The second patient was a young man after a spine fracture, the result of jumping into water. Initially the contact was extremely difficult- resignation, bitterness and muted responses. Once the life and soul of the party then left to be supported, needing help from others. Day after day we were finding common ground. Although the main part of rehabilitation was conducted by a therapist (the name in those days for physiotherapists) I had a lot of work with quite a large part of the body for massage and one basic rule: consistency, regularity and pushing forward.
The third little patient looked at me with mistrust when I approached her hospital bed. The girl was probably 5 years old, suffered from an injury with numerous scars from burns on a large surface of her thighs and abdominal wall and all down her side. When I wanted to get closer she “welcomed me” with a scream.
Finally, with the approval from the staff, I took off my white clothes off, got changed and getting into the large metal bed, as it was the only option; I started the treatment from playing. It took a while before she allowed me to touch her, or for the first time to apply a special ointment prepared individually for her at a pharmacy. I realize what the consequences may be of such scars, in these specific areas, especially for a future women. Furthermore they were causing contractures around the joints and slight pain. We finally managed to interact; day after day I worked both on healthy tissues and on the scars, especially focusing on the edges of the scars. Consequently, day after day I worked with these areas and finally they began becoming more flexible. The skin became smoother. We didn’t have facilities as they are now, no specialized lasers, physical therapy, what we had was massage without quantitative restrictions and order was continually renewed. The massage and work on soft tissue gradually brought results. Finally, by, discovering her and getting closer, she allowed a deeper massage, which clearly brought her relief.
From the first treatments based on having fun and playing, which I connected with calm pressure, passive movements of the joint and moving the skin, manipulation – despite the fact that it was done through clothes – it took a long time for direct massage. In the end she accepted them. That is why today, when working with patients regardless of age, I try to respect all the subjective reactions, fears, which may indicate problems with the acceptance of themselves, and their own body. It is worth to build up trust, be consistent and circumspect than „burn” treatment at the start.
Unfortunately, still in many facilities patients after accidents, amputations, burns, are being rehabilitated in the presence of third parties. We have no discernment or research or how well the young certified masseur, masseuse, physiotherapist, are prepared, standing on the threshold of a career from the theoretical side of the treatment and from the perspective of psychological support.
These meetings have taught me a lot. In the rehabilitation, prevention, regeneration after surgeries, physical and mental factors are both important. Patience, precision and focus in working with soft tissues teach humility and step by step effective treatments. There are no short cuts here. Latterly the successive patients came, often after physical and mental trauma, perhaps just as deep. Who is able to accurately assess whether after a car accident physical rehabilitation is more difficult than mental, especially if you are aware that you survived by yourself.
Today, the foundation is work done with soft tissues especially based on connective tissue. These experiences I use while working with patients after plastic surgery, reconstructive surgery and cosmetic surgery.
This is not against, as has been suggested, so called “trendy topics”, but effective, necessary assistance. When speaking about plastic surgery, so often we forget about the achievements of surgeons in the field of reconstructive surgery. Instead, we feast on the cheap sensations from the lives of celebrities, who undergo cosmetic surgery or more invasive methods of aesthetic medicine. I don’t mean to judge the phenomenon, but about the fact that to acquire practice in pre and post operational regeneration, it is recommended to first work in a hospital or clinic. It is important to learn how to apply therapeutic massage where it is really necessary, also for aesthetic results.
Problems with the face, swelling, scars from caesarean section, postoperative scars and post burn scars require more attention than focusing on popular faces from TV and commenting on who did what to their body. Today, a reasonable surgeon, regardless of specialization is aware that in the postoperative period, during preparation for the operation and sometimes for diagnostic purposes it is worth to use the help of experienced therapist masseurs and physiotherapists.
A doctor who specializes in aesthetic medicine can cooperate with the masseurs before and after treatments. In close co-operation they can consult as to the condition of the skin, tendency to swelling, potential areas of the flaccidity of the skin.
In understanding the psychological aspects of injuries and their negative effects on soft tissues and the role of a masseuse in such diverse therapy, a trip to the USA was very helpful. Not so much because I was not aware of these issues, but because our market was lacking information and publications. We therapists were lacking certainty and confidence. The cooperation between psychotherapists virtually didn’t exist. In the early 90’s, the psychological or psychosomatic aspect of strictly therapeutic massage was ignored with an ambiguous smile. What was needed was a special focus on the mental side of patient, also in strict medical treatments. Promoting these issues through conferences, publications and trainings is quite effective, but unfortunately scientific research is still very rare.
by Piotr Szczotka