When Massage Clients Present with Joint Pain

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Technically described as the junction between two bones, joints typically endure great amounts of pressure. Their responsibility of carrying weight and transmitting force while facilitating movement makes them especially prone to painful conditions. As professionals who are increasingly recruited to field a variety of painful conditions, massage therapists are particularly likely to work with clients complaining of joint pain. In order to provide the most effective treatment possible, massage therapists should be able to differentiate between the most common types of joint pain.

Unfortunately, our nation’s healthcare system dissuades many Americans from seeing a physician for anything less than a perceived emergency. Unless severely debilitating, joint pain is one of those discomforts that may be assumed too minor for a doctor visit. Although requiring an MD’s training and thus not included in a bodyworker’s scope of practice, many massage therapists find themselves in a quasi-diagnostician’s role anyway. Thus, having a general understanding of the origins, presentations and implications of your client’s joint pain can go a long way in providing excellent care.

Five of the most common reasons for joint pain, include:

Osteoarthritis – Also referred to as degenerative arthritis, osteoarthritis is a condition where the cartilage between joints wears down. This most common type of arthritis causes the bones to rub against each other causing joint pain, swelling, stiffness and loss of joint function. Osteoarthritis is more common in people aged 40-years and up, and is frequently seen in people with a family history of arthritis. With its risk increasing with obesity, osteoarthritis is most common in large, weight-bearing joints of the hips, knees and low back. A 2008 study by University of North Carolina researchers found that obese men and women were almost three times more likely to suffer from osteoarthritis than thinner people. While massage during the acute stage of osteoarthritis (with heat and redness present) is a local contraindication, bodywork’s ability to release affected hypertonic muscles and increase range of motion is very helpful to cases of chronic osteoarthritis.
Bursitis – Frequently confused with arthritis, bursitis involves inflammation around the joint (rather than the joint itself). Due to excessive movement, pressure or trauma, inflamed bursa causes discomfort, stiffness, tenderness and pain in the joint area. Often occurring near joints that perform frequent repetitive motion or must sustain long periods of pressure, the most common locations for bursitis are the shoulders, elbows or hips; however, it is also seen by the knee, heel and the base of the big toe. Bursitis often occurs in joints that perform frequent repetitive motion. When irritated, bursa generates excess fluid, which causes pain and limits mobility. Bursitis is considered to be a local contraindication for massage therapy – especially during acute inflammation. However, bodywork to relax the muscles crossing over the joint may help relieve the pain.
Lupus (systemic lupus erythematosus) – Lupus is a chronic inflammatory disease that may affect the joints, making them swollen, inflamed and tender. Characterized by the body’s immune system attacking its own tissues and organs, lupus occurs more frequently in women than men. While the outlook for people with lupus was once grim, diagnosis and treatment of this disease has improved considerably. Massage therapy is indicated for lupus patients to reduce stress, reduce inflammation and enhance circulation. Although, those with lupus may have complications of the liver, kidneys, spleen, heart and central nervous system that would be of concern to any therapist. Thus, a physician referral is advised for these clients.
Lyme Disease – Lyme disease is an infection with Borrelia burgdorferi that is transmitted through the bite of deer ticks. Early symptoms of Lyme disease generally appear 7 to 30 days after a tick bite. Initially, symptoms may or may not include a hot and itchy bull’s eye rash, fever, fatigue, night sweats, headache, swollen lymph nodes and a sore neck. Later symptoms can include irregular heartbeat, dizziness, confusion, facial paralysis, numbness, tingling and poor coordination. Finally, Lyme disease can cause extreme and painful inflammation of one or more large joints – usually the knees, elbows and shoulders. If joint inflammation is severe, deep bodywork should be avoided locally. Numbness and tingling could impair the client’s senses – hindering his or her ability to give accurate feedback about pressure or comfort. In addition, Lyme disease’s impact on the cardiovascular system could limit the safety of massage therapy. Therefore, therapists are acting in their affected client’s best interest when they discuss any potential massage limitations with their client’s physician.
Rheumatoid Arthritis – An autoimmune condition where the body mistakenly attacks its own tissues, rheumatoid arthritis can affect various joints, especially the hands and feet. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. Massage therapy is contraindicated during an acute flare-up, but it can also help relax taught tissue, improve mobility, help joint tissue health and ease stresses that could trigger another flare-up.

Since the mechanics of joints make them especially susceptible to stress and injury, nearly every practicing massage therapist will see clients whom cite joint pain as their main complaint. As we now recognize, the causes behind joint pain can be quite varied, from overuse, to an autoimmune disease to an insect bite. By being familiar with the general presentation of these five joint pain-causing conditions, massage therapists will have a clearer idea of how to move safely forward in providing their clients the highest level of professional care.

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