December 28, 2011

Putting Our Feet Down

People who give massages need to get massages – and lots of therapists, like myself, get a massage once a week or so. It helps a massage therapist “keep in touch.”

I got in touch with an old massage therapist friend over the holidays and was dismayed to find out she had taken a backwards flop over a storage box several months ago and had been working in pain.

She had tried a few massages and had some acupuncture and some energy work, but the hip had kept throbbing. It was slowly getting worse, and it was getting very hard to do massages. “I had to go to work,” she said. “So I just kept working through the pain, hoping it would clear up.”

After pointing out she had violated all the advice we give our clients (if I am your friend you can count on me to do so) we arranged for a massage over the Christmas holiday.

The pain had gotten a little better and a lot worse, waffling back and forth for several months, making it hard to walk, to drive, and especially to do massage. Sometimes it hurt to sit. It especially hurt to play racquetball. The pain was deep inside the hip joint, radiating around the capsule and now heading down the leg to the knee.

To make all of this more fun, my friend is hyper-mobile. She easily Gumbys through all kinds of twists and turns and impossible yoga stances. I like a challenge.

The pain and discomfort was evident when she came in for a massage. She stood, sort of, the affected side flamingo-ing up her good leg. A very frightening injury, to say the least. I asked her to stand up for me, feet even and weight 50-50 on each leg, while I looked at her feet.

“Do you want the good news or the bad news?” I asked. “The good news is I think I see what has gone wrong and can massage it. The bad news is you are just as human as the rest of us.”

Most of the time I look for hip trouble in the low back, but this was different. Here I was dealing with deep-seated pain, hypermobility, a backwards fall, and a few months of pain-enforcing activities. I checked the glutes for trigger points, massaging through the sheet to make the experience less gruesome. The glutes were sore and the sacrotuberous ligament felt taut on both sides. On the affected side, the right, the quadratus femoris felt like stone.

I had her go sideline to check the adductor magnus. Oh yes, this felt like a speed bump. I cross-fibered up and down the hump, hoping to feel some sign of the muscle letting go. I did the stretch, finding about half the expected range. Figure on a hyper mobile person, one-fourth the range.

It took another session, this one also to balance out the super-stressed pectineus and adductor brevis. The second time the adductor magnus felt more like muscle, but it still held trigger points like a string of pearls. I ended up working all the stressed muscles in the glutes and groin.

“So what did you mean about me being human?” she asked.

Ahh. Forceful lateral rotation of the right foot. She was massaging, and doing probably a lot of other things, with the right foot pointing laterally, heel in, toes out.

A pretty basic lesson that we all might take for granted. I had done a forceful lateral rotation while flipping out Wii bowling last year. I had to scream every time I took my foot off the gas pedal to touch the brake. While driving to work.

“Remember that both feet point in the direction of your stroke,” I said. A simple bit of advice that hopefully all student therapists hear in school. And if we forget, our hips will remind us.

December 27, 2011

Knee-Deep in Sheets

I love clean cotton sheets--I really do. At my business, we each did our own laundry when we were still very, very small, and I didn't mind a bit. Well, I didn't really like the hauling them to and from the business, to the car, to the house (repeat cycle), but the washing and folding process was very orderly and calming. Well... until there got to be so very many sheets, that getting my own household laundry done starting becoming a problem.

When the sheets started getting out of hand, my employer started looking at professional laundries. Now by professional laundry, I mean places like Darcie's, where individuals can go to use coin machines for their personal laundry, but where businesses can also drop off laundry to be washed and folded. The first one of these we went to charged us about $1.25 per pound to wash and fold our sheets. Sounds pretty cheap, right? Well, until you figure out that one sheet weighs roughly a pound, and that a sheet set is costing you about $2.50. And if you've basically been paying nothing while doing your own sheets, then turn around in one month and pay over $400 to a laundry for the same sheets, you can end up shocked and resentful.

Our next step would have been to get a quote from one of the larger services who deal exclusively in sheets, tablecloths, etc., and who pick up and drop off . . . cause if you're going to pay anyway, why do all that lugging? Or to ask the landlord if there was any chance of getting washer/dryer hook-ups in the basement of our building (not likely, but worth a shot). But then we thought, hmmmm, is there anyone on the team who needs extra funds? As it turns out, our newest LMP hire still had a patchy schedule, and she was willing to do the laundry for roughly $3.50 a load, detergent provided. If she charged the professional laundry fee of $1.25 a pound for one of her loads, it would be around $10--so you can easily see savings right there. The business not only saves money, but an employee who needs the cash gets it, and these sheets and loads add up.

Now at some point, this therapist's schedule may become so full that she can no longer do laundry for the business, but for now, I'm enjoying picking and choosing different top and bottom sheets for each massage on my massage table canvas. Maybe THAT'S actually my favorite part of doing the sheets :-)

December 20, 2011

Life Goes On

Every week for the past 10 years, this client has come in for a wellness massage. This client’s plate is full. A small business, multiple children in expensive colleges, and the biggest reason he has for a weekly massage: his wife has lupus.

Weekly massages have helped along the way. Last month, this client told me “If I hadn't been getting massages, I think my head would have exploded a long time ago.”

It has been a hard row. Multiple treatments, some experimental, and now the lupus appears to be gone. But the damage to internal organs is great. His wife had emergency surgery last week and it is possible that the end is near.

