Gentle and Effective Touch for Frail Elders

By Ann Catlin , LMT, NCTMB, OTR

Gentle and Effective Touch for Frail Elders

By Ann Catlin , LMT, NCTMB, OTR

While many massage techniques have been found to alleviate pain, foot and leg massage may be especially effective for elders who may not tolerate other forms of massage. Foot massage is non-invasive and considered "boundary-safe," meaning that it respects the personal space and dignity of the elder who may not have experience with receiving massage. It has been my experience that most elders are comfortable with having their feet rubbed. Except for shoes and socks, no other clothing need be removed in order to provide the nurturing effect of skin-on-skin contact.

Massaging the feet is also a powerful gesture of service. There are subtle associations of truly serving the elder when sitting or standing at the feet to provide caring and compassionate touch. The interpersonal dynamic shifts from a caregiver doing a task to serving the person. It conveys honor and respect.

Foot and leg massage contribute to both the alleviation of the physical sensation of pain and the individual's perception of the pain experience. The general benefits include:

  • Provides a subtle sense of security, grounding and peace.
  • Helps relieve emotional tension.
  • Stimulates reflex points in the feet, balancing the whole body.
  • Opens the flow of energy throughout the body.
  • Increases circulation to the area.
  • Powerful gesture of being in service to the person.

Protocol Preparation

Center yourself. If you are calm, the quality of your touch will be enhanced and you will enjoy the session more. Centering need not take but a few seconds. Take a deep breath and ground yourself before initiating the touch session.

Touch Quality and Intention

All forms of touch have quality and intention. The qualities are the physical attributes of your touch. For example, your touch may be warm or cold; firm or light; fast or slow; rhythmic or sporadic. The intention is what you communicate or convey through your touch, such as touch used to communicate caring; to guide someone; to greet a friend.

In the foot and leg massage instruction that follows, the qualities of the touch are:

  • Slow
  • Rhythmic
  • Light, full contact pressure
  • Encompassing

The intention is to offer non-invasive alleviation of pain and discomfort and provide supportive one-to-one focused attention.

Massage Protocol

The following protocol represents an effective 10 minute session — five minutes for each foot and leg for an elder who is sitting in a recliner with the footrest elevated. The length of time or number of repetitions that you apply any stroke is determined by the individual tolerance and response of the elder receiving the massage.

First, position the elder to provide support and comfort for the massage. Place a pillow under each arm to support the upper body. Place a towel under the feet to protect recliner upholstery.

Second, begin the massage with focused touch. Focused touch is touch that is given mindfully and with awareness of your intention of why you are providing the massage. It's a time to center yourself; to calm your mind and to focus your attention on the individual you are touching.

The third step is to establish a flowing stroke. Using pressure similar to that used to apply lotion, flow your hands from the knee down the leg, encompassing the entire foot. Repeat two to three times.

Make sure you apply lotion to the leg and make full contact kneading on the leg (modified petrissage). This stroke is using small circular motions with the flat surface of your hand — the palm and the flat surface of your fingers. Using the flat surfaces distributes the pressure, increasing the safety and comfort of massaging the frail body or thin skin. Start distally and work up to the knee. To transition back down you can use a flowing stroke. Massage the foot using full contact kneading with your palms. You may use the full surface of your thumbs in a circular motion on both the bottom and top aspects of the foot. Apply these circular strokes to the entire surface of the foot—heel, arch area and ball of the foot, as well as the top aspect from the toes to the ankle. Gently knead each of the toes if there are no contraindications such as fungal infection.

Then, repeat entire sequence on other leg and foot. After massaging both legs and feet, end the session with a bilateral flowing stroke to bring balance to the two sides of the body. When closing the session, return to the starting point of focused touch so that you end the massage mindfully as when you began.

Precautions and site restrictions for foot and leg massage:

  • Be sensitive to privacy and cover the thighs of the elder.
  • Do not massage any inflamed area.
  • Edema: Use only light touch or holding. No circulatory massage strokes.
  • Varicose veins: No direct stroking.
  • Deep vein thrombosis: Do not massage area affected.
  • Fungal infection: If toes are discolored, nails yellow or thickened, or skin is cracked, avoid contact.
  • Pressure or diabetic ulcers: Check heels and ankles for redness or blisters and avoid massage on these areas.

Safe Options

When one or more site restrictions exist, one of the following options can still provide safe benefits through touch. Massage around the affected site. Massage a different part of the body not affected by the condition.

Use only focused touch or holding. Through the power of touch, you become actively involved in a meaningful effort to increase the quality of life of those in your care. And since the gift of touch flows two ways you, too, can enjoy the mutual benefit of touch.