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What Is Really CI’d With Hypertension?

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Was it 140/90 or was it less than that?

Wait, 160/95 is what’s too high?

I always had a hard time remembering what was CI’d and what wasn’t. Positioning, heat, which blood pressure numbers were too high?

Many of these CI’s were based on massage increasing circulation, making it too hard on the heart when blood pressure was already too high.

But what about now that we know that massage doesn’t increase circulation and move fluids around like we once thought?

Are these things still a contraindication?

And do we really need to take every patients blood pressure before treatment?

Do We Really Need To Take Blood Pressure?

Part of the problem with hypertension is that it quite often goes unrecognized.

It has been called the “silent killer” because of the damage it can cause to the blood vessels, heart, brain and kidneys before any other noticed symptoms occur.

Where we need to pay attention is the degree of hypertension the person is experiencing.

  • Normal blood pressure: 120/80
  • Prehypertension: between 120-139 systolic over 80-89 diastolic.
  • Stage 1 high blood pressure; 140-159 systolic over 90-99 diastolic.
  • Stage 2 high blood pressure; 160 or higher systolic over 100 or higher diastolic.
  • Hypertensive crisis, a medical emergency; 180/110 or higher.

Looking back over my notes from college, we were told that 160/95 was contraindicated for a massage. This is probably true in the case of someone who doesn’t know they have hypertension and should see a doctor. If they are under the care of their doctor, they’re probably coming to see you for help with this very thing.

Which leads us to why we should be taking a patients blood pressure in the first place.

One paper examined the role of manual therapists taking blood pressure prior to treatments as an aid to their clinical reasoning, risk assessment, and vascular profiling. The paper presents three case studies where patients were having either neurological or musculoskeletal pain in the neck and/or thoracic chest area.

In each case blood pressure was taken, two of the cases were abnormally high, and one was low. Once the patients were referred out to appropriate care and the issues causing the rise or drop in BP was corrected, the issues they were experiencing decreased and manual therapy could continue.  The only way these issues would have ever been recognized was by the manual therapist taking blood pressure readings as part of their treatment protocols.

Also important is another study which showed a difference in blood pressure measurement depending on the position the patient was in. Systolic blood pressure decreased in semi-fowlers and sitting positions compared to being taken when the patient was supine. This stressed the importance of making sure measurements were being taken with the patient in the same position before and after treatment to get a true reading on whether therapy was effective.

If you took the initial measurement when the patient was sitting before the treatment started, then took a second measurement at the end of the treatment while they were laying on your table, your comparison before and after treatment wouldn’t be accurate.

So even if you think the patient you’re treating doesn’t fit the profile of someone who would be dealing with high blood pressure, it should still be part of your routine, especially if it’s the first time you’re seeing someone.

Photo by: Gadini

Shortening Strokes And Positioning

As we have discussed on this blog before about massage and circulation, many of the contraindications we learned in school probably aren’t as applicable anymore.

We were taught to shorten our strokes when it comes to hypertensive patients, but as research has shown, we aren’t increasing total body circulation, there is just a bit of circulation increase locally to the tissue we are working on. So, we probably don’t need to worry about specifically shortening our strokes with a hypertensive patient.

We were also told that positioning of the patient on the table could be a concern as well, we were instructed to not leave the person in the prone position for extended periods. Looking back through the textbooks and notes as I wrote this article, there was some good advice from one of the texts, the gist was that if the person could sleep in this position (eight hours sleeping compared to an hour on your table), they’re probably fine. Keeping communication open with that patient would be important, to see if they start feeling dizzy, or lightheaded during the treatment, but otherwise, you’re probably safe.

One study showed that just lying prone can actually help decrease blood pressure just as much as lying prone with a massage (however this study was done on healthy people and those with hypertension were excluded from the study).

Another systematic review(1) showed that massage therapy combined with antihypertensive drugs was more effective than just using the drugs alone. While researching for this, I found several articles and studies that show massage therapy to be an effective complimentary treatment for hypertension.

