Category Archives: Building Your Practice

Smart Companions

Numb fingertips, cramp-y necks and para-spinals that feel like abandoned rock quarries. We massage therapists treat the injuries that computer technology can produce.

My smart phone just updated itself (can it reproduce?) revealing the phrase “Lifetime Companion” on the home screen. Really? This whole phone thing has gotten out of hand.

People are ruining their eyesight, developing dowager humps and filling up my schedule book from peering at tiny screens. Weren’t these things supposed to help us?

Device injuries have delightful names such as Pac Man Pinky, Smart Phone Presbyopia, and Blackberry Thumb. Let’s hear it for the names. But when are we going to get devices that do not turn us into garden gnomes?

I have been waiting…tap…tap…tap. Captain Kirk just had to ask the computer to do stuff, he dictated his log, and sometimes he would twist a little button on his communicator. The only repetitive motion he suffered was trying to do that funny split-finger salute when Spock introduced him to the fam.

The techies have been awaiting the Apple I Watch, a device that looks like we will all be hunching over something even smaller in the coming months.

We massage therapists can hear a “Ca-Ching!” in our futures. The devices are not getting better. They are getting us more work than we can handle. So much for getting to that seminar in Costa Rica this year….

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The Price of Comfort

Recently I walked into a raging discussion among massage therapists over discount pricing. To discount or not to discount is a huge bugaboo for massage therapists.

Prices are subjective, of course, and one can only wonder why people ask for a discount from a single massage therapist when they wouldn’t dream of asking at a big spa. I came up with a list of concerns about prices:

Overhead: Discounting is tough for all therapists, really, because our stated prices and what we get paid are quite different. My asking price includes things that support my practice, such as office rent, website, phones, supplies, education and licensing. A friend who does house calls only has the expenses of phone, linens and oil. Another therapist has few expenses as an independent contractor, other than insurance and licensing, but taxes take a much bigger bite out of her paycheck and she rarely makes tips at her chiropractor’s office. At the end of the year, we all make radically different bottom lines, and our prices are quite different.

Perception: Most of the huffy comments from my friends on this topic come from the feeling that clients who ask for discounts are insulting them or their skills. People don’t haggle over many items, but they do haggle over personal services. My feeling is: do you want to be paid like the maid or the accountant?

Need: We all have clients who come in with limited means and in need of massage. How do you handle these? I have given people discounts for multiple sessions when they clearly have a need and lack resources. However, there are always a few people who ask for discounts and don’t have a need. In my experience, they are either thrifty or culturally used to haggling. I don’t take offense. If they really want a discount for the sake of a discount, I refer them to one of the $39 chains.

Desire: Another therapist friend had a home-based practice, (sub-rosa, no licensing or insurance) and needed clients, so she offered massages for $25 an hour, cash only. It worked. She did not have to leave her house She is also now very burned out and has no savings.

My friend who is a hair stylist put it this way: when she started her practice, her prices were low. As she built clientele, her prices rose. The clients who stayed valued her services. The others, well, one or two come in every year so she can fix their $8 haircut.

Massage Finger Maps Helps Reduce Numbness

Massage therapists will often have clients ask about foot or finger pain, or a strip of tightness around the knees or hips, but when is this a symptom of something gone wrong?

As we rub away with our talented hands, we may have an opportunity to assess if a nerve root or disc has been pinched or altered by time or trauma.

Recently a client sought help for numbness in the fingertips of the thumb, index and middle finger. Massage therapists are aware that numbness or weakness calls for evaluation by a doctor. This client had already seen her doctor, and an evaluation had shown disc problems in the neck.

My client was hoping for some improvement brought about by massage instead of more drastic measures.

A quick frisk of Google for numbness in these areas yields lots of articles regards dermatomes and myotomes, showing the body sliced into grids labeled with the common nerve root/disc source. The thumb, index and middle fingers are associated with the medial and radial nerves, and with C5-C6. Tingles in these areas might be caused anywhere from the spine and disc to the carpal tunnel.

By tracking the radial nerve from neck to fingers, I used several techniques to warm, stretch and free the nerve from adhesions. I also massaged the scalenes and applied light traction to the head, in hopes of opening the pinched off areas.

Her symptoms were greatly reduced, and my client is hopeful that massages and some physical therapy will keep her out of the operating room. Will my client have neck surgery? I don’t know, but her symptoms took a turn for the better, and that is what clients seek.

