In the first installment, the definition of complementary and alternative therapy (CAM) was reviewed as well as the mind body modalities available. The second domain under review is the Manipulative and Body-based practices. “Manipulative and body-based practices encompass a system of therapies that use either manual manipulation or movement of one or more parts of the body to address structural or systematic imbalances of the bones and joints, the soft tissues, and the circulatory and lymphatic systems.”1

Massage involves the “rubbing and kneading of muscles and joints of the body with the hands, especially to relieve tension or pain.”2

There are no research studies that explore this modality with persons with bleeding disorders. A recent article published in Massage Magazine highlights recommendations made by a massage therapist when persons with bleeding disorders are considering massage for pain management. “A massage therapist needs to be especially careful with manipulating joints, as bleeding can easily occur at the major joint sites. Modalities which mobilize or stretch limbs may cause unnecessary stress upon joint structures. Friction strokes, which are classically ideal for addressing joints, need to be performed more cautiously. Deep tissue massage can carry the risk of increased bruising as well.”3 Based upon the available information, it is important to know your massage therapist and their ability to help. Use of this therapy should be reviewed with your treatment center, where the possibility of factor infusions prior to massage may be required.