WWTD - What Would Travell Do?

That darn knot was driving me crazy.

It was embedded in the rib cage, just below and under the lower vertebral border of the right scapula. It seemed to ease with heat, but no amount of myofascial release, Swedish, cross-fiber, trigger point or lymphatic or any of another half-dozen styles of massage I had tried would budge it.

Every week that darn thing was there. Everything else had budged, and my client, whose principal complaint was major migraines on the right side, had been getting better gradually as I worked to erase the right-sided pain pattern. This client is hyper mobile and thus negative on most of the muscle tests such as range of motion.

I had hunted down a huge serratus anterior knot and it bit the dust. A mondo masseter knot was opening up. I even felt the scalenes starting to slip back into the matrix.

Except for that darn knot. Instinct and experience told me it was a progenitor of the migraines. It must go. I was close to naming it – Jethro? – And I wanted it out. Bad.

I followed it as if it was from the multifidus, progressing up and down the spinal points trying to balance the tension on both sides. I followed the lines of the rhomboids, the serratus and the latissimus choo-chooing with the anatomy trains.

I must be missing something. I must be chasing the wrong thing. I can do this. And when in doubt, look it up.

Years ago, at relatively great expense given that I was a humble massage student, I had invested about $450 in a set of Travell and Simons, “Myofascial Pain and Dysfunction: The Trigger Point Manual” (it's a good deal on Amazon now - $215). I use the Travell flip charts of trigger points pretty much daily. It is, for the manual therapist, the reference books for what we know, what we don’t know and why.

I went back to the font.

There, hidden away in plain sight in the latissimus chapter, was a drawing of how to get that damn knot out. Approach from the lateral anterior, slip under the latissimus and locate the trigger point. Fix it with pressure from the hand under the lat to the exterior hand. Massage it and draw the point out laterally away from the body. Sweat was dripping down my face, and my client’s eyes rolled back, a bit like a shot of anesthetic.

I felt “Jethro” melt.

Janet Travell would have been 109 years old this past Dec.17 if she had not passed on at the tender age of 96. She got John F. Kennedy out of a wheelchair after WWII so he could run for president. She understood that people were people, even doctors, and worked to bring manual therapies back to orthopedics.

I hope all massage therapists and manual folks know her name and her books and charts. Shouldn’t we have some sort of Bodywork Hall of Fame?

The Twelve Days of Christmas (Massage-Style)

On the first day of Christmas, my true love gave to me,
A tub of rose-infused crème!

On the second day of Christmas, my true love gave to me,
Two eye-pillows, and a tub of rose-infused crème!

On the third day of Christmas, my true love gave to me,
Three salt lamps, Two eye-pillows, and a tub of rose-infused crème!

On the fourth day of Christmas, my true love gave to me,
Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the fifth day of Christmas, my true love gave to me,
Five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the sixth day of Christmas, my true love gave to me,
Six lumbar strains, five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the seventh day of Christmas, my true love gave to me,
Seven chakra stones, six lumbar strains, five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the eighth day of Christmas, my true love gave to me,
Eight sinus headaches, seven chakra stones, six lumbar strains, five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the ninth day of Christmas, my true love gave to me,

Nine flute CDs, eight sinus headaches, seven chakra stones, six lumbar strains, five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the tenth day of Christmas, my true love gave to me,
Ten breath mints, nine flute CDs, eight sinus headaches, seven chakra stones, six lumbar strains, five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the eleventh day of Christmas, my true love gave to me,
Eleven face cradles, ten breath mints, nine flute CDs, eight sinus headaches, seven chakra stones, six lumbar strains, five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, and a tub of rose-infused crème!

On the twelfth day of Christmas, my true love gave to meeeeeeee,
Twelve frozen shoulders, eleven face cradles, ten breath mints, nine flute CDs, eight sinus headaches, seven chakra stones, six lumbar strains, five sets of sheeeeeets! Four finger cots, three salt lamps, two eye-pillows, AND A TUB . . . OF . . . ROSE-INFUSED . . . CRÈME!

Is It a Muscle or?

Every so often in massage you see someone who you think might be having visceral rather than muscular pain. Since my X-ray vision is on the blink, and my psychic abilities have never worked when picking next week’s lottery numbers, I tell folks who have a symptom that might be something else to go see the doctor.

Come to think of it, I’m sure most therapists have some opinions and probably a few good stories, about when to say “have you had that checked?”

I sent my granite guy to the urgent care for chest pains not because I didn’t think he had pectoral problems from lifting heavy granite all day, but because he hadn’t been to a doctor for 20 years. He was fine, by the way, and his pec’s felt like rock.

