Providing Back Care and Massage

Back care and massage are vital for patient well-being, offering more than just physical comfort. How can these practices boost recovery and ease pain? What techniques should nurses use for effective care? Understanding and integrating these methods into daily routines can greatly improve patient satisfaction and overall care quality.

Table of Contents

• Providing a Back Massage
  • Purposes of a Back Massage
  • Assessment
  • Planning
  • Precautions for Withholding Massage or Back Massage
  • Delegation
  • Implementation
  • Movements Used
  • Procedures for Back Massage
• References and Sources

Providing a Back Massage

Massage serves as a comfort measure that promotes relaxation, reduces muscle tension, and alleviates anxiety by conveying a sense of care through physical touch. Additionally, it can lessen pain intensity by enhancing superficial circulation in the affected area. Massage techniques can be applied to the back, neck, hands, arms, or feet. Utilizing ointments or liniments during massage may offer localized pain relief for joint or muscle discomfort. However, massage is not recommended for areas with skin breakdown, suspected blood clots, or infections.

Effleurage is a massage technique characterized by long, slow, gliding strokes that are typically performed with light to medium pressure. This method is designed to soothe and relax the muscles, promoting a sense of calm and well-being. According to research, incorporating back massage using effleurage strokes can significantly enhance a patient’s overall comfort and relaxation. Furthermore, it has been shown to improve the quality of sleep by reducing stress and anxiety levels. This gentle and rhythmic approach not only benefits the physical state of the muscles but also contributes to the psychological and emotional well-being of the patient, making it a valuable component of holistic nursing care.

Purposes of a Back Massage

Back massages serve as an essential therapeutic intervention in nursing care, offering multiple benefits to patients. The following detailed points outline the primary objectives of administering a back massage in a healthcare setting:

1. To Stimulate Circulation and Provide General Relief.
One of the primary purposes of back massage is to stimulate circulation. The gentle, rhythmic movements used in massage, such as effleurage, promote increased blood flow to the skin and underlying tissues. This enhanced circulation delivers more oxygen and essential nutrients to the cells, which supports tissue health and promotes healing. Additionally, increased blood flow helps to remove metabolic waste products, such as lactic acid, which can accumulate in muscles and cause soreness and fatigue. By enhancing circulation, a back massage can provide general relief from discomfort, reduce muscle stiffness, and improve the feeling of well-being. This makes it particularly beneficial for patients who are recovering from surgery or dealing with chronic pain conditions.

2. To Relieve Muscle Tension.
A back massage helps to loosen tight muscles and alleviate tension, making it particularly beneficial for patients who have been bedridden or immobile for extended periods. The mechanical action of massage increases blood flow to the muscles, facilitating the removal of metabolic waste products and promoting muscle recovery and relaxation.

3. To Decrease Pain Intensity.
Massage can effectively reduce the intensity of pain by enhancing superficial circulation, which helps to deliver oxygen and nutrients to the tissues while removing waste products. The increased blood flow and warmth generated by massage can also help to interrupt pain signals sent to the brain, providing a natural form of pain relief.

4. To Prevent Bedsores.
Back massage plays a crucial role in the prevention of pressure ulcers, commonly known as bedsores. These painful and potentially serious wounds can develop in patients who are bedridden or have limited mobility, as constant pressure on certain areas of the body reduces blood flow and leads to tissue damage. Regular back massages help to redistribute pressure and stimulate blood flow to vulnerable areas, such as the lower back and buttocks. This increased circulation nourishes the skin and underlying tissues, keeping them healthy and resilient. Additionally, the tactile stimulation of massage encourages the patient to move and shift positions more frequently, further reducing the risk of pressure ulcers. By incorporating back massage into the care routine, healthcare providers can significantly enhance the skin integrity and comfort of patients at risk for bedsores.

5. To Provide Comfort to the Patient.
Providing comfort is one of the most immediate and noticeable benefits of back massage. The soothing touch of a massage can have profound psychological effects, helping to reduce anxiety, stress, and feelings of isolation that patients may experience, particularly in a hospital or long-term care setting. The physical act of massage releases endorphins, which are natural painkillers and mood elevators, creating a sense of calm and well-being. For patients who are experiencing discomfort due to prolonged immobility, illness, or surgical recovery, the comfort provided by a back massage can be invaluable. It alleviates physical pain and stiffness and offers emotional solace, making patients feel cared for and valued. This enhanced sense of comfort can improve patient morale, foster a more positive outlook on their recovery journey, and ultimately contribute to better health outcomes.