So with all this evidence, it’s safe to say there is a lot we can do to help patients with hypertension. Keeping in mind a few different things, like when pressure is high enough to dictate an emergency, communication with your patient and knowing that a regular length stroke is okay, there shouldn’t be too many issues with your treatment. As we continue to try and gain respect as healthcare professionals, this is one easy step we can use to add to our clinical reasoning and risk assessments when dealing with our patients. If one of your patients is coming in for this specifically, take their blood pressure before and after the treatment (with them in the same position), so you can prove what you are doing is helping them, and communicate that information with their family doctor as well. I guess I’ll have to go buy one of those digital blood pressure cuffs now, they’re probably more accurate and less of a chance I’ll screw it up when using it.

References

  1. Xiong X, Li S, Zhang Y. Massage therapy for essential hypertension: a systematic review. Journal Of Human Hypertension [serial on the Internet]. (2015, Mar), [cited July 10, 2017]; 29(3): 143-151. Available from: MEDLINE with Full Text.

Recognizing And Treating Angina Attacks With Your Patients

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It used to freak me out all the time.

He’d come into my first aid room, complaining of chest pain, explaining that he just overdid it a little, then immediately the hair on the back of my neck would stand up.

Was this going to be the time? Should I start calling for more help? Should I just call 911 to be safe?

Inevitably I would ask the same questions every time, do the same thing, and it would usually work out just fine.

Sit him down, he’d take his meds and within twenty minutes or so, he’d be back on the job and carry on like it was any other day.

But I always worried about when one of his angina attacks was going to turn into a full on heart attack and be a major emergency.

Angina Types And Recognition

Angina Pectoralis is a coronary artery disease where people experience chest pain that comes and goes but the pain isn’t caused by a heart attack. One of the big differences is that a heart attack actually causes damage to the heart muscle, whereas angina does not.

If someone is having an angina attack it’s a sign that the heart isn’t getting enough oxygen-rich blood and usually happens during physical activities or during emotional stress.  Typically this will only last for three to five minutes, but usually for under 10 minutes. When this happens, the symptoms can look a lot like someone having a heart attack; constricting chest pain, jaw pain, neck pain, pain in the arms (mostly on the left), and sometimes difficulty breathing.

There are four different types of angina:

  • Stable Angina
    • pain is the same each time
    • brought on by physical exercise, extreme weather, heavy meals
    • relieved with rest/nitroglycerin
  • Unstable Angina
    • pain is worse than usual and lasts longer
    • brought on even when resting
    • no relief
  • Variant (Prizmental) Angina
    • caused by spasm of coronary arteries
    • brought on by medicine, cold weather, smoking, cocaine use
    • extreme pain
    • usually, happens during early morning hours
  • Microvascular Angina
    • affects the heart’s smallest coronary arteries and causes them to spasm
    • may be part of a coronary microvascular disease
    • severe unpredictable pain that lasts for an extended period
    • medication may not relieve the pain

Angina is one of those things that you may or may not have seen on one of your patient intake forms.

There are those patients who would recognize it as something you should know about and others figure that because they’re on prescribed medication and it’s being managed successfully it’s not that important to tell you. However, as healthcare professionals,  it’s important for us to know and understand all these types of angina in case a patient ever comes in complaining of chest pain.

Even more important is knowing how treating an angina attack is different from treating a heart attack, even though the risk factors, pain, and symptoms are quite similar.

By James Heilman, MD (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons

Emergency Care For Angina Attack

The difference between angina attack and a heart attack can be a little confusing. 

Both can look the same because of the visible signs and symptoms the patient presents with. 

One big difference is that someone with angina, typically knows they have it and have been through this before, so making sure to ask the person if they’ve ever experienced this kind of pain before is critically important. If they haven’t, assume it’s a heart attack and call 911. 

If there is no record on their intake form, and you’re not sure what’s going on, asking the SAMPLE questions can help you get to the bottom of the situation. 

S – Signs and symptoms?

A- Any allergies?

M- Medications? Are they taking any?

P- Past medical history?

L- Last meal?

E- Events leading up to this emergency. 

The critical ones, in this case, are signs and symptoms, past medical history, and medications. All of those should give you a clue if this is an angina attack (if the patient is being honest with you). 

We reviewed the signs and symptoms (chest pain, jaw pain etc), and hopefully, they would tell you angina when asking about past medical history. But it is also important to know the medication prescribed in this case, Nitroglycerin. Nitroglycerin is a vasodilator that relaxes the smooth muscle and blood vessels, increasing blood return to the heart and making it work less hard. It comes in a few different forms; a sublingual tablet, a spray, patch, aerosol solution, ointment, and an extended release caplet. The most common I’ve seen is the sublingual tablet. In this case, the patient puts it under their tongue and lets it dissolve. 

