Shingles, a viral infection stemming from the reactivation of the chickenpox virus, can cause significant pain and discomfort. While massage during an active shingles outbreak is generally contraindicated, massage therapy can play a supportive role in managing the condition and preventing future occurrences. This article explores the relationship between massage and shingles, providing insights for both massage therapists and individuals seeking relief.
Understanding Shingles
Shingles, also known as herpes zoster, is caused by the varicella-zoster virus - the same virus responsible for chickenpox. According to the Mayo Clinic, after a person recovers from chickenpox, the virus remains dormant in the body. It can reactivate years later, causing shingles. While not life-threatening, shingles can be very painful and disruptive.
Symptoms and Progression
The symptoms of shingles vary, but typically include:
- Skin sensitivity, itching, tingling, and pain
- A rash that develops into small, fluid-filled blisters
- Fever and fatigue
The rash usually appears on one side of the body, often in a band-like pattern following dermatome lines, which are areas of skin innervated by specific spinal nerves. The most commonly affected nerves are those emanating from T3 and T4, as well as the ophthalmic branch of the trigeminal nerve. If shingles appears on the face, especially near the eyes, prompt medical attention is crucial, even if the outbreak seems mild.
The virus typically clears within 2 to 4 weeks, but nerve damage from shingles can prolong recovery. In some cases, long-term nerve pain, known as postherpetic neuralgia (PHN), can develop and last for months, years, or even permanently. PHN can significantly impact a person's ability to perform daily activities and can disrupt sleep.
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Risk Factors and Prevention
Anyone who has had chickenpox is at risk of developing shingles. However, certain factors can increase the risk of reactivation, including:
- Age over 50
- Weakened immune system (due to stress, illness, certain medications, cancer treatment, organ transplant, or HIV/AIDS)
- Emotional stress
Vaccination can help prevent shingles or reduce the severity of an outbreak. The shingles vaccine (varicella-zoster vaccine) is recommended for adults aged 60 and older. While the vaccine does not guarantee complete protection, it can lessen the severity of an outbreak and reduce its duration.
Massage Therapy and Shingles: Considerations and Contraindications
Massage therapy can offer benefits for individuals affected by shingles, but it's crucial to understand the appropriate timing and techniques.
Active Shingles Outbreak
During an active shingles outbreak, massage is generally contraindicated. The intense pain associated with the rash can make even light touch unbearable. Moreover, direct contact with the rash could potentially irritate the blisters and increase the risk of secondary bacterial infections.
As one massage therapist noted, "Most massage therapists will not see an active case in their office, as the discomfort is so great that a person can experience excruciating pain merely from the weight of light clothing or even just a breeze blowing across his or her body."
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Post-Shingles Massage
After the shingles outbreak has subsided and the blisters have healed, massage therapy can be beneficial in addressing residual pain, muscle tension, and stress. Massage can help to:
- Reduce muscle tension caused by altered sleep patterns and odd sleeping positions adopted to avoid pain during the outbreak.
- Release adhesions that may have formed over the affected area.
- Improve circulation and promote healing.
- Reduce stress and promote relaxation.
One massage therapist shared an experience of working with a client after a shingles outbreak: "With the client prone, I checked the area of the outbreak for any reddish, hive-looking sores. None. The left side looked same as the right side. I palpated along the spine and asked her to let me know when I was on the spot… All the area really needed was some TLC. Massage after a shingles outbreak is good indeed."
Techniques and Precautions
When providing massage to a client who has had shingles, therapists should consider the following:
- Obtain a thorough health history, including information about the shingles outbreak, any residual pain or sensitivity, and any medications the client is taking.
- Avoid direct contact with any areas that are still sensitive or have not fully healed.
- Use gentle techniques, such as light Swedish massage, myofascial release, or craniosacral therapy.
- Communicate with the client throughout the session to ensure their comfort.
- Use hypoallergenic and fragrance-free products to minimize the risk of skin irritation.
Alternative Therapies
In addition to massage, other therapies may be helpful in managing shingles pain and promoting healing:
- Acupuncture and Acupressure: These Traditional Chinese Medicine (TCM) techniques can help to balance the body's energy and reduce pain. According to TCM theory, shingles is caused by a combination of excess and deficiency in the body, as well as the presence of pathogenic damp, heat, and wind. Acupressure can help to boost the immune system and address these imbalances.
- Physical Therapy: A trained physical therapist may use therapeutic ultrasound and electrical stimulation and guide you through customized exercises to stretch and strengthen the body while reducing pain.
- Medications: Medications are often the first go-to for any type of pain (shingles included). If you’re dealing with severe or ongoing pain, nerve blocks or injections might be a good option for you.
Lifestyle Modifications
Lifestyle changes can also play a crucial role in managing shingles and preventing future outbreaks:
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- Stress Management: Stress is a known trigger for shingles outbreaks. Techniques such as yoga, meditation, and deep breathing can help to reduce stress and boost the immune system.
- Healthy Diet: Eating a balanced, nutritious diet can support the immune system and promote healing. While there is no specific diet for shingles, some people may find that avoiding foods high in L-arginine, an amino acid that may help the virus replicate, can be beneficial.
- Skin Care: Protecting the skin can help ease the pain of the shingles rash and reduce the risk of secondary bacterial infections. Keeping the rash covered, using topical creams prescribed by a doctor, moisturizing the rash after the blisters have crusted, and avoiding scratching or irritating fabrics can all be helpful.
General Advice on Skin Health for Massage Therapists
As massage therapists work so closely with skin, they should be aware of skin pathologies, maintaining hand hygiene, identifying skin problems on the client's body.
Maintaining Healthy Hands
Massage therapists rely on their hands for their work, so it's essential to take care of them. Frequent handwashing can dry out the skin, so therapists should:
- Moisturize regularly, especially after washing hands.
- Use moisturizers with ceramides to help repair the skin barrier.
- Consider wearing cotton dermatology gloves overnight after applying moisturizer.
Identifying Skin Conditions
During massage, therapists may notice unusual skin conditions on clients. While it is beyond their scope of practice to diagnose, they can bring awareness to unusual skin spots that the client may not be able to see. Therapists should be aware of the signs of potential skin cancers, such as moles that are asymmetric, have irregular borders, are changing colors, or have a diameter larger than a pencil eraser.
Contraindications
Massage should be avoided when the client has a communicable disease, open wounds, or skin that is red, swollen, or hot.