Category Archives: Self-Care

Nail It!

We massage therapists pride ourselves on our abilities in touch – and that’s why I am so surprised when clients give me an earful about fingernails!

This is a touchy issue for massage therapists – we figure we’re doing things like avoiding perfumes and warming our oils so we can facilitate relaxation in our clients. And then they complain about fingernails?

Yup.

Actual Client Complaint Case #1: This guy must have been doing construction on the side or something. His fingernails were cracked and broken and his hands were covered with calluses. It was like being sanded!

Case #2: My massage started with a scrape-y hangnail across my feet. For the next hour, every time the masseuse did a stroke, I was dreading a re-appearance of The Claw!

Case #3: I’m slipping under the sheets and I hear the therapist out in the hallway clipping her nails. She comes in and jams these sharp edges in every time she works a knot. I expected to see little red half-moons all over my skin!

Case #4: Is it possible to do a massage with acrylic nails? These things were long – and she was more concerned with breaking one than doing a good job. It was the lightest massage of my life. I can put oil on myself, thank you.

Well, I am sure it was not these folks intention to make their fingernails the central memory of their massages. Most massage therapists know to keep nails trimmed, clean and gently filed and beveled to a soft edge. It perhaps slipped their minds those days…

…So I am off to check my manicure!

Treat Your Own Kinks…

While we massage therapists are busy rubbing away knots, an industry has been developing of how-to guides to assist clients between office visits.

The publications start with “Treat Your Own…” and I have always been a fan of the guru self-treatment book, Robin McKenzie’s “Treat Your Own Neck.”

When I worked in a busy office, I finally put McKenzie’s book on a chain by my desk because it would somehow disappear, especially when we all got busy and crabby.

I am also a fan of Jim Johnson’s “Treat Your Own Spinal Stenosis” a great guide to the basics of home therapy.

Clients recently diagnosed with stenosis understandably have a massive freak-out, especially if they read on-line medical websites about paralysis and loss of continence. Johnson takes the fear out and breaks it down to simple, regular stretching and strengthening.

Before I recommend any of these books to a client, I buy them, read them, and do them. I might just learn something new, and as long as the book advice appears sound, I’ll recommend it to clients. These publications are written by very experienced doctors, physical therapists or massage therapists, but I’ve seen a couple of pubs, and especially videos, I would call off-beat.

A check of the web turned up troves of “Treat Your Own….’’ books for shoulders, knees, carpal, shoulders, backs, etc.

It gives people with these conditions a step-up to consistent therapy. Human nature being what it is, few of us will do “knees to chest” six times, six times a day in Johnson’s stenosis book.

But a massage therapist or client who does draw knees to chest at least once a day will feel better than those who never do it. My personal favorites are those who stretch only during nine supervised physical therapy visits. A go-to book comes in handy!

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Negative Pressure Massage

Massage therapists learn many ways to push on trigger points and stuck areas. I’ve often wanted to see if pulling on these spots would help open them up.

Yet, of course, we are taught that pulling is bad body mechanics. Massage therapists who pull rather than push don’t last long on the job. They develop carpal-like syndromes and spinal issues very quickly. Pulling also draws energy from the client toward the therapist, a big no-no.

In thinking about these issues, I have been looking at two techniques that allow a massage therapist to “pull” without fear of injury. One method is quite old. It is called “furling,” and allows gathering skin, often with adipose and fascia, between the fingers to release adhesions and increase blood flow.

Ida Rolf added some lift to furling, calling the technique skin rolling and introducing a way to loosen sections of abnormal tightness, adhesions and scarring.

The way I have seen these techniques used is to furl or roll away from the therapist, often over a large area of muscular dysfunction such as the lats, or over the shoulder or hip rotators.

But the true act of pull has eluded us therapists, until the introduction of massage cupping. Once sort of exotic, cupping classes have brought the method to more therapists. In this technique, the therapist uses soft silicone cups and massage oil. The cups are compressed slightly to create a light vacuum along lubricated skin.

The vacuum area moves with the therapist’s hands, following muscle, fascia or lymphatic pathways. I have found the cups to be intensely relieving to a large number of conditions such as sluggish lymph, scarring, scarring with adhesions, etc. The simple act of gently lifting the skin activates lymph movement.

Lots of “stuck” tissues found in fibromyalgia, repetitive over-use and traumatic injury seem to respond well.

As my long-distance-runner client said: “Boy, this treatment really sucks.”

