Specialized massage therapy has been shown to improve clinical outcomes in post operative clients. Any invasive procedure will result in tissues being damaged and it takes time for them to heal and regain full range of motion.
Pain isn’t something that only happens in the immediate post operative period. Almost 25% of chronic pain cases are post-surgical patients whose pain lasts a few months , and the pain isn't limited to the incision site, but becomes compensatory in other areas, as patients find alternative ways to move that accommodate the initial pain. These compensatory postural changes can lead to long term dysfunction. Pain will interfere with mood, sleeping patterns and other aspects of mental and physical health, which are required for effective healing.
Research shows that massage can be highly beneficial in the post op recovery period to assist with healing, helping to reduce pain, anxiety, scar tissue, residual swelling and improving circulation. Common types of surgery that would particularly recommend massage, are cosmetic surgery and cancer related surgeries where the lymph nodes are often removed, causing lymphoedema. The following surgeries, however, also have some common post operative complaints:-
• GENERAL SURGERY - complications with general surgery will vary depending on the exact area that underwent surgery, but may include changes in breathing patterns or thick scar tissue, which is common on the abdominal area. Even scar tissue with laparoscopic surgery can be significant, and there are issues with trapped air which can produce a lot of pain around the shoulders, potentially causing postural changes
• ABDOMINAL/GYNAE SURGERY - can involve large incisions to deal with issues such as infection, inflammation and obstructions, which can cause scarring before the surgery even takes place. This is probably the type of surgery with the most extensive scarring/adhesions, which can continue to tighten after the recovery period and continue to cause pain. Many feel they no longer have control of their abdominal muscles after surgery and will compensate with their back muscles, thus they will start moving differently.
• CARDIOTHORACIC SURGERY - also an area which can involve severe scarring, especially if the chest has been cracked open. This type of surgery can result in shortness of breath, chest tightness during the healing process, and pain and restricted movement around the shoulders, particularly on the right side. Peri-operative trauma to the pectoral muscles can cause some loss of strength and therefore encourage compensatory measures.
• HIP REPLACEMENT - depending on the approach taken by each individual surgeon, the incision may be 4-5 inches long, and a posterior approach, which is more common, tends to be more traumatic than an anterior approach. Scarring and impact on the muscles, therefore, can vary, but a common issue that can cause further pain is the holding of muscles which can cause some misalignment and postural changes.
• POST OP ANXIETY - even positive surgical experiences are physically and emotionally stressful but managing these stress levels can really improve outcomes. High stress levels reduce wound-healing and immune function.
BENEFITS OF POST OP MASSAGE:-
• PAIN - massage has been shown to not only manage, but reduce pain levels after surgery, reducing the need for pain killers. This is because of the effect on peripheral and central neuroreceptors of the body, which are involved in pain transmission when their sensory neurons are activated. Massage blocks the amplified pain signals from reaching the neurons in the spinal cord. It will also relax any tightened muscles which are guarding the wound site.
• EASE POST CARDIAC BACK TENSION - following cardiac surgery many patients experience upper back tension due to the rib cage being cracked open but massage can release any tension
• CIRCULATION - by increasing blood circulation, massage improves transportation of oxygen and nutrients to the healing tissues. • DVT - calf massage can reduce the risk of deep vein thromboembolism due to reduced movement following surgery
• LYMPHATIC CIRCULATION - lymphatic drainage massage is particularly useful after cosmetic surgery, not only to prevent general swelling, but also stagnation caused by fatigue, stress, inflammation, swelling, bruising and lack of physical activity. By improving lymphatic circulation massage also improves cell regeneration required for healing. and reduces accumulation of toxins which can lead to impaired immune function. Manual lymphatic drainage is also often recommended for cancer patients following removal of lymph nodes, which can block the lymphatic system and cause pain and swelling that may progress to lymphoedema. By strengthening the immune system massage also helps to protect against post-operative infections.
• SCAR TISSUE - massage can reduce excessive growth of collagen fibres which results in thick, painful scars and reduce surrounding discomfort by re-aligning muscles and joints.
• MUSCLE ACTIVATION - massage can help to reactivate muscles that may not be functioning as normal due to post- surgical complications eg.obliques may, quite inefficiently, compensate for a transverse abdominus not offering core stability. By reducing muscle tone, particularly in large muscles, such as the quads or hamstrings, that have become hypertonic to help protect the surgical area from injury, massage can help the brain and muscle connect together again.
• RELAXATION - Massage will help release surgery related stress and anxiety which can increase pain levels and reduce wound healing potential and immune function.
FINDING A MASSAGE THERAPIST FOR POST OPERATIVE TREATMENT
Manual lymphatic drainage and swedish massage are particularly beneficial post surgery, but often a combination of techniques will be used, depending on the type of complications being experienced. Massage can be done in a very gentle manner a few days after surgery, depending on the scale of surgery performed, but generally it should not be carried out until at least 4-6 weeks post-op. If there are signs of infection, poor wound healing, or pain is not being managed, then certainly the wound site should be avoided.
Also, it is extremely important to only see a therapist who is registered and experienced in post-operative massage, to avoid damage to the healing wound. Depending on the type of surgery and stage of recovery, the therapist may need to consult with the doctor.