If you’re assisting a patient with their medication (remember assisting means getting it for them, not administering it), make sure it’s their medication and it’s the right dose. 

HOWEVER, before they can take the nitroglycerin you have to ask them if they have taken any erectile dysfunction drugs (probably the only time it’s appropriate for you to ask a patient this), and yes even for women as some women take it as well. If they have taken any, they CANNOT take the prescribed medication as the combination of the two can lower their blood pressure to a fatal level. If they have taken Viagra or Levitra in the past 24 hours or Cialis in the last 48, they cannot take nitroglycerin. 

Sit them down and have them rest in a comfortable position (sitting leaning forward usually makes it easier to breathe) and then they can take their medication. If after five minutes the chest pain doesn’t go away, give another dose. This can be done to a maximum of three doses, always five minutes apart. If after that 3rd dose, the pain hasn’t gone away it’s time to call 911 as this could be turning into a heart attack. 

If they don’t have nitroglycerin but there is Aspirin (ASA) available (make sure it’s Aspirin, not Ibuprofen or Tylenol), they can chew two 80mg or one 325mg dose but only one dose of either, do not repeat it. If after taking the proper medication, the pain subsides and everything goes back to normal, this isn’t necessarily a 911 call. This is a condition the patient deals with on a regular basis and their medication is doing what it was intended for. 

The biggest thing we can do to help is remain calm and recognize what is happening with our patient. It can be pretty scary having to deal with any kind of emergency that happens in our clinic, or anywhere else for that matter. The differences between an angina attack and heart attack can be hard to decipher, but with a good medical history and asking the right questions you can be successful in figuring it out. More importantly, as healthcare professionals, it’s important that we know what to do in these cases in order to give our patients the best care possible. 

 

 

 

Treating A Diabetic Reaction In Your Massage Clinic

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It was a few years ago and we were having a great conversation about our favourite topic, hockey.

Being a big Jets fan, he excitedly told me the news that Winnipeg was approved to get their team back.

You could feel the excitement come across the phone: “did you hear the Jets are coming back!?”

Not 30 seconds later, he said it again: “did you hear the Jets are coming back!?”

Umm yeah, we just talked about that.

Then he repeated it again, this time his speech was a little slurred.

Something was off.

Then I clued in and asked: “did you take your insulin this morning?”

“Why would I do that”, his speech was getting more slurred.

“When was the last time you ate?”

“Why would I do that, I don’t need anything!?”

I hung up and started phoning every extension in the office, no one was answering.

I drove to the office and found him slumped over his desk, looking and sounding very confused.

The small sugar drink he had taken wasn’t working, or more likely just wasn’t enough.

I ran next door to the coffee shop and grabbed some food, Coke and orange juice.

When I got back, I held everything up and asked what would work best.

He pointed at the Coke.

I took the top off, handed it to him and he took a sip. He sat up a little, then took another drink. The third drink perked him up some more, with each drink his condition improved.

Then he looked at me and said: “what the hell were we talking about!?”

“Hockey”

“Oh yeah, did you hear the Jets are coming back!?”

Understanding Types Of Diabetes

I’m sure we all know someone and have at least a few patients who have diabetes. However it is important to know which type of diabetes they have.

There are two different classifications, although one kind doesn’t get talked about or recognized as much.

  • Diabetes Insipidus:
    • Results because of dysfunction of the posterior pituitary.
    • Causes defects in antidiuretic hormone (ADH) receptors or can’t secrete it.
    • Neurogenic Diabetes Insipidus makes too much ADH because of a brain injury.
    • Nephrogenic Diabetes Insipidus the kidneys do not respond to ADH which results in too much urination leading to dehydration.
    • This type of diabetes is typically treated with hormone therapy.
  • Diabetes Mellitus:
    • The more common form of diabetes, with classification of Type 1 and Type 2 resulting from an inability to make or use insulin.
    • Type 1 referred to as juvenile diabetes or insulin dependent, the persons immune system destroys the beta cells in the pancreas, so they don’t produce insulin.
    • People with Type 1 typically have to take insulin injections to deal with the condition.
    • Type 2 aka: non-insulin dependent diabetes or adult onset diabetes most commonly caused by cells becoming less sensitive to insulin.
    • Type 2 diabetics may need insulin injections but it is typically managed with checking blood sugar and regulating with diet.

