Find Touch: Massage Therapy Community

Just Lucky, I Guess

noreply@blogger.com (Sue Peterson) — Fri, 17 May 2013 14:00:07 PDT

Sometimes during a massage a client will ask me how I got into the business of doing massages. I don’t really like to take that question seriously. I have a serious answer, but I don’t like to share it. I’d rather say that it just happened that I noticed one day that I had a knack for massage, or if the client is getting a deep tissue massage I’ll say that the Inquisition wasn’t hiring so massage seemed like the next best thing.

Flippancy isn’t really an answer, though, and I would like to say what happened, except it might just be a bit too much like real life, a bit bumpy and all the seams showing.

How did I get into massage? It was the only thing that helped me.

I was working at a large metropolitan newspaper, no not that one, and I was having more and more frequent migraines, shoulder pain and neck problems. After years of cradling the phone in my neck, running around on deadlines and parachuting into tense situations, I did not feel very good.

Mostly I was stiff, but I had trouble with weakness in my hands, pain running from my neck down to my hands, and a definite sense that the longer I stayed swirling in the news vortex the less good I would feel.

I tried different types of therapy, mostly physical therapy, and I would feel a little better for a while and then back to daily pain. Lucky for me, the symptoms were never bad enough to suggest surgery. At the time I didn’t know it, but that was dodging a big-caliber bullet.

One time at physical therapy I was assigned to a therapist who was doing trigger point therapy. I had no idea what she was doing, but after a few minutes of pushing on my neck, I felt a lot better. It seemed like it was the only thing that worked very well. At me next appointment I asked her to do the treatment again. She told me that once treated, trigger points were gone and did not need to be done again.

As I did my exercises in the common room, exercises which I knew would make everything hurt again, I felt motivated to investigate what worked for me.

Being a journalist helped a lot. I really knew how to look things up in a library. I spent a few hours at the medical library and emerged with an idea for a new career. Not only did I understand a lot more about trigger points, I also understood why they were not being treated properly. Trigger point therapy requires warm-up massage strokes, experienced treatment followed by soothing massage and repetition over several sessions to break the pattern. It was all very hands-on and required focus and dedication. The kind of service massages therapists provided.

After a while, I gave up on p.t. and went for massages. My insurance and health savings account did not cover massages, but since they worked, I was happy to pay for them. Feeling good was important to me.

Which leads me back to my other flip answer. When asked how I got into massage, sometimes I’ll rub my neck and say: “Just lucky, I guess.”

Aw Shucks, Twern’t Nuthin’…

noreply@blogger.com (Sue Peterson) — Fri, 03 May 2013 11:23:05 PDT

Sometimes clients love their massage so much they bring me gifts. I love a nice card or a bottle of olive oil. A box of cupcakes? Oh please, don’t feed me!

I have to admit it is wonderful for the ego. One long day – a Saturday - my clients brought me lunch. How did they know? Are we psychically linked?

Gifts are wonderful expressions of thanks, but are there a place to draw the line? Do we massage therapists’ need one?

When I worked at a newspaper we had strict rules because we didn’t want any implied or perceived favoritism through gifts. We in the news section picked up the lunch check; we turned down the offered goodies. But it was not all black and white. One day the business editor decided it was OK to accept goodies if it could be consumed in an afternoon. The next day the business section got a case of wine. Meanwhile, the travel editors and the sports guys did all kinds of things for free.

But in the therapeutic realm, is there a reason to turn down gifts? I don’t know. A sandwich and a box of cupcakes seem fine. What about a Hawaiian vacation? A free refi? Sponsorship at the country club? If it is a substantial gift is it still OK?

One of my good friends, a personal trainer, got a nice-looking pair of diamond earrings from a client at the holidays. She was fine with it, actually pretty giddy. It seemed to me fine to accept, as long as the client was not doing it for romantic reasons, which he wasn’t.

I guess I will think that one through if it ever comes up for me.

How do therapists feel about gifts? Are they bonuses for a job well done? Will they cause a problem in the therapeutic relationship? Are they any different from other tips?

Oh my the question virus has bitten me today. I suspect gifts are OK as long as they don’t stand in for something else – an invitation to a personal relationship or some obligation outside the massage room. That makes the free helicopter sightseeing ride a no-no because a lonely male client offers it. But the free use of the vacation home for a weekend seems all right. Therapists, what do you think?

Scooter-nomics

noreply@blogger.com (Sue Peterson) — Fri, 26 Apr 2013 19:44:17 PDT

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.

Pick Your Part

noreply@blogger.com (Sue Peterson) — Fri, 19 Apr 2013 15:41:14 PDT

A full-body massage is the best in my book. You get your aches and pains rubbed away, your brain has the opportunity to tune into every part in the massage sequence, and the relaxation response is brought from background to foreground.

This massage therapist has always been a fan of the full massage, but sometimes people want all of their massage time spent on the parts that hurt – The back and neck, the hands and feet, the scalp.

I am accommodating, of course, but I always mention the good reasons for a full massage – and offer it as an option available whenever they request it.

Most often it turns out that the subject of the massage slowly learns to trust me, and as that trust builds, I find out why they want a focused massage only. Sometimes it is just practicality – they are having a half-hour session and want the most relief for their achy parts.

