My jaw dropped and I had to apologize.
As he told stories, I mentioned that we had something in common because we both had experience in First Aid.
Turns out we didn’t.
As the stories progressed each was more horrific than the last and I felt bad for speaking out of turn.
The things he had seen and experienced were things no one should be subject to.
There was no way I could understand the pain he was going through, much less what could possibly be going on in his head.
The doctor had prescribed getting Massage Therapy to help treat PTSD.
I had no idea how to effectively manage this, so I just let him talk.
There was nothing great about the treatment, much less anything really specific about it, but for 45 minutes he talked, vented and decompressed.
I’ll admit I was pretty intrigued by the stories as well as learning how something that happened 40 years earlier was still playing on his mind.
While I couldn’t give any feedback or advice, the treatment did make a difference and he left in a better mood.
What Is PTSD?
I used to think that PTSD was something that just veterans were diagnosed with.
Over the past few years I have had a few people come into the clinic who have been diagnosed with PTSD, some were veterans, some were teenagers and not all of them had a background that would suggest a PTSD diagnosis (or so I thought).
Post Traumatic Stress Disorder is a type of mental illness.
The Canadian Mental Health Association gives a definition of the cause:
“It involves exposure to trauma involving death or the threat of death, serious injury, or sexual violence.”
Little did I realize that over the past few years, I have probably treated more people who might have been dealing with this than I thought.
Think about that definition for a second, “trauma involving death, threat of death, serious injury or sexual violence”. Every single person who has come in for treatment after a car accident could potentially have PTSD.
I get called out (with the fire department) to dozens of MVI’s every year and witness first hand how people react in these situations. Even very minor accidents are very traumatic experiences for most people.
If this is the first time they have experienced anything traumatic, it’s hard to know how they will respond.
Either way they will feel a loss.
It could be the loss of a loved one, the loss of their first vehicle, or just that they simply lost control. There is also the addition of how severe an accident is. Even as First Responders, the adrenaline gets pumping a little more when we hear that we are responding to a roll-over MVI, nevermind if you’re actually in the vehicle.
It can seem like a life or death experience (or at least a major injury experience) that can have severe repercussions to a person’s mental health down the road.
As for the topic of sexual violence, unfortunately this is all too common in our society these days. As time goes on, more and more I meet people or have friends admit to me, they have had to deal with this at some point.
I can’t imagine the mental trauma involved, nor am I going to pretend to.
However I have had to use First Aid skills before, in order to help people who are hyperventilating and having an emotional release due to an experience like this in their past.
PTSD, A Counsellor’s Point Of View
I reached out to my friend Tara Miller, she’s a Clinical Counsellor and Psychotherapist who deals with patients who have PTSD on a regular basis, here’s her advice for helping them:
What predisposes someone to PTSD is not the relative severity of the event or threat they have experienced, but rather what’s already in their nervous system.
A person with many overwhelming or traumatizing events in their life can function quite well but can experience symptoms after a relatively minor event because of what’s previously layered in their nervous system.
Knowing this can help your patients deal with any shame about their inability to heal mentally or physically compared to how minor they feel their accident or incident was.
With relationship violence, it’s important to remember that a person hurt them. You, as a therapist can feel just as threatening. Just like how a person bit by a dog can be afraid of all dogs, not just the breed or the dog that attacked them.
In both cases, you might see common symptoms expressed physically including:
- Chronic brace/tension.
- Repeated injuries to the same area of the body as previously injured.
- Gastrointestinal issues.
- Difficulty sleeping.
- Increase in headaches/migraines.
- Sensitivity to light and sound.
- Trouble reading/visual disturbances.
- Increased startle reflex/jumpiness.
The emotional and cognitive symptoms add to those and you might see your patients in treatment experience crying episodes, panic attacks/anxiety, and even dissociation (a sense of being there but not there, spaciness), and memory lapses.
What can help, is education around all of this – it’ll help reassure them that it’s normal and even expected. Being able to add information about some of their physical symptoms being related to how the brain holds trauma and recommending a trained psychotherapist to work in conjunction with the physical therapy they are receiving is highly beneficial.
Some things that can help your PTSD patient is to become familiar with the room, noticing elements they like and giving them time to settle in and feel comfortable.
