guidelines as general massage with only a few differences. Besides the consultation form and the evaluation process, a few other elements need to be addressed prior to treatment, including how MFR is performed. Contraindications must always be con- sidered. Also, you need to always ask, Is this client suitable for MFR?
As with every other form of therapy, how you set up your treatment room and perform your treatments does not just promote you professionally but also determines longev- ity in your career. It is also really important that you make clients feel comfortable throughout the process and that you adequately discuss their reasons for treatment as well as their responses to the treatment. This builds your confidence and your clients’ confidence in you.
Contraindications
MFR is generally not a core qualification; basic soft tissue and fascial skills are often included in courses such as sports therapy and physiotherapy. Because MFR is generally a postgraduate remedial rehabilitation approach used by a variety of therapists, an under- standing of pathology and contraindications is often already in place. Contraindications have to be in line with core training. For example, a physiotherapist using MFR would be able to work with a few more clients on the contraindications list than a massage therapist would. Check with your governing organisation if you need further clarifica- tion on this. For further information on contraindications, visit the General Council for Massage Therapy website at www.gcmt.org.uk or your relevant governing body.
If a client presents with symptoms indicating the possibility of an underlying patho- logical state, or if you are in any doubt, treat it as a contraindication and refer her to her doctor unless you are qualified to treat the condition. First, do no harm.
46 Myofascial Release
Following are lists of contraindications for the use of MFR, both global and local. In the case of local contraindications, you can work on the client but stay clear of contraindicated areas.
Global Contraindications
■ Alcohol and recreational drug use ■ Febrile state (high temperature) ■ Systemic infection
■ Colds and flus that are contagious
■ Acute circulatory conditions and acute blood disorders ■ Deep vein thrombosis and aneurysm
■ Uncontrolled hypertension usually involving anti-coagulant therapy ■ Severe undiagnosed swelling
■ Severe undiagnosed pain ■ Undiagnosed lumps ■ Rapid weight loss or gain
■ Undiagnosed breathing difficulties ■ Undiagnosed bowel and bladder issues
Local Contraindications
■ Open wounds ■ Sutures or stitches ■ Healing fracture
■ Skin hypersensitivity or inflammation ■ Infectious skin condition or sunburn ■ Radiation therapy
■ Localised infection
■ Cortisone therapy (wait three or four days on the specific area)
■ Osteomyelitis (avoid the inflamed areas; do not treat if the client has other sys-
temic symptoms)
■ Osteoporosis or advanced degenerative changes (avoid affected areas) ■ Rheumatological conditions (avoid inflamed areas)
■ Severe varicose veins
During MFR treatments, clients need to be able to note and describe what they are feeling. Clients on medications that dull the senses, such as anti-depressants, may need a little more time and help in responding to the therapy. Taking anti-depressants doesn’t necessarily mean that the client has depression; these drugs are also used to treat other conditions such as chronic pain and insomnia. Be sure to ask your clients their reasons for being on medications, and take that into consideration during therapy.
How many times do clients turns up full of the cold? Turning them away results in lost revenue, but working with them is a contraindication, not just for the client (because
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Preparation and Communication
it can increase the infection), but for you. If you catch the cold from the client, you won’t be able to work and you may pass it to other clients too. Consider posting on your website or brochures asking clients not to attend appointments when their tem- peratures are higher than normal or they have a cold, flu or stomach bug. Explain the importance of keeping your treatment room free of germs.
Conversely, if you have a contagious infection, cold or flu, you shouldn’t be treating clients. Apart from issues of contagion, it’s simply not professional to be sniffing and coughing your way through treatments. You may need to take a few days off so you can recover and not pass on germs to your clients.
Three contraindications for MFR that are particularly important to mention are preg- nancy, scar tissue and adhesions and cancer (malignant tumors that are being treated with chemotherapy or radiotherapy, or remission).
Pregnancy
MFR is an appropriate therapy for pregnant woman after their first trimester and can be extremely beneficial in preparation for labour. MFR helps to alleviate the stressful symptoms of body change and adaptation not only as the baby grows but as a result of the hormone relaxin being secreted into the system. Relaxin softens the cartilage at the pubic symphysis and the joints at the sacroiliac in preparation for labour. Many women suffer back and pelvic discomfort in these areas during pregnancy, and MFR can be an effective therapy to maintain their integrity. As with all other forms of bodywork, abdominal work is contraindicated during the entire pregnancy.
Some governing bodies and therapy insurers permit practitioners to treat pregnant women without having to attend a pregnancy massage course; others require such courses. Be sure to check the guidelines of your governing body before accepting pregnant clients.