Part of that practicality is newness as well. For people new to massage, a half-hour seems less invasive and creepy than getting relaxed by a stranger.

I do hear the occasional horror story – someone has been relaxing during a massage, slowly drifting away when suddenly the therapist climbs up on the table and walks on them.

No, I don’t do that, I explain. If I ever had a reason to do that, I would ask and discuss it first, I say. It would be totally up to the person getting the massage. No, I wouldn’t take offense if told no.

That said, often the client will start getting full-body massages. The client is, of course, coming in to relax.

Get Online with It: Face the Facts

noreply@blogger.com (Sue Peterson) — Mon, 08 Apr 2013 09:28:23 PDT

I had a very good feeling about the practitioner I was learning about online – the picture, the story, the information fit what I was looking for in a massage therapist.

So I went to my first appointment – and I couldn’t believe my eyes – the person I expected to meet had aged 20 years since I looked at the photo online. I didn’t quite know what to do. I definitely didn’t say anything.

Is it naïve to expect the picture online to look like the person you meet? This wasn’t a dating site. I was looking for a good massage. Before this I didn’t think age was an issue in a massage therapist.

Just for yucks I went back to the website afterwards. The picture I saw did have a few clues that it was an old shot – the hairstyle was out of date ‘80s, the focus was fuzzy, the clothes style much gone by.

Still, I did not know what to do, if anything about the discrepancy. But I felt bad, that as a fellow massage therapist, I had said nothing during the first session.

I went back for another session, and this time I got my scriblets together and decided to bring it up.

“Gee, you do such a great massage. I was surprised that you use such an old picture on your site. Perhaps it is time to update.”

Nothing like jumping right into the lake.

A long, frigid and deafening silence followed my remark.

“Oh you noticed that, did you,” the therapist said.

That went so well. After I drove away I parked at a convenience store to have a little private cringe. Old portrait photos online apparently are in the same category as comb-overs. Never to be noticed or mentioned. All I can say is fellow therapists, don’t let this happen to you.

Through the Sheets

noreply@blogger.com (Sue Peterson) — Sat, 30 Mar 2013 19:43:18 PDT

Sometimes in the course of massage therapy practice, we will meet clients who want to have some delicate and sensitive areas relieved of trigger points and adhesions.

My most recent experience was with a client who had gone into a full-body clench during a car accident, braced with both feet on the brake pedal as the vehicle did a dervish and ended upside down.

It is almost a cliché to say that people who are unaware they are about to have an accident are better off. They don’t have time to react in terror, they don’t have the cascade of hormones and the emotions of fear.

The ones who see it coming, if they brace with arms and legs can end up with not only their accident injury, but a cascade of spastic muscles from jamming into the brake pedal, steering wheel and seat belt.

In addition to the usual back and neck pain, this client developed rectal and vaginal pain referred from injuries to the adductors, hamstrings and glutes.

As a therapist, the last thing I want to do is trigger more trauma to these areas with massage techniques.

First I like to talk to the clients about what areas are involved and could be helped by massage. Then I suggest making sure the client knows he/she is in control and are able to tell me to stop or lighten up at any time.

With these areas, because they are near areas of vulnerability I feel need some special security, especially for female clients. The clients are always draped with a sheet, and if they want they can also wear their outer clothes and underwear. The layers make the massage methods such as trigger point less invasive.

That said, I have always found that it is better to be cautious about client comfort when dealing with delicate areas.

Table Talk

noreply@blogger.com (Sue Peterson) — Fri, 22 Mar 2013 09:21:44 PDT

Have you caught yourself talking too much during a session? We massage therapists can all lead with our chins on this one, can we not?

One of my therapist friends believes every session should be hushed – no talk of any kind, music only, and if the client tries to talk only answer with “hmmms” and “ah-huhs.” She felt any speech beyond the basic whispered: “let me know if you want more or less pressure,” disturbed the energy of the session. The outside world is too noisy, so the massage session should be the one quiet spot in a person’s schedule.

I like to let the client set the tone, but I notice that some clients seem too chatty, some too tight-lipped. I will often go with my instinct to encourage conversation about the session if the client seems too silent. I try to dampen non-stop chatterers with some wasting Swedish strokes.

Having a bit of chat at the start of a client’s first-ever massage can also help ease the awkwardness if that is an issue. But I have had friends who have gotten massages on vacations that they are happiest when the massage is somewhat anonymous – a silent rub with hands only making the impression.

If the client tells me they didn’t like their last massage because the therapist was chatty, I definitely take note and keep it quiet.

At the risk of setting off some fiery debate, is there an acceptable level of chat during a massage?

New Tricks

noreply@blogger.com (Sue Peterson) — Sat, 16 Mar 2013 13:44:40 PDT

Sometimes I visit people at home for massages instead of at my therapy office, usually for convenience but sometimes because they are not able to travel. Folks who cannot travel to the office tend to be in recovery from injuries or in a fragile state.

Usually they are getting plenty of homecare from their relatives, visiting therapists, etc. but they are not getting the one thing that might help them feel better faster: nurturing touch.

In addition to the feel-good effects of massage, I like to give folks a few “new tricks” to help them navigate around the home. When you are there solely to make people feel better they tend to be listening and also more likely to remember a few easy steps.

