Massage to Measures

Massage therapists like to think we help people deal with stress, injuries and fatigue. But how do we know we help?

Massage is, after all one-on-one. We are stars or idiots one hour at a time, and we often don’t take much credit for our clients’ successes or failures. Is a massage therapist a facilitator or a game-changer? Do we really know?

I’m reminded of the times I thought I had no clue what I was doing, only to have the client hop off the table and give me a compliment and a big tip.

But I also remember that once on vacation – after one particularly hideous massage from someone who thought they were fantastic – that I said thank you and left a tip anyway. I made a mental note of the therapist’s name in case I ever happened to go to this resort again so I could get someone else.measure

How we measure ourselves and our effectiveness in massage therapy is something of an emerging issue. In a practice that is more art than science, can we really measure ourselves?

People have often received treatments for medical conditions that have no proof or promise – but the treatments are tried in the belief that they may relieve suffering or repair the underlying condition. That is the art of medicine.

Can we also preserve the art of massage while some therapists attempt to move into the medical – and the reimbursed – field?

A recent post by long-time and very respected massage instructor Noel Norwick of Los Angeles asked the question on Facebook.

His question on medicalmassage@groups.facebook.com group referred to a study. It found that soothing talk – reassurance – worked just as well as physical therapy treatment after whiplash. Here’s the link: http://www.bodyinmind.org/treating-whiplash

It appears to say that treatment versus soothing talk have the same results. My comment was that it might say much about the quality or delivery of treatment instead of its effectiveness in the right hands.

Would that be the case if reassuring talk were compared to massage? I think not. Hope not. But let us ask this question another way – if we could offer nothing hands-on, would we offer reassuring speech? Isn’t that sometimes the de facto treatment for stress disorders – even though many of us would propose that massage would be much better?

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Delivering the Right Massage for the Clients’ True Goals

One of my pet peeves, as someone who receives massage regularly, is getting what I call “the wrong massage.” That’s when you’re there on the table, being worked on, but you don’t get the work you need. You know what I mean, like when you want full body, but instead get work on just your back and legs. Or, your shoulders really hurt, but you end up with a lot of time spent on your feet, head, and hands. It can be really unsatisfying. It’s a key responsibility of therapists to tune in to communication from their clients so that the right places get the attention that they need.

So what happens to cause a massage therapist to ‘get it wrong?’  A lot of therapists during massage intake ask clients if there are areas where they want focus and then they create a massage plan that treats just those areas. That can be a mistake, especially if the client’s general stress level is contributing to their discomfort or if they are not aware of tension in other areas that is contributing to the pain in the primary area.

It’s necessary for massage therapists to connect with the client’s true goals by asking their clients plainly and straightforwardly if they would like to work exclusively on their problem areas, or if they would prefer a full body relaxing massage with a little extra focus in their area of concern. The results can be surprising. Just because a client speaks at length about a particular condition doesn’t mean that’s the only place where they want work.  Taking the time to ask, to really listen, and to act on the answer ensures a more effective massage for the client and a more satisfied client for the therapist.

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Simple Question to Add to Your Massage Session

dreamclinic massage seattleCommunication is key between massage therapists and their client, both before the session and while the client is on the table. Despite great technique delivered with care, it’s not unheard of for a client to feel like the therapist almost addressed their primary complaint, but they would have liked a little more work on the problem area. Or the client would have liked the therapist to spend some time on the area or to have focused a little higher or lower along the muscles.

Imagine a client who comes in with a chronic condition, or an injury. The therapist determines where the issue is and starts their massage plan. They work diligently on that issue, and after 20 minutes they feel confident that they’ve done a good job, they’re are ready to move on to the rest of the body so that the client can get an overall effective massage. Question: did they do their best for the client and did they address their primary complaint? Most likely they did, but sometimes not.

When the therapist thinks they are ready to move on from the primary area of complaint, a simple question increases the likelihood of getting results and having a truly satisfied client who is going to not only come back to see that therapist but also refer others to them, and that question is: “Do you feel that we’ve gotten good results? Do you need me to spend any more time here?”

