It was 3:32 on a Tuesday afternoon in Myofascial II class and I was confused.
I couldn’t believe what the instructor was saying.
She was talking about people having an emotional response while having certain areas of the body treated.
Specifically she mentioned SCM (Sternocleidomastoid) and how it can sometimes be upsetting for people to have treated, and actually having people cry from treatment.
I didn’t believe her.
As we worked through our trades in class, I remember looking across the room and seeing it happen. People quickly wrapping sheets around their body and hopping off Massage tables.
Head down, tears rolling down their faces and heading to the bathroom to get away from the class.
I looked down at my buddy, with a dumb look on my face and said “What the hell are we going to do once we’re in clinic and someone starts crying on the table?”
I don’t want to see that, I hate seeing women cry.
Fortunately I went through the rest of college and the student clinic without ever having someone start crying. So glad, made it through never to have to deal with this again
When Someone Hyperventilates In Your Massage Clinic
Yeah, I wasn’t off that easy.
Years later I had a new patient come in to the clinic. In a recent car accident and she needed some work for limited range of motion and neck pain.
She had never had Massage before and was excited that treatments would help out with things after her car accident.
Starting with her face down on the table and things were going well. When she turned over and I started working through the neck, it all started to change.
She started getting a little agitated and couldn’t explain why she was feeling that way.
Her head lifted off the table in an attempt to breathe easier.
She wanted to continue with the treatment, but couldn’t quite catch her breath. She started breathing faster and was getting a little light-headed, anxious and scared.
Her breathing increased. It was more difficult to catch her breath. Her previously calm demeanor shifted to fearful and agitated.
Now I’m starting to get worried.
What Is Hyperventilation?
Someone getting this anxious can turn into a medical emergency, right on your table.
When someone starts breathing this rapidly it’s called hyperventilating.
It becomes a medical emergency if they can’t calm down because if it goes on too long, it can render the person unconscious.
Because they are breathing so fast, it actually starts to change the pH levels in their blood. With too much oxygen coming in, the blood starts to become too alkaline (respiratory alkalosis) and proper nutrition is not making its way to the rest of the body.
This is also the reason that the persons fingers and toes can start becoming numb and tingling.
Having this happen will only compound the scared feelings the person was having initially, so we need to deal with it.
In this case we know that something is happening in our treatment that is causing the person to hyperventilate, but there are a few other causes that we should know about:
- Severe bleeding.
- Injuries to the head.
- Illness/medical conditions.
- Emotions like fear and anxiety.
This is important to know, just in case you ever see this happening with a person and you don’t know the underlying cause that is making them hyperventilate.
If the underlying cause isn’t apparent, you need to dig deeper to see if you can find out. It may be the only way to actually deal with the problem at hand.
Remember your Secondary Survey? Great way to use the SAMPLE questions to dig deeper.
How To Treat Hyperventilation And Panic Attacks
The biggest thing we need to do is calm the person down.
Give them as much reassurance as possible, especially if they are becoming more anxious and scared.
You have to become their coach.
Coach them on their breathing.
Use whatever cues you find appropriate to begin calming them down. If you know them well, talk to them about whatever is important to them, or some memories/thoughts that would start to calm them down.
Have them mimic your breathing. If need be, take their hand and place it on your diaphragm. Breathe normally so they can feel it. Coach them to breathe with you, let them feel the rhythm and consistency of your breathing.
The more you can do to calm them down and get them back to normal breathing again, the better success you will have.
I used to think it was an old wives tale to get a person to breathe into a paper bag, but like so many other times…I was wrong.
I looked up hyperventilation in my Anatomy and Physiology textbook and it’s actually recommended as a method of treatment. As the person breathes into the bag, it helps to get more carbon dioxide back into their system to balance the pH level and help the person calm down.
Who knew a paper bag should be part of a First Aid kit?
Why Massage Therapists Should Not Fear Patients Who Hyperventilate
Fortunately knowing how to deal with someone hyperventilating helped in more ways than one with my patient. She was able to continue treatments after she understood why she was becoming upset and scared during that first treatment.
If you ever have to deal with someone who’s going through this, remember these steps:
- Try to distract them from the fact that they are hyperventilating. Let them talk about whatever triggered this response.
- Reassure them, let them know that this type of response can be a reaction to the treatment.
- Coach him or her on their breathing.
- Have them look at you and try to mimic your slower breathing.
- If necessary have them place their hand on your diaphragm to get the feeling and rhythm of your breathing as a tactile response to relate to.
It can be a scary thing, but it doesn’t have to be. As long as you’re prepared and know how to deal with the situation you’ll be successful. Recognizing what’s happening and following the above steps will ensure your patients safety and their trust in you as their therapist.
Always be ready to coach and reassure your patients through whatever is happening in your treatment room. And again if you’re not sure of the cause, going through the SAMPLE questions will get you what you need to know.
While I’m not as scared of this happening anymore, I still can’t handle seeing a woman cry.
I may need to keep a paper bag handy the next time I watch “The Notebook”
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