Falling is the biggest danger and worry for people coping with infirmities of age or injury. That leads to Trick Number 1:

When a person has been sitting or lying in bed for a while, the psoas flexor has trouble adjusting to a standing position. Massage therapists know this is the only muscle in the body that works backwards, by controlled lengthening. When arising from a sitting or lying position, stand and give yourself 15-30 seconds for the psoas to adjust before starting to walk. Those few seconds will allow the psoas to kick in and steady those first few steps.

Trick Number 2: Sitting down requires effort, too. Sometimes people find themselves “falling” into a chair rather than sitting down and this can create more injury. Try placing the feet further to the sides than usual, the toes turned slightly out. Then squat to sit, a bit like sitting on a horse. This helps stabilize descent, avoiding the flop!

The “new tricks” added to a home visit has made my massage therapy practice more satisfying both for myself and my clients.

Massage as Rehab

noreply@blogger.com (Sue Peterson) — Mon, 11 Mar 2013 10:12:35 PDT

This massage therapist loves a challenge, and I frequently get them. Yet sometimes I wonder if I am doing the “right” thing. You know, the right thing as in “Do the Right Thing.”

Massage therapists are darned good at shaving a few points off a golf game. We excel at getting rid of the post-lunch headache. I’ve never met a trigger point I couldn’t conquer.

But what happened the other day got me good and flummoxed.

Here’s what happened: A new client with a long record of running lots of Ironman triathalons came in for relief from back pain from two crushed discs - so he can continue to compete in many more Ironmans.

I have to admit I asked a good many questions. And the bottom line came back to competition. He has to be able to go back to compete. If massage won’t help, he plans to take a year off to have back surgery (even the surgeon told him he didn’t need it) so he can go back to racing. It is that important.

What is the right thing? Frankly, the client is “the decider.” Yes, I am unqualified to decide what another person wants or desires or what is right for them. I can ask questions, I can offer ideas, but it is the client’s choice. It was time to pull up my big girl panties and see what I could do to help this client.

How would you deal with this?

Finding the Right Touch…

noreply@blogger.com (Sue Peterson) — Mon, 25 Feb 2013 11:17:19 PST

Recently a prospective client quizzed me on the phone about my massage therapy services. This is the type of call I used to be frustrated with – some people only ask about price and hang up.

I’ve never found a great way to turn the price-callers into appointments – I try to get a question in before they hang up after a pregnant pause that seems to indicate unhappiness with the bottom line – but they seem to be on a mission to find a price they like, not a service they need.

Money can be a source of consternation for massage therapists – we have to make a living but we also want to help people. Lots of my friends, including myself, have gone through periods of price accommodations that have left us very tired and unhappy with our income.

Price, it turns out, is a boundary, not a barrier.

People who ask questions about the massage, rather than the price, are the most likely to make an appointment. I try to answer as simply as I can and coax enough information to find out if I can be of help. That helps the prospective client understand and appreciate the value of the service.

The odd thing about price-shoppers, too, is the ones who have issues about price rarely have a true need for a lower rate. They are savvy shoppers.

Well, I’m a savvy shopper, too. But I know when I look at a shirt on the rack at a mega-discount store that I can see what I am buying, and I have to be OK with the presumed source of that wonderful discount – someone’s cheap, hard labor.

Massage, it turns out, can be like that too. I feel no “guilt” not booking a price-shopper because I know they will get what they pay for.

I find if I can communicate the value of my service – and there are ears to listen to that message, I can turn that call into an appointment.

Massage therapy is not a shirt.

Tools for Massage

noreply@blogger.com (Sue Peterson) — Mon, 18 Feb 2013 13:15:01 PST

As an “old hand” at massage, I am not too impressed with tools sometimes used in massage therapy. I have stayed away from knobbles and thumb covers and even hot stones in my practice, largely because they tend to create elbow and shoulder problems for therapists who are tempted to use too tight a grip.

One of my cohorts in a day spa had chronic extensor tendonitis from using hot stones, which eventually led to surgery on both forearms. It was a career-ending surgery. Rather than use the stones only in hot stone massages, she had begun using stones warmed in the towel cabby during every massage as an added treat.

I feel the pain, having had a 10-year bout with extensor tendonitis myself as a result of working an old computer keyboards at various newspapers. My flying fingers suddenly got stiff one day and the forearms had a toothache-like burn that never went away. It took years of therapy and ice to correct the problem.

Yet here I am feeling rather good about using a device in massages – conservatively – because I think it does some good for the client as well as the therapist.

I recently took a class with esteemed medical massage therapist Boris Prilutsky. He has been experimenting on using silicone cups as a negative pressure tool in massage.

What I like about this technique is that it is not the Chinese cupping. The Chinese method uses fire (scary to the clients) to create a vacuum and then leaves cups on an injured area or blocked meridian for several minutes. Skin is sucked into the cup, creating a bright red mark that can last for several days. Near as I can tell it treats by creating a secondary injury – inflammation and hyperemia – to draw healing factors to the region.

I have seen folks over the years with cupping marks and it has always struck me as not a therapy I would not enjoy doing or having done to me. But I have liked the effects of negative pressure when I have been treated with cups.