A satisfied client will simply say “yes, you can move on,” but in those occasional situations where something is off, this gives the client the opportunity to speak up for their needs, and the therapist gets instant kudos for caring enough to ask and to check.

End result: happier client, better massage, and a busier clientele.

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Plans, Practice and Control

It is a new world for the massage therapist, just as it is for many other personal services industries.

App companies are going whole hog into personal service. Rides, house-cleaning, errands, baby-sitters, pet-sitters, and yes, massage therapists. Where is it heading? For a big thumping collision as we struggle to define ourselves, our employers and our clients….

Oh yes, big questions. It’s going to be a bumpy ride. Hang on.

Are app companies employers? Are service providers employees or clients? Are clients users or beneficiaries? Who cares? Massage therapists care because the answers to those questions will determine how much money we make, how much we pay in taxes and how free we are to make decisions in our professional lives.control

Here’s how it shakes out: Google is an advertising service that provides therapists with a way for people seeking their services to find a provider – and leaves the rest of the transaction up to the therapists and clients.

The app services are vetting providers, setting prices, presentation, times and even setting tips. The amount of control they have means they appear to be employers, not middlemen. If a therapist wants to provide more or charge more, they are not able to.

A therapist is not an independent provider of service when someone else sets the price and pay. If a therapist is not independent, then basic labor laws about employees apply.

The bottom line for therapists is that it is all about control. Control of prices, providers and policies such as tipping makes apps employers. That means the app gets to pay a lot more money in taxes for Social Security, payroll, disability, etc. that would otherwise be paid by the therapists.

There’s been some talk that the new services may yield a new classification of worker – the dependent contractor. That’s where the therapist would be a service provider who would pay less in taxes in exchange for less control. But will the apps pay the taxes? And pay for the benefits? Stay tuned.

In the interim, the people who may be the biggest targets are small businesses who have called their employees independent contractors to avoid higher costs. If the apps can’t have independent contractors, then spas and clinics can’t either. That will make major changes in the way multiple-therapist businesses operate.

Meanwhile, a massage therapist’s best bet remains Google or the other online search providers. People looking for a massage can find you in an efficient way. If they do not want your services, or don’t want to pay your price, they will find someone else who better matches their needs.

 

 

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Heavy Hearts, Light Touch

A massage therapist’s toolbox is crowd with all kinds of fancy techniques to address troubles in the body.

Yet one of the most effective techniques one can use to release tension is to say something. Just a little something to put the client at ease.

A small joke is letting clients know your empathy for their stress. Yes, the inmates are running the asylum. The Red Queen has lost her head. Welcome to the “e.r. for p.r.” Some people drive like they think –not. It is part of life to acknowledge the crazy and nonsensical.

Life teaches us that the way to release tension is to laugh, and sometimes it is the best solution to release thoracic tension during a massage.Transversus_thoracis

For people who have recently been through the wringer, and back again, it is good to remind ourselves that we can laugh at the strange things in life.

It gets clients ready to relax. It says you understand, that you have been there, and no matter what else transpires in the next hour, you have met a friend who gets it.

Not a bad way to start? It will not work for everyone, but it often is a great opening to healing energy. If the body can laugh, it can raise and lower the rib cage, it can expand and contract the diaphragm. It can liberate itself from the heavy weights of life.

 

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Flames Climb Higher Than Hands

Those who do therapeutic massage are well aware of the statistics in the field. Burnout is a huge problem amongst therapists.

What I have often heard from people is that massage is too hard to do enough of it to be secure financially and take care of one’s personal needs as well. I’ve also heard from folks who don’t have much commitment to the field that they are surprised when it turns out massage is work, and they stay in the hobby-job cloud.

I have also heard the burnout complaint from therapists, who don’t charge enough, spend too much on frills or never take a vacation. I’ve never heard it from my core group of friends who have been practicing for nearly 20 years.

So I’m a bit surprised to say that this week I felt burnt out. Yes, dark and twisted like a used paper match. Done inside and out. Phhhht! burnout

There, I said it. I feel fried!

But I do take vacations – and the occasional mental health day – and I also vary the types of massages I do, and now I even limit the number of massages I do a week. I also coach other therapists and test them on techniques… what on earth is going on?