Once I felt a little pebble in a client’s foot and sent him off to his doctor. It was some kind of benign but destructive tumor. He had it taken out.

I have no clue to what’s going on when I refer people for diagnostic work, but I do probe enough to at least find out if they have taken their symptom to the doctor at some point, especially if it has happened before.

That said, I’ve wondered sometimes if I’m playing Russian roulette. If someone who has aches and pains and never goes to the doctor okay? What if they’ve been through all that and been pronounced fine. Did they miss something? Who am I to say anything at all?

Plus the idea of mentioning the sawbones might just scare the fiddlesticks out of some clients. Some people don’t do well with the whole medical thing. Rather than scare the stuffing out of a client, I might say “it’s probably nothing, but you will be doing some good for the economy running up a bill.”

I’m careful not to mention what something might be, as that might be taken as diagnostic, which is doctor stuff.

On the other hand, if every time a client came in with a pain you sent the person away, we never get a massage done. There’s a balance somewhere, and I like to think I’m close to it.

A client who been dragged in by his wife said his “friend” told him that “you should never rub a sore muscle,” with a tone that suggested the Ten Commandments. I promptly told him that what I’ve been doing daily for the past 15 years. Massage therapists help people relax and let go of aches and pains. It’s just part of the landscape.

I added that I don’t rub fevers or road rash or hives, or something that looks red or swollen, but with good assessment before starting the massage I’ve managed to avoid killing people.

At the WAY other end of the spectrum referrals can be frustrating. I had a long talk with a client with a deep fear of doctors into taking the lump under her jaw line in to the clinic. She finally went to see a specialist and found out it was a benign salivary tumor. She started taking supplements to get rid of it.

As the tumor grew larger, I suggested that benign doesn’t mean it can’t do bad things by just getting bigger. She felt the tumor was getting smaller and would go away without surgery. Then she stopped getting massages from me. I saw her one day in the market. The tumor was the size of a grapefruit, and she had combed her hair, very unsuccessfully, over it.

Spa Olympics

Working at a spa is one of the most rewarding and challenging environments for a massage therapist – the pressures of running on time, keeping within guidelines and getting along with a bunch of other therapists – and their egos – all while trying to learn protocols and make a living.

I’ve always found spas a great learning laboratory when I worked in one and when I owned spas. What I found most interesting is how individual therapists perceive the spa environment as a challenge or an obstacle course. A case in point -

While operating a hotel day spa, one of the employees, a male therapist, showed great determination in developing a clientele. He worked mostly “slower” shifts and kept at it, despite the preference clients have for gender. After working a typically “slow” shift – Friday nights - for a good year, he had developed enough of a following that his Friday book was consistently full.

I, of course, was quite happy with this - it worked for him and for me to keep the books chubby and money rolling in. One of the other therapists saw the book and decided that the Friday night shift was rightfully hers. She called me to let me know that our male therapist didn’t want to work Fridays anymore and she would be happy to take that shift.

I thanked her for volunteering to take up the shift and told her I would think about it. Needless to mention, the moment I checked with the male therapist, I found out it was a ruse. After investing time and effort to build up that evening with steady clients, he was not interested in moving off it at all.

I was marveling about the chutzpah when I talked a confidant, the manager at the hotel’s restaurant.

Can you imagine someone just trying to shove somebody aside like that? I said.

“It happens in the restaurant all the time,” he said.

Really?

“Yes, I’ll have a new hire learning the restaurant and I’ll know if they will work out after the first full shift.”

OK I’ll bite. How?

“If they come up to me and complain that another server has all the best tables and they get the dregs, I know it’s not going to work. They’re just telling me that they don’t see how experience and focus pays off in tips. They assume there’s some magical reason why they are not doing as well as the server who has worked here for years.

“Now if they tell me they are going to work hard and try to emulate the good servers, until they get it, I know they’ll be fine.”

I must say that was a good lesson learned. Oh, and our “grabby” therapist didn’t work out.

Sick for the Holidays

Once, on the morning of my first day of work as a massage therapist at a large day spa, I woke up with a cold.

Should I go into work sick? Breathing on clients, close contact, hands all over people? I did not want to get people sick. But I couldn't "flake" out my first day.

Calling in sick on your first day of work simply isn't done. I took daytime cold symptom drugs, vitamin C, slid some de-puff stuff under my eyes and went to work. I felt guilty about having a cold, but I tried my best to make sure I didn’t pass it around.

