Author Archives: Sue Peterson

About Sue Peterson

Sue Peterson has practiced massage since 1995 and is also an accomplished medical writer. Read her blogs at Findtouch.com.

Meetups for Massage Therapists

I am just back from our massage therapist state convention Classes, networking, stuff to buy and a bit of fun. I had the joy of being a test body, demonstrating treatment by one of the best bodyworkers in the world today.
But the big annual meeting/convention paradigm is changing Conventions are losing attendance, and may be going the way of the pay phone. We have lots of other opportunities to communicate, so fewer therapists every year, also means fewer people selling products, fewer recruiters and fewer classes.
At some point our state meeting may change to every other year, or it may morph into some sort of social event that happens to have some classes the same weekend. They just don’t want to call it a convention, because conventions are losing money.
Well, should the community of massage therapists care? What does a convention do for we who rub?
As someone who has spent 25 to 30 hours a week for the past 20 years in a dimly-lit room, I have to say I like seeing other people who do what I do. It’s a good time to compare notes. How’s business? What are your shoulders feeling like? Find a good program for your schedule? How do you unstick scalenes?
Hey, we can do all this online, of course, but I do like to see folks in person. I notice that the web has replaced much communication, yet people still gather in groups. Perhaps we should have bonfires on the beach, so we can feel our tribalism as in days gone by. Whoop-whoop!

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Joyful, Useful Skin Massage

Snappy massage therapists used to make fun of “skin massage”, using it as a stand-in for a massage of no connection, a mere application of oil, an unmemorable massage of no consequence.
But hey, snappy aside, there is a really awesome aspect to skin massage worth thinking about – and doing.
Here we are dealing not with lilting pressure, but often no pressure, and a term perhaps last heard on whaling ships: furling.
Furling, really? Yeppers-peppers.
Sometimes a pain complaint from a client is the ghost of the past. An imprint still there long after the trauma is gone. If lucky, the massage therapist may feel it in the easiest structure to touch and modify, the skin.
Once in a while I find one of these morphed patches of skin, right at the beginning of a massage when I am scanning and feeling the area of complaint. It might be over a stuck infraspinatus, a wedged down trapezius, or a plastered temporalis.
When I find these spots, I gently- heed that word – gently try to pick up the skin between thumb and forefinger, skin only, and see if the pain disperses. Sometimes the planets align, and the pain goes whoosh! The client may think it was magic (not a bad way thought when it comes time to re-book) and it certainly can seem that way. Of course it is not, just another expression of starting at the beginning and checking layer by layer of the structures involved in a pattern of pain or tension.
If the skin won’t open to lifting touch, it is time to go on to gentle rocking, range of motion, itsy-bitsy circles, anything to remind the skin that it is supposed to move moderately independent of the structures below. Sometimes that is the key, and the skin releases.
If it does not let go, it puts the massage therapist on the ship deck with the whaling sailors. We probably all furl, but perhaps don’t call it that because we drop words unique to the 19th century. But I like antiques, and this antique tells the story best. To furl, we pick up all of the portion of a sail, bunch it up and smooth our bunch before we seek to add more.
Massage furling is picking up a bit of skin, with a bit of adipose, and possibly a bit of connective tissue and muscle, and gently rolling it to smooth and open the adhesions.
Reminder time, this is a gentle technique. One of my buddies did this as a pinch, a locking pliers kind of pinch, which made me levitate, and wouldn’t let go until I came back down to the table. Fun amongst therapist friends, but zooming across the pain threshold will lose you most clients. Gentle takes the day.
It’s a cool way to begin a massage with first relieving the pain, then following with a Swedish or mixed technique massage to address the entire body.
Well, call me Ishmael. Skin massage has some purpose too!

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Therapeutic Massage?