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Massage and the Past Perfect

The Adventures of Ana Log, Massage Therapist

My alter ego in my massage therapist career has been “Ana Log.” She is a heroine of old school practices that simplify life instead of clouding it.

Contrary to trends out there in e-land, Ana Log has her own schedule book, written in pencil, to give her the flexibility a good therapist needs. She doesn’t want to do 10 hours of massage in one day, then two the next. Her antique paper day planner keeps all of her appointments, client names and phone numbers and daily/weekly/monthly trends in check. To look something up, she turns a page. She even takes lunch a few times a week.

Ana Log also keeps her muse, a clock with a second hand, in her therapy room. Ana can count stretches, trigger point treatments and coordinate breath-work without being too obvious about it. The clock makes just enough noise to be able to tune into the seconds count when turned away from it.

Ana’s brother, whose alter ego is “Mr. IT Excel,” loves to point out that all of these things can be programmed in to a good scheduling software and “make life easier.” All of Ana’s preferences can be handled by her automated device of choice, “making her life easier.”

“P-shaw” says Ana, with the vigor of a 19^th century ink-stained author. That would involve learning how those programs work and then applying it. And what happens if the cloud is clouded? Or the device is dropped? Or the charger is at home? And what about sunspots?

Mr. IT Excel, whose life involves countless hours of making things easier by adding things to programs, and then even more hours of making those changes actually work as promised, then extracting viruses that try to wreck those programs and then changing the “shaky” platforms those devices dislike (etc., etc., etc.) insists that devices do “make life easier.”

Says Ana Log: “Remember when Dad said if he wanted to talk to someone he didn’t need a computer to do it? He would just pick up a phone or go see the guy?”

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Massage Therapists Do the Math

Perhaps you have seen the ads in the massage therapist trade publications: What would happen if you could see four clients in an hour?

Folks in the massage biz are not often associated with great math skills. Four clients in a single hour? As a private practice therapist, heck, I figure could make a lot more money. The bottom line is a tough talk for most massage therapists. We work hard, yet few of us make the mythical “six figures.” It’s the same elusive goal of others in hard-working, hands-on, self-businesses such as hair stylists, estheticians and realtors.

Most of us make our bills OK, but few achieve the income that we feel we deserve based on our combination of effort, hours worked, and costs of training and licensing. The three times the money carrot sure made me look further into the pitch. Aha, this ad is for acupuncture school.

That’s enticing. Learn a very similar technique that requires a lot less sweat. More clients, more income, and yes, in most states you get to call yourself a doctor. Hmmmm. Then there is the tuition, the time spent and the apprentice time and licensing tests and costs. Could it work? How many acupuncturists have to take three months off for carpal?

That’s way too much math for me. I cut to the chase. I asked the acupuncturist I share space with. He has been in practice for more than 30 years.

My officemate looked at me in horror. After graduation, he had no idea how to book a client, let alone manage a practice. For years he worked as a contractor for other acupuncturists – at about half of the $50 session fee. It didn’t seem very fair then, of course now that he knows about office rent, insurance, ads, etc. he has a different perspective.

So he saw about 30 patients a week for others, and tried to see at least 20 people a week in his own practice. That’s 50 plus treatments a week, about double what I can do. “I hit the wall,” he said. “I burned myself out. It took a long time to be able to come back and feel good about doing treatments again.”

Well, fudgesticks.

We talked a bit about burnout and why. I have to admit I really didn’t see it at first. He explained that it takes a lot out of an acupuncturist to perform treatments that address specific complaints. “It’s the energy,” he said. “It’s all about the energy.”

You know, I totally get that math.

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Massaging Without a Net

One of my favorite massage therapists to trade with recently let me in on a secret.

She has been doing massage for more than 20 years without health or disability coverage.

That pressed some buttons with me. Since getting into massage, I have always had coverage, health through my own individual plan, then my spouse’s work policy, and disability through my professional massage association. I wouldn’t think of going “bare.”

My friend explained to me that she wasn’t aware that she could get coverage through her association, and had she been, she might sign up. She carries practice insurance because she is a contractor for a spa that requires it.

Why not look into her options?

Well, she said, she didn’t look into it because no one told her it was available. And even then, it is probably too expensive to pay out of pocket for insurance every month and still pay rent.

So what happens if she breaks her wrist while mountain biking?

Well, she can always move back with her parents for a while.

I know my friend very well, so I held back a bit and counted to 10.

She has a very nice mountain bike, I noted. And a nice, though used, car. Every other year, sometimes every year, she takes continuing education classes Hawaii or Costa Rica. How can she fit those in but not insurance?