6. To Promote Physical and Mental Relaxation.
Beyond the physical benefits, a back massage can significantly impact mental health. The comforting and caring touch of a massage can reduce stress hormones like cortisol while boosting the release of endorphins, the body’s natural feel-good chemicals. This dual action promotes a sense of relaxation and well-being, which can be especially important for patients experiencing anxiety or depression.

Assessment

A thorough nursing assessment is necessary before administering a back massage to ensure patient safety and optimize therapeutic benefits.

1. Assess behaviors indicating the potential need for a back massage.
It is important to observe and recognize behaviors that may suggest a patient could benefit from a back massage. Patients might complain of stiffness or muscle tension in the back or shoulders, often indicating the need for muscle relaxation and relief. Additionally, difficulty sleeping, especially if related to tenseness or anxiety, can be a strong indicator that a back massage might provide significant relief and promote better rest.

2. Assess the willingness of the patient.
Before proceeding with a back massage, it is vital to assess the patient’s willingness and comfort with the procedure. Some individuals may not enjoy or feel comfortable with physical touch, even if it is therapeutic. Respecting the patient’s personal preferences and obtaining explicit consent ensures a positive and cooperative experience.

3. Assess vital signs, skin color and temperature, nail bed color, and tissue perfusion of extremities.
Performing a back massage allows healthcare providers to gather important baseline data, such as vital signs, skin color and temperature, nail bed color, and tissue perfusion of extremities. This assessment can help in monitoring the patient’s health status and detecting any early signs of complications.

4. Assess for allergies.
Before performing a massage, it is important to assess the patient for any allergies, particularly to adhesives or topical products that might be used during the massage. Ensuring that the products used are safe for the patient helps prevent adverse reactions and enhances the therapeutic experience.

5. Consider contraindications for back massage.
Identifying contraindications is a critical component of the assessment process. Patients with coagulation issues or blood clots may be at risk for complications if a massage is performed. Those with impaired skin integrity, such as open wounds or infections, should also avoid massage in those areas to prevent further damage or spread of infection. Patients who have undergone recent back surgery or have vertebral issues or risk of fractures require careful consideration and often need to avoid back massages to prevent exacerbating their condition. Understanding these contraindications ensures the safety and appropriateness of the massage for each patient.

Planning

Make sure to schedule enough time for the massage session. While the massage itself may only take approximately 5 minutes to perform, it’s important to approach the entire process with a calm and unrushed attitude.

1. Allocate adequate time.
It is essential to allocate sufficient time for the entire back massage process, beyond just the execution of the technique. While the massage itself may only take about 5 minutes, it is important to plan for additional time to ensure the session is calm and unhurried. This allows for a more therapeutic and relaxing experience for the patient.

2. Create a calm environment.
Planning involves setting up an environment conducive to relaxation. This means choosing a quiet space, minimizing interruptions, and ensuring the room is at a comfortable temperature. Preparing the space with soothing elements such as soft lighting, relaxing music, and comfortable bedding can enhance the patient’ experience.

3. Gather necessary supplies.
Before beginning the massage, ensure that all necessary supplies are within reach. This includes massage oils or lotions, clean towels, pillows for support, and any other items needed for patient comfort. Having everything prepared in advance helps prevent interruptions and maintains the flow of the session.

Equipment needed:

• Alcohol 25%. Alcohol at 25% concentration is commonly used for disinfection purposes before performing a back massage. It helps sterilize the hands of the healthcare provider to minimize the risk of infection transmission. Proper hand hygiene is crucial to maintain aseptic conditions during the massage and ensure patient safety.
• Talcum powder. Talcum powder is often utilized to enhance the glide of the hands during the massage. It reduces friction between the skin and the hands of the massage therapist, facilitating smooth movements and preventing discomfort for the patient. Talcum powder is especially useful when performing deep tissue or friction massages, as it allows for greater control and precision.
• Lotion. A suitable massage lotion or oil is essential for providing nourishment and hydration to the skin during the massage. It moisturizes the skin, making it more pliable and receptive to massage techniques. Additionally, the use of lotion or oil helps reduce friction and allows for smoother, more fluid movements, enhancing the effectiveness and comfort of the massage.
• Bath towel. A bath towel is a versatile tool that serves multiple purposes during a back massage. It can be used to cover and protect the patient’s clothing or bedding, ensuring cleanliness and minimizing mess. Additionally, a towel can provide warmth and comfort to the patient by covering areas not currently being massaged. After the massage, the towel can be used to gently wipe away excess lotion or oil, leaving the skin feeling refreshed.

