One of my personal goals is to learn something new about massage and bodywork each day. Sometimes that is a new technique, and sometimes it is new information about a pathology or condition presented by one of my clients.
One of my regular, weekly clients has mild Type II diabetes. She also suffers from being overweight and from arthritis, and although very active in her life, her range of motion is impaired by her ailments. Massage and regular chiropractic appointments make her feel better and help improve her ability to do the things she enjoys with greater ease of movement.
I’ve been trying to discover the reason for her toe cramps for a while now. Other massage therapists have suggested that these might be caused by mineral deficiencies (potassium, magnesium, and calcium primarily), dehydration or by the massage releasing a muscle and thus causing the antagonist areas go into spasm. My client has tried many of the suggested remedies, plus homeopathic quinine and switching to lite potassium chloride salt. She even put a cork under her pillow although that folk remedy didn’t work.
My client’s regular doctor suggested, however, that the cramps might be related to her diabetes. That led me to do more research, and I’ve learned a good bit in the last week about diabetes and massage.
First, I learned that if the cramping is related to the diabetes, it may be coming from the drug she is using to control her sugar levels. The cramping may also be a complication of Type II diabetes itself though it is not as well-known as neuropathy or even the skin hardening that may precede neuropathy. Ulcerated skin is one of the worst of these related complications, so while I advise using the mineral supplements with the doctor’s approval, I also want my client to be vigilant for any decrease in feeling in her feet and toes.
I also learned some general things about diabetes and massage. In general, massage is beneficial for people who have diabetes. Massage helps the client relax and release endorphins which in turn helps blood sugar levels balance to healthy levels. Similarly, massage improves circulation, which in turn improves cellular insulin uptake. Finally, regular massage improves the elasticity of the connective tissue and makes movement easier.
This last benefit got me thinking about how often the superficial tissue of my diabetic clients seems stretched unusually taut and how often even light pressure seems to cause an unusual pain response. So I began to do more digging. What I discovered is that increased blood sugars cause connective tissues to thicken and even harden. The is true of the superficial fascia and also of the deeper fascia that surrounds the muscles, muscle fibers and the organs themselves. The thickening also causes swelling because lymph flow is restricted and further inhibits the range of motion. The skin itself can become dry, calloused and cracked. No wonder my client hurts!
I always work slowly, releasing the superficial connective tissue before working individual muscles. This is the way I was taught and is also an intuitive response as I palpate the tissues. Working slowly and broadly with long strokes, myofascial stretching and energy techniques first relaxes and releases the dense connective tissue before I begin using more specific deep tissue pressure and trigger point therapy on individual muscles.
I remember this same client telling me that her previous massage therapist often made her hurt for several days before she felt better. I suspect the MT went into the trigger points too quickly and caused damage to the connective tissue by not warming and melting it first. Now that I know about the effect of diabetes on the cellular density of the tissue, I will be even more careful to warm the tissue and proceed slowly to the deeper layers.
Another thing I learned is both a benefit and a caution. Massage can cause the blood sugar levels to drop as much as 20-40 points. Overall, this is a good thing, but if the client’s blood sugar levels drop too much while on the table or just after the massage, it could cause hypoglycemia and be dangerous. That defeats all the potential benefits of the relaxing massage.
Symptoms of a dangerous drop in blood sugar levels include:
- Excessive sweating or clammy skin
- Faintness or headache
- Inability to awaken
- Certain “spaced-out” tendencies, such as slow speech or clumsiness
- Personality changes
- Rapid heartbeat
That’s why I went out to the store and bought some fruit juice boxes to have on hand in case I have a client on the table whose sugar drops too much. However, if you are diabetic and receive massage, you should have a snack in your purse or car and always tell the therapist if you need to stop the massage and take care of your blood sugar needs. I assure you, the therapist will be thankful. You also need to check your blood sugar levels for several hours after you leave the massage office because the effects of blood sugar lowering can continue for several hours.
Be sure to update your therapist about what medications you are taking, especially if you are taking insulin shots. The injection sites are particularly sensitive to massage, and although the tissue there may feel especially dense (causing the therapist to work there more), studies have shown that massage on injection sites can increase the rate at which the insulin enters the blood stream and further lower your blood sugar.
Finally, be sure you eat before the massage and that you are hydrated both before and after the massage. If you feel unusual, after the massage, don’t drive until you feel normal.
The beneficial effects of massage for diabetics seem to outweigh the contraindications. However, it is a must that you and your massage therapist communicate effectively. Share you needs and concerns, and realize that honest feedback allows you and your massage therapist to learn from each other and develop a supportive rapport.