Client who has amputation below knee on one leg

[nobodys home]

I've a client I've been massaging who has one leg amputated below the knee from a car accident many years ago. He wears a leg prosthesis that connects/goes up to the very top of his remaining legs, perineum to hip, some of the time. His thigh of one leg, where he wears the prosthesis lacks muscle tone, even though he exercises reguarly. I do a lot of work in his mid section back and front. He says most massage therapists are cool with this although I have to admit I was somewhat uncomfortable at the beginning. I am getting very comfortable helping him with his body to help everything flow better and am getting comfortable working on him. He's the first client I've ever had like this out of over a thousand different people I've massaged. I wonder though, what else I can be doing? I work the muscles very thoroughly, all the connective tissue, and etceteras. It's a very healing environment all around in every way. What do other massage therapists do for clients like this? What are the best massage techniques you've found to give the greatest relief to someone who is missing the lower half of one of his legs and wears a prosthesis? (He uses crutches the other part of the time). PS  I do make sure I also pay extra attention to his hands, one of which can get extra rough than the other, the same side he's missing part of his leg. From using/gripping crutches.I do work the upper body and around the shoulder girdle areas, rhomboids area, etcetera wherever he is tense in his muscles.I try to make sure he is as balanced as possible.

 

[MariVi]

Client who has amputation below knee on one le

I have never worked with an amputee in a massage setting, but I remember reading a couple of articles about it.  One stated that tapotement at/above the amputation site was good.  The other was energy work below the amputation site - massage as if the leg was there.  I'm sorry I can't reference these.  I know they were on the net.  I will see if I can find them again.

Hope this helps and good luck with it,
Scav

 

[Staggerlee]

Client who has amputation below knee on one le

This link may help some too.  From http://www.massageresource.com  I know it has more to deal with a fresh amputation, but there may be something that is helpful there.   :-/

Post-amputation massage??
http://www.massageresource.com/ubbcgi/ultimatebb.cgi?ubb=get_topic&f=11&t=000035

I worked on an individual who had some fingers amputated, and was left with a functional, yet very changed hand appearance.  Working the scar tissue and forearm helped tremendously.

I have worked on a few wheelchair bound individuals.  Upper body work was always extremely helpful with them too.  It sounds like you are doing all the right stuff.  The opposite leg and foot probabaly need extra attention too.

Please let us know how it goes.  And what new info you find.

 

[Pompal 09.]

Client who has amputation below knee on one le

I have a client with an amputated arm.  It happened when he broke his arm when he was ten years old.  His mother took him to the hospital (this was in the 1950's) and the doctor made them wait overnight without being seen (he is African-American).  When they finally looked at his arm they told him that he was fine and go home and put ice on it.  Two weeks later, and still in excruciating pain, he went back to the hospital and had to have it amputated. :'(  Sorry for the depressing story...but I just thought I'd share because I feel honored to be able to help him now...

Anyway...It is amputated half way down the left humerus right below the deltoid insertion.  I work on the deltiod and pec (which are undertonus) surrounding muscle areas and really focus on the opposite limb which is over-used.  I also do energy work around the missing limb because I learned that energy still acts as if the limb is still attached.  Also because there was so much emotional trauma involved in the injury, even though it was so long ago.

 

[Alhamdulilah]

Client who has amputation below knee on one le

i remember being taught energetically the energy still resides in the place where the leg was, so energetic work as simple as slowly running your hand down his missing leg like it was there and energetically strip the energy, like brushing it and pulling it out.  i hope this made sense ???.

 

[inlove7]

Client who has amputation below knee on one le

I've heard that energy work helps also.....especially meridians work.  Work the meridians that extend into the limb.........like they are really there.  It seems to help a lot with the phantom pain many amputees have.

Also........massage along the incision to help prevent adhesions.  Hope this helps.

 

[vicki_gratt63]

Client who has amputation below knee on one le

I mainly practice Medical Massage... I have a client that had her right leg amputated above the knee, and she doesn't want me going any where near the stump.

But if I was to work on it... First of all... I hope you have a doctors note if you are working on the stump and remaining limb, yes they do need work in common sense speaking but it is always good to be safe than sorry.  Yes there will be a severe amount of atrophy on that side, and hypertrophy on the remaining limb trying to account for the postural distortion.  I would concentrate on the unaffected side to relieve some of the stress and increased tension on that limb.  The upper body will be highly affected due to having to stabalize the crutches, especially lats, pecs, tricepts and delts.  QL will also be very tender due to the unequal pressure to the lower extremities.  It will usually be contracted on the side of the amputation.

And remember it is common for them to have phantom limb pain, and have the sensation of that limb still being there, which can vary client to client.  As for the tone, that really is more for a PT to handle.  He needs his exercise program modified, and he may never return to a normal tone due to the injury and surgery that they had to perform.  Atropy is VERY common in these situations.  As long as they continue to work on it to maintain whatever they can is the best that they can do.