If dermatomes and myotomes are new to you, try a Google of them for some great information that will help your massage practice. I also keep a printed chart handy in my massage appointment book.

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Knowing Your Client – What Works For One Person Doesn’t Work For All

In the early days of a massage therapist’s career, discovering which techniques work well in a treatment session can be baffling.

Is it deep tissue? Soothing strokes? Is it short sessions? Long sessions? Is it movement? Breath? Is it the clients’ mindset? Perceived value? Desire?

Somehow fumbling about in our dim-lit treatment rooms we establish our patterns of understanding, and hopefully we can match those up to our clients’ expectations.

But ask a room full of massage therapists what works can be maddening. Folks who otherwise feel compassion for others can get rigid about their thinking. After all, if something works for them, should it not work for everyone?

It’s a hard fact of life that what works for one person doesn’t work for all. Yet we as a profession are constantly trying to define and establish “scientific” protocols for what works. An effort of little reward, it seems, for therapists and their clients. It does seem to fill up chat rooms and discussion groups.

I saw a lot of this discussion in other professions, as I spent much of my first career reporting on medicine and health sciences. People in these professions don’t want to do any harm, but they want to alleviate suffering and improve lives. Complicating that is the fact that outcomes vary widely. Protocols often work far better for one doctor over another, and for one facility versus another.

The human factor, a long-time friend explained, is what drives people a bit crazy in clinical practice. Was it the protocol or the nurse/doctor/therapist/team/facility or the family prayer group in the waiting room? Is the new drug a wonder pill or is it the selection of patients and monitoring of its use?

I suspect the answers in massage therapy may be about as difficult to vet as it is in medicine. Meanwhile, we practice in the dim-lit rooms of our vocation. If lucky, our clients will tell us what we need to know.

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A Degree from Massage University

My education in massage did not stop with graduation from a massage school. If anything, it intensified. Now a practicing therapist, I was learning every day from the most prolific of authors, the best logisticians, the brightest of the best.

It has been hard to keep up sometimes, but very rewarding. The classroom has been my therapy room, the teachers: my clients. Lessons learned go from the obvious to the subtle.

Some favorites:

Don’t smack your hands together like humpy honeymooners to warm your oil. (Can we get that one on a billboard?)

Don’t breathe on your clients face while doing neck stretches. (Again, billboard?)

Do listen to a client without distractions when they are speaking to you, even if you are getting a text.

Do ask every client to return. A genuine invitation goes a long way in a society where millions of people don’t mean what they say.

I was pondering some of the big lessons I garnered from clients the other day, after I heard that a former client, a very prominent man, had died at age 91.

Sad, yes, for I was thinking he would reach 100. But I remembered what he taught me about massage. He was a connoisseur, having had massages all over the world for many years.

He told me he liked me because I did “real” massages. He never told me how many therapists he had interviewed, but one day the house manager let it slip that a parade of therapists had come, once, and gone before he picked me.

That was good for my ego, of course.

So what did I learn? These were big lessons and small.

He always apologized if he was late. Always.

It’s important to take time for oneself.

And always buy the best seat at the ballpark that you can afford. Otherwise why go to the game?

Hmmm. Is it April yet?

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Massage Relief for Reflux and Indigestion

So many people work on computers and in hunched positions that massage therapists are seeing more clients for acid reflux and heartburn problems.

Recently I doctors have referred clients for massage to relieve reflux, and the results seem good. I wanted to offer some treatment tips.

First, reflux symptoms – burning in the throat, burping or stomach discomfort, especially at night, need to be evaluated by a doctor for other conditions. Clients I have seen for this problem have been to the doctor and had various tests to rule out other troubles. Most are taking medicine and avoiding certain foods to relieve their discomfort.

Second, I assess the client’s posture and ask questions about their body mechanics at work. Hunched shoulders and thoracic kyphosis are common. Some have had car accidents where their chest was compressed by seat belts. Many work on computers for long hours or have jobs where bending and lifting are frequent, for example, nurses or bartenders. I have also observed some cyclists who use racing-style bikes requiring bent posture.

These observations tell me that when I do the massage, chances are their backs and shoulders will be very sore from overstretching and the abdominals will be flaccid and shortened. Often the shoulder girdle is quite high and forward, the thoracic flexed, creating shallow, upper-chest breathing.

Lying flat on a table is often very difficult, so I like to start with the client prone. A back and neck massage comes first to relieve back and neck soreness and also to assess the stiffness in ribs and spine and specifically the scalenes and serrati. After massage I like to gently mobilize the shoulders toward their anatomical positions.