Diabetes Mellitus is the condition we are most likely going to be faced with in our clinic, so it is important for us to understand what is happening and how to deal with this if we are ever faced with someone having a diabetic emergency before or after a treatment.

If someone who requires the use of insulin takes too much (hyperinsulinism) this can cause the body to use up any extra glucose in the blood (hypoglycemia), which then deprives the brain of the sugar it needs.

When this happens the brain cannot function properly and the body begins to shut down.

If someone is having this kind of a diabetic reaction, it can eventually lead into a diabetic coma and eventually death if it is not dealt with appropriately.

It is then our responsibility as healthcare professionals to be able to recognize and deal with this, preventing the coma and reversing the reaction.

Signs And Symptoms Of A Diabetic Reaction

If we have a patient with diabetes, chances are it is going to be Type 1 or 2.

Those with Type 2 typically manage their blood sugar with diet and monitoring blood sugar levels (sometimes they use insulin as well). This comes on later in life, usually past the age of 35.

However those with Type 1 (who use insulin) can end up suffering from hyper or hypoglycemia.

If they are experiencing hyperglycemia, there is sugar in their blood, but not enough insulin to allow their cells to be receptive to the sugar.

When this happens the body attempts to get the sugar from other sources, such as fats from within the body. This produces increased waste in the body and knocks pH balance off and the person starts to feel ill.

When the person is experiencing hypoglycemia (not enough sugar), the sugar in the body is used up and in turn affects brain function which can be life threatening.

This can be caused by a few different things:

  • Takes too much insulin.
  • Hasn’t eaten enough, or regularly enough.
  • Exercise has burned off their blood sugar faster than normal.
  • Great emotional stress.

In order to recognize a possible emergency, there are similarities between the hyper and hypoglycemic conditions:

  • An altered level of consciousness, dizzy, drowsy and confused.
  • Rapid breathing.
  • Rapid pulse.
  • Feeling ill as well as looking ill.

If you know one of your patients has diabetes and starts to show any of these symptoms, it is essential to provide the appropriate care.

Photo by: stevepb

Photo by: stevepb

Providing Care During A Diabetic Emergency

There are some specific steps to take when trying to help someone during a diabetic emergency.

If you’re not sure why the person is having an issue, we do what is called a Primary Survey. Check to see if they have their ABCs (Airway, Breathing, Circulation). If they are unconscious, call 911.

If they are conscious and speaking to you, then the ABCs are present and you can go into your Secondary Survey.

During the Secondary Survey we do a quick check of the rest of the body to see if there are any injuries that could be causing the issue. It’s just a quick rapid scan of the persons body from head to toe looking for possible injuries.

This is where you could possibly find a medic alert bracelet or necklace that could tell you they are diabetic. Nowadays some people are also getting them as tattoos, so you may see this as well.

Assuming the person can talk to you, then there is a series of questions to use called the SAMPLE questions. It is just a simple mnemonic which can help you determine what is going on:

  • S – signs and symptoms?
  • A – allergies?
  • M – medications?
  • P – past medical history?
  • L – last meal?
  • E – events leading up to the emergency?

In the case of a diabetic emergency, there are a few questions that can really help you out.

If you didn’t already know it was a diabetic emergency, knowing their medication (insulin), past medical history (diabetes) and their last meal can give you great insight into what is going on.

The person might tell you right away what is wrong and ask for something to help, but just in case they don’t, asking those questions can get you the information you need.

Now that you have determined the emergency, we need to get sugar into their system.

Keeping fruit juice, candy or non-diet soft drinks in your clinic are all great resources to help someone in this condition. After they have some sugar, it will help quickly, actually it’s surprising how quickly it can turn things around.

If the person is unconscious, do not give them anything, you could end up compromising the airway and making things worse.

Just monitor their ABCs until further help arrives.

There is a bit of controversy about determining the difference between hyper and hypoglycemic conditions as there could be a concern about giving someone sugar who already has too much sugar in their system.

While this could cause some more damage, it is not going be as life threatening as it is for someone who has low blood sugar and needs to get sugar in their system.

For our purposes in a clinical setting, we are going to treat the person with sugar because it will be difficult to know which condition is causing a problem.

