et al , 1997 ; Gehlsen et al , 1999 ; Patino et al , 1999 ). Just be sure to respect the recommended 24 to 72 hour time frames , depending upon the medication .
Injections : Botox and Cortisone . Avoid massage and heat / ice applications over sites of recent botulinum toxin ( Botox ) and cortisone injection for 72 hours . Botulinum toxin and cortisone exert their action on local structures such as muscles , tendons , or bursae . Pressure over these injection sites may reduce the local desired effect by causing the drug to disperse into neighboring unintended areas . Additionally , use of head rests and other accessories should be avoided if they apply pressure on sites of recent botulinum toxin and cortisone injection during the 72-hour window . Pressure from these commonly used accessories could have the effect of drug disbursement similar to that of massage therapy and therefore should be avoided . 72-hour window is a practice guideline and may be extended by the client ’ s health care provider .
Injections : Vaccines . Avoid massage and heat / ice applications over vaccinated areas for 72 hours . If the area of vaccine injection is painful , red , or swollen after 72 hours , refer the client to his or her health care provider because these signs may indicate a complication related to the vaccine . If your client received the smallpox vaccine , avoid the area until the scab that forms falls off on its own , which may be as long as 3 weeks ( CDC ).
Drug Infusion Pumps . Avoid massage and heat / ice applications over the area of drug delivery , which is usually the abdomen . Additionally , do not get massage lubricant on the sensor , transmitter , pump , or its tubing . For added comfort , offer your client a soft cushion to place over the pump while lying prone . Most drugs are injected into subcutaneous tissues ; guidelines for subcutaneous injections also apply for drug pumps . Drug pumps are used to deliver nutrients or medications such as insulin and other hormones , chemotherapy drugs , antibiotics , or pain relievers .
Transdermal Patches . Avoid vigorous massage and heat / ice applications over the patch as massage was found to increase skin temperature and peripheral blood flow ( Hinds et al , 2004 ; Sefton et al , 2010 ) that may lead to increased transdermal drug absorption . Moreover , if the goal of transdermal administration is focused drug delivery to a specific area ( e . g ., lidocaine patch for local anesthesia ), massage could cause disbursement of the drug into neighboring unintended areas and reduce the desired local effect . Additionally , avoid lubricated massage in a 4-inch circumference around the patch edge because the skin lubricant may interfere with the adhesive properties of the patch .
Subcutaneous Pellets . Avoid areas containing them for 6 months because massage might increase absorption rates of the drug ( Cothren , 2015 ). Pellets are peasized and are inserted under the skin of the hip or abdomen . This drug delivery method is most often used in in hormone replacement therapy or pregnancy prevention .
Topical Applications of Prescription Medications . Avoid contact with the application site of the drug to prevent secondary exposure . If the therapist comes into contact with the application site , the area of secondary exposure be washed thoroughly with soap and water to remove any drug residue . Another alternative is to wear disposable gloves if the area that requires treatment contains a topically-applied drug ( such as the hormone testosterone ) and then remove and dispose of the gloves after treatment of the area . Additionally , laws regulating massage usually do not permit therapists to apply prescriptive products .
The field of pharmacology and massage is constantly changing . Having access to the most current information is essential . Massage therapists are advised to consult a reputable reference book in current editions . Some Internet sites such as the FDA ( http :// www . fda . gov ), Health Canada ( https :// www . canada . ca / en / health-canada . html ), Centers for Disease Control and Prevention ( http :// www . cdc . gov ), and the National Institutes of Health ( http :// www . nih . gov ) have current drug information , as well as information related to specific diseases . Information also can be found on the package insert for the drug . Pharmacists are another source of drug information . Stay current and use this information to make good practice decisions with client safety a top priority .
References : Berger , M . Cüppers , H . J ., Hegner , H ., Jörgens , V ., Berchtold , P . ( 1982 ). Absorption kinetics and biologic effects of subcutaneously injected insulin preparation . Diabetes Care , 5 ( 2 ), 77 – 91 . Centers for Disease Control ( CDC ): Smallpox pre-vaccination information packet . Retrieved from https :// stacks . cdc . gov / view / cdc / 26092 / cdc _ 26092 _ DS1 . pdf Ciccone , C . D . ( 1995 ). Basic pharmacokinetics and the potential effect of physical therapy interventions of pharmacokinetic variables . Phys Ther , 75 ( 5 ), 343 – 351 . Cothren , J . ( 2015 ). Hormone replacement with pellet implants . Retrieved from http :// www . jackcothrenmd . com / hormone-replacement-therapy . html Davidson , C . J ., Ganion , L . R ., Gehlsen , G . M ., Verhoestra , B ., Roepke , J . E ., Sevier , T . L . ( 1997 ). Rat tendon morphologic and functional changes resulting from soft tissue mobilization . Med Sci Sports Exerc , 29 ( 3 ), 313 – 319 . Drust , B ., Atkinson , G ., Gregson , W ., French , D ., Binningsley , D . ( 2003 ). The effects of massage on intra muscular temperature in the vastus lateralis in humans . Int J Sports Med , 24 ( 6 ), 395 – 399 . Gehlsen , G . M ., Ganion , L . R ., Helfst , R . ( 1999 ). Fibroblast responses to variation in soft tissue mobilization pressure . Med Sci Sports Exerc , 31 ( 4 ), 531 – 535 . Hinds , T ., McEwan , I ., Perkes , J ., Dawson , E ., Ball , D ., George , K . ( 2004 ). Effects of massage on limb and skin blood flow after quadriceps exercise . Med Sci Sports Exerc , 36 ( 8 ), 1308-1313 . Linde , B . ( 1986 ). Dissociation of insulin absorption and blood flow during massage of a subcutaneous injection site . Diabetes Care , 9 ( 6 ), 570 – 574 . Patino , O ., Novick , C ., Merlo , A ., Benaim . F . ( 1999 ). Massage in hypertrophic scars . J Burn Care Rehabil , 20 ( 3 ), 268 – 271 . Salvo , S . G . ( 2018 ). Mosby ’ s Pathology for Massage therapists , ed 4 , Elsevier , Saunders . Sefton , J . M ., Yarar , C ., Berry , J . W ., Pascoe , D . D . ( 2010 ). Therapeutic massage of the neck and shoulders produces changes in peripheral blood flow when assessed with dynamic infrared thermography . J Altern Complement Med , 16 ( 7 ), 723-32 . Statistics Canada : Prescription medication use by Canadians aged 6 to 79 . Retrieved from https :// www150 . statcan . gc . ca / n1 / pub / 82-003-x / 2014006 / article / 14032-eng . htm
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