Diabetes and Massage

Sir Fredrick Banting – (14 Nov 1891 – 21 Feb 1941), Canadian medical scientist, doctor & Nobel laureate; noted as one of the main discoverers of insulin.

11-17 June is Diabetes Awareness Week

You may not realise, but massage can help if you are a diabetic. We won’t be looking at the causes and reasons for diabetes; there is a plethora of information on the internet available for you to browse at your leisure. What I want to focus on here is how massage can help, and if there are any techniques we need to modify or avoid with the diabetic client. First we’ll look at whether massage is appropriate for the diabetic client – your safety and health are paramount to us.

In a treatment the first thing we would do is to check that the client has their insulin levels well controlled. That includes noting the time of their last insulin injection (if appropriate), and where the site of the injection was. If  diabetes is uncontrolled, or there are unhealthy tissues present (e.g. ulcers or unhealed skin lesions) then these are considered contraindications and massage would not take place.

The other contraindication we look out for is pitting edema – this differs from edema which can be harmless excess fluid. Having seen pitting edema first hand it is unmistakable, so we know what we’re looking for – and that the client needs to seek urgent medical advice.

Returning to the injection site: during the massage treatment this area is avoided. This is because one of the key physiological effects of massage is the movement of fluids around the body. If we were to massage directly over the injection site we could increase the rate of insulin absorption.

The main considerations for a successful massage treatment are that tissues need to be healthy and responsive, with a good blood supply. Clients are encouraged to measure their blood glucose before and after a massage treatment to determine whether it is best to eat a small meal prior to future massages. We always have sugary snacks close by in case a client shows signs of hypoglycemia. There has been research carried out which suggests that massage can lower blood sugar levels by 20-40 points.

The benefits of massage for diabetic clients are:

Improved circulation: increasing circulation helps to reduce edema (swelling), thereby reducing the irritation caused to pain receptors.  The main aim of massage with a diabetic client is to warm soft tissues and stimulate blood movement around the body. By increasing circulation we can help to move excess fluids away from the extremities which can lead to the development of stasis dermatitis, which in turn can cause ulcers.

One issue which we are sensitive to with diabetic clients is the perception of pain – or in this case the potential lack of perception. Poor, or lack of, circulation and excessive sugar in the blood can both contribute to nerve damage, and the resultant peripheral neuropathy.  If this condition is present it can cause lack of sensation in the extremities – another contributing factor that can give rise to ulcers.

Relaxation: our daily lives are stressful enough with home, family and work commitments. Adding a medical condition on top of that is another ball to keep juggling in the air constantly. This isn’t a condition which comes and goes, it needs constant monitoring, adjusting medication and lifestyle, exercise and nutrition awareness. All of these things add up and can cause anxiety and stress, and put strain on your sympathetic nervous system – that’s the system which is responsible for the ‘flight or fight’ response.  During massage we can address the dominance of the sympathetic nervous system, decreasing the levels of stress hormones released as a result. The benefit of that could mean your blood sugar levels are lowered or become more stable, as well as you feeling calmer and better able to cope.

Myofascial health: massage treatments directly manipulate the soft tissues within the body (myo = muscle, fascia = connective tissues). By releasing restrictions within muscles, tendons and ligaments the flow of blood, lymph and other fluids in the body will be more like a river, and less like a swamp. And that’s a good thing. We need our bodies to have free-flowing rivers within them in order to reduce the stress and strain upon our internal systems. This includes the endocrine system: diabetes is a metabolic disorder characterised by disturbances in glucose metabolism. Thickening or stiffening of connective tissues can be a result of increased blood sugars, so massage can be used to counteract this by increasing mobility and elasticity of tissues.

We would encourage anyone who has diabetes to seek out a soft tissue therapist and incorporate massage into your routine management of this condition. Not only can massage help to relieve symptoms, but the therapist is well placed to spot danger signs within deep tissues before you may even know a problem is occurring. We’re sure you will agree with us that prevention is far better than being reactive after the event.

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