April 25, 2011

Is Technique Everything?

In the course of about 200 or so hours of continuing education courses, I have been harboring some questions. The big one is “How much technique can you learn in a CE class?”

With new online technology, massage therapists can take most if not all CE courses online, rather than attend traditional classes. Given Bill Gates’ prediction that most higher and supplemental education will be taken online, especially for college and graduate classes, I wonder if can we really do it all on the screen and keyboard?

Anatomy, physiology, and the more “book-based” aspects of massage therapy, certainly lend themselves to online classes and testing. But can it replace going to the smelly-uck lab and actually seeing a cadaver?

I don’t think I would quite get what Erick Dalton taught me about working on the quadratus lumborum, without that hands-on, stand-by wonderment of watching him work.

For me, the fearsome QL often presents as a thick mortared wall of bricks, which have weathered traumas by melting together with other lumbar muscles and formed their own biological magma. Trying to find individual fibers, the tendon, or even just some active circulation can leave me breathless.

Dalton, rather elegantly tall for a massage person, sat on the edge of a table. His subject was laying sideline, facing away. Dalton relaxed and rested his elbow in the divot between the iliac crest and the lower ribs. He slowly pumped into the QL, making it softer and much more muscle-like.

I don’t have his long humerus, but the technique gave me ideas for my more short and wide arms. But it wasn’t just technique: he also gave a word or two of wisdom. “Why hurt yourself working on a muscle? Do what is comfortable for your body.” That advice was worth the course alone.

So what about hands-on teacher-supervised attempts to copy a technique such a lymphatic therapy? Can you really learn the “scoop” from a course online?

I can tell you when I worked as a medical writer at a newspaper people were questioning the qualifications of doctors who took weekend classes in Las Vegas watching others do cosmetic surgery. In teaching hospitals, surgical techniques are learned by watching, assisting and then practicing surgeries under the watchful eyes of a very scary chief of surgery.

Not that we therapists are surgeons, but the value of hands-on, monitored practice cannot be denied. Of course surgeons who have already completed training often learn new techniques solely by watching demonstrations. It’s up to them to decide if they are able to do it after a class.

If you ever want to start a food fight in the doctors’ dining room, just ask out loud if new techniques in surgery need to be proctored. Most community hospitals end the debate by requiring proctoring and a number of procedure assists before surgeons can go solo. What those surgeons do outside the hospital, of course, is their own business.

Let me ruin that argument by adding another CE experience. While taking a class with the dean of cranio sacral therapy, Dr. John Upledger, I realized that no matter what I did I could not feel the cranio-sacral rhythm. My course-mate gleefully picked out the rhythm on the first try. Baffled and feeling dense, I took my six CE hours of cranio-sacral and decided it was not for me. Sometimes when practicing with another therapist, I give it a try. Blank. Duh.

My course-mate loves practicing cranio-sacral and uses it constantly in massages. Great class!

April 18, 2011

Practice, Practice, Practice...

Getting a massage while on vacation is a bit of a write-off, so I do it as often as I can. It goes under market research, as long as I ask a few questions, save the menu and brochures, and do some furtive ferreting.

All this sounds fabulous, of course, until you realize that at many places, the massage therapists are quite new to the biz and are learning as they go.

This last time I broke my 15-year rule of not telling the massage therapist that I, too, am a massage therapist. I have kept that undercover rule for many years now, so I surprised myself when I changed my mind, immediately and on the table, and “came out.”

I will now admit it to myself, and to you, why I dropped the cloak. I was tired of getting so-so massages. I’ve had Swedish massages that skip major muscle groups and push away from the heart. I’ve had deep tissue trigger point sans the circulatory strokes before and after that flush the deep tissue areas. I have been coated with cold oil drizzled straight from the bottle.

During my first massage I thought the therapist had good touch, but I was wondering how she could massage the entire back without ever moving from her stance behind the face cradle. It seemed like she would be pretty sore at the end of the day.

“A lot of times my arms are too short for any low back work, so I either do it from the side or I stand to the side of the face cradle, right up against the table.” I said.

“This is the way I was taught to do it,” she said.

I didn’t sense an open mind here, so I went quiet for a good bit.

As she worked on my back, she told me her mother and aunt had been massage therapists at a nearby resort. She had tried there, but they weren’t hiring right then. Since graduation she had worked at the hotel spa where I was getting my massage, even though she was unhappy about the pay (about a third), the rooms, bad tips and a few other things.