Many clients have had doubts about getting any massage on their abdomen, fearing tickling or invasive techniques. I assure them that as a ticklish person myself; I use slow, firm touch to avoid triggering tickle reactions. I also assure them that the techniques are not invasive and I can lighten them at any time without tickling.

If a client is still averse to tummy massage, I will suggest that they allow it over the sheet as a demonstration. If the answer is still no, I move on to breath work and ask them to let me know if they feel comfortable getting tummy massage later.

As you may infer, permission to treat is important. If the client is defensive, the massage will not work.

The actual massage for reflux is fairly simple. Slow Swedish-circles in the direction of the colon (counter-clock-wise) followed by slow half-circles over the solar plexus just under the rib cage. The stomach is on the client’s left side of the abdomen, immediately under and to the left of the xyphoid process. Gentle effluerage away from the rib cage; this encourages the stomach to drop down into its anatomical position.

Then I suggest they fill the area under their navel with air as they breathe in. This encourages diaphragm breath and releases the thoracic area from paradoxical chest breathing.

Let me emphasize that a doctor’s exam and diagnosis are important before starting this work. Some very serious illnesses such as cancers and heart disease can masquerade as heartburn.

With the occasional client who refuses to get medical exams, I ask them to write in their own hand a release for massage, in which they specifically state that they understand they could have serious medical conditions. Not seeing a doctor could cause death or disability. They should specifically state they do not hold the massage therapist liable. (I have never seen a client finish such a note.)

The joy of massage for reflux is that as the clients unwind and practice diaphragm breath, their reflux lessens and often disappears. If it does not, I refer to an osteopathic who practices visceral manipulation.

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Stalking the Numb Thumb

Sometimes massage therapists are faced with a whodunit – and it takes a good bit of detective work to unveil the unusual suspect.

The fun of massage therapy, I find, is solving these puzzles and giving a client not only relief but also the confidence that they will get better.

Recently a client came in looking frazzled and tired. A friend had referred her and she didn’t expect much. While she sat in the waiting room, she clutched her purse in front of her midsection with both arms.

A recent trip to the doctor and some bad X-rays had revealed some pretty bulgy discs in her neck. Her MRI was scheduled. She had known about the discs for a while, but these pictures looked worse and her left arm had experienced shooting pains. Now her thumb was numb, and the numbness seemed to be creeping up her thumb toward the wrist.

When a massage therapist listens to a client’s history and observes the posture, it tells a story. I was not sure what was going on yet, but I had a pretty good working theory. But puzzles can be tricky.

Cautiously, I warmed up her anterior shoulder and neck with Swedish massage. The skin was sore to the touch, and the muscles underneath were rock-hard. Working within her tolerance, I drew a flat forearm across her left anterior shoulder to gently press the suspects: subclavius, anterior trapezius, pectoralis major and pectoralis minor.

The thumb and forearm tingled a bit but the numbness remained. I took the shadow referrals to the arm as a hopeful sign. Erik Dalton teaches the forearm sweep as a great way to bust up sludge, adhesions and gummy bears stuck to the muscles and fascia just below the coracoid process. I used his inspiration and started down the shoulder girdle toward the arm.

Technically, my trigger point charts tell me subclavius should be the bad boy in this hunt for thumb-numb. But the constant pressure of rounded shoulders, stress, poor circulation, etc. had brought all these muscles to the table. Just picking one out would not do. Too many other players were jammed into the small space beneath the acromium to pick them apart.

All of these players were so stuck they were acting in a clump. Her numbness and pain gradually subsided. I then spent a long time doing Swedish warming massage up and down the arm, shoulder and neck.

My reward?

“It feels like my arm again,” the client said.

I feel like Nancy Drew.

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Offering Reassurance and Hope to Your Clients

When will this get better? When will my pain be gone? When can I do what I want to do – when I want to?

Tough questions for us massage therapists to handle. Truth, we don’t usually know. Massage does marvelous things for the mind, body and soul – but what it does is often entirely up to the person receiving the massage – and the intent and skill of the person giving the massage.

The timeline? That may be set by many other things – perhaps even a higher authority.

When clients drop these questions on me I look them right in the eye and tell them all I can do is try to help them feel better. As pain drops, function returns. One can’t predict the time involved in healing.

