Massage and Pharmacology:
Evidence-Informed Approaches Based on Routes of Administration
By Susan Salvo, EdD, LMT, BCTMB
Nothing in life is to be
feared, it is only to be
understood.
—Marie Curie
Many of your clients will have diseases
and conditions and also will use drugs
to manage signs and symptoms such as
pain and hypertension, or, as hormone
replacement therapy. Drugs can be pre-
scription or nonprescription and admin-
istered orally, by injection, or transder-
mally through skin and mucous mem-
branes. According to Statistics Canada,
medications costs to manage chronic
conditions and diseases are one of the
highest health care costs, and, heart dis-
ease, diabetes, depression, and pregnancy
prevention are the most common reasons
for drug use (Statistics Canada). Prescrip-
tion medication use is strongly correlated
with age as only 3% of Canadians aged 6 to
14 use them compared to 70% of Canadi-
ans aged 65 and older.
Learning about pathologies, pharma-
cology, and how medications are adminis-
tered is important for massage therapists
and it may alter your approach with a par-
ticular client. Additionally, many clients
have multiple chronic conditions that are
managed by several types of medications,
all administered differently. For example,
your client may be using insulin to man-
age diabetes mellitus type two, hormone
crème to increase testosterone levels,
and nicotine patches to reduce or stop a
smoking habit. These situations add lay-
ers of complexity to treatment planning.
Keep in mind that a thorough intake
is crucial. Inquire about pathologies and
medication use during the client intake.
If the client is taking medications, ask
why your client is taking a particular
drug, if he or she is experiencing any
side effects, and how the medications are
being administered. This article focuses
on drugs that are administered by injec-
tions, drug pumps, transdermal patches,
subcutaneous pellets, and by topically
applied products.
Injections: Subcutaneous and Intra-
muscular. Avoid vigorous massage and
heat/ice applications over sites of recent
injections for 24 hours. Massage therapy
was found to increase insulin absorption
(Berger et al, 1982; Linde, 1986) and the
increased absorption produced by mas-
sage could cause or contribute to compli-
cations such as hypoglycemia. Massage
may also increase drug absorption and
distribution to manipulated tissues by
mechanisms of increased local blood flow
(Ciccone, 1995) and increased intramus-
cular temperature (Drust et al, 2003).
Keep in mind that sites of frequent injec-
tions may contain scar tissue, which can
be reduced by massage therapy (Davidson
FALL 2018
21