Prilutsky brought his massage skills to the table and presented a way of using soft cups made of silicone and very slight vacuum pressure over oiled skin. The technique lifts tissue over adhesed areas and seems to promote both lymphatic and blood movement.

And he advised us to use it slowly, sparingly, and with attention to not creating a tight grip and warring with the tissues.

Good advice, I think.

I’ve been trying the cups here and there on very “stuck” zones and I think it is a tool I will use. Carefully.

Class Struggles

noreply@blogger.com (Sue Peterson) — Fri, 15 Feb 2013 09:16:15 PST

At a recent continuing education class, our instructor went around and asked us to introduce ourselves and talk about how we are doing with our massage therapy practices.

Our first participant said she is doing a few house calls and working for a chiropractor two days a week. Her practice is slow. Renting a space is out because her house call clients will not come to an office once they are used to home service.

Our second participant has an office 30 miles away from her home, and is hampered by chronic health issues. Her practice is sporadic at best. She has to turn away business, mostly because many clients want simultaneous couples massages. She is thinking about recruiting another therapist.

Our third therapist networks with friends, family and networking groups constantly. She is looking for more clients all the time and finds many do not want to pay $75 an hour for a massage. She does a lot of showers, spa parties, etc. and is struggling.

Another therapist, a male, had gone broke renting a therapy room for $500 a month while struggling to get two to three clients in that time. He gave up the office and has been going to the local swap meet, doing chair massages. Most people do not want to pay his fee for a full massage, preferring the cheaper joints around town, many of which do not use credentialed therapists. He is also often rejected because of his gender.

I wasn’t feeling the confidence or success in this room. And people who bother to take c.e.u.s tend to be the go-getters. How can therapists develop practices when confronted with people who won’t pay or do not want the services offered?

I also felt like the oddball. My practice is going well, I have been too busy and I am working at my office and at homes. I can’t fit in all my clients.

A small sampling, but does it represent the struggles all massage therapists face?

Our instructor, an experienced and very smart therapist asked another question. “How many of you use social media?”

My hand went up. No others.

For folks trying to build a practice, remember much of social media is free. Cover the basics such as having proper credentials and licensing and you can list your availability on a number of sites. People looking for massage will find you.

Having your clients recommend your services to others often works very slowly. Their online review of your work makes that referral work for everyone who reads your information.

During the break, I was waiting for questions. No questions. Before class adjourned, I told my practice mate to stop going to swap meets. “Don’t chase people who do not want or value your services,” I said. Loudly enough for the rest of the class to hear, I hope.

Practice Punts

noreply@blogger.com (Sue Peterson) — Fri, 08 Feb 2013 09:13:04 PST

Massage therapists are not all alike when it comes to their understanding of how to build a practice. I have heard lots of explanations as to why bookings stay low, very few explanations of why they are full.

How to develop a practice is an art just as much as massage. It requires some close self-observation and sometimes an outside hand to help therapists along. Often when I catch an episode of some show like Salon Take-over or Bar Rescue or Hotel Impossible, I am reminded very quickly of what it takes to have a consistent practice.

If you catch one of these shows the clichés are numerous. The owner wants help to make their business pay, but they don’t want to hear anything critical of their skills. The help is interested in making money, but stymied and discouraged by unsolved problems. Often there is a sacred cow: a lazy staffer or manager whom the owner wants to avoid confronting - or an unworkable idea that the manager/owner won’t drop. The bottom line is that the bank wants its money, not excuses.

I enjoy these shows as a kind of self-therapy even though the environments are very different. Most massage therapists work alone. They are the owner, staff, manager and investor. The outlay to start a massage practice tends to be small, and there are very few therapists who make anywhere near “six-figures” when it comes to gross income.

In common, though, are some basic universal truths. The formula for success is not a secret requiring an expensive marketing class or a practice coach. It is, just like the roaches in the kitchen of a failing restaurant, right in front of a person with eyes to see.

Yes, darn it, arrive on time. Be clean. Do not wear jeans. Listen to the client. If it is a return client, go over your notes before they arrive. No notes? Where are they? Why be paid professionally if you don’t practice like a professional? Do you report your cash? And yes, a warm room and a clean heart.

Argh.

No shortcuts.

Steamrolling the QL

noreply@blogger.com (Sue Peterson) — Fri, 01 Feb 2013 08:55:33 PST

The tough part of massage therapy long-term back pain is chasing trigger points in the quadratus lumborem. This is one of those muscles that not only keep clients awake at night; it keeps the therapist up, too.

I have done prone QL massage, prone with approximation, prone with stretch.

I have massaged the QL sideline with the olecranon. Sideline with directed relaxation. Sideline with directed breathing. Sideline with heat and a tennis ball.

It feels sometimes, that I have done everything except roller-skate to get those pesky points.

Does some massage therapist, somewhere, have a quick and easy method for releasing the QL?

Not to pick on the QL. The multifidus and the longissimuss and iliocostalis contribute to the problems of repeating lumbar pain. I find that if those muscles are skipped, they can recruit the QL back to tension and TrP.

And the opposing muscle, the psoas, can be just as equally weak as the QL is knotted. Bilateral weakness of the psoas and I will definitely have to roll my sleeves up. It is going to be a bumpy ride.