I think this tiredness is more than just needing a vacation. Next Steps: the self-audit, then the friend audit.

Here’s my list: Eating right? Exercising? Sleeping well? Time for me? Time for non-massage activities? Getting massage once a week? Going for acupuncture or chiro? Am I crabby?

OK, I flunked a bunch of those questions. I had a flood in my house early this year and my days off have been spent dealing with contractors, tossing, organizing and cleaning…my whole holistic schedule went phhhht. I realized the last time I did tai chi was at New Year’s break. So I have been rolling along thinking I was handling all this stuff, and it has caught up with me. One cannot be a balanced therapist without a balanced life.

My friend’s audit was a bit worse. I have been positively snappy when dealing with all the extra chores. Apparently I get up in the morning before work and like one possessed I crank right into my to-do list. Before work.

Well, the list is going bye-bye for now. I’ve booked a massage, a session with my counselor and my tai chi sensei. I’ve been acting like I lived on the kind of schedule my clients come in to undo. Lesson learned!

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The Downs of Stress Breath

bellowsMy client had tremendous pain – 12 on a scale of 10 – in the area between the shoulder blades. She begged for deep pressure massage, and that did lessen it temporarily. But after 2 days the pain remained a 12.

How many times has a client begged for a tough massage in hopes of relieving pain? And how many times has that solution been temporary at best?

Upon this client’s return visit we had a talk. I explained that no amount of pressure would budge the pain pattern because it was originating from the front – the area where the rib cage meets the sternum — the costochondrals.

A leak had been discovered in her condo and a fairly heated fight had ensued with the homeowner’s association over who was responsible. It was several weeks before repairs were finally done. My client had been breathing shallow, from fear of mold spores, and fear of a huge repair bill.

After many massages, therapists come to understand how fundamental relaxed breathing is to health. Clients who are stressed breathe less deeply; they develop problems over time from shallow patterns of breath.

My acupuncturist friends tell me that in terms of energy, the diaphragm is the bellows of the body. If it is tight or dysfunctional, the energy stagnates. Acupuncture looks to relieve the traffic jam and restore the diaphragm’s natural movement.

If this seems technical or not applicable to most massages, think of the upper posterior serratus right at the apex of the shoulder and neck…how many times do people seek massage for distress in that area? I can’t imagine the last time a new client didn’t point to that spot.

Stress breath is what we treat whether we are doing basic Swedish or more complex massage techniques. It’s all in the core of the body’s energy.

My client, by the way, was much relieved by massage of the sternum, costochondrals and rib cage. (This is done with proper draping and avoiding the breast tissue.) Perhaps next time she might even let me massage the diaphragm.

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The Snooze Button

It’s a great compliment to a massage therapist when the person receiving falls asleep during a session.

Those little zzz’s say trust, relief, serenity and healing. And for this massage therapist, it most often happens during the Swedish portion of the treatment, when long flowing strokes push dream-like consciousness over the line into sleep.

So what on earth is going on when the therapist finds a knot to end all knots and the client takes a snooze?

Let me explain. In the midst of a treatment combining myofascial release and TrP release for adhesions and tension in the temporalis and masseter group. My client went from “that’s it”…” to total zzzz’s. During trigger point release!

I hit the Travell & Simons (not Simons & Travell) trigger point chart – I had touched, very lightly, above anterior TrP1 of the temporalis. Whatever happened next was totally weird.Pterion

The client went into sleep, snoring lightly and diaphragm breathing for perhaps the first time since I’ve been treating her. Y-reka! A minute later it was gone.

“I don’t know where I went,” she said. “No idea. But it was nice.”

“I’m not sure either,” I said. “But you relaxed beautifully. I think your whole body just did a reboot.”

I’ve been looking in a lot of my massage books, but only finding general points to induce sleep. I flipped to Wikipedia for help. In this region the skull bones are thinnest. It is the junction of the coronal, sphenoid-parietal and squamous sutures. This area is certainly a big player in the TMJ patterns of jaw clenching and imbalanced sutures. Craniosacral anyone? Polarity?

Baffling. This little spot is called the Pterion. Uhuh. Try saying that with a mouthful of granola.