Since we are not authorized to give medications we don’t inject insulin for people. If this happens before a treatment, you cannot carry on with the massage even if the patient has some sugar and starts to feel better. They need to go eat a proper meal to help balance out blood sugar. It doesn’t mean they need to go to the hospital (unless they don’t start to feel better within five minutes of getting sugar in their system), remember this is something they deal with on a regular basis (if they go unconscious, call 911). Since 9.3% of the population has diabetes and a large population remains undiagnosed, as well as the prevalence of gestational diabetes affecting 9.2% of pregnant women, there is a strong chance you will have to deal with this kind of an emergency in your clinic one day. Knowing the signs, symptoms and ways to deal with it will be the biggest way you can help any one of your patients should this happen. And yes, the Jets came back and I still get to talk to my buddy about it regularly.  

Managing A Collapse In Your Massage Therapy Clinic

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Like it or not, it is going to happen one day.

You do your intake with a patient, leave the room and on your return there they are, lying on the floor not breathing.

Your adrenaline rushes because you never thought you’d actually have to deal with this…ever.

But the odds are against you.

According to the heart rhythm society, in the U.S. more than 350,000 deaths occur each year because of sudden cardiac arrest, which is more than breast cancer, lung cancer or AIDS.

Sudden cardiac arrest takes an average of one life every two minutes.

Unfortunately 95% of people who suffer a cardiac arrest lose their life because of delayed treatment.

However the bright side is that you can help. The odds of being able to revive someone greatly increases when you witness the collapse.

Fortunately when we have our patients in the clinic, chances are we are going to witness the collapse in case they experience a cardiac arrest.

Initial CPR

If you ever witness a collapse, or walk back into your massage treatment room and see someone unconscious, the first thing you have to do is assess if the person is breathing.

We do this by using a technique called: “look, listen and feel”.

Firstly, squeeze the persons traps and see if they respond in anyway. Then put your ear overtop the persons mouth, place a hand on their chest and look at the chest for 15 seconds.

See if you can feel a breath on your ear and watch to see if your hand on the chest rises at all to indicate breathing.

If there is no air exchange occurring, tilt the persons head back, check to see if they start breathing. If they don’t start breathing on their own keep the head tilted back and attempt to give the person two breaths.

Watch to see if the chest rises, indicating air going into the lungs.

If the chest rises, it shows that the person has an open airway, so you can begin chest compressions (if the air didn’t go in, it means something is blocking the airway so they could have choked on something).

If they had choked on something, you would start compressions as well, however the intent of the compressions now is to clear whatever the person had choked on.

To start your compressions, landmark at the persons armpit on the side of the body opposite to you. Then bring the palm of your hand up to the sternum and deliver 30 chest compressions.

Continue to deliver 30 compressions and two breaths until more help arrives.

Once you realized the person was not breathing and CPR was necessary it is important to get someone to call 911 for you, and if available get an A.E.D. (automated external defibrillator).

If you’re on your own, grab a phone, bring it back to the person and call 911. Put it on speaker phone and the 911 dispatchers will coach you on what to do.

Using An AED

People often think that an AED works like the paddles the doctors on TV shows like ER use to jumpstart a persons heart.

It doesn’t work like that.

If the heart is completely stopped and flat lined, the AED isn’t going to do anything.

There has to be a “shockable” rhythm, a tachycardia (fast rhythym) or bradycardia (slow rhythym) for the AED to do anything.

There are a few things to take into consideration when using an AED.

If you are in a wet environment (you sports therapists) you have to do a splash test.

If the ground is wet and you slap it, if it makes a splash you have to move the person before you can allow the AED to deliver a shock. If the ground is just wet and there is no splash, it’s fine to deliver the shock.

If the person has a really hairy chest, then you have to shave the chest before putting the pads on. The pads have to be in direct contact with the skin to work properly (fortunately AED kits come with a razor in them).

Also if there is any metal (ie: underwire bra, jewelery etc.) in the path of the pads, it should be removed or it will leave burn marks. Same for any kind of nicotine or medical patches, they should come off.

Then just turn the machine on and follow the directions, don’t try and jump ahead, just do what it tells you.

Make sure when the machine says “everyone stand clear”, no one is touching the patient. If someone was still doing compressions, the machine would read that as the rhythm of the heart instead of it’s actual rhythm.

Also, the second time it advises to make sure “everyone stand clear”, is when it’s about to deliver a shock. Make sure no one is touching the patient or they will get shocked as well.