It is some consolation to know that QL problems tend to fester, painless and subclinical for years. The massages are unwinding years of QL spasticity making up for a lack of core strength.

That is a little comforting, I guess. Time to sharpen my elbow.

Massage School Memories

noreply@blogger.com (Sue Peterson) — Fri, 25 Jan 2013 19:25:11 PST

Going to massage school, this massage therapist learned a lot about dealing with “tense” situations and people. The other day my local association asked for some massage schools memories and it made me laugh.

Warm Fuzzy? More like shrieking students levitating on the practice tables.

My first scream came during the first class. We were supposed to practice a simple effleurage of the leg. My practice partner, whom I had just met, swooped up my inside leg, aimed right for my crotch and at the last possible second – and I mean the last possible second – swooped laterally to finish the stroke.

“That was very uncomfortable,” I recall saying.

“I have to do the whole muscle,” she said.

That night our first student quit. He didn’t want to take off his necklace for a demo, and the teacher said he had to.
“I never take it off,” I recall him saying, as he backed out of the room, never to be seen again.

Some classes later, what was left of us were learning face massage. My practice partner this time was a very talented Asian man who had been doing acupressure for years and was kind of annoyed by the namby-pamby Swedish stuff we were learning.

Suddenly two hands formed a V and thanars pushed straight across and down across my cheeks, with what felt like the full weight of his upper body. The next day I had a business meeting in Los Angeles. I felt like I had a fiery helmet glued to the front of my sinuses. I did not think harmonious thoughts of world peace.

I will admit I performed some of the mayhem as well. Something large, rubbery and unmoving presented itself in the upper trapezius of my victim. I pushed on it with my ulnar, steamrolling down toward the spine of the scapula. Move, I thought. Move!

My practice partner’s shoulder came up off the table and pushed back right into my arm.

“What’s going on?” I asked.

“I have a right to protect myself,’” she said.

Somehow, come graduation about 18 months later, our hardy group was able to stand and walk to the stage to get our certificates. Our horrors had become vignettes.

“Remember that time I said your stomach was just like Play dough?” one of my classmates whispered to me.

“Yes,” I said. “Just remember, next time I do an effleurage on your leg, I might just ‘have to do the whole muscle.’

Blinded by the $10 Grand Solution

noreply@blogger.com (Sue Peterson) — Thu, 24 Jan 2013 00:52:36 PST

Folks with big troubles like this client – blinding headaches and vertigo – shop around for help. This massage therapist has been working with this client for a while. Her headaches get better with massage and heat packs but it never seems quite enough to make them go away.
This client has tried injections, acupuncture, a full course program at a pain management clinic and a few other things. Some treatments don’t work; some work a little and some have proven really toxic dead-ends.

The latest sojourn was to new clinic advertising a low-level electro-magnetic treatment. The client went to a presentation and tried a free treatment. The full course of therapy requires treatment every weekday for a month. Cost upfront $10,000. No insurance coverage.

The treatment seemed fine at first, the client said, then it seemed like her headache suddenly got worse. She told the technician administering the treatment. “She said no one had ever complained before,” the client said.

The treatment continued, although after she complained again, the technician turned the machine down some.

And then there was the $10,000.

“For $10,000, I want to know that the treatment will work. That’s a lot of money,” she said. Oh yes indeedy. There were too many red flags for her, from a lack of concern about her feedback to the big price tag etc.

Then the big question.
“What do you think?”

“I think you made the right decision. A new treatment. New clinic. Big price and what sounds like an inexperienced staff. Plus people who know what they are doing never blow off a complaint with a comment like no one has complained before.”

I have to admit, though, that my inner wheels were turning. I wondered about offering the client a free massage every day for a month. If the headaches get lost, why not pay me $10,000.

Somehow, somewhere, smarter folks than I decided that paying only if treatment works is somehow unethical. I’m still looking that one up, but I’m pretty sure it is on the books as a no-no. Fudge crumpets. The idea of this lady getting better - and my spouse and I going on a Hawaiian vacation - was pretty tempting.

After she left, I had the mental picture of myself running after her car offering the deal.
“Waaaaiiitttttt….” Puff-puff-puff.

Fee for service is a major tenant of our profession, however, and one that other health professions may have been wiser to stick to.

Fudge crumpets.

Loan Mod Trigger Points

noreply@blogger.com (Sue Peterson) — Mon, 07 Jan 2013 13:27:35 PST

I’m making it official: It is possible for massage therapists to map a stress pattern of trigger points related to home loan modifications.

Folks going through that process have had months of fruitless phone calls, waiting on holds, sleepless nights.

When they come in for massages, I have found they have the runaway stress trigger points of legend. I wonder if other massage therapists like myself have noticed this pattern, or any others.

#1 Super Mod Trigger Point: Serratus anterior superior. This is the pain Julius Caesar must have felt when Marc Anthony shivved him. This trigger point, tucked away under the arm and in the middle of the ribs, appears to stem from hours of breathless holding on fruitless phone calls. When it lights up, you can crumple. I have been using lots of warm slow Swedish strokes just to get near it. I like holding the palm of my hand over it until the warmth starts to melt what feels like a half-softball of tense muscle. I note clients start to breathe after a minute or two.

