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Post-Joint Replacement massage

I recently had a client in her seventies that was over three months post-op for a right hip replacment. Her doctor had cleared her for all activity and never prescriber her any PT, which I found unusual. She came to see me for an hour and enjoyed the massage and it effects on her leg pain. She booked again, but i reccomended a 30 min massage instead to focus on the hip and legmuscles. Her second appt. I worked all the muscles of her thigh and hip using primarily Swedish and trigger point therapy. No Stretching or ROM. She felt good directly after the massage but then canceled her next weeks appointment due to severe leg pain post massage. I didn't work very deeply and checked in with her often about the pressure. I just was wondering if anyone else has had this happen or if there are any techniques I shouldn't have used. Any advice?

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Permalink Reply by Landon Wiedenman on March 11, 2011 at 1:19am

Trigger point therapy can cause a lot of soreness a few days later, even moderate pressure with a therapeutic massage can have this effect. To do therapeutic work it can be hard to avoid. You need to be very careful not to overwork an area and it's easier to make this mistake with people that haven't had much massage before. The only way to learn where this line lies is by trial and error, unfortunately. It's better to err on the side of less intense work. The best practice is to make sure your clients are aware of this side effect if they don't have a lot of experience with massage therapy. Usually, it's the third day after the massage that the soreness will be the worst. Tell your clients that they may experience this and that it's a normal part of the process, after the soreness goes away they will feel better and have greater mobility with less stiffness and pain. If they're not expecting it, they'll just think you messed up and hurt them!

- Landon

Profile Massage | ENSO Spa - Low back pain

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Permalink Reply by Kay Warren on March 12, 2011 at 11:19pm

Ok, I have no idea how long you've been in practice, but as a therapist who specializes in injury & surgical work, I'm not going to pull any punches here.

She should have had MT and PT by properly trained professionals after her surgery. That she didn't get it is nothing short of appalling. Not your fault. As a result, there are any number of things that could have happened, some of them within your control, some of them not. Three months post-op is not much for a client in her 70's. This type of client needs special care and attention, and you don't have the training for it. You also don't mention wether the hip replacement was done anterior or posterior... a basic level intake question that should have been asked prior to doing specific work on the hip. At that age, ligaments take many months to heal. Tightness in that time frame is usually due to the fact that in the operating room, they shorten most of the muscles acting on the head of the femur by nearly an inch. They aren't stable! I wouldn't be doing trigger point work until at least 6 - 9 months out, especially on a client I had seen only once, and hadn't read the surgeon's notes. I spent the first five years of my practice working directly for an orthopedic surgeon doing hip, knee & ankle injury and surgical re-hab, and even now, I would flatly refuse trigger point or detailed hip work on such a patient without a lot more information, and I've been doing this for 26 years!

You should have done relaxation on her, or, if you had the training, fascial release. The increase to the lymphatic flow would have done her good without overloading her system. I have no idea how good your school is, but without specialized training in something like that, you should have referred her out for the specific work. The fact that you suggested deeper work for a condition in which you have NO training was not smart. In fact, it borders on actionable malpractice, and your client paid for it. Best case scenario? She's sore for a few days to a week. Worst case scenario? You detached something, and she needs another surgery to fix it. Get yourself into an ethics class on scope of practice relative to your training.