My massage client had gone to a fancy resort spa with an extraordinary view of the ocean. The spa was world-class. The services were expensive, the atmosphere somewhat reminiscent of a place where Roman emperors might have gone for a holiday.
How was your massage? I asked him when the holiday was over.
I had the guy they said was the best there, my client said, and I probably had the worst massage of my life.
Okay, I was not-so-secretly delighted that the fancy place didn’t measure up. But what was wrong with the massage? Shouldn’t it be pretty good if not better than average?
My client thought so. His masseuse didn’t ask any questions and spent 80 minutes gliding his hands and forearms over his body, impersonal and disconnected. I asked him afterwards why he didn’t work more on my bad spots, my client said. The guy told me oh, you wanted a therapeutic massage. Remind me next time.
Yowza. Great moments in customer service. Of course there would be no next time. I felt bad for my client, worse for my profession. What had gone wrong here? Why would a supposed deep-tissue massage turn into an oil basting? Even more important, why would there be a difference if my client had spoken up and asked for a “therapeutic” massage?
Unimpressed, yes, but it gave us both a moment to consider what a therapeutic massage means. I have been doing massage for 21 years. My client is a connoisseur, having had two to three massages a week for a good 40-plus years.
The person we couldn’t quiz was the spa therapist. Don’t know if he was hung over, injured, overworked or just uncaring. Maybe he didn’t like working on old guys. Maybe he was a Johnny-one-note with a recipe for conserving energy. The great unknown.
Either way, he had insured that my client would never get a massage from this guy ever again. And my client was soured on the resort, too.
To my way of thinking, all massages are therapeutic, he said.
I could not agree with him more. I’ve had great massages from experts to the humble, self-taught therapists. The names of the massages did not matter. The caring connection matters most.

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All Thumbs Massage

Massage therapists have a few tricks for using specific pressure techniques without straining their thumbs. Whether light, firm or deep, these handy tips provide support for precious thumb during massage strokes.
These body mechanics require split legs, from 4 inches to shoulder width apart, one behind the other and slightly flexed at the knees and hips. Movement forward springs from the back leg. The visual cue is to imagine your foot pushing the floor away. As you push forward, the hands effleurage the client’s back. When this “fencing lunge” stops, the forward stroke stops. Return strokes should be glides rather than more forceful strokes to avoid activating the lats and rotators, which can lead to shoulder and neck pain.
With these mechanics the length of these strokes depends on the length of the therapist’s arms. Shorter-arm therapists tend to have smaller zones, for instance half the back rather than full length. Taller therapists can cover more territory but are at risk for using their neck and thoracic muscles if they do not take care to split and flex legs.
Here are some photos of thumb-saving stances that allow therapists to work as deeply or lightly as they like. The first is the main thumb saver: Pressing the straight thumb into the flexed index finger and using the other fingers for support. The fingers are flexed so the wrist must be slightly flexed or straight to avoid carpal injury. This allows for stripping along muscle fibers or for transverse friction without risk to the thumb. It also feels better to the client.
The second photo demonstrates the thumbs pressed against each other, but this time the fingers are spread so the massage therapist can knead with the second phalanges of the fingers. This kneading feels more broad and intense top the client than flat finger kneads. Think of it as a step between finger and forearm kneading.
The third photo shows some more thumb stabilization to avoid hyper extension and strain. This time both hands support both thumbs providing a wide and very stable effleurage.
These thumb tips have kept myself and colleagues out of danger while pursuing long careers in healing. One of my clients calls these strokes the teddy bear paws. Thumbs up!

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Massage Clients Need Training, Too