As soon as I said it, I knew I’d gone off a cliff again: “How about checking in with the spa where you want to work every few months and telling them you are still interested?”

“Well they have had some ownership changes and financial problems,” she said. “I’m not sure I want to get involved in that.”

“That’s everybody I know in the full-service spa business,” I said. “It is common to go through a couple of owners nowadays. Overheads are high and income is unstable.”

After a few minutes of silent massaging, she lifted my head and did some effleurages down my traps. “That was some nice neck work,” said.

“Oh, I’m so glad,” she dripped with sarcasm.

I was ready to throw my cloak back on. I wasn’t helping me or the therapist and it seemed like a lot of frustrating back-seat driving.

Therapist number two had the best touch and the worst body mechanics I have ever felt. Oddly, she went to the same school as therapist number one, but perhaps had totally different instructors as it is a chain-owned vocational school.

What seemed to be the big difference here was attitude. Therapist Number Two knew she had things to learn, and had been taking some private lessons with a more experienced therapist at her spa. She was up for learning her trade.

She did some attempts at deep tissue, but using her C-6, C-7 as her fulcrum. I told her she was working way too hard. When your stroke’s power comes from the neck, I explained, the pressure often feels very suddenly invasive and lightens significantly as the stroke completes, almost to a tickle.

She seemed really surprised and soon she was practicing the strokes with a semi-erect back, using the feet as fulcrum. “This is a lot easier,” she said.

I went for it. “Do you want to feel the difference as a client?


We switched spots for a few minutes at the end of the massage. “This feels a lot better!” she said.

“Remember. Practice as soon as you get home. Otherwise, you will be at work tomorrow, thinking “now what did she say about the soft fist?” If the brain doesn’t send the messages to the hands, it is gone.”

Well, it was an experiment with mixed results to let my undercover therapist cloak go. I know I felt better, so I’m putting my cloak on the hook for a while. Let’s just see what happens.

April 14, 2011

Life Energy: Frog and Toad Are Friends

When I first came to work with my friend Sarah, she asked me if I had any thoughts on further decorating her already established office. I looked around and said, "I think we need some life energy in here. Something green or living or growing." And so, we went off to the nursery for plants and to the pet store for fish.

I have to confess that if I could, I'd make the whole back of our office into a pond with turtles, fish, frogs, snails, etc., etc. But until that estactically happy day comes, I'm content with what we have. Having living things in our massage space adds something positive that I'm not always sure I can define, but that we and our clients definitely sense. Now, you might argue that plants and creatures can be expensive. True, but you can control that somewhat by making wise choices. For example, going to a nursery for plants, describing your space, and getting advice can improve the possibility that your choice of a plant will be able to live a long, cheap, and happy life with you. "Lucky bamboo," for example, is cheap, pretty, strong, and grows well in only water with little light.

Fish require even more restraint. I turn into a five-year-old if I'm not careful: "Ooooh, pretty colors, pretty colors, I want that one!!" Sarah and I learned a lot from our betas Fishybuns (who is still happily making bubble nests) and The Kraken (who we lost after a fight with finrot). If I had to make a fist recommendation for a massage therapy fish, I'd say choose a single, relatively low-care fish (goldfish, beta, etc.) and put him in a 2-3 gallon tank with a whisper filter and light. Add a heater, some water conditioner, and a few pieces of lucky bamboo and you're set. They don't eat much, so your intial outlay for food, equipment, and fish should be between $50-60.

My favorite life energy right now comes from our African dwarf frogs, Frog and Toad. Their somewhat unimaginative names are acutally from one of my favorite childhood books, Frog and Toad Are Friends. African dwarf frogs are often sold in tiny little bowls, but keep them like this, and they can go from social to cannabalistic, which is not very healing to observe )-: Keep them in the same environment as the fish, with a tiny terra cotta pot for them to hide in when they feel the need. They can be hysterically funny. They exhibit these blank, taciturn expressions, and sometimes float in such still, odd positions that they seem dead until they spring to life, kicking and playing and splaying themselves against the glass.

Having living things in our office has seemed to solidfy our sense of belonging to the massage space, not just to the clients. We talk to the plants and the creatures, move them around, feed them. We stare at them dreamily when we pause from paperwork, and our clients' faces soften when they bend close to observe a new shoot or an acrobatic turn. Life energy is a good thing. If it feels right to you, choose a plant or a creature, start small, and see if it helps your massage grow more green too.

