March 30, 2013

Through the Sheets

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.

March 22, 2013

Table Talk

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?

March 16, 2013

New Tricks

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.

March 11, 2013

Massage as Rehab

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?