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As massage therapists, we touch the body to help restore harmony and stay fit. Our clients place their welfare, literally, in our hands. Most come to us relatively healthy, asking us to treat specific aches or help reduce stress, but there are those arriving with untreated and, often unseen, wounds wounds perhaps inflicted upon them by others, either physical or psychological in nature.

With the military being so much in todays news, we are becoming more aware of the high incidence of Post Traumatic Stress Disorder (PTSD) in soldiers returning from combat. Distressed by what they see and experience, they may have difficulty readjusting to normal life.

Recent reports indicate that military troops diagnosed with PTSD jumped by approximately 50 percent in 2007. In 2006, 14,000 troops were diagnosed with this disorder, whereas only 1632 were diagnosed in 2003. Within four years the number jumped to 40,000 troops. With early treatment, chances for recovery are better, but PTSD symptoms may stay with them for the remainder of their lives.

Not only in the military, PTSD is also seen in victims of child abuse, domestic violence, national disasters and other traumatic events. Some individuals heal from these events and lead a normal life, but there are those who carry the burden of the trauma with them forever. The event is imprinted in their body, hidden and locked away.

Researchers believe that, at least in part, imprinted memories of these traumatic events remain as distant echoes of the experience. PTSD symptoms may surface later when something, even unrelated to the event, triggers a release of the traumatic experience.

According to the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association (APA) considers PTSD an anxiety disorder developed after being exposed to, either by direct experience or witnessing, an extreme or overwhelming traumatic event where they felt intense fear, helplessness or horror.

In our anatomy and physiology classes we learn that our nervous systems usually react to threatening situations with a flight or fight reaction. But researchers studying PTSD found some people react with a kind of freeze reaction instead, feeling helpless and hopeless during the trauma. Unable to either defend themselves or run away they, in effect, play dead, becoming numb to the experience. Though the memories of these experiences fade from everyday thoughts, they remain hidden in the nervous system and muscles where they become deeply imbedded.

Sometime after the initial experience, either almost immediately or in some cases much later, the person shows signs of PTSD, including hyper-vigilance, avoidant behavior and intrusive thoughts. These affect their everyday lives and those of their families, friends and co-workers. They may become depressed for prolonged periods, abuse drugs or alcohol, have obsessive/compulsive behaviors, anxiety attacks, flashbacks or simply withdraw from normal activities.

People want massage for a variety of reasons, but you will not usually hear I want massage for PTSD. They may not even be aware of it and instead come for a variety of other reasons such as stress, anxiety, having chronic pain or simply someone gave them a gift certificate.

You then proceed with a full-body Swedish massage, only to find they dont relax into it, but remain tense and alert, or completely dissociate from the experience. They may cry or have some other unexpected reaction. Even a thorough intake may not alert you that this person experienced a traumatic event that wounded not only their mind and spirit, but their body as well.

Even if the event doesnt directly involve the body, it remembers, on a visceral level, what the mind experienced. In working with the body, we can help heal those wounds. Working in conjunction with physicians and psychiatric professionals specializing in PTSD, massage therapists can help them be comfortable in their body, to learn to relax and be in the present moment.

If PTSD has been diagnosed, you can develop a plan of treatment that slowly introduces non-intrusive bodywork and leaves them feeling less vulnerable Chair massage is an easy way to establish trust between the massage therapist and the PTSD client with the person clothed, and sitting, not lying down. A chair massage can be as complete and relaxing a massage as one on the massage table. Initial sessions might be 15 minutes and over a period of time increase to 30 or 45 minutes.

Later you might introduce Shiatsu, bringing the bodywork from a sitting position, to one of lying on the floor, still fully clothed. Encourage the client to wear something loose and comfortable, such as a sweat suit or yoga attire to allow for stretches during the session.

Your sessions may never go beyond this phase, or might graduate into work done on the massage table such as cranial sacral work or polarity therapy, both of which can be done while the client is clothed. These techniques are non-intrusive and help re-harmonize the energies and rhythms of the persons body. They may also help reinforce work done with other medical professionals.

Massage therapy doesnt cure PTSD. Nothing cures it completely; sufferers merely learn how to live with it. But studies show that massage does improve associated symptoms such as chronic pain, immune system deficiencies and stress. PTSD sufferers have also been found to have elevated levels of cortisol, which leads to cognitive impairment, poor glucose management and lowered immune response, as well as interruption of homeostasis. Massage helps reduce cortisol blood levels, according to studies by the Touch Research Institute, and so lessens the damaging effects.

PTSD is not new, only newly defined and reexamined. It has been around, using different terms, for a very long time. It is a disorder with no hard and fast rules. For many it is a lifelong problem. Compassion, understanding and patience are a massage therapists most valuable tools in helping to assist the healing of their internal wounds.

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Advanced Anatomy and PhysiologyChair MassageCranial Sacral FundamentalsEthical Case ManagementPolarity TherapyShiatsu Anma Therapy

Post-Traumatic Stress Disorder: Massage Benefits and Precautions

Cutler, Nicole, L.Ac., The Therapeutic Relationship in Post Traumatic Stress Disorder, Institute for Integrative Healthcare, July 21, 2005.

Dryden, Trish, M.ED., RMT, and Fitch, Pamela, B.A., RMT, Recovering Body and Soul from PTSD, Massage Therapy Journal, Issue W107, American Massage Therapy Association, http://www.amtamassage.org.

Jelinek, Pauline, Number of Troops With PTSD Up 50 Percent, Associated Press, Washington, D.C., May 28, 2008, http://www.ap.org.

Levine, Peter A., Ph.D. Waking the Tiger: Healing Trauma, North Atlantic Books, 1997, http://www.northatlanticbooks.com.

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Fact Sheet What is PTSD?, U.S. Department of Veterans Affairs,2008, http://www.va.gov.

Working With Trauma Survivors: What Workers Need to Know, National Center for PTSD Research, 2008, http://www.ncptsd.org.

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