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Varicose Veins and Massage Contraindications

Virtually all massage therapists are taught that massaging varicose veins is contraindicated. The argument that is use is that increasing the back pressure in the veins either at the site of the varicose veins or distal to the varicose vein can increase vascular pressure, dislodge clots and the client runs the risk of a deep vein thrombosis. Massaging proximal to the site of the varicose vein is generally considered as being safe.

For most therapists this is probably reasonable advice although asking whether we can safely massage clients who have varicose veins is a fair question.

Varicose Veins and Massage Contraindications

Varicose veins are fairly prevalent amongst the general population although there are recognised risk factors such as gender (females are more susceptible to getting them), if you have been pregnant and if you need to stand a lot at work. Genetics can also play a significant role in whether or not you will develop varicose veins during your life. However, if you regularly exercise and have a high fibre diet then the risk of you getting varicose veins is reduced.

Within the veins of the body are valves which prevent blood flowing backwards through them. Whilst blood flow in the arteries is the result of the pressure exerted by the heart, the flow in the veins is more the result of a muscular pumping action. For example, in the legs which is where most varicose veins occur, the flow of blood against gravity is achieved by what is known as the calf pump mechanism. When the valves in the veins do not close properly as the veins become dilated then the blood can flow into superficial veins which cause them to dilate further. If there is continued constriction of blood flow in the veins to the heart (eg from constant standing) then the blood can pool in the legs and the veins can lose their elasticity. The result is the bulbous thick veins as shown in the above picture.

Blood clots are likely to develop, particularly in larger varicose veins and the risk of dislodging these clots are why therapists are taught never to massage varicose veins (directly or distal to the veins).

However, with suitable training and approval of client’s doctors, some therapists consider that massage can provide benefit for those who are affected by this condition. The massage strokes would tend to be short and of light pressure, more aimed at promoting local circulation and/or lymphatic drainage. Strokes such as petrissage, deep tissue frictions, stripping and cross-fibre are never recommended. Some therapists who have received training in massage veins would often consider having the leg elevated to promote venous return.

  
If you suffer from varicose veins yourself then there are a number of steps you can take yourself to reduce any pain associated with them. Firstly move and exercise as much as possible. As mentioned previously, movement assists the calf muscle pump mechanism and even moving your ankles backwards and forwards can provide some benefit (particularly if you are sedentary and have limited mobility). Secondly, if possible, stop standing for long periods of time. If you do have to stand then try to shift your weight from time to time. For some, compression clothing can help although probably a good idea to discuss this with your doctor to determine whether such garments will be appropriate for you.

By Richard Lane

Health Funds and Remedial Massage

In Australia, many people are encouraged by the tax and health care system to take out private health insurance. For high income earners, they are penalised by a Medicare Levy if they do not register for suitable cover. health fund rebate and massage

If you take out private health insurance then chances are that you will be offered and will probably take up extras packages which will include some degree of cover for things such as physiotherapy, chiropractors, osteopaths, optical, dental and massage. Currently all of the major health funds in Australia, such as BUPA, HCF, Medibank Private, NIB, Grand United, AHM and Australian Unity offer rebates but generally only for remedial massage (ie other massage modalities may not be eligible for rebates).

Occasionally we are asked to provide recommendations about which fund we believe to the best. As we are in the health profession then people suspect that we will be “in-the-know” and assist them with information that can help them make a decision. Unfortunately this is not the case as the optimum choice of health fund will vary very much depending on the individual circumstances. In addition, the best fund can also change from time to time depending on you and any changes in the terms, rebates and fees of the fund.

In addition, even within a specific health fund the level of cover can differ significantly and the only way to work out which health fund is best for you is to look at your individual position and make an assessment as to the level of cover you require.

To be honest, it is rare that rebates for remedial massage should enter significantly into the calculation as there are many more bigger picture items that are likely to govern the decision making process. For example, do you require family care, obstetrics, joint replacements, etc? The amount you will be covered for and the amount of rebates that you would get will be significantly more important than whether you receive $25 or $28 back on your remedial massage. Whilst it is tempting to consider not opting in for cover for particular items to save a few dollars, be mindful that your health insurance should cover you for what you cannot afford to cover yourself. Although you might not think that you will need a joint replacement in the near future, unfortunately you never know what is just around the corner and adding a few dollars a month may save you from a major decision in the future.

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Whilst we do not specifically recommend any particular health fund, I would just like to mention a cool feature that is offered by Australian Unity. If you are a member with them then you can just download their app and whenever you incur a claimable medical charge then all you do is simply send a photo of the receipt and they will automatically transfer the rebate to your account.

  
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Please note that a significant issue with health funds is perceived to be fraudulent claims. Receipts for remedial massage can only issued to a person specifically receiving a remedial massage so if you receive a Swedish/relaxation massage then your therapist will not be able to provide you with a receipt that you can use to claim. Similarly, if your partner is the one getting the massage then we are not allowed to put your name on the receipt, even if you are the one paying for the session.

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By Richard Lane


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