My friend and colleague thought about that one for a while. Her time to count to 10.

She told me she works really hard and has to have some reward for her efforts. The physical and mental health benefits of those activities outweigh paying for insurance, something she may never use. Thinking about it stresses her out.

I asked my friend not to resent the questions I was asking. It was just my way of identifying priorities. I do that sometimes with clients who need massage but are too busy for massage. Or with clients who need to stretch but are too busy to stretch.

I ask if they manage to get their hair done, get the car washed, or take a shower every day. Do those “get in the way” of doing other things or are they necessary?

We all have priorities, even I, who would rather go get a massage than organize the taxes box and put it in storage that day. Or fold sheets. Or make out a will. Or a few thousand other things I designate optional, like a mountain bike trail ride.

We made a deal. She is going to look into her insurance options with her association or Obamacare. I’m going with her (wrists and elbows wrapped, or course) on a trail ride.

by Sue Peterson

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Save Your Hands

Hands are the best tools in a massage therapist’s toolbox and the most likely to be injured.

It happens to even the most careful therapists: a burn from a hot pan, a scratch that gets oily, a bit of tendonitis that turns into a raging case of nerve inflammation.

Plan A for most therapists is don’t do stuff that can hurt your hands. Hopefully we learned these things in school:

No unsupported thumb work, glide with the whole hand, wrist straight when using pressure. Push with the entire body from the feet, not the shoulders, neck or back. Avoid radial and ulnar deviation during effleurages.

Prudence in off-hours helps, too. No ATV riding, no mountain-biking, no rock-climbing, wear gloves while gardening, etc.

Plan B for many therapists is a few forced weeks off, with the resulting flat wallet. Few of us have disability benefits or the inclination to sit idle.

So there is a need for therapists to tap some resources from our wiser colleagues. Books are helpful, such as “Save Your Hands!” by Lauriann Greene et al.

Most conventions have one if not two classes in ergonomics for therapists, yoga for therapists, Tai Chi for therapists, etc.

I have enjoyed Val Guin’s classes and her DVD “Forearm Dance” that demonstrates the principles of working with a Tai Chi stance and avoiding use of the hands as much as possible.

One good self-audit for your work is to video yourself while performing basic massage moves. You will see when you lose form or go off track.

The resources are there for us to use before injury. Hopefully we can practice prevention and recovery as much as we preach it to clients….

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Taming the Tube

It had been a particularly busy Saturday, with lots of clients coming in for massage therapy at my office. After work, tired though I was, honey and I went over to the local promenade for dinner and walked along the cement boardwalk for quite a ways looking at the crowds and shops.

Usually we stop for a few moments to listen to the street musicians. This time I wanted to stop at the benches by the flamenco guitarist. We found a spot. Honey asked me what was wrong.

“My quad(ricep)s are numb,” I said. “It seems to go away when I sit down.”

After a few minutes we resumed walking. Again, the front of my legs above the knee went numb.

“What’s going on?” Sweetie asked.

“I don’t know, but I am going to find out,” I said.

We walked back to the car pretty slowly, my legs complaining the whole way back.

As massage therapists we are used to people having symptoms of things that might be a bit worse than just sore muscles. I know I have. It is easy to tell a client to go have it checked out. But do we forget how hard that can be?

My doctor wanted to know what was going on right away. He recommended a lumbar X-ray series and a lumbar MRI. The X-rays, no problem. I walked in to the offices of the local. The MRI?

Oh heavens. I’d had one years ago for my neck and shoulders, and I remembered being able to handle it as long as I kept my eyes shut. Starting in the hall outside the machine. I put the test off for a few days.

My doctor called to find out if I had the MRI yet. The X-rays showed suspected spinal stenosis. I needed to get in ASAP.

Spinal stenosis? I did what everyone else does. I looked it up on WebMD. By the way, never do that. By the time I went in for the MRI, I was convinced I would be disabled for life.

MRIs have not changed much, but I have. This time my arms hit the side of the tube, making me feel like I was being held. I couldn’t do the time in the machine. Two tries later I was sweating and resigned. I went to the local “open” MRI. Much better. Except for the train-wreck sounds. The tech had insisted I listen to some spa music. Thank heavens. It gave me something to focus on besides the noise of the MRI.

I was pretty tense when I went in for a consult with a neurosurgeon. The lady in the waiting room was about 30, in a wheelchair. She smiled at me. I thought about whether they have to measure you for a tongue stick. You know, the kind you use to paint watercolors because you are in a wheelchair for life.