It’s not a very satisfactory answer for some clients impatient to going back to doing the exact thing that brought them in feeling wounded. With as soft a tread as possible, as we develop a therapeutic relationship, I have a few ways to explain further. These come in handy with sticky troubles such as fibromyalgia or other conditions that vary day by day.

Answer # 1: You will turn the corner, but you may not realize it. Often you realize it afterward. You will discover that some pain or restriction has been gone for a while.

The body really heals itself in its own time. All we can do is try to make it easier to get there.

Is that fair to clients? I think so. I have rarely ever seen someone making no progress from massage. But I have often observed one factor in common with the impatient client: A chronic problem has often been ignored for so long it takes time to create an awareness of how to heal and avoid re-injury.

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Give the Gift of Stretch

My massage clients are much smarter than I, and that is why they need my help.

I am, of course, very smart myself, that is why my spouse likes to call me “hala kahiki po’o” (pineapple head) when I’ve done Einstein-ed myself into some predicament.

Case in point: When I was learning to stretch, I would try, try, and try my darndest to stretch only to feel more pain and less flexibility. Stretching, I thought, just doesn’t work for me. It might work for people who are naturally stretchy, but not for tight, inflexible me. So thought the pineapple head.

Later on when training as a massage therapist, I was introduced to the art and science of stretch – how to, how not to, and when. My assumptions about stretch not working had to go out the window.

Yes stretching does help. And the people like myself who are stretch-proof are the people who need it the most.

In true pineapple head tradition, I found the answer to why stretching is difficult for many people right under my nose. Before I had just skipped to the illustrations in the stretching book without learning the basics first. This time I actually read the book we studied on stretching and learned the steps I missed.

So now when my clients come in with furled hamstrings, I freely tell them about my foible, how I missed the basics, then found them. And I explain that for stretching to work, you must focus, breathe out with the stretch and stay in a pain-free zone, no matter how miniscule, until the muscles allow the stretch.

Then we practice.

As a massage therapist, I take pride in my skills to get people to relax and unwind knots. And I love to give the gift that can give clients relief every day, no matter where they are.

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Playground Moves

We massage therapists see a lot of people seeking relief. If it isn’t the upper back and neck, it is the lower back and legs. I’m a fan of giving people something they can do, on their own, to loosen up.

Most people go from doing a lot of movement in their salad days to increasingly stiffening marathons of driving, sitting or standing as they grow into their occupations. My loosen-up moves are an attempt to get some wiggle back into the muscles and joints we freeze up with age.

Like most massage therapists, I freely steal moves – giving credit of course – to multiple disciplines. My go-to sources range from Tai Chi Ch’uan, Yoga, Pilates and Hula to Islam. Give a girl credit for observation.

The ground rules are: everything in slow motion, no pain, exhale with effort and keep breathing normally. I practice with my clients so they get the rules in their head and can mirror me. This is also my secret way to get some stretches in for myself between massages.

For example, the hula roll-about allows people to balance abdominal, oblique and back muscles. Standing in neutral, use the tummy, then the side muscles and then back muscles to rotate the hips in a slow circle. The shoulders stay still and the breathing relaxed. If you can do the slow hula, you can swing a golf club.

I like to frame warming moves and stretches not as work, but an opportunity to revive our latent desire to play. Hula hip circles are a blast. When you get a bunch of serious golfers laughing while rotating their hips, you get a serious jolt of fun. And when those scores drop, the golf guys keep coming back….

The back flexion warm-up borrows from Yoga and Islam – start out on your knees on a soft surface like a bed or mat. Lean forward and extend your arms on the surface in front of you, slowly lowering your upper body into a stretch. Just like the Moslem prayer position, and a bit like the yoga child pose. To stretch the QLs, move one hand to the left, while aiming the hips back to the right. Then reverse hands and hips to stretch the other QL.

Heck, that’s a very good thing to do three times a day for your back. Funny how a move associated with a religious ritual can be so good for the body.

What about Tai Chi? My go-to is “Wave Hands Like Clouds.” This move helps people with balance and fluidity as well as peripheral vision and coordination. All you do is hold your palm in front of your face and look at it as you turn from center to one side. As you turn to reverse, you raise your other palm and look at it as you turn back to center and to the opposite side.

Simple yet complex, this move builds core and balance. Hmmmm. Who thought goofing around and playing could be so liberating and healthy?

Please send me some of your go-to play moves in the blog comments section. I’ll steal it, and give you credit, of course. Hula!

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