 

[adam g]

Client who has amputation below knee on one le

Texas-gal,
Yes, I do work the opposite leg, etcetera.Thank you for caring   And, thank you everybody for caring and haring... : Seriously..Thank you everybody for all your replies to this topic.It seems like a lot of people are suggesting energy work as to where the limb is missing from.

Thank you for pointing this out. It seems so obvious that it is many times overlooked.
The misssing part came about decades ago and I have read that phantom pain usually stops about 7 years after or so. But, that is just an average or something?

So I really thought there was nothing I could do. But, you're right, there is something I can do E N E R G E T I C A L L Y.

Pure Agape type of Love and Thankfulness are good starting points, energetically in what I convey in massage. I did think of it in the last session, then wrote this topic to clarify ideas. This is good.

No matter how old the missing part has been missing it is important to honor the missing part to know that for the client and your self, the missing part is never missing energetically -  Only physically.

 

[Chihiro00]

Client who has amputation below knee on one le

Phantom limb pain can be forever, there really isn't a time limit for it to go away.  It all depends upon why it was amputated and how good your surgeon was.  Mainly because of the nervous system reactions.  Sensations are there but not conducting properly so it is sending confused signals to the brain.

For an example... the first time I came across PLP I was working as an EMT prior to my further medical training... I put my O2 tank where the leg would have been, made sure it wasn't anywhere close to the stump, and secured it... well the woman started SCREAMING to get it off her leg that I was hurting her!!!  She was a long time diabetic and had her leg amputated below the knee many many years before I came in contact with her.  

 

[frmthesouthgrl]

Client who has amputation below knee on one le

Phantom limb pain can be forever, there really isn't a time limit for it to go away.  It all depends upon why it was amputated and how good your surgeon was.  Mainly because of the nervous system reactions.  Sensations are there but not conducting properly so it is sending confused signals to the brain.

For an example... the first time I came across PLP I was working as an EMT prior to my further medical training... I put my O2 tank where the leg would have been, made sure it wasn't anywhere close to the stump, and secured it... well the woman started SCREAMING to get it off her leg that I was hurting her!!!  She was a long time diabetic and had her leg amputated below the knee many many years before I came in contact with her.  

Good point. Timeless.

Thank you.

 

[Alwaysknows]

Client who has amputation below knee on one le

I've heard that energy work helps also.....especially meridians work.  Work the meridians that extend into the limb.........like they are really there.  It seems to help a lot with the phantom pain many amputees have.

    Also........massage along the incision to help prevent adhesions.  Hope this helps.

I have found massage along the incision end of the knee area not inviting energetically. I have felt somewhat like I should sort of mostly leave that area alone.

It reminds me of an end of a wave, very subtle. Not hardened but, very soft. There are a lot of ridges in it. Wrinkled skin. He doesn't really have any adhesions from it. It's more like the softest part on his partial leg.

I will try to massage him more there next time and see and feel his reactions more.

It's not where he requests massage to be done and it is probably the least worked area of his body. But, I can see because of these facts it would be good to work the incision area more completely each time.

 

[.Me.]

Client who has amputation below knee on one le

I don't guess I mentioned it, but I recall years ago, when I was about 15... so that is more than 20 years now.... that they were doing some work with mirrors for amputees, in order to help with the phantom limb pain.  You may be able to look this up somewhere.  

I remember them saying they would attach the mirror so that it made the other extremity appear to be in the place of the amputated limb, as the individual looked at the mirror.  If I recall right, they had really good results with the phantom pain dissipating.

Don't know if it helps, but I thought I'd add it.

 

[Los Rojiblancos]

Client who has amputation below knee on one le

I don't guess I mentioned it, but I recall years ago, when I was about 15... so that is more than 20 years now.... that they were doing some work with mirrors for amputees, in order to help with the phantom limb pain.  You may be able to look this up somewhere.  

I remember them saying they would attach the mirror so that it made the other extremity appear to be in the place of the amputated limb, as the individual looked at the mirror.  If I recall right, they had really good results with the phantom pain dissipating.

Don't know if it helps, but I thought I'd add it.

Updating this thread, because Jason provided a "youtube" (below) which shows what was being mentioned in this post (above) today. Thanks! Thanks! Thanks!

• • From: Frozen hand due to injury

    One interesting therapeutic method available to physical therapists is mirror box therapy. It takes a solid understanding of neuroscience, but the results can be dramatic. Definitely outside our scope of practice, but here's a vid clip explaining the basics of mirror box therapy: http://www.youtube.com/watch?v=hMBA15Hu35M
    
    If you can find a PT that uses mirror box therapy, they might be a good person for clients that have phantom limb pain, motor control problems, complex chronic pain patterns, and other stubborn issues.

 

[mcrgirl18]

Client who has amputation below knee on one leg

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