If the AED detects a “shockable” rhythm it will deliver a shock and you will see the body rise up a bit.

If there is not a “shockable”rhythm it will say: “no shock advised, continue doing two minutes of CPR”.

If you have a second person with you, have them take over doing CPR, so you get a break. Then alternate with the other person every two minutes so that one person doesn’t get tired out.

It should look something like this:


This can be a pretty scary situation to have to deal with. I honestly hope you never have to. However if this ever happens and the outcome isn’t what you had hoped for, please reach out and talk to someone about it. As healthcare professionals we are constantly telling patients to do proper home care, or are referring people to get more help should they need it. This is one of those cases where we really have to take care of ourselves after an incident like this. Chances are if this happens in your clinic, you already have a therapeutic relationship (and possibly a long standing one) with your patient. Going through a shocking scenario (no pun intended) such as this can bring up some very strong and sometimes scary emotions from the person who has to perform CPR. So please reach out and get some counselling or talk to some sort of mental health professional should you ever go through this. Remember how important your own self care is.

 

 

Choking Emergencies And Infant Massage

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More and more I’m seeing Massage Therapists offering infant massage as well as massage classes for parents to teach them how to connect with baby and give that extra bit of care to their new infant.

But what happens when there is a medical emergency with an infant in your clinic?

Do you know what to do when one of those infants starts choking?

To start, play the first video below and I’ll get into some instructions on how to handle this kind of emergency in your clinic.

It’s a valuable skill to have and is important in and out of your clinic. But keep in mind, the videos are not a substitute for taking a proper course.

So remember, if the baby is coughing that means they have an open airway it is just somewhat restricted.

We don’t do anything except encourage them to cough up whatever it is they are choking on.

You need to intervene if:

  • The baby is making high pitched noises.
  • Is too weak to cough.
  • Is wheezing.
  • Becomes rigid due to a completely restricted airway.

Have someone call 911, get an AED (if available) and start your back blows and compressions.

Make sure the baby is always supported on your thigh, so there is a solid surface to deliver your back blows and compressions against. With the baby sandwiched between your forearms deliver five back blows between the shoulder blades.

Then flip baby over and rest on your other thigh, deliver five chest compressions with two fingers land marking between the nipples. You want to deliver about a 1.5 inch compression.

Continue to do this until the object is cleared and baby starts to cry, or becomes unconscious.

If the back blows and compressions didn’t clear the airway, now you’re doing CPR.

However once the baby went unconscious there is a chance the airway opened up because of the musculature in the neck relaxing, so we “look listen and feel” for 15 seconds to see if baby has started to breathe at all.

If they’re still not breathing, we slightly tilt the head back to try and open the airway and attempt to give two breaths. If there is still a blockage and we see that no air went in with the breaths, (if air does go in and baby is still unconscious and not breathing, we still continue) we landmark between the nipples and deliver 30 chest compressions using two fingers.

We continue with 30 compressions and two breaths until the baby starts breathing on its own, or more help arrives to take over CPR.

When First Responders arrive, they will take over CPR but have some equipment and different techniques they will use to help the baby.

Hopefully if you are doing infant massage, or just know someone who has a baby, these videos will help you feel a little more confident should you ever have to deal with a choking emergency. Please remember that these videos and this blog should not be used as a replacement for taking an actual CPR course. If this is something you do a lot in your practice, please take the time to go and get the necessary training to be confident in dealing with infant emergencies, it could literally mean someones life one day. If you know someone or have a colleague that could benefit from the information here please share it with them.

Osteoporosis And My Mistake

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I came around the corner just as he was sitting this elderly gentleman down.

He looked at me and said: “deal with this I’m going back to the bench”.

Fairly confused, I looked at this elderly gentleman and asked what happened?

He was on the ice taking pictures of the hockey team, as he walked off he slipped and fell on the ice.

Bearing weight on the right side was painful, but there wasn’t a lot of pain while sitting down. I grabbed his leg and passively moved it, no pain.

He called his wife (who was more than a little upset as the game had just started and now she was missing it) because I said he needed to go to the hospital.

We draped his arms over our shoulders and walked him out to their mini-van. She took him to the hospital and I didn’t see them for another year.

The Mistake

For years I have taught first aid courses to other Massage Therapists.