Most massage therapists charge by their time spent in a session, so dealing with client cancellations and no-shows is a particularly dear subject.
Big massage businesses just put their policies out there: 24-hour cancellation or full charge for the missed session. No appointment without a credit card to “guarantee a reservation.” It is a survival tactic that keeps the bills paid.
But what happens when the massage is not part of a big edifice of business complete with a receptionist to state the policy? Massage is a client-based business, after all. Can you afford to alienate a client for a missed appointment? Can you nicely charge folks for services not rendered? Is a cancellation policy a must or a risk for the small massage practice or clinic?
Those questions are an excellent place to start when considering your practice and its future. But keep in mind that massage therapists tend to be quiet, healing people who do not like confrontations, especially with those people seeking relief from stress. If you don’t have any policy stated up front, you may be in the position none of us healing people like: broke and behind in the bills.
Aaargh. Yes, boundaries. Those darn things hopefully they talked about a lot in massage school. Is there a middle ground? Can a therapist walk the fine line between impersonal business policy and caring personal service? And still pay the bills?
This is a tough subject. Why? Because out there in the universe, most people are honest and upfront and understand that you need to be paid for your time. Then there are others who feel every nickel saved on a cancel fee is a personal victory attesting to their ability to avoid paying for anything. Yes, these are the legendary “cheap clients” who will turn your book into a sea of red ink if you are not careful.
Airlines and other big shops generally don’t give money back or reverse charges. They have found out the hard way that when a big biz is involved, many people perceive lying to not be charged or to get your money back is okay fibbing. Hey, the airlines can afford it, right? Well, not really. Big shops have to defend themselves.
The most important thing here is that if you have a “cheap client” with a great excuse is to get rid of them. A cancellation policy will do that. Otherwise these folks will suck your energy dry with no regrets.
Sometimes, yes it happens, the client is actually using the no-show as a way of firing you. It says in a big way that the client does not value the service. It means “cya.” Whatever is going on, this is the client you will be relieved to remove from your book. If that client ever calls again, they pay the no-show fee before getting a massage for their “emergency.”
In the big and small picture of customer service, I think it is important to respect your skills enough to have a firm cancellation policy. It can be full charge, half charge, whatever you want, but have it. And when a regular client who appreciates your work has a true emergency, it is okay to say “no charge.” That will be appreciated. After all, small business is personal, eh?

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Taking Chances with Your Massage Muse

Massage therapists are like musicians, athletes and dancers. We train, we practice, and yes, we ache.
Those of us who are in it for real are often playing despite pain. Therapists should be doing all kinds of things to stay in the game, from stretching icing and exercising. But like our musician and dancer friends we are often too busy doing lots of massages and working on our careers to do these things regularly.
Lately folks have wondered about the longevity of a massage therapist’s career based on body mechanics. The stats are kind of miserable: Some newbies are out in three months. The average career is five years. The longer-lasting folks seem invincible but are not really.
My long-timer buddies look fine but have complaints of tendonitis and numb appendages. In my observation, people who work out or do a cardio activity such as cycling seem to wear well. I will think that and then I see a friend out for six months after an accident on the bike.
I suspect there is no magic formula to surviving and thriving in a massage career, but I also suspect that some people leave their starting gates with their feet tied. Hyper-mobile thumbs, hips, shoulders don’t do that well in time. Too stiff people seem to get by but have a lot of osteoarthritis. A long-time therapist friend (25 years) says it all comes down to whether she can play racquetball twice a week.
Well, we all have our goals/expectations.
The older and wiser therapist, has, hopefully learned. My exercise ball is in my living room; another is at the office. My racquetball-crazed friend has her Pilates reformer in her living room. Another has her own cold laser on the nightstand by the bed. How many ice packs can fit in a side-by-side fridge?
We all know the best prevention of all is massage, of course, and when therapists get a massage once a week they seem to do well. How many of us do it? How many of us pay for it?
My master plan is to continue to enjoy doing massages for a good while longer. That takes dedication to prevention. I feel like the musician who has made it to the symphony. I’d better take care of what I have so I don’t have to retire before I am ready.
What is your strategy? Do you have one? Are you dedicated to prevention, the thing we tell all our clients about endlessly?

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Trigger Me Mine

Massage therapists often enjoy showing clients something they can do on their own to relieve a chronic trigger point.
I do it too: “Here, try an old tennis ball and lean up against the wall. Just a little pressure, not your whole weight. Keep gentle pressure on the point for 10 to 15 seconds and then gradually lift.”
Most massage clients are surprised by what they can do one their own. But I am mindful of human nature. Like most therapists, I emphasize caution. “Avoid the urge to push too hard. You will be tempted. But too much pressure for too long can make the point come back much worse later. Always do this easy.”
But humanity has its nature. And unfortunately, the numerous videos and self-treatment trigger point therapy books can be the road to perdition.
In the last two years I have had two clients pop in with Olympian trigger points that don’t respond to usual treatment. These trigger points want to stay and drive the clients crazy. What do these two clients have in common? They learned from a book or video how to do their own trigger points.
I had the advantage of learning trigger point therapy in school. The instructors and the books all cautioned students not to go crazy doing trigger points. One by one, every student in my class learned the hard way why trigger point therapy rules are good to follow. I found an especially precious trigger point in my temporalis. I worked it like crazy. Sure that when I erased it I would get relief. Within a few days, I had blinding migraines.
Clients don’t have that experience to help them believe in under-treating trigger points. I am so much more cautious about giving out old tennis balls now.
So what do you do with runaway trigger points? With these clients I tried a few different tactics. The first responded to active release techniques, but the monolith trigger point tended to return after a week or two. The second came around with dedicated, repetitious Swedish massage. I had to get the relaxation system back up and running in the nervous system. Funny, huh?

