any areas of bruising should be avoided until they heal. With aging, our blood vessels also become less sturdy over time, and they also require collagen to stay strong. (I put collagen in my coffee at home: it has no taste and dissolves completely.)

Keratosis looks something like a mole that has blossomed into a big wart. It is raised, brownish, and feels rough as you glide over it. Don’t worry. Keratosis is not contagious, but it is hereditary in nature. Where there is one, there will usually be several. Massaging over these areas takes a bit of getting used to as you go from smooth to scratchy, or from rough to smooth again.

Moles need a close eye. You may be the one who catches a potentially cancerous one and refers the client to a doctor to have it checked out. How many people can see their own backs? If it doesn’t look right, alert someone so that they can get checked out by their doctor.

Sometimes you will see raised scar tissue or keloids. This is where scar tissue building has gone a bit overboard. Systemic enzymes can reduce the excess over time, leaving a more normal-looking area.

Skin tags are small bumps on various areas of the body that usually have the same coloring as the skin. They are generally harmless. Some will fall away in time, but most stick around unless the person chooses to have them removed.

Although not exactly a skin condition, toenail fungus is quite common in the elderly. The nails are chalky white or yellow-tinged and often have a rough look to them. They tend to be thicker than normal nails and can have a smell. This is a fungal infection. I have seen this condition on all the toes on some clients.

I had this on both big toes in my fifties. The right nail fell off eventually and grew back to normal. The left stayed infected for several years. I began bathing in eucalyptus soap, just because I like it. Changes began to occur in the nail. It took a long time, but eventually the infection disappeared and has not resurfaced.

For those around the person, know that it is not common to catch this from someone else. Transmission is not impossible but unlikely unless you wear their socks.

Parkinson’s disease is a relatively common disorder in seniors. The body is a balanced system. When something causes an imbalance, the system reacts. Low dopamine imbalance is thought to be the cause of Parkinson’s. Without enough dopamine, the result is nervous excitation and uncontrolled movement, which can be seen in the hallmark hand tremors.

Medications often seek to increase the level of dopamine. There are foods, such as bananas, that help too. Proper diet can utilize these natural sources.

Over time the muscles in Parkinson’s patient start to become rigid, pulling the client into a stooped posture. Eventually, their balance is affected by the forward weight of the body. I once tried to help a tall man with Parkinson’s from one building to another. His forward lean was almost the undoing of us both. I should have gotten staff assistance. Learn from my mistake.

Some develop a Parkinson’s dementia known as Lewy body. As with Parkinson’s, there is no cure for this degenerative disease. I had a client who had Parkinson’s with this kind of dementia who showed me photos of his rumpled sheets from the night before. He conveyed to me the hallucinations he experienced that these sheets triggered. He knew in daylight that they were only sheets, but at night they scared him.

Partial seizure disorder affects many over sixty. Associated diseases are diabetes and Alzheimer’s, but there are other causes. Affected seniors often lose their driving privileges, thus becoming dependent on public transportation, family, and friends. As the name implies, only some parts of the body are affected. Other seizure disorders affect the entire body.

Balance is impaired in many older adults. As with all else, nerves running to our vestibular system decline with age. This is the system that tells us where we are in space. I have had a chiropractor work on this system with me before he adjusted me, and it helped. By seeing how my body reacted to his movements as my eyes followed, he knew where I needed adjusting to bring me into a better balance.

If the response system of the body is blocked, an imbalance is the result. Vertigo fits in here too. The room can feel as though it is reeling if you make any sudden movement. Try balancing yourself with that going on inside you.

Lack of balance causes many broken bones, and bones don’t heal as well in the elderly. This problem just causes further disability and often further decline.

Know that many medications seniors take can also cause dizziness and disturb balance. I want you to be aware of this so that you don’t automatically think everything that goes wrong with a client is due to aging. Some doctors put so many declines into the “You’re just getting older,” box and look no further. A few good questions and a bit of research may find the cause is not simply a result of age.

You will also see various neuropathies, especially in diabetics. Feet are often affected, but hands can also suffer nerve damage. The nerve pathways have been broken. The affected area can feel numb or tingly. If someone can’t feel their feet, can’t feel the surface they are walking on, can’t feel injuries, then they are very prone to accidents and wounds. Have you ever walked on your feet when your legs were asleep? How sure about your steps were you when you walked?

There are some devices out there that offer electric stimulation for pain and numbness stemming from neuropathy. Combined with massage, this can help those who are suffering. I have a customer who uses a strong CBD salve that I sell to her that helps her. CBD is neuroprotective.

Blood pressure is important to circulatory health. High blood pressure can result from spiderlike webs of scar tissue spanning the interior of the vessels, catching debris like a dam and thus narrowing the room for the blood to flow. When there is less room for the flow, pressure builds up. (This can also happen inside the kidney when the filtering area gets scarred over.)

