Integration of Massage & Manual Therapy into Amputee Rehabilitation and Care

Limb loss is a physical and psychological trauma that has a profound influence on the life of an amputee. Providing comprehensive rehabilitation services and programs to individuals recovering from amputation is, therefore, a complex process. It is generally recognized that a multidisciplinary team approach is required to address the individual's functional, emotional, social and psychological needs.

Precision Muscle Recovery is highly qualified in treating individuals recovering from amputations, burns, multiple trauma injuries, complex orthopedic conditions, stroke and heart surgery. Amputee patients typically receive therapy from a team of professionals, including a physical therapist, occupational therapist, psychologist, social worker, nurse and other medical specialists. In the past few years, however, it was recognized that there was a missing element in the rehabilitation services being provided. In response to this need, massage and manual therapy was integrated into the amputee rehabilitation programs to provide the “missing link.”

Why Massage & Manual Therapy?

Massage and manual therapy is used to prevent and treat physical dysfunction and pain through applying various manual techniques to the soft tissues of the body (muscles, connective tissue) and joints. It is recognized as a noninvasive therapy, which, when applied by a trained therapist, can have a number of highly beneficial effects.

What Are the Benefits of Massage & Manual Therapy?

Massage and manual therapy is supported by research to have a number of interrelated physical and psychological benefits, many of which are frequently indicated as rehabilitation goals. These benefits include:

  • Reduced swelling
  • Increased circulation
  • Less muscle stiffness
  • Reduced scar tissue tightness
  • Reduced spasms
  • Increased muscle length
  • Less pain
  • Decreased anxiety and stress
  • Longer sleep
  • Increased relaxation

Common Amputee Conditions Treatable by Massage & Manual Therapy

Every amputee is unique in his or her history and particular symptoms, depending on a variety of factors, such as age, health status, cause of amputation and current stage of rehabilitation. The therapist takes the patient's full history, assessment findings, and rehabilitation goals into account before discussing the appropriate treatment plan with the patient. Further, therapist, with a thorough knowledge of anatomy and physiology, can improve any of the following conditions commonly experienced by amputees.

Phantom Pain

Phantom pain is unique to amputees. It is the subjective sensation of pain, not arising from an external stimulus, felt in the part of the limb that is no longer there. Research suggests that 70 to 80 percent of amputees experience phantom pain. Most report it immediately after surgery, although studies indicate that 40 percent may experience phantom pain a year or more afterward. Phantom pain has been described using a variety of terms, including burning, stabbing, twisting, cramping, crushing and throbbing.

Massage and manual therapy treatments have had varying results in reducing reported phantom pain. For some, it has been a great source of relief; for others, it has had little effect. It is often cited in amputee rehabilitation textbooks that noninvasive techniques such as massage therapy increase sensory input from the residual limb that may override the brain's perception of pain, providing temporary or partial relief of phantom pain. How this is achieved depends on each individual and the therapist's ability to locate areas where the patient reports a change in the level of pain. Treatment may consist of directly massaging the end of the residual limb or the muscle and soft tissues above the amputated area. A more general approach may also be appropriate, with the goal being to reduce stress and anxiety, which are recognized as increasing the intensity or frequency of pain.

Residual Limb Pain

Residual limb pain is the pain felt in the remaining portion of the affected limb after amputation. The causes of residual limb pain are numerous and include tissue damage during surgery, poor prosthetic fit, an unprotected neuroma, rubbing of the skin, and joint dysfunctions.

Additional causes or contributing factors are swelling, poor circulation, adhered scars, muscle spasms or referred pain (pain felt in an area of the body that is not the actual source of the pain). All of these can be effectively treated with massage and manual therapy.

Hypersensitivity

Many amputees have highly sensitive residual limbs that cause discomfort and pain and limit their ability to use their affected limb. Our therapy is an effective method of reducing hypersensitivity and its associated pain and discomfort.

