Harm by “Massage” ?In Cases of Amyotrophic Lateral Sclerosis (ALS)? Part 1

From the Author

It is not by accident that I titled this article "Harm by 'Massage'" rather than "Harm by Massage Therapy." The reason is simple: therapy implies a contribution to health improvement, while harm signifies the opposite.

In all healthcare fields, there is a foundational principle: “First, do no harm.”

In what situations can massage cause harm?

1. When contraindications are ignored
2. When excessive pressure is applied
3. When overstimulation occurs

Today, I would like to discuss an additional, often overlooked form of harm—when the therapist's own energy imbalance can unintentionally aggravate the patient's condition.

I was inspired to write this after being invited to comment on a Facebook post. Here's a portion of what was shared by a fellow therapist:

"Okay colleagues, I need advice if you have experience with this. I saw my client at his home... he was diagnosed with ALS last August. It has taken him this long to reach out and ask me for a massage. He was told he's had it for five years already. I've read and re-read everything in our pathology book, but nothing beats real experience. We’re setting up a table in his home because I can’t bring mine unless I'm training.
I was able to stretch his legs while he was in his wheelchair—his ankles are so swollen. He’s very stubborn. It took me three months to convince him to get a second opinion in Boston after he developed drop foot. Once he did, we got some answers.
Still, he was hesitant to ask for help. I kept texting him monthly just to check in. He still works from home and pays for all services out-of-pocket because he doesn’t want to file for short-term disability.
If anyone has experience with ALS cases, I welcome your recommendations. In the meantime, I got him to agree to continue water therapy. Thank you so much."

My Response on Facebook:

To Sheila:
Dear Sheila,
Thank you for your thoughtful message. I truly appreciate your sincerity and desire to learn. A good massage therapist does not pretend to know everything but instead seeks knowledge and growth. It’s a pleasure to share my experience, and I hope it will help expand your clinical perspective. I’ll be publishing a full article on this topic soon.
Best wishes,
Boris

To Sue:
Hi Sue,
Thank you for the invitation. It's difficult to overstate how important it is to discuss cases like this. This is one of those unfortunate situations where massage therapists find themselves “working in the dark.”

The original post is a powerful example: you're working with a disabled individual who hasn't lost hope and has reached out for help—yet our tools may be limited in such complex conditions. Situations like this can affect our emotional and physical well-being, while harming the patient.

Although I’m currently very busy moving between clinics, I will try to contribute more when time permits. In cases like this, we can help—but only with proper understanding and caution.

For clarity and clinical accuracy, I recommend always using the full term amyotrophic lateral sclerosis (ALS). This is important because massage therapy causes a massive release of action potentials—a physiological effect that must be carefully considered in neurodegenerative conditions like ALS.
Best wishes,
Boris

The Human Factor: When We Don’t Know What to Do

Can you imagine what it feels like to stand in front of a disabled patient, uncertain of what to do, feeling your own inner turmoil, confusion, or energetic imbalance? Such a situation is not only dangerous for the therapist—it can aggravate the patient’s condition.

And this doesn’t only happen with ALS. Conditions such as disc herniations, thoracic outlet syndrome, sciatica, and many other painful disorders can have the same effect. If you're not trained to handle these conditions but proceed with treatment anyway, what happens to your much-needed confidence? Is your own energy balanced?

Some may feel I’m speaking about vague metaphysical concepts. I assure you, I am not. I am urging massage therapists to understand the power of the placebo and nocebo effects. These are real physiological phenomena. We must master these concepts to avoid harming ourselves and our patients.

Please remember: “First, do no harm.”

I recommend you read my article on this subject carefully. If you have questions or disagree with any points, please feel free to post your thoughts. This material is meant to be studied thoughtfully and applied wisely.

https://www.medicalmassage-edu.com/blog/the-placebo-effect-and-its-role-in-massage-therapy.htm

On the Power of Placebo—and Nocebo

In Part One of The placebo effect and its role in massage therapy “article, I discussed the power of the placebo—a real and clinically significant phenomenon. I also emphasized the need to understand the nocebo effect. When a therapist lacks confidence and clarity in their treatment approach, their energy balance is disturbed. Would like to stress again This not only affects the therapist’s health, but it can worsen the patient’s condition.

Massage therapy is a proven and powerful treatment methodology, effective for:

• Stress management (note: not to be confused with simple stress reduction)
• Spinal disorders
• Crippling myofascial pain syndromes
• True detoxification
  ...and much more.

In addition to these benefits, we have the potential to trigger the placebo response, which greatly enhances treatment outcomes.

Please read Part 2 carefully.

https://www.medicalmassage-edu.com/blog/the-placebo-effect-and-its-role-in-massage-therapy-part-2.htm

In my Program #10 (video), I demonstrate how to “see with your hands”—how to sense what the eyes cannot perceive. For those who learn best visually, this video lesson can be very helpful.

https://www.medicalmassage-edu.com/products/ceu-volume-10.htm#video_only

In the second part of “Harm by “Massage” ?In Cases of Amyotrophic Lateral Sclerosis (ALS)?, I’ll go deeper into the clinical application of medical massage in ALS cases. I’ll share a fascinating story from nearly 25 years ago. A rheumatologist who attended one of my lectures on fibromyalgia convinced me to undertake a clinical experiment treating ALS patients. I initially refused, simply because I didn’t know what to do—but eventually agreed. The results, and everything I learned, will be presented in full detail.

Best wishes,
Boris Prilutsky