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Exploring the Body’s Bermuda Triangles

Massage as therapy can be pretty basic. Therapists compress and glide along major muscle groups in the direction of the heart. The effort requires skill and practice. It reduces tension and boosts circulation of blood, taking some load off the heart.

That kind of therapy is refreshing and soothing. But what about the spots that make the tension return and impede circulation?

I have come to think of these areas as the Bermuda Triangles of the body. Stuff flies in, and it never flies out. Inside the stress of life is found: Too many hours at the computer, the unpleasant anger of a loved one, the contracted fear of an old injury.bermuda triangle

For myself, and I suspect most therapists, the challenge in massage is to identify and release these zones so the person has a massage outcome that lasts and gradually heals the area. Easier said than done.

My most frequent triangle is at the posterior shoulder, roughly the area of the infraspinatus. This area tends to get skipped in general massage that focuses on major muscle such as trapezius.

In this area I often find near stone like contractions, loads of trigger points and for whatever reason, unresolved grief. Slow gentle work from Swedish to rolling to restore circulation leads to light and gradual TRP work and lymphatic drainage. When this area feels “normal” again – that is its temperature and texture feel like the rest of the body, headaches, chronic shoulder pains and even thoracic outlet symptoms fade.

My next Bermuda Triangle is the upper posterior shoulder/neck. Here lay a number of stuck structures: posterior scalenes, the oft-forgotten serrate posterior superior among them. What lies beneath? Treatment here often opens the diaphragm, perhaps by inhibiting reverse breathing.

For the stuck pelvis, along with referral hip and lumbar pain, I find the next triangle at the posterior-medial thigh. Here hamstrings often stick to neighboring adductors, pulling the legs inward and affecting balance. This area seems to be directly connected to unexplained pelvic pain in women. Hmmm.

My next fun zone is the medial calf. Here lies the only area of the soleus and posterior tibialis accessible to massaging hands. Here lies also a lot of leg stiffness, ankle dysfunction and lack of stability. Even simple effluerage help in this no-man’s land of the leg. With major lymphatic channels deep to the soleus, virtually on the posterior tibia, this is an action zone for swollen feet.

Some themes arise from the patterns. The lower body triangles are very protected and core supporting. The uppers are surprisingly accessible but daunting. It is very difficult to apply techniques there because of a combination of pain and sensitivity there. Some first massages are simply spent making the brain aware of these spots.

As ever I am curious how therapists deal with these areas and how they identify ”Bermuda Triangles” in their clients….

 

 

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LMP Etiquette – Is offering food to clients a good idea?

Food in the massage room is a delicate subject. No doubt it is needed. Massage therapists burn off some energy providing treatments to clients. Those who hop off the table rejuvenated often look for a little something in addition to cool water.

But what is appropriate? Some of us squint in horror of sugar in the massage room. It doesn’t seem karmic to have cookies or turkey jerky either.

I have experimented on occasion with foods in my office water jug: Sliced cucumbers, strawberries, or lemons floating in ice. Until a client told me that cucumbers make his skin itch. Another could not look at a strawberry without breaking out. Iced water? Oh, that triggers my IBS, another said. Sigh.

Which is when I went back to plain purified water, available tepid or chilled, and added a little candy dish of individually wrapped wintergreen candies. Not being chocolate, I was safe around them. Most clients seem to like them enough that I buy a big bag once a month.

This seemed a good match, as the wintergreen flavor seems to complement the refreshment of massage. Wintergreen is used in arthritis and muscle balms such as Ben Gay and has a storied history as a treatment for soreness.

Which is not to say it is a good aromatherapy or oil treatment. True oil of wintergreen is made mostly of concentrated methyl salicylate (aspirin) and can cause overdose just as aspirin creams can. I have always found it to be a good policy not to kill massage clients.

My other forays into massage food have included keeping a bowl of washed apples in the waiting room. I found the staff and I demolished them more often than the clients, which in a way is good.

Fresh fruit, however, does have drawbacks. Fruit flies may appear in the office, along with problems maintaining freshness and supply.

Actually, now I have another sweet problem. A client brought in some peanut butter-filled caramels. She left them in the candy dish where I could find them. Don’t worry, I quickly made sure my clients are safe from these..

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