Precautions for Withholding Massage or Back Massage

Understanding when to abstain from massage therapy is essential to prevent potential harm and complications. By carefully considering contraindications and patient-specific factors, healthcare providers can ensure appropriate and effective care delivery.

1. Skin Breakdown or Open Wounds.
Avoid massaging over areas of the skin that have open wounds, lesions, or significant skin breakdown. Massaging these areas can increase the risk of infection or further tissue damage. It is important to allow these areas to heal undisturbed.

2. Suspected Blood Clots or Deep Vein Thrombosis (DVT).
Refrain from providing massage therapy if there is suspicion or a history of blood clots, particularly in the legs. Massage techniques that involve deep pressure or vigorous movements may dislodge blood clots and pose a risk of embolism. Consult with the healthcare team to determine appropriate precautions and alternative therapies.

3. Impaired Skin Integrity or Fragile Skin.
Exercise caution when massaging patients with fragile or compromised skin, such as those with severe eczema, dermatitis, or burns. Vigorous massage techniques may exacerbate skin irritation or cause further damage. Instead, opt for gentle, light pressure and avoid areas of inflammation or irritation.

4. Recent Surgical Procedures or Injuries.
Avoid massaging areas that have undergone recent surgery or are recovering from acute injuries, such as fractures or sprains. Massaging these areas can disrupt the healing process, increase pain, and potentially cause complications. It is advisable to wait until the patient has fully recovered and received clearance from their healthcare provider before initiating massage therapy.

5. Vertebral Issues or Risk of Fracture.
Exercise caution when massaging patients with known vertebral issues, such as spinal fractures or degenerative disc disease. Manipulative massage techniques may exacerbate spinal instability or increase the risk of fractures. It is essential to obtain clearance from a healthcare provider and modify massage techniques accordingly to ensure patient safety.

6. Severe Pain or Discomfort.
If a patient experiences severe pain or discomfort during the massage or has a history of hypersensitivity to touch, it may be necessary to withhold or modify the massage therapy. Pay close attention to the patient’s verbal and nonverbal cues, and adjust the intensity and pressure of the massage accordingly. Always prioritize patient comfort and well-being.

7. Patient Preference or Refusal.
Respect the patient’s autonomy and preferences regarding massage therapy. Some individuals may feel uncomfortable or anxious about receiving a massage, while others may have personal or cultural reasons for declining. Always obtain informed consent from the patient before initiating any massage therapy and be prepared to offer alternative comfort measures or interventions.

Delegation

Delegating the skill of massage or back massage to Unlicensed Assistive Personnel (UAP) is permissible, but it necessitates careful assessment beforehand.

1. Assess UAP comfort and ability.
Before delegating the task of providing a massage or back massage to an Unlicensed Assistive Personnel (UAP), the nurse must assess the UAP’s comfort level and proficiency with the skill. This involves evaluating the UAP’s training, experience, and familiarity with massage techniques. Providing appropriate education and training may be necessary to ensure the UAP can perform the massage safely and effectively.

2. Provide clear instructions and supervision.
Once the decision to delegate has been made, the nurse should provide clear instructions and guidelines to the UAP regarding the specific parameters of the massage. This includes detailing the techniques to be used, any precautions or contraindications to be aware of, and the expected outcomes of the massage. Ongoing supervision and feedback from the nurse are essential to ensure the UAP performs the task safely and appropriately.

3. Monitor and evaluate.
Throughout the delegated massage session, the nurse must closely monitor the UAP’s performance and the patient’s response. This includes observing the technique used, assessing the patient’s comfort level, and addressing any concerns or complications that arise. After the massage, the nurse should evaluate the effectiveness of the intervention and follow up with the patient to assess their satisfaction and any changes in their condition.

Implementation

With a focus on patient comfort and safety, the implementation of back massage serves as a valuable component of comprehensive patient-centered care.

1. Determine skin condition.
Before initiating a back massage, it’s essential to review previous assessments of the skin to identify any existing issues or concerns. This includes noting any areas of skin breakdown, irritation, or sensitivity that may affect the massage technique or choice of products. By understanding the skin’s condition, healthcare providers can adapt the massage approach to ensure patient comfort and prevent exacerbation of skin issues.

