Recently it became apparent to me that women who have gone through genetic counseling for breast cancer are not being told to avoid deep tissue massage if they have had nodes removed. A young woman made an appointment with me for a massage. She told me of frequent neck and shoulder pain. I knew that she had gone for a prophylactic mastectomy within the past year. I asked her if she had had any nodes removed and she told me 2 on each side. I informed her that due to the nodes being removed, my training had taught me that deep massage would be a contraindication for her arms and her upper shoulders and back. No one had mentioned this fact to her and when I followed up with the genetic counselor at work she agreed with my decision to refrain from doing deep tissue massage.
Within this same period of time at the Living Beyond Breast Cancer Conference in Jacksonville, when I asked survivors prior to their chair massage how many nodes they had removed, they always answered me with the number removed and then prefaced whether they were positive or negative for cancer. Their responses made me realize that survivors, or anyone who has had surgery with nodes removed, didn’t understand the significance of nodes being removed; positive or negative not being the issue.
These incidents make me very aware of the need for Massage Therapists trained in safe practices for cancer and massage. These Massage Therapists understand the potential for Lymphedema if deep tissue massage is done in an extremity where nodes have been removed due to a surgical procedure. The issue is the nodes removed and the amount of pressure exerted over the site, not diagnosis of cancer or whether the nodes were positive or negative. Site restriction is always taken into consideration when there is recent surgery and any concern of cancer returning to lymph nodes.
Considering the percentages of people expected to get cancer sometime in their life, it becomes apparent that Massage Therapists in the community need to understand that they must be able to explain to a potential client the reason not to have “deep tissue massage” when nodes have been removed. I have not met a single client who has demanded their old style of massage when they have been educated as to the precautions that I need to take to ensure a safe massage. They quickly adapt to their “new normal massage” with good results.
I like to use the example that was shared in class at a seminar to explain the lymphatic pathway. Imagine the busiest highway in your town and it is backed up due to an accident. You will get home, by another route, but it will be slower. The lymphatic system is similar. When someone has a node removed, even just one, the Sentinel Node, the pathway is impaired. It doesn’t mean that lymphatic fluid won’t get home (your heart) it will just have to find another route and go a bit slower.
A lymphatic system that has nodes removed is susceptible to Lymphedema. Which means that anyone with even one node removed is at risk for lymphedema for life. That sounds frightening, but the reality is with precautions a patient should be fine. Being aware of deep tissue massage and how it can cause lymphedema needs to be understood by Massage Therapists and communicated in a clear and precise manner to clients.
Understandably a person would choose this surgery if it means prolonging their life. To give up deep tissue massage so that they could see their children grow to adulthood and become grandparents far out weighs this minor life style change. Somewhere through this chain of events from genetic counseling to surgery to a day at a spa, a client/patient has the right to be informed of this information. No women needs to get LE due to lack of information.
The reality is that no one knows why one woman with a very active life style has 10 nodes removed and doesn’t get lymphedema. Yet, the next woman with just one removed is diagnosed with lymphedema. A Massage Therapist that explains the signs and symptoms of lympedema helps her client be vigilant in taking care of themselves.