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Rub me down! Medical massage for stroke

March 1, 2014 11:40 pm

Q & A with massage therapist Heather Cutlip on how massage can help with young adult stroke recovery

Heather Cutlip, medical massage therapist


Q. Tell me about yourself.
A. My name is Heather Cutlip and I am a licensed massage therapist, myomassologist, Level III Reiki practitioner and proud member of the wellness community. I’ve been a practicing therapist since 2011 working in a medical setting as well as a private practice.

I’ve done mostly therapeutic/medical massage my entire career. I am the head massage therapist and marketing/wellness director at Complete Care Chiropractic Clinic in Warren, Michigan. There, I work with three chiropractors and do mostly insurance-based massage therapy on clients with chronic pain, car accidents and those who need rehabilitative work, including those who have suffered strokes. My private practice is Little Lotus Wellness Studio in Ferndale.

I host workshops on subjects such as stress management, meditation, essential oils and my pay it forward campaign One Drop – teaching you how to go green and pay it forward to help create a better world. In my training, I studied subjects such as Shiatsu, orthopedic assessment, elder massage, lymphatic drainage, spa treatments, TMJD treatments, mind/body medicine and spiritual development. I am CPR and First Aid certified, however I am not a doctor, exercise professional or nutritionist. I educate myself and pass on healthy tips I’ve learned in my education to help everyone live a healthy lifestyle.


Q. What is medical massage and how does it relate to stroke?

A. Medical massage therapy is prescribed by a physician following his or her directives for a desired outcome to the patient’s condition. It is used to help many ailments and can help in the following:

  • Increasing range of motion,
  • Joint flexibility,
  • Reducing spasms and cramping,
  • Promoting tissue regeneration,
  • Reducing scar tissue and adhesions,
  • Lessening medication dependence,
  • Decreasing depression and anxiety, and,
  • Improving circulation.

There is still a perception that massage is simply a luxury you use when you splurge to pamper yourself. Doing medical massage therapy, I’ve seen the wonderful therapeutic effects it can have not only on your physical self but your emotional self as well. Often times an emotional component will be present, especially if there has been paralysis or long-term speech issues due to a stroke. Massage can help ease the stress and anxiety that comes along with recovering from a stroke and have a definite impact of a stroke survivor’s progress and recovery.

Massage therapist Heather Cutlip

Q. What kind of role in recovery does medical massage play?
A. If medical massage is used in conjunction with other therapies, it can be really beneficial, whether you’ve had a “fresh” stroke or are continuing therapy. Most importantly, you must get your primary care/neurologist/specialist’s approval to receive massage therapy, as it may not be a benefit at certain times in recovery or there may be special considerations the therapist would need to know about.

Massage therapists can measure results and track these results and their progress in our SOAP notes. We can do range of motion testing, sensory testing even strength testing. We document the progress until we get to the patient’s desired result. We can’t diagnose conditions, but we can track progress for sure.

Q. How does medical massage benefit stroke survivors?
A. The goals of therapy vary with each individual, depending on whether it is a recent stroke or they are far into their recovery process and need maintenance. Medical massage can help ease the symptoms of many physical ailments after stroke including:

  • Reducing spasticity and contractures,
  • Improving tissue and joint health and circulation,
  • Decreasing sympathetic nervous system firing,
  • Decreasing edema/swelling,
  • Increasing range of motion,
  • Helping the compensatory side if there is paralysis on one side of the body, often times there are overuse syndromes that can develop,
  • Helping to alleviate emotional stress,
  • Helping aid in the correction of an altered gait.

Everyone is different; modifications and safety are most important. If there is a functional disability or specific doctors recommendations, those need to be considered first, or if the stroke was the result of an underlying condition.

Hydrotherapy can also be used. Often times heat therapy is used on contractures and cold therapy may help with edema.

It’s always good to work in conjunction with other providers if possible, whether it be physical therapy, occupational therapy or others. Having an integrative wellness team is beneficial.

Heather and Tony DeNardo

Heather and Tony DeNardo

Q. Do you have any personal stories of stroke survivors that you’ve helped?
A. Tony Denardo had been receiving massage therapy for a decade after his stroke when I started working with him. Massage has been part of his maintenance program to keep performing at his optimal level. He has made great progress with massage as a regular routine. His attitude was immediately inspiring and he shared with me his story and his path to recovery.