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Plumb Out of Thumb

Body mechanics are important to massage therapists because they can make or break our careers We only have two forearms, two hands and ten fingers So why do many of us take such enormous risks with our thumbs?
When you go to classes for massage, you will hear some jaded tales. “I did this one thing and it took a year to heal.” “I knew it was trouble as soon as I did it.” Or the haughty brag: “I abuse my thumbs all the time and they are fine.” Well, just wait.
Thumb injuries are perhaps worse than the tennis elbow or carpal symptoms many massage therapists can develop because they are a long time healing, prone to immediate re-injury, and crippling for other life activities.
Most of us know better, but sometimes we do something without thinking. (Really?) The thumb can become a lightning rod when injured, because many of our techniques require the use of both pressure and specificity. The thumb provides both, but used recklessly can end your career.
I’m going to list the ‘rules of thumb’ for massage therapists.
Never hike out alone: When the thumb is split away from the fingers, you may think it gives a better sensation of pressure. Actually it does not. The client will feel a marked difference between thumb and finger pressure, not in a good way, while you are risking hyper-extension. At worst, your client will feel as if the thumb is digging while the fingers glide. Your hand, meanwhile, will be all set to resolve that hyper-extension by crimping into flexion while you sleep, compressing the radial nerve and carpal tunnel.
Stick Together: With nearly all massage moves, the thumb should be pressed against and supported by the fingers. This spreads the pressure evenly and results in a glide or effleurage that feels better to the client and to your hand. The entire palm, not just fingers, is used for these moves. What about wringing? Try it with the thumb stuck to the fingers. It will feel better to you and the client.
Thanar, not thumb: When the angle of a stroke tempts you to swing out the thumb, try using the thenar surface, the underside of the thumb, with the upper thumb pressed to the index finger. An example is in trying to shift the lateral quadriceps away from the ilio-tibial band. Using the thenar surface preserves the strength of the stroke without endangering the digit.
Two thumbs and eight fingers are better than one thumb: Depending on the shape and length of your phalanges, you can press two thumbs together to do a specific power glide – as long as the fingers are flexed at the second joint so you are using the thumbs with support on both sides. The second joint is the one just up from the knuckle.
No Lollygagging: Never drag the thumb behind a stroke. This is total thumb suicide.
Lucky for us all, good mechanics also feel much better to the client. If it hurts the client or will hurt you, why do it?

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Finding and Keeping a Massage Office

