Overview of Retrograde Massage Therapy

Retrograde massage is a common technique used by occupational therapists to reduce swelling, particularly in the hand. The massage consists of manually moving fluid from the tips of the fingers back toward the heart to be reabsorbed into the bloodstream.

Despite the fact that this is a common technique, the effectiveness has not been well studied. There is no strong evidence to support it, but also none to refute its efficacy.

The following advice concerning best practices comes from a 2012 British OT journal article that collected interviews from occupational therapists in the UK about their use of retrograde massage. Through analyzing these interviews, the researchers were able to establish a consensus on common practices. Again, whether these are the most cost-effective or effective approaches has not been researched, but simply represent what the majority of OTs do. 

When Is It Helpful?

Retrograde massage is recommended for dependent swelling. This means that the swelling is happening from lack of movement, which traditionally aids in pumping fluid back to the heart.

Dependent swelling is particularly common among patients who have experienced a stroke, as strokes can cause a loss of movement and sensation. A 2005 study found swelling to be prevalent in up to 73% of stroke patients. This swelling can limit the person’s ability to move their hand, participate in daily tasks, and engage in rehabilitation. Retrograde massage is used to reduce swelling in order to neutralize these effects.

When Should It Be Avoided/More Closely Monitored?

Supervision by a medical professional is recommended for initiating retrograde massage for several reasons:

1. The source of the swelling may have some other cause, which could make the massage dangerous. For example, a stroke patient may injure their hand without realizing it, causing the swelling in which case massaging could exacerbate the wound. The swelling could also be caused by a deep vein thrombosis (DVT), meaning a blood clot, in this case, massage could send the blood clot to the lungs.
2. The circulatory system may not be able to handle having fluid quickly pushed back toward the heart. If the patient has a heart condition, their heart may not be able to manage the amount of fluid being pushed back toward it during the massage process.
3. The massage may simply be ineffective. For example, lymphedema can also cause swelling of the hand, but the swelling has a different cause. In this case, the lymphatic system is compromised. This system is separate from the blood circulatory system and responds to a different type of massage.

Strategies Used to Increase the Effectiveness of Massage

As mentioned above, these strategies are not part of a set protocol, but they do seem to be common practice.

• Elevate the hand above the elbow and heart level
• Administer on a daily basis for 10-15 min.
• Educate family members/ the patient on how to administer for when a therapist is not available
• Use a moisturizer/lubricant to reduce friction
• Keep the hand/wrist in a neutral position
• Massage from the tips of the fingers down toward the elbow, both the front and back of the hand

Other Options for Swelling Reduction

There are several options that can be used in conjunction with retrograde massage:

• A positioning program involving the elevation of the upper limb
• Encouraging functional use and active movement of the arm (such as fist pumps)
• Edema glove or compression sleeve

Why You Should Get a Formal Assessment

As a patient, you should never hesitate to ask for a formal assessment that a technique is working, particularly in this type of case, where there is no clear evidence behind it.

The two most common techniques are simply measuring the circumference of the arm at the same spot over a series of days to make sure the swelling is going down. The second is a volumetric measurement, which involves placing the hand in the water to measure how much water it displaces. As the swelling goes down, less water should be displaced. Volumetric measurements are the best approach as they have a set protocol.