In Safe Hands: Massage & PTSD

By Ian McCafferty, from May 24, 2016
According to the National Institute of Mental Health, post-traumatic stress disorder (PTSD) develops in some people who have seen or lived through an event that is shocking, scary or dangerous. These events might be combat related, for example, or involve violence, abuse or trauma.

According to PTSD United, an organization dedicated to providing support and resources for people who suffer from PTSD, roughly 24.4 million people are dealing with PTSD at any given time. Although nearly everyone experiences a traumatic event at some time or another, the difference for people who develop PTSD is that their reactions to the trauma continue instead of resolving naturally over time. Often, people with PTSD will feel stressed even when they aren’t in danger.
“People experience PTSD when their choices over what happens to their bodies are taken from them,” says Pamela Fitch, the author of Talking Body, Listening Hands: A Guide to Professionalism, Communication and the Therapeutic Relationship, and a massage therapist with extensive experience working with clients with PTSD. “When actions are taken that they have no control over, then no place or person feels safe. Add to this the context of how a person was loved or not loved, and the more strikes against them, the harder it is to overcome the trauma.”
What Are the Symptoms?

PTSD is highly individualized, meaning that few people are going to experience PTSD in exactly the same way. Being familiar with some of the primary symptoms, however, will help you better understand how massage therapy may prove helpful. According to Fitch, symptoms usually manifest in some of the following ways:

Generally speaking, hyperarousal refers to an increased psychological and physiological tension. For example, the person might feel anxious or tired, or suffer from insomnia. Additionally, their tolerance for pain might decrease while their startle responses become exaggerated. Here, too, personality traits might become accentuated.

Abnormal awareness of environmental stimuli, or being alert and attentive to potential threats, are signs of hypervigilance. You might also notice clients holding their breath or clenching their fingers, for example.

Guilt and shame

Clients who suffer from PTSD may also feel guilty or shameful, faulting themselves for what happened or having feelings of humiliation and unworthiness.


Dissociation describes how a person might distance themselves from a traumatic event. Some may detach emotionally or appear absent or unconscious. Other people suffering from PTSD might “lose time” and be unable to remember significant aspects of the trauma, for example. Panic, nausea and fear can also be aspects of dissociation.

Intrusive thoughts

Recurrent, unwanted and distressing memories of the traumatic event might also occur, along with upsetting dreams or flashbacks. According to the Mayo Clinic, PTSD symptoms typically begin within three months of the trauma occurring, although it’s also possible for years to pass before symptoms surface.
No matter how symptoms manifest and when they appear, the one constant for many people dealing with PTSD is that their symptoms significantly affect their daily lives, sometimes making it difficult to work and develop and maintain personal and professional relationships.
Remember, however, that even with an understanding of symptoms, you absolutely must stay within your scope of practice when working with clients with PTSD. “It is not within a massage therapist’s scope of practice to actively engage in conversation about the trauma, other than to listen, support and refer,” says Fitch.
Treatment for PTSD

Similar to other mental health diagnoses, like depression or anxiety, PTSD is commonly treated with an integrative approach that may include both medication and some form of psychotherapy, with the goal being to help the person effectively work through the trauma.
Cognitive therapy, for example, is a type of talk therapy that focuses on helping the person recognize patterns in their thinking that keep them “stuck,” like misinterpreting normal situations as threatening. Exposure therapy, where a person works to re-enter the setting where trauma was experienced, sometimes through the use of virtual reality, aims to help people suffering from PTSD safely confront what they find threatening or frightening so they can learn to more effectively cope with the traumatic event.
Many times, talk therapy (such as cognitive therapy) and exposure therapy are used in combination, along with anti-depressants or anti-anxiety medication, in some cases.
For clients with PTSD seeking massage therapy, Fitch believes working through their trauma history with an experienced psychologist or psychotherapist is a must. “If clients with PTSD seek massage therapy before they have done some reflection with a psychotherapist, they could be at risk of worsening their symptoms, becoming triggered by the touch, or feeling depressed or angry,” she explains.
How Can Massage Therapy Help Clients with PTSD?

Stess relief, decreasing anxiety, reducing depression1 and improving personal mood are all positive outcomes massage may provide clients. Additionally, a 2012 study focusing on how integrative therapies can help promote reintegration among veterans found that those participants who received massage therapy reported significant reductions in physical pain, tension, irritability, anxiety/worry and depression.2

Another recent study of Somali women refugees with chronic pain—the majority of whom reported military and/or sexual trauma—found that massage therapy provided enormous relief for distressing physical and psychological symptoms largely attributed to the exposure to trauma,3 according to Cynthia Price, a research professor at the University of Washington and massage therapist.
Research also indicates massage therapy may be effective for those clients who experience dissociation as a symptom of PTSD,4,5 allowing these clients to experience a more coherent sense of self, which for some is a primary reason they initially seek out massage therapy .6,7
While almost all studies on the subject point to the positive effects of massage therapy, making sweeping generalizations about its effectiveness for PTSD would be unwise.
“Given that the studies to date have involved small samples, we do not know the magnitude of these effects, nor do we know how massage facilitates health in trauma recovery,” says Price. “However, research findings suggest that dissociation reduction, i.e., a more coherent sense of self, may play an important role in positive massage therapy effects.”
There are aspects of massage therapy, too, that appear to provide some unique benefits to clients with PTSD—mainly giving these clients a feeling of comfort, safety and control they often can’t achieve on their own.
According to Fitch, some of the massage therapist’s most powerful tools come from how the massage therapy session itself is handled, from the informed consent and opportunity for a client to ask questions that start each session to the therapist’s ability to respond to the individual’s needs during a session, whether that’s stopping altogether, changing positioning or adapting levels of pressure. “All of these actions ensure that clients are safe and know they can stop the treatment at any time, providing them a safe environment to experience touch,” she explains.
Massage therapists can also provide clients with self-care strategies to help prolong the positive benefits achieved, not only in massage therapy sessions, but with other integrative treatment approaches as well. “People who have been traumatized are no longer at home in their bodies,” Fitch says. “Massage therapists can teach clients safe and effective ways of self-soothing and stress management.”

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