Checking in on light, sound, even the loudness of your voice and adjusting to their comfort level. You want to avoid the word ‘safe’ – it automatically brings up what is not safe. Use the word “comfortable” – what would make you more comfortable?
Trauma happens quickly, remind them they have all the time they need to settle. From there, when you work on an area where they brace or tense up, ask them what level of pressure they’d like – too much pressure can increase the brace in the injured area and cause more pain.
Pain is activation and their system is already in high sympathetic arousal. These patients might need a gentler approach as you work psycho-physiologically with their injury while being mindful of PTSD.
Another thing to be aware of, when working on an injured area or area of brace is knowing that all activity around the injury brings back their traumatic incident – potentially reliving it each time.
They might start talking about it when you go to the area as well.
What we know about the brain and nervous system is that talking about trauma does not heal trauma.
Clients feel the need to talk about what happened but that light’s up their brain and releases all the same fight or flight chemicals as when they first experienced the trauma. This adds more of a charge to the system we are trying to regulate down.
This can be overwhelming for the therapist as well!
Instead, encourage them to use their imaginations in treatment. Where would be your favourite place to go and relax, have them describe it in detail (see if their muscles don’t start to let go with the visualization at the same time). Ask what would feel best on the injured area, visualizing a warm compress, floating in the ocean or a magic ointment that could seep through the pores and remove all the inflammation.
Notice what happens in their physical body as they imagine the perfect healing, the perfect environment, or what they will do once healed, how it would feel to move their bodies when well again. This works as little brain hacks encouraging the brain to light up and release chemicals that are relaxing vs activating.
Help your patient avoid talking about the worst moments of their trauma if they haven’t worked through their traumatic experiences with a professional. You can explain what happens when we retell and re-live traumatic experiences and how that can cause tension in the body during treatment.
Encourage them to see a psychotherapist or counsellor that is trained in a neuroscience based, trauma-centered modality, like Self Regulation Therapy.
These patients need extra support and are more sensitive to their environment and therapist than others. It might be helpful to book a little extra time for them to settle in. Check their comfort level and help them direct the discussion and imagination into positive directions to get the most benefit from treatment.
Find a therapist that can work with them and collaborate on their care for overall best outcome.
Useful resources for more information on this:
- Why Zebras Don’t Get Ulcers
- The Trauma Spectrum,
- The Canadian Foundation for Trauma Research and Education
Massage Therapy Treatment And PTSD
It turns out Massage Therapy can and should be a part of therapy for anyone dealing with PTSD.
When someone is suspected of having PTSD, a PDS (Posttraumatic Diagnostic Scale) can be used to determine the severity of the condition. It is used to measure how helpless the person felt during an event and if there are any avoidance or arousal symptoms they are experiencing.
Communication with a patients counsellor or psychiatrist is crucial to understand what measurements they are using in their assessment, so that we may be able to get a better idea of how someone is progressing once they start receiving Massage Therapy.
Studies have shown that incorporating Massage into a patient’s treatment has helped in their recovery.
One pilot study had National Guard Veteran patients do massage with their partners at home to the shoulders, back, neck, head, and feet. They were encouraged to do as much as they wanted each week but were required to do one 20 minute session as a Massage reporting session. The results showed a significant reduction in physical pain, tension, irritability, anxiety, and depression. However, one of the things noticed was how important it was to leverage an existing trusted relationship to initiate care for these veterans.
What is little talked about is the improvement in home life and effect on family members. I have personally seen a spouse insist on regular Massage Therapy treatment because of the improvement in mood at home. I also truly believe that these treatments are not for the faint of heart. While I know that Massage does make a difference and helps, I also believe there is another facet to the treatment (and this is strictly just my opinion). Letting people talk. I’m pretty fortunate because it takes a lot to offend me (okay maybe fortunate isn’t the word) and have had people swear while telling their story, which could be hard for some therapists. People will want to tell their story while on the Massage table, but should only be done if they are working through things professionally with a trained counsellor and feel like they can talk about it, without being impacted by it. If this starts to happen, (just as Tara recommended) try to shape the conversation to something more positive. While we can’t give them advice (other than recommending seeing a counsellor if they aren’t already) we can be a very therapeutic service for anyone dealing with PTSD. Just make sure you can handle hearing a few f-bombs.