I believe attitude and the right mindset are so important, and Tony definitely has the right attitude. He knows his limitations, as one side of his body was affected after his stroke. He knows by now what works for him and what doesn’t, so we would work together every week to achieve what his goal was at the time. Being a musician with several bands, including Detroit’s own The Muggs, he had to make certain changes when he had his stroke; one being having to adapt to playing the bass on a keyboard as opposed with a guitar.

Often times, I would give extra time to his arms and hands before and after a show, and he said it shows improvement in his ability as a performer. But I’ve seen him play and he has NO problem! Sometimes we’d focus on his hands and circulation in his legs. Other times, his hips would need alignment and would need some extra stretching and his arms would need extra attention. His resolve is wonderful and he is very active in his own treatment. We’ve had great success in maintaining his health and functionality with regular massage therapy.

Q. How does medical massage work?
A. By working directly on tissues and moving different layers of muscle and skin, medical massage can help increase circulation, blood flow and get oxygen to the tissues. If there has been scar tissue built up, a massage therapist can physically work to break up the scar tissue and promote healthy tissue growth. If there are functional disabilities or gait is affected (how a patient walks or moves their arms), medical massage along with stretching can help straighten up the hips and get that gait and swing going in the right direction again. If there are compensating issues on the unaffected side of the body due to paralysis massage can help repetitive strain injuries of hypertension of muscles, and increase fluid in the joints to help them move more freely.

Q. How is medical massage different than traditional massage?
A. Medical massage can be quite similar to a traditional massage session. The work I do is typically one hour sessions where a client gets undressed and lays on the table. In both traditional and medical massage, the massage therapist works on the specific areas that need the most work and have the most tension. In medical massage, there is usually a treatment plan set in place and certain goals are set for treatment, such as increasing range of motion, or trying to ease contractures, spasticity or inflammation and the massage therapist takes notes on the progress of the client’s condition. Many different modalities can be blended into a single session to achieve whatever the client needs for that specific session. One day it can be range of motion, but the next session we may focus on increasing circulation to their legs or reducing edema. Other times, the client can be fully dressed, perhaps even in a wheelchair. Sessions all depend on the each client’s individual needs and limitations.

Q. What is the training for a medical massage therapist?
A. You must be a licensed massage therapist and there is a mandated training and testing by the state to receive your license to able to practice massage therapy. I took over 600 hours of training and studies subjects such as anatomy, physiology, pathology as well as several other subjects on different modalities and techniques in therapeutic massage therapy. Therapists may choose to go on and continue their education and specialize in certain modalities, it’s important to find the right therapist for you.

A qualified therapist needs to know the ins and outs of the human body and what you can and can’t do. As much as I say medical massage is beneficial, it can work against you if the therapist isn’t properly trained and educated. So finding a qualified therapist is paramount. So far in my career I’ve been lucky to work mainly under three doctors, and my education in medical massage has grown immensely in the past few years.

Q. How can a stroke survivor find the right massage therapist?
A. The most important thing is to first get permission from your doctor. Your doctor might have a massage therapist that they refer, or you can find one on your own. There are so many different modalities and specialties in massage therapy, so you can find someone that specializes in different areas depending on your needs, such as sports therapy, medical massage, shiatsu, trigger point therapy and more. Most therapists are trained in all of these areas as well to some extent.

Working with an integrative team is often beneficial but not necessary. As a massage therapist, I can work the muscles and increase range of motion for example. But like physical therapy or occupational therapy, I cannot prescribe exercises on how to build your muscles or teach how to learn to function in certain situations. So communication between practitioners would work well for an overall desired result.

