The two main categories of surgery are major surgery and minor surgery. Massage was reported to benefit patients before and after surgery. Benefits were also found when massage was given to caregivers of patients undergoing surgery. Intrigued? Read on.
Major surgery involves entering a body cavity and/or altering normal anatomy. This type of surgery usually involves general anesthesia and respiratory assistance. Examples of major surgeries include joint replacement, organ transplant, breast augmentation, and open heart surgery.
Minor surgery involves the skin, mucous membranes, and neighboring tissues. In comparison to major surgery, minor surgery does not encompass cutting into a body cavity and usually does not require general anesthesia. Minor surgery often involves local or regional anesthesia. Examples of minor surgeries include removal of superficial skin lesions such as warts, moles, spider veins, muscle and joint injections, and most biopsies, surgical procedures to obtain tissue samples or body fluids. Most day surgeries or outpatient surgeries are minor surgeries.
Massage Therapy & Surgery: Massage therapy can begin after major surgery once the client is medically stable. Medically stable occurs when vital signs such as pulse, temperature, and blood pressure are within normal limits, the client is conscious and comfortable, and prognosis is good to excellent. Be sure to communicate with the patient care coordinator if the client is still under medical supervision and follow his or her directives. Position the client for comfort. A side-lying or other body positions may be needed to avoid pressure on areas containing unhealed incisions, drain tubes, or recently implanted medical devices, such as catheters or pacemakers. In most cases, the prone position is avoided because the majority of incisions and medical devices are located on the anterior surface of the body.
The incision produced by surgical instruments during the operation and areas near the incision should be avoided until the sutures or staples are removed and the area is clean and dry. This may take up to 8 weeks after surgery. Additionally, the area around the incision should not be manipulated in a way that places stress on the incision while it is healing. Once healed, massage of the scar tissue can begin. Use pressure that respects your client’s pain tolerance.
Avoid vigorous massage techniques on the lower extremities (thighs and legs) for 12 weeks after surgery. This restriction is because of the increased risk of blood clots that could last up to 3 months (1). Although use of prophylactic anticoagulants such as low-weight heparin, warfarin, and aspirin to mitigate the risk of blood clots is commonplace today (2), avoiding vigorous massage techniques on the lower extremities for 12 weeks after major surgery is a safe practice precautionary measure.
Manual lymphatic drainage may begin immediately after surgery unless there is a contraindication present. Specialized training is recommended to determine specific contraindications and to gain skills in applying lymphatic drainage techniques in postsurgical situations. Manual lymph drainage techniques are applied in a particular order, and the techniques themselves are different from massage techniques such as effleurage and pétrissage.
The same general guidelines apply for minor surgeries as listed for major surgeries with one exception—blood clot risk. It appears that the risk of blood clots for minor surgeries is low and brief, so lighter pressure on the lower extremities may not be warranted.
Patients awaiting cardiac catheterization who received back massage experienced reduced blood pressure, respiration rate, perceived psychological distress, and pain (3). Hand massage reduced anxiety, blood pressure, and pulse rate in patients who underwent eye surgery under local anesthesia (4, 5) and while awaiting major surgery (6). Hand-holding also produced these effects (6).
Back massage, hand massage, and foot massage decreased postoperative pain and/or anxiety in several studies (7 – 12). LeBlanc-Louvry et al (13) found that abdominal massage lowered postoperative pain, reduced dosages of analgesics, and expelled gas significantly faster than in those who did not receive massage. Treatment began the first day after surgery and was performed daily until postoperative day 7. Massage and acupuncture in addition to standard medical care decreased pain and depressive mood among postoperative cancer patients compared to standard medical care alone (14).
Patients who received massage during the postoperative period after cardiac surgery experienced decreased pain, anxiety, and tension compared to those who received standard medical care alone (15). Patient feedback regarding the massage sessions were markedly positive (15, 16). Foot massage and guided imagery improved psychological well-being in patients after cardiac surgery (17). Massage therapy reduced fatigue and improved sleep in patients recovering from cardiopulmonary artery bypass graft surgery (18)
Massage reduced distress, fatigue, nausea, and anxiety in days after surgery among patients who underwent bone marrow transplant (19). Foot massage decreased pain in women after laparoscopic sterilization surgery (20). Massage therapy combined with relaxation techniques were given to patients at bedtime during days 1 to 3 after total hip or knee replacements and was found to reduce pain and anxiety and stabilize vital signs (21). Manual lymphatic drainage techniques increased knee flexion after knee replacement surgery (22). The increases in knee flexion were still noted at the 6-week follow-up appointments. The American Massage Therapy Association issued a position statement in 2008 that massage therapy is beneficial for reducing postoperative pain.
