Case Study

My case study included six massages spread out over a period of nine weeks. Ideally, I would have liked to have seen my client at least once a week, but because of our different schedules and time constraints it took nine weeks to complete all six massages.

My client was a 42 year old female. During the first intake the client told me that she was on blood thinners (Coumadin). In January of 2009 she was experiencing pain in her legs, sever fatigue and dizziness. She ended up in the emergency room and it was discovered that she had many blood clots in her left leg. She was admitted to the hospital and stayed for a week under close supervision until she was stable enough to go into surgery where the Doctors placed a filter in her Vena Cava. The filter was put in place to help catch the clots so they would not go through her heart, into her lungs and cause a possible pulmonary embolism.During this time she was also placed on blood thinners, namely Coumadin, to help prevent further clotting. Her leg gets achy when she is on her feet all day and she has been told to elevate it at the end of the day. She now takes blood thinners daily and sometimes hydrocodone for the pain in her legs. The Dr.’s say she will probably have to be on Coumadin for the rest of her life. Because of the blood thinners she tends to bruise easily. She used to go in for lymphatic drainage massage (usually only the axillary and clavicle area) twice a month but doesn’t do this anymore. She has been cleared by her Dr. for regular massage therapy.

During her time in the hospital she also drastically lost weight. Since then she has had low energy and no regular physical exercise plan and has put on a lot of weight. This makes her upset and sometimes sad and frustrated about her lack of energy. She experiences swelling in her legs after extended periods of being on her feet (walking, standing, ect..) and has had difficulty staying active because of this and stress with kids, work, and everyday life. She has said that when she can fit in regular exercise her leg feels less achy and she sleeps better.
Also during the intake she indicated that she has a medium stress level and holds her stress in her shoulders and low back. She also tends to get very bad headaches when she gets very stressed out. Works in an office and has for most of her professional life.

My client’s main goal for her massage was relaxation. I could tell by the way she spoke and the concerns she had that her thoughts seemed hurried and rushed. Her eyes looked tired and tended to sigh often while she talked. Her skin was healthy and soft, well tanned. Although she had not been doing regular exercise and had gained some weight, her muscle tone was still good and her energy felt strong but tired. She had lots of tension in her neck and upper traps, with a large knot in the left occipitals. She was very sensitive in the neck area. Small bump on palmar side of right forearm (says it has been there since she was young) that could be a possible ganglion cyst. Her left leg was noticeably more swollen than her right from the iliac crest to her ankle, seemed to be more so around thigh area. Edema but not pitting. Feet were both cold and limited ROM in hip area. Some tension in low back and erector spinae and knots in L levator scapulae and R rhomboids. All shu points on back felt good except for small pluckable knot in R LV shu point.

Because of the clients blood thinner medication I used only light/moderate pressure with lots of soothing strokes. She was sensitive in certain places, liker her neck, but liked a little more pressure on her back and so I adjusted accordingly. I spent a good amount of time on face and head massage to open up and relieve tension in that area to help with headaches. I did more detailed work on her neck and upper traps to help loosen and break up stagnant energy. On her arms I emphasized strokes toward the body to help with lymph drainage and included Li 11, 10, 9 &4 to open up arms and give stagnant energy a place to go. She did not want abdominal work during the first few massages but during the last two sessions I did do some work through the sheet. On days when she had a head ache I was sure to include grasping down the GB meridian and lots of scalp massage, Li 4. Strokes on her legs were all towards the body to help with lymph drainage and I always gave a very nice foot massage to help soothe and relax. Points in her feet and legs included following Ki merdian from Ki 1, 2, 3 & 7 (8x). Lv 2-3 (50x). and St 36 (8x). On her back I used a little more pressure. Mostly long gliding strokes with focus on knots in levator scapulae and rhomboids. Sacral roll on low back and grasping. All shu points were included and stimulated 24x. On our last session I did reviving the yang to help with her low energy level (Ki1, Ki3, Sp6, St36, Cv12 Pc8, Li4, Gv15)

Over the course of the 9 weeks of treatment I saw some alleviation of tension in the neck, specifically the knot in L occipitals released. Tension also decreased in shoulders and rhomboids. When massages were weekly I noticed that her left leg was not as swollen most likely due to lymph drainage and increased circulation to that area. Her headaches were not as frequent and were always gone by the end of a massage. She really enjoyed all massages and felt very relaxed and rested. She and I plan on continuing to work together once our schedules settle into a regular routine. Now that I have learned the 64-point acupressure foot massage I would like to include that into the massage for her left foot/leg. Also, I would recommend a longer session with time at the beginning for a QiGong. She is open and interested in QiGong and I was hoping to start showing her the Dragon QiGong, which is good for weight loss and tonifying the meridians.