#2 Granite Upper Trap: Yow! Never have I felt such a bolt of tension as in these upper traps. I have actually started rolling shoulders Ida-Rolf-like just to try and get these to move. Rolling the shoulder forward, gently pulling it back, then teeter tottering the entire arm to establish some movement. Standard kneading almost seems to reinforce the rock-like tension. I’m taking suggestions.

#3 Rusted Pectoralis Minor: And sometimes the pec major, too. I usually associate this muscle only in clients with frozen shoulder or heart disease (or retired major league baseball pitchers) – now I find it just stuck all over folks in modification muddles. Slow and steady I go; this area is the most tender of all. Go with moist heat and a little contract-relax PNF.

Working with an emergency loan mod client this past week I had to ask myself: Has the American Dream come to this?

I like to do a little bit of breath-work with clients in this situation. Folks need some self-treatment TLC tips for the next time they call the bank.

Family Matters

noreply@blogger.com (Sue Peterson) — Mon, 07 Jan 2013 13:18:49 PST

Holidays bring out the best in people – and the visiting relatives. I have just moved the office and the massage therapy room still looked a little bit like a MASH unit. My phone message, for a change, said I was off for two days before and after the holiday – but the calls just kept coming.

Despite a long history of scoliosis, this client had never had massage for the condition. She had enjoyed the occasional vacation massage here and there.

Holiday massages tend to be emergencies, anyways. This time I had a referral from a client. This was a young lady with mild scoliosis, who between funny positions on the couch and airplane rides and long conversations with the parents had woke up to find that turning to the left was impossible. O Joy.

While going over her intake, I suggested she do regular massage to keep discomfort in check and possibly to help prevent the scoliosis from getting tighter. "How do I find a massage therapist who specializes in scoliosis?” she asked. I felt a bit surprised by the question. I explained that so many massage clients have slight to mild scoliosis I consider scoliosis therapy part of the mainstream of therapeutic massage.

Perhaps look for a more therapeutic massage person, I suggested. I felt on thin ground. All massages, in my mind, are therapeutic, even the ones where intent is solely to relax the person while on vacation. That is a pretty awesome skill.

This client comes from an area of the country with very minimal requirements for massage licensing. It is also known for having lots of people who are into a kind of flower-child view of life and massage.

“I don’t really mind that stuff as long as it is not the only thing in the massage,” she said. “I would also like to get some work done on my problem spots.”

Oh heck, I might as well dive into the pool. “I understand what you are saying,” I said. “I’ve had those massages where the person giving them is off on their own trip and not that into why you are there. It is no guarantee, but if you look for someone with boards or more education than the minimum, you have a chance of getting someone into therapy.”

Good advice, I thought, for a person looking for therapeutic massage. But as a therapist, I felt pretty uncomfortable. Rarely, I have had great massages from people with little education or experience. But the norm is I get a bad massage from someone who has no idea what they are doing.

It is very controversial in our field. Is a great relaxation massage at a resort not therapeutic? Is a highly trained therapist capable of being clueless? What about those folks who chant and tap in to the energy of the universe? Are their skills just different?

The answer, I think, is client by client. If clients want a massage therapist to focus on their scoliosis, they need to find someone they believe will help them. Oh heavens, I’ve said the famous “good fit” cliché.

Clichés, however, tend to be a bit truthful. “Finding a massage therapist is like finding a dentist,” I told her. “You can do all the research, look at qualifications, get referrals, but you won’t know if you like them until you are sitting in that chair.”

Moving Grumbles and Sage Advice

noreply@blogger.com (Sue Peterson) — Mon, 07 Jan 2013 13:02:07 PST

This massage therapist thinks she is organized. She thinks she has a good grip on where things are and handy when needed.

Ho, Ho, Ho, delusional again.

Moving is a drag under the best circumstances. This circumstance was a Wednesday. I had clients on the book. Ho, Ho, Ho. Mistake again.

When we got to the new office, two blocks away. The furniture was dusty, and all the boxes were labeled “Mom’s dolls.” I had to work not knowing where anything was.

At least it wasn’t too hard to get the table up and find bins with sheets in them. I had the oil sitting in the front seat of my car, on top of my schedule book.

The clock was in one of the bins marked “Mom’s Dolls,” so I used my cell phone to track the time. In the middle of a massage, it started vibrating with an incoming call.

I could not find any of the aromatherapies either, so I took my plain oil and ventured forward. The fellows had to unpack the rest of the truck without me while I was in session, so I came out of the therapy room to a nice huge pile of boxes and stuff.

Pier One Imports had room dividers on sale. Eureka. I hid half the pile behind the divider and got back to work. Then I noticed there were two sheets of toilet paper left in the bathroom. Off to the market.

My phone kept buzzing. Everyone wanted appointments. I wanted to lie down.

At the hardware store later that day, I found a nice shower curtain to cover the rest of the pile. The clock was still in the pile somewhere. My phone rang again. Every time it rang I looked at it in terror.

Well, sometimes you cannot do too much about how the schedule goes. Rooms aren’t ready, landlords do demolitions, clients want in. I wondered how my clients felt about the jumble.

