Sandwiched between the worlds of Western medicine and holistic wellness, massage therapists occupy a unique position in healthcare. In general, today’s harried doctors spend more time writing prescriptions than communicating with their patients. On the other hand, most massage therapists prioritize their personal interactions with clients. Thus, massage therapists may be one of the only practitioners who listen to their clients’ experiences and can recognize when a physician-prescribed medication is responsible for their complaints.
During the pre-massage interview, therapists discover their client’s specific concerns and health issues. As one of the most frequently reported gastrointestinal complaints, most healthcare practitioners are accustomed to fielding heartburn.
Described as a burning sensation in the chest behind the breastbone, heartburn pain is often worse when lying down or bending over. While occasional heartburn is common and not a cause for alarm, many can manage heartburn on their own with lifestyle changes and over-the-counter medications. Frequent heartburn that interferes with someone’s daily routine can be a symptom of something more serious and requires a doctor’s evaluation.
Most cases of heartburn can be explained by stomach acid backing up into the esophagus. Normally, the esophageal sphincter relaxes to allow food and liquid into the stomach upon swallowing; then it closes to prevent leakage. However, when the lower esophageal sphincter relaxes abnormally or weakens, stomach acid flows back up into the esophagus and results in heartburn.
Proton Pump Inhibitors
Because so many Americans regularly take medications, bodyworkers find themselves needing to understand and explain the impact that certain pharmaceuticals have. When it comes to meds for heartburn, there is a wide range of over-the-counter and prescription medications available. If antacids or acid blockers are ineffective at controlling heartburn, physicians may prescribe a proton pump inhibitor. Among the most widely used prescription medications in the world, proton pump inhibitors have been confirmed to intensify the very ailment they are indicated for upon their cessation.
Common proton pump inhibitors (PPIs) include:
PPIs and Massage
Proton pump inhibitors act directly on the stomach cells to decrease acid production. This action does not affect the response of the body to massage; thus, no alteration or changes in massage’s application are needed. However, PPIs impact can be mitigated by keeping the following in mind:
- Constipation and flatulence are common side effects of PPIs; thus massage therapists may be able to help affected clients by performing abdominal massage to help increase the movement of stool through the intestines.
- Additional PPI side effects include headaches and dizziness that can be minimized by increasing water consumption. Drinking more water is especially helpful to keep clients on PPIs hydrated following a massage session.
- Proper positioning is another massage therapy consideration for clients taking PPIs. Since heartburn is worsened when lying down, clients with this symptom are usually much more comfortable with one (or several) pillows to elevate their head.
Learn more about How Massage Can Relieve Heartburn Symptoms.
According to new research published in the July 2009 issue of Gastroenterology, proton pump inhibitors can lead to dependency and cause a rebound of symptoms after taking them for just a few months. Based on an eight-week study, treatment with PPIs in healthy individuals induced acid-related symptoms like heartburn, acid regurgitation and dyspepsia once treatment was withdrawn.
According to Christina Reimer, MD, of Copenhagen University and lead study author, “The observation that more than 40 percent of healthy volunteers, who have never been bothered by heartburn, acid regurgitation or dyspepsia, develop such symptoms in the weeks after cessation of PPIs is remarkable and has potentially important clinical and economic implications.”
Theorized to be due to an overproduction of stomach acid following its suppression on PPIs, this study’s authors estimate that the PPI rebound effect lasts between four weeks and four months.
Recognizing the rebound effect from stopping PPIs appears to be information useful only to pharmacists and physicians. However, massage therapists are also likely to see clients taking – and stopping – PPIs. Upon learning that a client has recently stopped taking a proton pump inhibitor and is struggling with a resurgence of heartburn, bodyworkers can educate them on the likely cause, and may even be able to help reduce this aggravating symptom. In addition, informing a client that the PPI rebound effect is short-lived will help ease their frustration and foster trust in your competent care.