I have viewed the power point slide, I have repeated the information in the slide, I have highlighted the importance of the slide.

The slide I’m talking about says you should all 911 if:

  • The injury involves the head, neck, or back.
  • The injury makes walking difficult.
  • The injury involves the thigh bone or pelvis.
  • There is an altered level of consciousness.

However, things didn’t add up.

When it comes to treating injuries and dealing with first aid, one of the things we always harp on is “Mechanism Of Injury” (MOI).

We always use this as a method to quickly determine if there is a spinal, head or neck injury, to see if spinal precautions need to be taken. For those of you who have taken advanced or even basic first aid (and let’s be honest, just as the anatomy pro’s that you are) you understand the importance of stabilizing the neck to reduces possible spinal injuries.

But in this case the mechanism of injury made me second guess myself.

We always worry about further injury when a persons injury is a result of:

  • A fall from any height.
  • Found unconscious for an unknown reason.
  • A diving injury.
  • A blow to the head, neck or trunk.
  • A car accident.
  • Lightning strike or electrocution.
  • A persons helmet is damaged.

But this guy didn’t fall from a height, so why would I worry about the injury being that extensive!?

All he did was slip on the ice, there was no fall from a height of any kind.

But like an idiot, I didn’t use the information I had taught so many times.

Walking was difficult and the injury was to the pelvis, it should have been a 911 call.

However since I didn’t think the mechanism was bad enough, I was comfortable to get him to the hospital without using an ambulance.

Photo by: CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=243621

Photo by: CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=243621

Osteoporosis

For years I taught these courses and never understood why there would be a power point slide about Osteoporosis.

NOW I KNOW!

When I saw this fellow a year or so later, he looked completely different (he had developed some other health issues well beyond his fall that night).

I asked him how things turned out, he said he had broken his hip and had to have a full hip replacement (as a disclaimer, the injury caused the hip problem, not the fact that I didn’t call 911 that day, I just should have handled things a bit better).

Osteoporosis is the leading cause of bone and joint injuries in older adults, the bones don’t have enough calcium, which makes them frail.

According to osteoporosis.ca there are some frightening statistics:

  • 70-90% 0f 30,000 annual hip fractures are a result of osteoporosis.
  • 1 in 3 women and 1 in 5 men will suffer a fracture due to the disease.
  • Without BMD (bone mineral density testing) 80% of fracture patients are not getting proper osteoporosis therapy.
  • 80% of all fractures in people over the age of 5o are a result of osteoporosis.
  • Fractures from Osteoporosis are more common than heart attack, stroke and breast cancer combined.

Think about what this means for your practice.

How many people do you see on a regular basis that are over the age of 50?

This exact situation could happen at any point in your clinic with an older person coming in for treatment. That gentleman didn’t know he had Osteoporosis, but was diagnosed with it after he fell.

If at anytime one of your patients comes in and suffers a fall on-site that seems harmless enough but there is an injury to the pelvis or thigh and makes it difficult to walk, be sure to call 911 and get them to the hospital in an ambulance. If the person suffered a fall at home and is coming in for treatment, there are some things to look out for. Check for any deformities in the area they are complaining about, along with swelling and point tenderness that could indicate possible injury.(1)  

Studies are showing how exercise and strength training are effective ways to manage Osteoporosis once a patient receives the diagnosis, which also plays an important role in building confidence to prevent future falls. As Massage Therapists we want to make sure to use the appropriate pressure when giving treatment, to avoid any injury while the patient is on your table. One study researched a L5 unilateral pedicle fracture on a 66 year old man as a result of an aggressive back massage.(2)  

Do yourself, and your patients a favour by not making either of these mistakes when trying to help them out.


References

  1. Badiyani K, Bottomley J. OSTEOPOROSIS AND ITS MANAGEMENT IN THE ELDERLY. Gerinotes [serial on the Internet]. (2014, Mar), [cited October 24, 2016]; 21(2): 11-18. Available from: CINAHL Complete.
  2. Guo Z, Chen W, Su Y, Yuan J, Zhang Y. Isolated unilateral vertebral pedicle fracture caused by a back massage in an elderly patient: a case report and literature review. European Journal Of Orthopaedic Surgery & Traumatology [serial on the Internet]. (2013, Nov 2), [cited October 24, 2016]; 23(2): 149-153. Available from: CINAHL Complete.

 

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