It’s different now.

Just before Thanksgiving I had house calls lined up like limos on Oscar night, before, during and after the holiday. Nice thing about Thanksgiving is that relatives and feasts and shopping tend to make people so stressed they want massages. And they don’t want to drive.

I felt a little tightness in my chest during my third massage at the office the Tuesday before Thanksgiving. I had felt a dry, tickly throat all day that I blamed on allergies and the desert winds. Now I was not so sure. I sat down at my desk and listened to my breathing. That slight, binding-like pull in the chest told me I was getting congested.

I canceled the last appointments of my Tuesday schedule and went home sick, thinking if I took enough immune-boosting stuff I could beat the sludge in my chest and the pain in my head.

Next morning I sat down in front of the mirror and looked at my puffy lids and watery eyes. Should I go to work? No way! My first client was going to have elective surgery in a week. Another client had just finished chemo, another has killer work stress and a spouse disabled by lupus.

I picked up the phone and made the calls.

It's better to be responsible about one's health, or lack of it, than expose people to the crud. Everyone understood, and they were more than happy to make appointments for another time.

These days I'm more independent, and it is better for the long-term karma of being responsibly infectious. Principles come first, as do the clients. The rest of world can spend the holidays passing the crummies around the workplace, but I’m not going to add to the septic soup.

I wonder, sometimes, how massage therapists handle this one. Is it OK to work sick? Does it depend on where you work? Where do principles go when you are worried about your pocketbook? Do you tell the clients and give them a choice? What about when you work for someone else?

What's in a CEU?

There's nothing like a Sunday morning continuing education class, and this was no exception. Massage therapists who do these classes are the true blues, the ones who take it seriously, the ones who figure they might learn something even though they went to school and have been doing massage for a few years.

This was an ethics class, and the instructor was quite pleased after asking for a show of hands that not a single therapist in the room thought it was okay to have sex with clients.

Glad that hump seemed to be over, as compared to years passed, the basic message was that paying attention counts. Do you communicate with the client before and during the session? Do you have the client’s permission? Do you acknowledge and address pain? Do you validate or discount? How about the follow-up? Do people get better? What if they don’t?

It is one of the ironies of these classes that the people who get up early to go to them are generally not the ones who need to be there the most. Self-auditing skills and curiosity were emphasized, and it seems that most therapists attending were more than familiar with the concepts.

What is the value of a CEU? For me, Sunday morning, it was to see and hear with other working therapists that trying to do well is an everyday task. That learning is life-long, a habit developed because you care and want to do better than yesterday. Perhaps it is something that can’t be taught, but it can be learned.

Inspiration Spa & Massage & Rub Emporium

While practicing our brains out in massage school, my classmates and I enjoyed designing new day spas in our notebooks and trying to frame our concept of the ultimate massage experience.

Neophytes to massage and business, we were quite earnest, quite naïve and quite unintentionally amusing.

One afternoon I very thoughtfully drew a spa layout on graph paper - trying to stuff as many rooms and amenities as possible into a fantasy 1,200 foot space. I gave it the round file treatment after I realized the corridor in my rabbit-warren spa was about 18 inches wide and I hadn’t drawn room for any toilets.

That didn’t slow me down at all, of course, given my breathy enthusiasm to bring the gift of massage to the world. The idea of a non-tacky day spa that didn’t look like a back room of a salon rolled in my head. But what to call it?

Massage names, of course, set the tone for the whole experience. Like Exhale, a name I thought I had coined until I found out it was already in use at a spa in New York. No, Inhale was much worse. What about Gasp?

I also felt inventive ownership to Massage Masters, until I realized it suggested several things that I did not want to suggest. Massage Misses was even funnier. So too Massage Mixer. Oasis seemed to be used by at least one business in every town, and way too many bars here and there.

Then I got on the task of something that begins with “A” to get first in the phonebook, a concern that seems quite retro today. Abba Spa seemed quite Swedish, but perhaps litigious. Abbott Massage too close to the temp service. Then up popped Aardvark Spa; now who would go to a place named Aardvark Spa? Biologists?

Brainstorming works best with more than one stormy brain, of course, so during my practice session at school that day I engaged one of my classmates in the name contest. If you were going to open your own spa and could name it whatever you want, what would it be?

I rolled out some of my attempts at naming a spa with unintentional double meanings. I admitted to liking Urban Spa, but it would be too low in the phone book to do much good.

My classmate thought for a while.

“I’ve got it,” she announced proudly. “Massage Muffs!”