Q. How could a massage therapist (who isn’t properly educated) potentially hurt a patient?
A. Well if you have your license from the state then you should be properly trained in the contraindications (what not to do) in certain situations. And by this fall it will be required that you have a license to practice in the state of Michigan. But if a therapist isn’t properly trained, then massage can have undesirable results. There are many things that need to be taken into consideration such as blood clots, blood thinners, medications, seizures, congestive heart failure, blood pressure and working around the carotid artery in the neck just to name a few. For example, we know stroke survivors and people with heart conditions may be prone to blood clots in their legs or other parts of their body. If performed incorrectly or without proper knowledge of the patient’s condition, too vigorous a massage may cause blood clots to dislodge. Ultimately, it is the responsibility of the massage therapist to do a thorough intake with the patient or caregiver and be aware of the client’s medical history and specific needs. Any special instructions from the doctor should be given to the caregiver and/or therapist.

Q. How would a stroke survivor get started and does insurance cover medical massage?
A. First again, please make sure you have prescription from your doctor and then you need to find a qualified licensed therapist for your needs (see above question). Often times, a physician may have someone they refer. If not, you can find one on your own. Just be sure to check those credentials and ask if they provide paperwork for insurance reimbursement.

Sometimes health insurance or Medicaid will cover massage therapy (80% of the body work I do is covered), as medical massage is becoming more and more accepted as a viable therapy. If you go through a massage therapist working directly under a doctor, they will more than likely bill the insurance if it is covered. But if it is an independent therapist you will most likely need to find out yourself if massage is covered, pay upfront and then submit paperwork for a reimbursement.

Work with your physician and other caregivers on what your goals are. These will be relayed to the therapist so that you may work together to achieve your desired goal. I’m sure that the process to begin recovery after a stroke can be quite overwhelming and challenging, not only for the survivor but as well as for the family and caregivers. Having a plan and support team in place will certainly help the process.

Q. How much does medical massage cost?
A. It varies, depending on where you go and the training of the therapist. Shop around if you are paying out of pocket to see what they best rate is your area is.

Q. How do emotions play a role in healing and massage therapy?
A. Taking care of every aspect of the person is so important. If there’s an emotional issue, it’s probably going to hinder your process. There is a mind, body and spirit connection.

Other things to try besides massage may be meditation, acupuncture, relaxation exercises and chair yoga to help alleviate additional stressors and emotional issues that come along with recovery.

I am a big believer in the power of the mind and its effect on the body, and often I will do a guided meditation if the client desires to get them in a nice relaxed state.

Q. What is your advice for a young adult stroke survivor who is looking to try new things to recover?

A. There are so many things out there in additional to traditional therapies that can help in recovery. Again, I am a big believer in taking care of the mind, body and spirit-as everything is connected and find it’s important to treat every aspect of a person. You can help someone physically but if they are suffering emotionally or spiritually that will certainly hinder their process.

Being a member of a chiropractic and wellness clinic, we use many different therapies to help all types of conditions including massage, chiropractic, nutrition, hydrotherapies, hot and cold therapies, essential oils and more. We also host weekly meditation groups, wellness seminars and educational classes to help make people knowledgeable about the different things available to them. One of our doctors is a nutritionist. He has great advice on how you can act nutritionally too help things such as increasing circulation to the brain and he uses natural herbal supplements based on your needs that can help guide you in the right direction, and will always do a free consult.

Things such as acupuncture, meditation, yoga, aromatherapy and tai chi are some additional alternative therapies that may compliment treatment. By no means should someone abandon their doctors’ treatment and switch to an alternative therapy to solely treat their condition, they should actually get their doctors approval when considering an alternative therapy to make sure it is safe in your specific case.

I am also a Reiki practitioner and energy worker, and this can be very beneficial both physically and emotionally to someone recovering from a stroke. Energy work is very calming and non evasive, often times no touching at all is even needed and can bring balance and peace back to the body and help aid in healing.

Q. Do you have any resources, links and videos on medical massage you could provide for more information?

A. There are two main websites that are great resources for both more information on massage therapy as well as finding a therapist in your area.

Q. Anything else you would like to add?
A. There’s a lot more to massage therapy than most people think. There’s a lot of good we can go that’s measurable toward a stroke survivors recovery. It’s so important to have support and take care of every aspect of yourself. So not only taking care of the physical you but the emotional and spiritual you as well. I truly think that massage therapy can help take care of all of those aspects, help to ease stress as well as physical ailments. Never give up and stay active in your own treatment! Attitude is EVERYTHING!

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