2. Determine specialized lotions to be used.
Choosing the appropriate lotions or oils for the massage is crucial for enhancing its therapeutic benefits. Specialized products formulated for massage therapy can provide added nourishment to the skin and promote relaxation. Consideration should be given to the patient’s preferences, skin type, and any allergies or sensitivities they may have. By selecting the right lotions, healthcare providers can enhance the effectiveness and comfort of the massage experience.

3. Identify positions contraindicated for the patient.
Certain positions may be contraindicated for the patient based on their medical history, physical condition, or current symptoms. For example, patients with spinal injuries or herniated discs may require specific positioning to avoid exacerbating their condition. Similarly, individuals with respiratory issues or cardiovascular concerns may benefit from alternative positions to ensure optimal comfort and safety during the massage. By identifying contraindicated positions in advance, healthcare providers can tailor the massage approach to meet the individual needs of each patient.

Movements Used

1. Effleurage (stroking). A long sweeping movement with palm of hand conforming to the contour of the surface treated, over small surface (on the neck) the thumb and fingers are used. Strokes should be slow, rhythmical and gentle with pressure constant and in the direction of venous stream.

2. Kneading. Performed with the ulnar side palm resting on the surface and the fingers, and thumb grasping the skin and subcutaneous tissues which move with the hand of the operator.

3. Friction. Performed with the whole palmar surface of the hand or fingers and thumbs over limited areas. This movement is a circular form of kneading with pressure against the underlying part of tissue that cannot be grasped.

Procedures for Back Massage

1. Prior to performing the procedure, introduce self and verify the patient’s identity using agency protocol.
Introducing oneself and verifying the patient’s identity fosters trust and establishes a professional rapport. It ensures that the nurse is providing care to the correct individual, preventing errors and enhancing patient safety.

2. Explain to the patient what you are going to do, why it is necessary, and how he or she can participate.
Providing a clear explanation of the procedure promotes patient understanding and cooperation. It empowers the patient to actively participate in their care, leading to a more positive experience and improved outcomes.

3. Encourage the patient to give you feedback as to the amount of pressure you are using during the back rub.
Soliciting feedback from the patient ensures that the massage is tailored to their comfort level and preferences. It allows the nurse to adjust the pressure and technique accordingly, enhancing the therapeutic benefits of the massage while minimizing discomfort or pain.

4. Perform hand hygiene and observe other appropriate infection prevention procedures.
Performing hand hygiene and adhering to infection prevention protocols reduce the risk of transmitting pathogens and prevent healthcare-associated infections. It maintains a safe and hygienic environment for both the patient and the healthcare provider.

5. Provide for patient privacy.
Respecting the patient’s privacy promotes dignity and maintains confidentiality. It creates a comfortable and respectful environment for the patient, enhancing their trust in the healthcare provider and facilitating open communication.

6. Prepare the patient.
Assisting the patient to move and adjusting the bed height prevents strain on the nurse’s back and ensures ergonomic positioning for optimal access to the patient’s back. It promotes safety and comfort for both the patient and the healthcare provider.

7. Assist the patient to move to the near side of the bed within reach and adjust the bed to a comfortable working height.
This prevents back strain.

8. Establish which position the patient prefers.
The prone position is recommended for a back rub. The side-lying position can be used if a patient cannot assume the prone position.

9. Expose the back from the shoulders to the inferior sacral area. Cover the remainder of the body. Exposing the back while covering the remainder of the body maintains the patient’s modesty and prevents chilling. Proper draping techniques minimize exposure and ensure the patient’s comfort and dignity throughout the procedure.

10. Help the patient turn on their abdomen or their side with their back toward the nurse and their body near the edge of the bed so that they are as near the operator as possible. If the supine position is used and the patient is a woman, a pillow under the abdomen removes pressure from the breasts and favor relaxation.
Placing the patient on their abdomen or side with their back towards the nurse allows for optimal access to the back muscles, facilitating the massage procedure. This positioning also promotes comfort for the patient, as it minimizes strain on the neck and spine while providing support. Positioning the patient near the edge of the bed ensures that they are as close to the nurse as possible, facilitating ease of movement and minimizing the need for the nurse to stretch or lean excessively during the massage. This proximity enhances the nurse’s ability to apply appropriate pressure and maintain control over the massage technique. Placing a pillow under the abdomen of a female patient in the supine position helps alleviate pressure from the breasts, promoting relaxation and comfort. This technique prevents discomfort or compression of breast tissue during the massage, enhancing the therapeutic experience for the patient.