A person I know had high blood pressure that neither the doctors nor meds fixed. Her problem was made obvious in a dangerous way. She had an abdominal aortic aneurysm and then an aortic aneurysm years later. Neither of these issues, which almost killed her twice, was diagnosed properly. They erupted without intervention. A weakened portion of her circulatory system ballooned out and eventually burst. She is lucky to be alive.

Systemic enzymes eat away at the scar tissue or fibrin in the circulatory system so that blood can flow normally. But if the vessels are not strong enough, they can still balloon out in weakened areas, causing aneurysms. This is another area that collagen, along with vitamin C and other nutritional partners, can repair.

If fluids flow slowly, the delivery of oxygen and nutrients to the heart is also slowed, affecting the organ’s performance. Fluid buildup can be seen in the legs in edema. Whenever I see someone with edema, I automatically think that there is likely a problem with the heart.

Shortness of breath can indicate fluid buildup in the lungs. Pulmonary edema can be caused by heart problems, but not always. The vessels in the lung seep liquid into the alveoli. There are several conditions that can cause this, including kidney problems.

A lack of proteins could be a factor since protein carries the fluid in the plasma. Whey is a good source of protein for seniors. I use high-quality whey in my coffee, and most days I begin with a Rise Bar that has honey, almonds, and whey for ingredients.

In older clients, you’ll see open-heart surgery survivors and people with pacemakers. I find it best to get a doctor’s note before massaging these clients. Pacemakers can make it difficult to work the pectoral muscle on the left side, since you must maintain a perimeter around the device. You may also not be told about the device at all unless you run your hand over the area or actually see the device under the skin. Give the pacemaker a wide berth to avoid damaging it.

Perimeters must also be observed in cancer patients who have undergone radiation treatments. The irradiated areas have extensive damage that takes a very long time to heal. Refer these clients to a specialist in oncology massage if they are within two years of their last treatment. Do not treat them yourself if you do not have the training. Be careful even after two years and get a doctor’s note if you do choose to treat that client.

Chemotherapy, ongoing drug regimens, and radiation therapy all assault the patient’s system in an attempt to kill cancerous cells. Precautions and contraindications are numerous, so that we, as therapists, do no further damage. Honor that and refer the client to someone else if you are untrained.

For those clients a few years past radiation therapy, massage can be more routine. Some may need lymphatic drainage techniques to reduce swelling in the extremities. If you have that training, great. If not, refer out for that specific treatment.

Just the diagnosis of cancer can be scary and affect your physiology. Your brain may be flooded with questions, and, physically speaking, your heart beats faster, pounding in your chest. The elevated anxiety levels may stay high until you are cured or until you die.

I once discovered a suspicious mole on my back. I made an appointment right away. It was melanoma. The doctor said he could dig it out right then, or I could make an appointment later for a prettier removal. I don’t think doctors really understand that, after hearing the word cancer, a patient hears very little else. My mind instantly retreated into a fog of fear and anxiety. Although he told me that it was a slow-growing cancer, I had him remove it right there and then. I just wanted it gone. I was lucky he could remove it that day. After the removal, he told me I had about ten years before I had to worry.

Young and old cancer patients have been through a lot. Make them comfortable. Some clients may have had breasts or other parts removed. Accepting their body as it is now may be difficult for them, even years later. Showing their body to a stranger for massage may create fear about judgment or rejection. For me, I have found a matter-of-fact approach has helped people to relax and get the treatment they need. No judgment.

That approach helped me years ago when I was drafted to dress a mastectomy wound for a lady who didn’t like me. Oddly enough, the nurse was too squeamish with this client to help. The lady may not have been happy that I was chosen, but my straight-on, let’s-get-it-done attitude got the task accomplished.

I also knew a lady who was told that there was nothing more the doctors could do for her multiple myeloma. Can you imagine her level of fear in that moment? She insisted that the doctors give her more chemotherapy, which they finally did. They had told her it would do no good, but her fear overcame good judgment. She chose to have the doctors introduce more drastic chemicals in her already weakened and dying body. Who knows how much longer she might have had if she had not had more of the chemotherapy? Might a reduction in the chemical damage have allowed her an easier death? This lady was my mother.

Long ago, another lady mentioned to me, out of the blue, that she had symptoms that bothered and scared her. I asked if she had gone to a doctor for a diagnosis. She hadn’t. The fear of what she would find out kept her from going. When she finally was diagnosed, the result was terminal cancer. Had she caught it earlier, who knows how things would have gone. But once again, fear ruled the day.

Sadly, there are many people of all ages affected by cancer. The fear of feeling that you may never again be whole is real. Fear of dying is very real. Even the fear of knowing, and thus delaying treatment so you won’t find out, is real. We can help these people get through one of the most difficult times of their lives with dignity, peace, and comfort. We would want the same done for us.