“I couldn’t wait to move out of my office,” my first client told me. “The landlord was a total pill, the place was too expensive and it didn’t fit my business anymore.”

I am lucky enough to have people who understand.

“By the way,” she added. “Don’t let any of the guys pick the paint.”

Sage advice, literally. We went With Mountain Sage and celery, with a celadon for my therapy room. And I found my clock - a week later.

Chopsticks: Catching the Posterior Scalene in Action

noreply@blogger.com (Sue Peterson) — Wed, 12 Dec 2012 22:06:56 PST

That’s a lot of old-fashioned chronic inflammation with the posterior scalene stretched far from its anatomical role. Those poor guys are stretched over the precipice and desperately pulling back. Adhesed, unloved, overworked and so far under the trapezius that even a deep tissue massage barely touches it, the posterior scalenes are crying for help.

Massaging many people with neck pain, I have developed a deep respect for the nefarious actions of overstretched posterior scalenes.

Most neck pain folks looking for massage come in with a history of working on computers, lots of driving and an old accident – usually whiplash or cervical strain.

Getting my teddy bear paws in the posterior scalene zone is a tough goal to achieve. First, the trapezuis acts like a prison. Going through from the back of the neck just plain hurts.

With the client supine, I like to flex the neck to the side slightly and slip soft fingers along the posterior scalene. Then I gently shorten the scalene until it can sense that a different way of life is possible. With the scalene approximated for about 30 seconds, I add a light, slow cross-fiber crushing with soft fingers. (I said soft again didn’t I? Ever feel a hard touch on a scalene?)

Anyhow, if there is a hope of redemption here, the scalene should soften, going from concrete to something more like jerky.

I try to get clients to start chin retractions, pushing the chin back while keeping the head level. I find they can do it best on the table, against a wall or even better against the car seat headrest.

Three gentle (that pesky word again) chin retractions of above 5 seconds each, with a five-second relax in between. That should put the head closer to the anatomical position and take the posterior scalene off precipice duty.

It isn’t an easy path, but well worth it to get the neck feeling better. I then suggest the client stop playing piano with their nose.

Touch and the End of the World as We Know It

noreply@blogger.com (Sue Peterson) — Wed, 12 Dec 2012 22:10:49 PST

Stress comes in all forms, and I feel it on my massage table. Most likely it is a personal issue, a problem, a challenge in life or relationships. But a lot of people get their biggest stress from work, most specifically the feeling of being out of control, powerless, voiceless.

It is a tall order to unwind all that. I try. Massage therapy is not going to change the world, of course, just our reaction to it.

One of my regular fellows has been stressing for months about the national election. He has told me straight out on a number of times that if his candidate did not win, or more importantly if the other guy didn’t lose, that he would be out of business overnight.

Long hard years of work and dedication down the drain. Mentored employees adrift. An entire sophisticated market kaputz, with the eventuality the ruin of the quality medical care in the United States. Instead of working on the important stuff, he might just be trying to come up with the next Sham-Wow, while sitting in an old rv somewhere trying to stay one park ahead of his creditors.

Ok. That is pretty dreadful.

Well, the national election didn’t go too well for his guys. On top of that, Californians, apparently insane from overdoses of Twinkies and silicone, actually voted to raise their own taxes.

And you just don’t talk politics with clients. I can mumble a sympathetic “that’s terrible” here and there, but otherwise it is a game out of bounds for massage therapy.

I was thinking, though, that it has been my experience that if someone tries to frighten your vote, they are on thin ground. I don’t vote that way and never have. Well, that’s an opinion I kept to myself.

I felt somehow that the blow could be softened. I suggested that it would be best to let the political process play out. If the industry was on a precipice and ready to be demolished by new taxes and regulations, surely the major economic interests involved would make themselves heard. Those in government, ever mindful of the power of money, jobs and investments, will certainly listen. Give it time, I said.

“I s’pose,” he said.

Solace? Perhaps I can offer just a little candlelight at the end of a long hard-fought campaign….

Boundaries and the Fine Print

noreply@blogger.com (Larisa) — Fri, 16 Nov 2012 14:12:50 PST

Independent massage therapists (like myself) have a few extra duties to perform during the course of their careers. One of the least fun is leasing space.

My first office was a pretty simple deal. I rented two days in another therapist’s office and we had a handshake deal. I paid once a month and kept the place tidy while I was there. The biggest challenge was making sure we did not “borrow” each other’s supplies without at least a note and a replacement and or payment. Boundaries. Pretty easy stuff.

My next venture involved renting space in two local hotels. I had to come up with a contract that protected them, protected me and kept the business model viable. The first hotel signed the contract I wrote with the help of an attorney. No sweat. The second hotel wanted me to indemnify them from any negligence on their part with any of my clients and to pay court fees, etc. We went round and round for months. The hotel manager and I wanted the deal, the attorneys “got in the way.” We ended up changing the wording just enough to make it look like it was in compliance with corporate but did not really put me on the hook for anything beyond my massage room door. Whew.

A third facility was a negotiation nightmare. The corporate folks had in-house attorneys make up a “standard contract” for everyone that fit far better for a salon (and their toxic chemicals) than a massage center. The proposed contract ended up with about 20 paragraphs that were checked “does not apply.” Corporate would put the stuff back in. I ended up walking away from the deal rather than get hooked up with the “robo-lease.”