Muscle Tightness, Stiffness and Spasms

Amputees often experience pain in muscles and joints that are not directly associated with the area of amputation. These areas are called compensatory structures because they are required to perform additional functions to compensate for limitations resulting from the amputation. This imbalance in muscle activity often results in muscular tightness, stiffness and spasms, which may be manifested in the following ways:

  • Upper-extremity amputees often develop carpal tunnel or related symptoms in their unaffected hand due to their increased dependence on it to do everything they used to do with their other hand.
  • In lower-extremity amputees, weight distribution during standing and walking is often shifted to the unaffected leg, and alterations in posture and biomechanics are very common. As a result, lower-extremity amputees often suffer from persistent low-back pain.
  • Development of muscle tightness and spasms with the use of prostheses is very common due to the demands placed on the muscles to perform new activities and to carry the added weight of the prosthesis.
  • During recovery from amputation, muscles and joints may be kept in one position to ensure wound closure or healing of bones. This can result in contractures (permanent tightening or shortening of muscles, which causes stiffness of the involved joints). Contractures occur frequently in joints above an amputation site, restricting the range of motion and potentially leading to complications such as gait deviation, poor prosthetic fit and the inability to use a prosthesis.
  • Headaches are a very common symptom reported by amputees and can be caused by such things as medication side-effects, poor sleep, stress, dehydration, or referred pain resulting from muscle tightness at “trigger points” in the head, neck and shoulder muscles. By decreasing the muscle tightness and related soft-tissue restrictions through massage therapy, headache symptoms can be managed or eliminated.

It is necessary to determine the possible cause of muscular restrictions and reported pain to develop an appropriate treatment plan. The massage and manual therapy treatment may consist of trigger point therapy, joint mobilization, and specific massage techniques to the affected soft tissue. Education in proper posture and instruction in home care (stretching, for example) are also important elements of the treatments.

Scar Tissue

Many amputees have scar tissue in the affected limb associated with surgery or the original injury. Scar tissue is tougher, less elastic and often thicker than normal skin and muscle. Due to its restrictive characteristics, scar tissue can have a negative effect on adjacent tissue, resulting in stiffness and/or pain. Itching and sensitivity of scar tissue is also common and can interfere with wearing a prosthesis or reduce the range of motion of affected joints. Scar tissue cross-fiber massage is highly recommended to reduce tightness, stiffness, pain and itching and to increase the range of motion of affected and surrounding joints.

Swelling

Swelling (edema) in the residual limb is common, especially after surgery, drastic atmospheric pressure changes, or wearing a prosthesis for a prolonged period. The swelling, caused by excess fluid, can exert pressure on internal structures, resulting in tingling, numbness or pain. Swelling can also alter the fit of a person's prosthesis and limit his or her ability to wear a prosthesis comfortably. A skilled therapist can apply specific techniques that effectively reduce swelling, such as manual lymphatic drainage (a specialized form of very light massage that helps to move fluid from the end of the limb toward the trunk of the body).

Poor Blood Circulation

Good blood circulation is very important since it is the source of nutrients (food and oxygen) to all tissues. Amputation results in reduced use of the directly affected muscles and a consequent loss of “muscle pump” action that helps blood flow in and out of the area. Poor circulation also results in a cold residual limb, which is often associated with pain and increased phantom pain. Massage therapy is recognized for its ability to increase local circulation in the area being massaged.

Massage & Manual Therapy: Beneficial for Mind and Body at Any Stage

Massage and manual therapy can be of great benefit to amputees, whether as a preventive or maintenance measure or as an integral element in the various phases of rehabilitation. It is highly recommended that amputees receive massage and manual therapy in conjunction with beginning prosthetic training and ongoing prosthetic use. This can help prevent muscle strain, tightness and related pain symptoms that may develop due to alterations in posture and biomechanics and the new demands placed on the muscles directly and indirectly involved.

Massage and manual therapy can produce short-term or long-term relief from a variety of symptoms. It is important to stress that even short-term relief can have a huge positive effect psychologically. A number of studies suggest that type of therapy is also highly effective in reducing stress and anxiety and in increasing sleep duration – all important factors that can affect an amputee's quality of life.

For more information or to schedule an appointment, please call Precision Muscle Recovery at 480.755.5065.