I feel compassion for this client; I feel helpless, too. The one thing he and his family want most of all appears to be slipping away. This time the family Christmas may be the saddest of all.

I must say most people could not handle the stress of all this going on at once. Lots of people would shirk at least some of these problems if not all. It would be easier to think, “I didn't sign up for this.”

An acquaintance said those exact words to me one day when I was relating the story of how my spouse had a heart attack and bypass during a Hawaiian vacation. She would not stayed around, she said. It would have been a good time to exit, stage right, leaving the “relatives” to handle the situation.

I was shocked. I have to say, “I did not sign up for this,” never crossed my mind.

We don’t sign up for things knowing they are coming, of course. Things happen, life changes and we make the best of it. It is our lot in life to take good and hard times, challenges and joys.

How we do these things is our measure. Heroic measures by the day. 

December 14, 2011

Rotating Migraines and Other Bumps on the Ligamentum Nuchae Highway

Feeling around for trigger points all day, I am most impressed with the Ligamentum Nuchae. It has such abundant thickness, depth and tension. I marvel at the cummerbund design featuring what I feel is an actual forest of referring trigger points. It could be called the secret garden. There, all sorts of things grow in total seclusion.

I first started spending time on the ligamentum because of how it felt to massage people suffering with migraines. The migraine is by most accounts in the medical literature is a phenomenon of stress-dilated blood vessels. That said the recommendation is to do a general massage to release stress and avoid the pain zones.
But the dense thicket of TrPs in the posterior cranium has always pointed me straight to the ligamentum as the origin of pain.

Following where my fingers lead, I find that the root of migraines often land in the convergence of two muscle tendons – the twining fascicles of the rubbery sternocleidomastoids and the tough-as-nails suboccipitals right in the heart of the ligamentum.

Slowly rotating the head to the affected side, the SCM fascia pops up, usually leading clients to say I am on target. Moving the cranium in a slight nod, the dense fibers of the suboccipitals cross and intertwine with the SCM. This zone is a perfect storm of adhesed, anaerobic connective tissue. That is usually when clients volunteer that I have found “ground zero.”

If my hands can suppose what is going on during a migraine, I would turn away from the dilated blood vessel model and instead look to chronic, cumulative TrPs, activated by stressed posture. As the connective tissue tightens, the TrPs activate and begin to send impulses to the pain zones associated with migraines – usually the unilateral area near the temples.

This zone is a literal highway of headache and stiffness.

December 9, 2011

Infographic: Benefits of Massage

The amazing crew at SubmitInfographics made a chart about benefits of massage for massage therapy patients. Feel free to share with clients!

December 7, 2011

Clients Say the Darndest Things

It's the time of year when I can enjoy the lively recollections of table-talk from my massage clients.

My favorite Thanksgiving comment this year: "l love my parents but thank g-- they live in New York."

What pops out of people's mouths in a session can be very touching, funny, sad and true.

Nothing brings people to share more than close quarters with their extended families.

Some more favorites:

"No matter how many times I try to change subject to the weather or the dog, my sister manages to start WWIII."

"My family had plenty to talk about at dinner this year. I refused to cook so now I'm the Grinch and Scrooge."

"Next year we are going to Ecuador so we can get out of seeing everyone."

"This is our first year without mom. We sat around and told funny stories about how she would trick us into behaving while she cooked."

"We had Chinese food and went to see the Muppets."

"My gift-wish this year is for the kids to get jobs and move out."

"What happens during Thanksgiving dinner usually comes up again during Christmas."

Yep, it's my busiest time of year Thank heaven for the holidays. Perhaps I should order extra oil. Happy Holidays!

December 1, 2011

Finding the Right Position

I have had a couple of massage students ask me how to find a job when they graduate from massage school. Oh heck, that’s a big one. How do you look when you are not sure what type of massage practice you want? If you have an idea of where you want to start, that is a big step forward.

Given the sluggish economy, though, going for your ideal setting may not be in the cards. You may be in an area where you need experience before you can decide what you want to do. How do you know you will like or fit into a setting before you have tried it?

My sage advice on this subject is to jump in. If jobs are tight, apply for lots of them. If no one is hiring, tell people you will cover on-calls or vacations. Get your license/credentials so you can start right away. Just get out there.

How you apply matters. I used to hire people a lot, and I saw some potentially spectacular therapists go down in flames for dumb reasons. It doesn’t matter how good you are, be on time and dress for an interview as if you are ready to start work. No jeans, no sleepy-head. No broken cars or missing babysitters. If you can’t show up and look nice for an interview, no one will ever discover your gifts.

Also, pay drops when jobs are tight. If you expect to be paid well even though you have no experience, it is not going to happen. Get in the door and ask during the interview for your performance goals. Keep notes and ask for help in achieving those goals. When you perform, managers will notice and will want to keep you around.

If you experience rejection, or blow an interview, remember everyone has an experience like that. Use it to your advantage and learn from it. Persistent people get jobs and become successful. People who give up at the first obstacle show up at bars at opening time.

There are lots of  “you”s in the above paragraphs, and that is what it takes. Effort, focus and follow-up, all done by you. Hey, if it was easy, everyone would do it.

P.S. Make sure your nails are trimmed and beveled. You don’t want to kill the client during an interview massage.