I learned to negotiate, a difficult skill for any businessperson, and I also waxed nostalgic for my handshake room-share lease. Keeping good boundaries, as in massage practice, is never easy.

By Sue Peterson

Travel Tips Redoux!

noreply@blogger.com (Sue Peterson) — Wed, 12 Dec 2012 22:12:28 PST

I love sharing travel tips with clients, as since they are classified top-secrets of the secret society Knights of the Massage Therapists, I want to share them with you.

Sciatica Roll: This can be a pillow, a rolled-up towel or jacket/coat. Use it for passive realignment in any airplane, car or train seat. Tuck it between your lateral quad and the armchair or seat console. It will reduce lateral rotation while sitting.

Instant Airplane Hot pack: I must credit one of my faithful clients for this one, and she learned it from an experienced flight attendant who deserves a medal. When you need a hot pack, fold over a dozen paper towels. Pour hot water from the tea dispenser over it. Put the folded towels in a barf bag, which is insulated from the inside. Warm moist heat for hours!

Headache Fixer Ice Pack: Even when traveling by yak, it is usually easy to find a cold soda can. Wrap in a paper towel or hanky or something, place at the back of the neck at the hairline. Try to keep it there for about two to five minutes. Also works on sore butts, smalls of the back, anywhere an icy pack is needed. Frozen bottled Guinness’s also work. Don’t ask about the story behind that. My memory is very fuzzy about that day.

Anywhere liniment: A tablespoon of Epsom salts in a couple of ounces of any clear cooking oil. Nuke for 10-second increments and stir until salts dissolve. I once made this in a 7-11. Can we be any more McGyver?

Fencing and Using Your Feet in Massage

noreply@blogger.com (Sue Peterson) — Thu, 01 Nov 2012 11:49:36 PDT

For a while now, a good bit of my practice has been working on other massage therapists. I don’t say it to brag, it just is. Folks in the biz bring their aches to me, and I do massage therapy.

And, if they are interested, I do a little coaching, too.

It is just part of the business, especially for newbie therapists, to end up working in rooms that are too small and on tables that don’t adjust and all kinds of body-mechanic horrors.

The worst body-mechanic situation I have ever seen is a 5’7” therapist working nights at a casino doing table-side massages. No room for feet, no room for body and the result is long hours spent leaning on clients. Well, it is a job that pays the bills.

With most of my non-therapist clients, they have the options of changing their work-stations and tweaking with their smarty-phone mechanics to eliminate the return of trigger points.

All in all, some massage therapists can’t change up their situations – but they can change how they use their bodies in massages.

With tiny rooms, I recommend putting a foot on the wall to provide the fulcrum for effleurages. If the power of the stroke comes from a foot pressing against the floor or wall it does not come from your serratus, rotator muscles, T3 or worst, C-6.

Feet need to be lined up with the direction of the stroke. If the foot is at 90-degrees, chances are your psoas is the fulcrum and your massage career will be short.

For therapists doing back massages from the head of the table, I recommend inching close to the side of the headrest right up against the table. As a short-armed little wobble-toy myself, I can’t even entertain the thought of standing a foot behind the face-rest. Lucky me. I work the back in quadrants following lymph flow.

The casino? That’s a toughie. I recommended that it be a starter job – good experience and get out of there as soon as the right opportunity comes along. Think of it as just another way of working with your feet.

Parking Stones

noreply@blogger.com (Sue Peterson) — Thu, 25 Oct 2012 15:03:07 PDT

Tailbone problems plague people – and massage therapists. The worst is the sideways curl, keeping hips, feet, lumbar vertebrae and cervical vertebrae all a-twist.

This massage therapist finds a lot of trouble in tailbones. They are really supposed to flex a bit when sitting, guide and balance while walking or running. Too may of my clients have stuckee tailbones, drifting off and away and leaving clients with everything from migraines to crabby personalities?

Oh my, I had a good one the other day. The rest of this client’s spine has been a challenge of momentous proportions. I have chased every symptom up and down the row and always been perplexed by this tailbone. It dips out and in. This tailbone defies gentle suggestion, firm guidance and repeated nudging.

It has been a full-court offense for this client. Weekly massages and regular adjustments, acupuncture and daily yoga. She has had coccyx cushions, ice packs, warm packs, you name it.

Funny thing happened the other day.

The client was doing the breathy hatha yoga, trying to open the diaphragm and get the energy moving. In the middle of the pose, her tailbone adjusted itself with a “POP!”

“It was really loud,” she said. “I didn’t move for a few minutes. I wasn’t sure what happened.”

Well the pop heard round the block didn’t hurt, and now she is walking a lot better. My turn to ask: Do you remember hurting the tailbone?

Well she did, and funny thing was, she didn’t remember it until she popped. She was in a parking lot, age 12, and had tripped backwards over a parking stone and landed squarely on her tailbone. She saw stars and couldn’t move. The area hurt for a really long time and she never had it looked at because she was embarrassed.

Somehow that tailbone wasn’t broken, but it had been in a bad way for a very long time. And probably it was annoying the heck out of her spine every time she sat down.

“I think that pop was a good sign,” I told her.