11. Raise the gown.
Raising the gown allows the nurse to access the patient’s back effectively, exposing the area that requires massage therapy. This ensures that the massage can be performed directly on the skin, maximizing the therapeutic benefits and effectiveness of the procedure.

12. Massage the back.
Using a variety of massage strokes and appropriate pressure ensures thorough and effective muscle relaxation.

13. Pour a small amount of lotion onto the palms of the hands and hold it for a minute. The lotion bottle can also be placed in a bath basin filled with warm water.
Back rub preparations tend to feel uncomfortably cold to people. Warming the solution facilitates patient comfort.

14. Using the palm, begin in the sacral area using smooth, circular strokes.
Starting in the sacral area allows for gradual relaxation of the muscles and prepares the patient for deeper massage techniques. Smooth, circular strokes in this area help promote blood circulation, alleviate tension, and set the foundation for the rest of the massage.

15. Move hands up the center of the back and then over both scapulae.
Moving hands up the center of the back targets the larger muscle groups along the spine, providing comprehensive relief from tension and promoting relaxation. This motion helps distribute massage pressure evenly across the back, ensuring a balanced therapeutic effect.

16. Massage in a circular motion over the scapulae.
Circular motions over the scapulae address specific areas of tension and stress commonly found in the upper back and shoulder region. Massaging this area helps alleviate muscle tightness, improve flexibility, and reduce discomfort associated with poor posture or repetitive movements.

17. Move hands down the sides of the back.
Massaging down the sides of the back targets the latissimus dorsi muscles and other muscle groups along the sides of the spine. This motion helps release tension in the lateral back muscles.

18. Massage the areas over the right and left iliac crests.
Addressing the areas over the right and left iliac crests targets the lower back and pelvic region, where many individuals experience tension and discomfort. Massaging this area helps relieve lower back pain, improve circulation, and enhance mobility, particularly in individuals with sedentary lifestyles or those prone to lower back strain.

19. Massage the back in an orderly pattern using a variety of strokes and appropriate pressure. Employing a variety of massage strokes and adjusting pressure levels ensures comprehensive muscle relaxation and addresses individual patient needs. Alternating between techniques such as effleurage, petrissage, and kneading helps stimulate blood flow, release muscle knots, and promote relaxation. Adjusting pressure based on patient feedback ensures a comfortable and effective massage experience.

20. Apply firm, continuous pressure without breaking contact with the patient’s skin.
Applying firm, continuous pressure without breaking contact maximizes the therapeutic benefits of the massage as this promotes deeper muscle relaxation and relieves tension.

21. Turn patient on his back and put on the gown.
Turning the patient onto their back and ensuring their comfort with proper gowning and positioning concludes the massage session safely and respectfully.

22. Fix and make patient comfortable.
After completing the back massage, it is essential to ensure that the patient is comfortable and at ease. For example, adjust their pillows, straighten their sheets, and ensure they have easy access to water or the call button.

23. Prevent discomfort or injury.
Adjusting the patient’s position or surroundings helps prevent discomfort or injury following the massage. It ensures that the patient is in a safe and supportive environment as they transition out of the massage session and this reduces the risk of postural strain or discomfort.

24. Finalize the therapeutic experience.
Fixing and making the patient comfortable serves as the final step in the therapeutic experience. It provides closure to the massage session and allows the patient to transition back into their daily activities feeling refreshed and relaxed. This step reinforces the positive impact of massage therapy and encourages the patient to seek further holistic care in the future.

References and Sources

Additional resources you can use to further your reading about massage and back care:

• Buckley, J. (2002). Massage and aromatherapy massage: nursing art and science. International Journal of Palliative Nursing, 8(6), 276-280.
• Kozier, B., Erb, G. L., Berman, A., Snyder, S., Levett-Jones, T., Dwyer, T., … & Stanley, D. (2015). Kozier and Erb’s Fundamentals of Nursing [3rd Australian edition].
• Labrique-Walusis, F., Keister, K. J., & Russell, A. C. (2010). Massage therapy for stress management: implications for nursing practice. Orthopaedic Nursing, 29(4), 254-257.
• Westman, K. F., & Blaisdell, C. (2016). CE: Many benefits, little risk: The use of massage in nursing practice. AJN The American Journal of Nursing, 116(1), 34-39.