In the exam room, I had high blood pressure for the first time in my life. “White coat syndrome?” the assistant asked.

Seeing a neurosurgeon. Egads. The assistant loaded the MRI onto a computer. I stared at the image. What was that? Lobster tail?

The discs and all were fine, but I do have spinal stenosis and a pinched nerve at the L4-L5 foramen. The doctor smiled at me and recommended a cortisone shot. “You should be fine,” he said. “That should take care of your symptoms. You need to strengthen your psoas and spinal erectors.”

Hmm. That last part sounded like what I find with many massage clients. I thought I could feel my blood pressure drop back to normal.

I took a breath, perhaps my first of the day. “I’m sorry. I have been pretty freaked out about this,” I said.

Time for a massage.

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Look! No Hands!

It being the crack of summer and my massage practice being filled to the seams, I decided to take 10 days off. Daring, I know, for anyone in private practice, but it was great.

For 10 days, no massages, no excess use of my hands and now, heading back to the office for another full slate, I am doing my back exercises in hopes I can keep it all working just right when I head back in.

Taking time for a vacation can be a big guilt trip for therapists. It can take years to build a decent practice, and sometimes it entails working through your weekends – a massage here and there on Sunday or Mondays off to keep the books full.

In my first five years of practice, I worked four days a week at a spa and spent my “off” days serving private clients. Trouble was, if the spa called me and I could fit it in, I would also work extra shifts. I was being a team player, of course, helping the manager avoid canceling massage appointments because of someone calling in sick on a weekend.

After 30 days with no days off, I took the daring step of saying no to some extra shifts. They managed to live without me, and I saw the error of my ways.

Then I took vacations fairly regularly, a week here and there, and used my time off to do massage related things such as attend conventions. I loved the classes, and I came back recharged.

As time passed, however, I felt less like immersing myself in c.e.u. classes on my time off. The true massage-less vacations began and I enjoy them.

A good friend in practice for more years than I explained the math to me: If you do too many massages in a week or a month, maybe that is fine. But let’s say you do too many massages in a quarter or half-year or a year?

My friend was seeing 35 clients a week. After a few months, he woke up one morning with no energy for anything. He dropped two of his side jobs and went with his own practice clients exclusively. It took him a year to recover.

Frying out is a danger to all massage therapists. Every person has their own personal limits, and before you reach them you may have no clue as to what those limits are.

As I teetered along the edge of burnout for a few years, I began to see no-work vacations as a blessing. Yes, leave a message that you are gone. It will be OK.

When clients come in, they notice you are fresh. And it is a great compliment when they admit two-timing you while you were off, and coming back because the massage elsewhere wasn’t that good.

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Scooter-nomics

Massage therapists take a big risk every time they do a house call – it is the time they are most likely to be injured on the job. Not by doing a massage but from lifting and carrying massage tables.

Anyone who has negotiated the front steps and the doorway only to find a long staircase inside knows the pain – Carrying a bulky table, even with the best body mechanics in the world, doesn’t negate the risk. Eventually table-wrangling will get you.

Therapists can mitigate their risks. For instance, I have always carried the lightest table on the market – it has aluminum legs that reduce weight by about 10 pounds over the standard wooden tables.

Many therapists learn early in their careers that the nice, expensive table their school recommended is also the heaviest and bulkiest to carry. One day a sharp-eyed classmate pointed out to our little study group that our teacher kept an aluminum-legged table in the car. Guess which type we bought.

Also, I use those funny-looking straps on the table cover. FYI, the long one goes over the opposite shoulder, the short one over the front pocket is for the arm closest to the table and – this is the one many people forget to use – the short handle on the upper inside of the table cover is used by the opposite arm. You may not be able to run through an airport with it, but at least the weight is distributed enough to reduce the risk of wrecking the quadratus lumborum.

Carrying the case with the long strap on the same side as the table – while ignoring the other straps leads to lumbar and flexor injuries.

Not much has changed in the technology of carrying cases in the past 10 years until recently. In the past, cases could be bought with optional “skates” little skateboard attachments that strapped on a table and allowed a therapist to scoot it along. These skates became nightmares when you got to stairs. They added to the weight and you had to take them off and leave them at the bottom of the stairs where someone in the house could trip over them.

Now I notice that manufacturers are adding built-in wheels like the ones that come on suitcases. These new covers make the transition from floor to stairs with very little added weight. I love the scooter cases.

Best of all, there are those rare clients who have a massage room in their home. This is massage therapist nirvana. They have their own tables; linens and a few even have an electric (yeaa!) table.

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