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massage is often highly beneficial in the postsurgical environment, there are important precautions as well. These precautions may require some knowledge of the surgery, and also an understanding of how the body is compensating for the surgical intervention. Here are a few general rules. Do not treat fresh surgical sites; it usually takes some amount of time—sometimes several weeks—before massage close to an incision is appropriate depending on the rate of tissue healing, which can be unique to each individual. Be careful working over any area that has implants or any other instrumentation inserted. For example, screws, pins or rods may be used for serious fractures or to straighten bone deformities in orthopedic surgeries. You should not apply pressure over instrumentation that could damage the soft tissues. Most practitioners also understand that movement of the region should be limited and only performed within | www.massagemag.com | September 2015 | MASSAGE Magazine | 63 64 | MASSAGE Magazine | September 2015 | www.massagemag.com | pain limitations. Keep in mind that when joint regions are unstable, as is the case in an ACL repair surgery, a certain degree of muscle tightness is beneficial to make up for the ligament impairment. In cases like this, be cautious about working extensively on muscles near the treatment site because hypertonic muscles may be serving a purpose. As another example, massage can be very helpful for restoring proper biomechanical patterns in the hip region after a hip replacement surgery. However, for at least six weeks postsurgery, certain motions, including hip flexion past 90 degrees, adduction or internal rotation—which might be performed during range-of-motion or stretching activities—should be avoided. Artificial hip joints are, in general, less stable. Techniques One of the common questions that comes up about postsurgical massage is what type of techniques should be used. The technique is highly dependent on the nature of the surgery, the patient’s condition, primary goals of treatment, and the physiological effects of the treatment. The most effective way to properly choose treatments for postsurgical massage is to consider all of these factors and use good clinical reasoning to determine a proper course of action. While the general guideline about not treating recent surgeries has some merit, massage appropriateness really depends more on the type of massage and where it is applied. It is very important to communicate with the client’s physician or rehabilitation professional to determine effective and safe treatment strategies, and to pay attention to the precautions to avoid adverse effects. Consulting with the client’s other health care practitioners is particularly important if you are working immediately after a surgical procedure. When a length of time has passed, be sure your understanding and knowledge of this type of work is up to par. If other health care practitioners are involved in the client’s care, reach out to them or have your client consult with them. You will be far more effective in addressing postsurgical massage if you have a good understanding of the surgical procedure itself. Arm yourself with greater knowledge and understanding of common medical interventions, and the types of massage that are most effective, and you can be an outstanding addition to the health care team.

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