Caregivers of patients undergoing surgery experienced significant declines in anxiety, depression, emotional fatigue, and subjective caregiver burden (23).
Articles and Journals Referenced:
- Sweetland S, et al: Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study, BMJ 339:b45832009
- Bass AR: Using new oral anticoagulants in patients undergoing major orthopedic surgery, Curr Rheumatol Rep 17(4):25, 2015.
- McNamara et al: The effects of back massage before diagnostic cardiac catheterization. Altern Ther Health Med. 9(1):50-7, 2003.
- Kim MS, Cho KS, Woo H: Effects of hand massage on anxiety in cataract surgery using local anesthesia, J Cataract Refract Surg 27(6):884-890, 2001.
- Nazari R, et al: Effects of hand massage on anxiety in patients undergoing ophthalmology surgery using local anesthesia, J Caring Sci. 1(3): 129–134, 2012.
- Oh H.J, Park JS: Effects of hand massage and hand holding on the anxiety in patients with local infiltration anesthesia. Taehan Kanho Hakhoe Chi. 34(6):924-933, 2004.
- Dreyer NE, et al: Effect of massage therapy on pain, anxiety, relaxation, and tension after colorectal surgery: a randomized study, Complement Ther Clin Pract. 21(3):154–15-9, 2015.
- Kshettry VR, et al: Complementary alternative medical therapies for heart surgery patients: feasibility, safety, and impact, Ann Thorac Surg. 81(1):201–205, 2006.
- Mitchinson AR, et al: Acute postoperative pain management using massage as an adjuvant therapy: a randomized trial, Arch Surg. 142(12):1158–1167, 2007.
- Nixon M, Teschendorff J, Finney J, Karnilowicz W. Expanding the nursing repertoire: the effect of massage on post-operative pain. Aust J Adv Nurs. 14(3):21–26, 1997.
- Piotrowski MM, et al: Massage as adjuvant therapy in the management of acute postoperative pain: a preliminary study in men. J Am Coll Surg. 197(6):1037–1046, 2003.
- Wang HL, Keck JF: Foot and hand massage as an intervention for postoperative pain. Pain Manag Nurs 59(2):59–65, 2004.
- LeBlanc-Louvry I, et al: Does mechanical massage of the abdominal wall after colectomy reduce postoperative pain and shorten the duration of ileus? Results of a randomized study, J Gastrointest Surg. 6(1):43–49, 2002
- Mehling WE, et al: Symptom management with massage and acupuncture in postoperative cancer patients: a randomized controlled trial, J Pain Symptom Manage. 33(3):258–266, 2007.
- Cutshall SM, et al: Effect of massage therapy on pain, anxiety, and tension in cardiac surgical patients: a pilot study, Complement Ther Clin Pract. 16(2):92–95, 2010.
- Bauer BA, et al: Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study, Complement Ther Clin Pract. 16(2):70–75, 2010.
- Hattan J, King L, Griffiths P: The impact of foot massage and guided relaxation following cardiac surgery: a randomized controlled trial, J Adv Nurs. 37(2):199–207, 2002.
- Nerbass et al: Effects of massage therapy on sleep quality after coronary artery bypass graft surgery, Clinics (Sao Paulo). 65(11):1105-10, 2010.
- Ahles et al: Massage therapy for patients undergoing autologous bone marrow transplantation. J Pain Symptom Manage. 18(3):157-63, 1999.
- Hulme J, Waterman H, Hillier VF: The effect of foot massage on patients’ perception of care following laparoscopic sterilization as day case patients,. J Adv Nurs. 30(2):460–468, 1999.
- Büyükyılmaz & Aştı: The effect of relaxation techniques and back massage on pain and anxiety in Turkish total hip or knee arthroplasty patients. Pain Manag Nurs. 14(3):143-54, 2013.
- Ebert et al: Randomized trial investigating the efficacy of manual lymphatic drainage to improve early outcome after total knee arthroplasty. Arch Phys Med Rehabil. 94(11): 2103-11, 2103.
- Rexilius et al: Therapeutic effects of massage therapy and handling touch on caregivers of patients undergoing autologous hematopoietic stem cell transplant. Oncol Nurs Forum. 29(3):E35-44, 2002.
Susan Salvo is a board certified massage therapist with 30+ years of experience. Susan is passionate about massage therapy and massage education. You can contact her at firstname.lastname@example.org.