Offering soft-tissue therapy safely during COVID-19

The following is a guide for those of you thinking of returning to offering soft-tissue therapy, manual therapy, massage therapy, or any other hands-on massage modality. This guide on operating safely during COVID-19 has been developed in conjunction with an infection control expert and offers simple, practical steps on how you can offer massage therapy services while keeping your clients, your staff, and yourself safe. While all risk can never be entirely eliminated, these strategies will help you minimise the risk of transmission in your clinic. 

Minimising transmission

A face mask and good hand hygiene, along with proper client screening is the best strategy to avoid infection. 

The evidence so far indicates COVID-19 is only transmitted by droplets. As the virus is not airborne it cannot remain suspended in air where you can breathe it in. 

Transmission of the virus requires you to be in close proximity to a carrier with respiratory symptoms who sneezes or coughs onto you within a meter. This means that, although COVID-19 is highly infectious, the risk of infection can be managed with proper risk assessment, wearing appropriate PPE, and practising good hygiene. 

Avoid touching your eyes, nose, and mouth, and treat surfaces as potential vectors for contamination. Regular, routine sanitising ofn your treatment surfaces and tools will help minimise the transmission of COVID-19 and many other respiratory bugs. 

Always follow the directives from government health officials

This guide can not and does not take precedence over federal, state, and local government health recommendations. Always ensure that you check that you are compliant with directives from these agencies and monitor them regularly for changes. 

Your professional association should be providing its members with actionable advice relevant to your location, but don't assume that just because you haven't heard of any changes to their recommendations that there haven't been any new directives from health officials. 

1. Ensure you are not symptomatic

Even if you're confident that you have not been exposed, you should do 14-day isolation first to be 100% confident that you are not symptomatic. As frontline health professionals, it is incumbent on us to ensure we are not exposing our clients to unnecessary risk. 

2. Risk assessment

Interview potential clients and ask if they have experienced any respiratory symptoms or if they have returned from overseas travel or from COVID-19 hotspots in the last 14 days. These symptoms include:

• Headaches
• Myalgia
• Runny or stuffy nose
• Vomiting
• Diarrhoea 

You will need to keep a current list of hotspots and ask the clients about them specifically; don't rely on clients to know about these hotspots. The Department of Health is a good place to start looking for current information relevant to your area. 

This interview should be conducted at the time the booking is taken and ideally before the client has even set foot inside the clinic. Make sure you keep a record of their answers, including the time and date of the conversation, for contract-tracing purposes. 

If they have experienced any of these symptoms or have visited a hotspot, they must not attend the clinic and will need to reschedule their appointment.

If they answer no, then they will be fine to attend. Ask them if they have experienced symptoms or visited a hotspot again when they attend for their appointment. 

You could consider excluding the elderly because of their increased susceptibility to COVID-19. However, these clients may be more in need of therapy depending on their co-morbidities; you will need to consider whether the increased risk to both you and these clients is acceptable. 

Make sure you explain your infection control practices and expectations prior to the appointment! Clients should understand what they will be expected to do upon arrival to minimise infection risk, including pre-paying for appointments if possible. Infection control can seem tedious and overbearing, but it is necessary to ensure yours and your clients' safety. Managing your clients' expectations prior to their appointments will make this process smoother and mean fewer pain points during their experience. 

3. During the appointment

The waiting room should be closed. Clients should wait in their cars instead and call or text when they arrive. Remember to ask them again if they have experienced any respiratory symptoms. 

When clients are admitted to the treatment room they should be required to perform proper hand hygiene with provided hand sanitiser or with a hand-wash basin if sanitiser is unavailable. Clients should be admitted directly to the treatment room to avoid other parts of the business being exposed. 

Try to keep appointments to 30 minutes or less. 

You can operate multiple treatment rooms simultaneously providing there is nobody left in waiting areas or any other common areas. 

The shoulders, neck, and head are all higher-risk areas for infection due to their proximity to the face. If treating these areas, both you and the client should be wearing a mask. 

If you touch any equipment or items during the treatment, ensure you perform hand hygiene immediately after touching the client and before you touch anything else. 

4. After the appointment 

When the treatment is complete, the client should dress, perform hand hygiene again, and immediately leave the clinic. Ideally, they will have pre-paid for their appointment to further minimise the time they spend in your clinic. Ensure you maintain a safe distance from clients when you are not providing treatments. 

Follow-up discussions should also be made over the phone after appointments to minimise face-to-face contact time. 

Once the client has left, perform hand hygiene and dispose of linens. Laundering linen in hot water and detergent is sufficient. 

Wipe down all surfaces with a cleaning and disinfection product and allow the surface to dry. The drying process should be completed by the time new linens have been applied and the next client has been admitted. Any creams or tools like vacuum cups used during the appointment should also be disinfected after the appointment. 

Although COVID-19 is highly infectious, the risk of transmission can be managed through proper client risk assessment, implementing contact-limitation strategies at your clinic, and performing regular and routine hand hygiene and sanitisation. 

* * *

This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.