Many therapists could benefit from the use of a massage office. Your own spot saves your back from wrangling tables at house calls. Your own spot also offers a great learning experience – how to develop skills to negotiate and keep an office, handle bills and make more income.
At some point in every massage therapist’s career the question comes up: Would you rather work for yourself or someone else? Would you rather handle the details to enjoy the freedom? Does it suit your style and your abilities? If it does not, are you interested in developing those skills?
Being able to answer those questions thoughtfully is just the start. I’ve pulled together some tips from a long career; some of it spent working for others and some for me.
Find the Time: Lots of therapists I worked with at spas and medical offices talked about getting their own place, but most never took their first steps. You have to plot out your time. Will you spend every Monday and Tuesday looking at places? What about collecting equipment and décor on the second-hand market? Will you be spending full retail for what you need?
Study up: There are lots of online resources, most free, where therapists share their stories and advice. Tap in. I also looked at consumer columns on such things as commercial leases, tax advantages of an office and how to use your noggin to determine if potential officemates and/or landlords will be a good fit.
Work up you own agreement. If you find a place to share or rent full-time, you will get your best deal from your own hand. Sure, lots of landlords have their own agreements, but those agreements often turn back on themselves and nullify the very things you want or need. If you can use a one-page, simple agreement of your own design, you are better off.
Know your noise: Massage needs peace and quiet. The most common complaint I have heard from people is that they didn’t know the neighbors would be noisy. Or their landlord rented to a noisy neighbor just to fill space. You need some quiet neighbors, like accountants, other wellness offices, etc. Restaurants, machine shops and daycare are going to drive you crazy. Get it in writing that you won’t be subject to excessive noise incompatible with your business.
Have one-year’s rent in the bank before you leap. If your office is going to cost $500 a month or $5,000, you need to know you can pay for it while you figure out your business. Don’t rely on your hands to make paying clients magically appear.
Have more than one income stream available: If you run ads on Google, have a good website and your cousin the chiropractor sends you clients, you might make it. Most people forget to figure in the cost of marketing and keeping good referral sources in place.
It is also a frequent and fatal mistake to assume that if you leave your employer, your clients will follow. Most won’t. And your employer has paid money to get those clients in the door and the clients may just like it there just fine. How do you handle that? Trust me, it will take about 5 minutes for your employer to find out you are telling clients about your new venture. Ethics applies in business and in massage. Read up on how to leave gracefully. You don’t want to be one of those therapists who have to go to work for someone else a year later because you venture failed or created a lawsuit.

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Massage Heals Whiplash

Massage at the Top of the Spine

People who have suffered whiplash are a good number of the clients in massage therapists’ practices. They seek relief from neck and shoulder pain, tension headaches, migraines and fatigue.
Massage does wonders for sore muscles of the neck and shoulder even years after a whiplash. It opens fused muscles, improves circulation of blood and lymph, and helps muscles re-learn movement.
Usually people with whiplash have been around to many different doctors and therapists. Often they have gone as far as they can with them and have decided to try massage to reduce symptoms.
And here is where the massage therapist can shine. Depending on whether the whiplash was from the rear, front, sides or diagonal directions, massage can open up clogs of adhesed muscles and return their natural movement.
Most have thick fibrous bands starting at the occipital ridge and ligamentum nuchae, and simple Swedish strokes – softly drawing away from the occiput and gliding back – can draw down the congestion.
Light to medium trigger point work on taut bands of the trapezius, splenii, scm’s and scalenes will further restore motion.
What I find, however, is that many clients tell me massage therapists shy away from their whiplash zones, even though this relatively simple work will bring much relief.
The whiplash survivor is not a china doll, but someone who needs the relief of massage.
Sometimes we are used to massaging the thick muscles of the shoulder area but clients start to cringe when we move up to the neck. It is a natural reflex to dig in to hardened tissue of the neck in order to loosen it. Actually, the opposite works much better. When I check the neck I soften my hands and do more soft molding strokes. I want the defenses to drop, not increase. When hands are soft, the tissue responds by allowing you to massage more deeply, but with gentleness.
Another common reflex is starting a stroke lightly and adding pressure as it proceeds. In effect, it is a grinding motion and a very unpleasant sensation to the client.
Instead, use the same medium pressure throughout the stroke. Go back and start the stroke again with slightly more pressure, repeating and adding slightly to the pressure with each glide, taking care not to depress the vertebrae. At the end of four to six strokes, the tissue will have been opened and drained. Success!
Drawing away from the congestion and doing light pressure techniques on the neck and upper shoulders will bring a great deal of relief without having to get into more complex techniques best left to intensive workshops. There is no reason to be afraid of making these areas worse. Your hands can’t go from 40 miles per hour to zero in one second!
A few who have had severe whiplash – and survived – they are the tough clients. Their symptoms are more serious – vertigo, sleep disruptions, fascia that forms nooses and restrictive loops over the years of compensating for severe imbalance.
I like to think I have great massage skills for all these folks, but I am cautious. Have neurologists or osteopaths with experience in these dysfunctions evaluated their injuries? Are they stuck or hyper-mobile? Have they had an increase in symptoms from additional injuries?

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