April 10, 2011

Erector Forensics

When I feel thick cables between the shoulder blades of an uptight client, I am reminded of Bodyworlds, the forensic anatomy exhibition in which real folks were presented, in living color, plasticized and preserved for inspection.

When the show was in Los Angeles, I figured it would be a bit gruesome, but I was eager to go. I am an admitted anatomy hag, and the nice thing about plasticized cadavers is that they do not smell.

Bodyworlds opened the eyes in my fingertips, so to speak. For the first time I saw what I was touching in my overtaxed, under-rested clients,

With two therapist friends as eager to as I, we spent about four hours going over the arthritic hip implants, craggy knees, studying the kyphotic chess-player. Far too fascinated to be creeped out, I found one thing lacking: How many whiplashes had these people had? Any gymnasts? What about their pertinent body histories?

Deductions as to their history were confined to who would possibly donate their body for exhibition. The exhibits were probably people of Asian race, as the laboratory and study center was in China. The donors could easily be medical or university instructors or perhaps those who spent more than a few hours in front of books and computers, at least from what I could see of their erectors.

What I saw, interestingly, were peaks and ridges of mountainous fascia poking upright. The upper traps shortened, twisted and plumped in effort, the lower traps expansive and worn flat. In the bodies where the traps had been removed, the erectors popped up like mountain peaks – not at the exact attachments as I expected, but a bit over in the lamina groove. Just like many of my computer-bound clients, I noted. Ah, I thought, these were the look of those pesky bundles of stuck bits.

Fun as the grown-ups were, I skipped the fetus-baby stuff as too gross. By the time I arrived at the last room the man on the plasticized horse holding his brain got me to chuckle. I signed up to be a potential donor. Before we left I wrote a long note in the comment book about how I wanted a body history to go with the exhibits. Nothing to upset the family, of course, just to know how much of these cadaver’s road mileage was inflicted by work, sports or calamities.

Bodyworlds will come back on tour now and then, and they have a book and DVD. I look forward to some more new plasticized bodies, and the DVD and book are especially helpful. The LA show was so popular the museum stayed open 24 hours on its last night. Lots of people, including me, had gone back for second and third visits.

In all, nothing beats seeing a real longissimus bearing down on C-7 looking like a Swedish fjord on fire. Perhaps the next round will include a little body biography – something like “Our donor was a computer-user, avid golfer and carried a heavy briefcase….”

April 4, 2011

Project Management and the Massage Therapist

A beautiful spring morning, toasty 80s in Southern California, and my client sat in one of her garden patio chairs and sipped coffee. Gone were the weeks of clouds and rain, and the flowers and plants in the garden had sucked it all up. One sunny day and it seemed everything was going to grow like crazy.

Well, the chairs were grimy. Weeds were sprouting up. Twigs and leaves were scattered like pick-up-sticks.

About two hours later, the weeds were gone and scrub-brush in hand, the patio chairs sparkled. Her coffee was cold, and my client she called me for a massage. Too much bending, scrubbing and pulling had her looking for me.

When she called I was home, tending to my little patio, pulling up stray ice plants.

No we hadn’t had any water, just coffee. No warm-up, just the urge to tidy. I had stooped for a few weeds and swept the patio. She had done the entire white tornado.

"I can’t just sit there ands sip coffee,” she said. “I’ve never been that way. I see something that needs doing and I get to it. I’m such a Type A. I need to be more of a B-minus.”

It’s tough being the organized organizer, the COO of OCD, the one who flits about picking up empty cups and dirty napkins while others chat. The calm spring garden is a joy, and like many people my client and I were running down a list of things that must be done or else.

“I was doing the same thing when you called,” I said, “But I have learned the hard way. I had two cubic feet of garden soil to open and spread, I should move the fountain, the garden stones and rake, and I should feed all the plants that survived the winter. Lots of shoulda-shouldas, and I decided to whack some stray plants and sweep instead. Just a small chunk of what I think it needed and I called it a day.”

It is hard to pick a smaller patch, a shorter list, or to ignore most of what “needs” doing, but it seems if no one does it, the earth continues to wobble on its journey through space. Picking a chunk of a project, instead of going for it all, is a way to manage the “A” inside you without going a bit bonkers. I like to think of it as giving it the old “68.7 percent” – a barely passing grade with no gold key at the end.

“I don’t know if I can do that,” she said. “But I think it is well worth a try.”

And your massage therapist - and your illicostalli, upper traps, scalenes, solei and longissimi will thank you for it.