How Well Do We Remember Our CEU’s?

Most massage therapists take continuing education classes, our beloved CEU’s. They usually start with a bit of lecture, some demonstration, a bit of practice. Then break for lunch. Back for a bit of talk, a bit more practice, and it is a wrap.

I am thinking I learned a lot in those classes, I usually take about 20 hours or so a year, and heck, I must have learned some good stuff. Or did I?

At school, we got the same deal but with a lot more practice during, after and then at the start of the next class. We practiced more, got yelled at a bit, then take a practical test. I’m wondering if the extra practice review and testing made us learn more and with better retention.

I have to admit, after a Chinese food lunch, no one in my muscle skeletal ceu class looked like they would remember what they practiced. There’s a lot of shuffling on and off the tables and there are always a few participants who are showing their own stuff during the practice stuff instead of trying to imitate the teacher. Or something happens in the class that makes it memorable, but not its subject matter. For instance, one fellow in my forearm class had scouring-pad body hair. Tough on my forearms but nothing like what his forearms felt like during my turn. Talk about a body scrub!

Oh, well.

When I was in school, I would try to practice again as soon as I got home from class. It was a good 30-minute drive home, and I would run in to the house and practice on the cat, convinced one more run-through would improve the “memory in my hands.”  One happy little Tommy cat, I must say. Then I graduated. For months Tommy would flop on his side on the couch the moment the key turned in the door. He would look at me long time.

I flipped through my CEUs recently while renewing national boards, and I realized I have the brain of a feeble hamster. I learned in Thai massage class that I hated massage on the floor and might one day need a hip implant. Snorting up blinded samples in an aromatherapy class gave me a floor-dropping migraine. I worked in a plasticized cadaver class with a psychic lady who told me to eat mangoes. At the start of a lymph class, the teacher admitted to having never taken a lymph class. I got to work with one fellow in a shoulder sideline class who I swear wore Richard Simmons gym wear.

Wait a minute, where is the fine anatomy, the finesse of positioning, the goody inside stuff that we paid for?
Frankly, I have no idea. I think I am doing things I learned in class, but I have no idea if the teacher would recognize it if demonstrated. Trouble with a lot of classes, there is no time for review and re-practice under the watchful eye of a teacher. I could be doing MFR of the intracostals, or I could be playing chopsticks on a toy piano.

Well, perhaps. I try to get a practice in with another therapist as soon as I finish a class. I would rather find out from a test-body therapist how something feels than experiment on a client. And I have to assume I have some clue to basic massage techniques as they apply to different areas of the body. And if it is intricate and I don’t think I have it, I don’t do it on clients.

I think procedural doctors must have this quandary, too, when they take a CEU class. Is a weekend in Vegas class watching surgery and doing it on cadaver or animal parts enough training? Would I get a nose job from that doctor? Perhaps the doctors should give each other nose jobs first. But I digress....

P.S. Find Touch now has a CEU board - check it out if you haven't already. 

Where is all the Carpal?

So, going on my 16th year in massage therapy, I have to ask: Has anyone out there in practice-land ever seen a real case of carpal tunnel syndrome?

Please, I wish to be enlightened. I’ve been beating the flexors for years, and this condition seems as elusive as Sasquatch. Every time I think I see a CTS coming in, I find something else entirely. Not that I’m complaining, it just seems with so much CTS surgery out there, I should have, by this time, seen at least one.

What do I find? Well, most of it is on the TRP charts by Travell & Simons, but enough is different I’ll run it by you.

Mostly, I find screaming, adhesed flexors. Flexors so stressed from computer work, driving and video games that they feel like steel bedsprings in wet cement. And heck, wringing them out with some myo-fascial release combined with pronation and supination seems to open them up. Then they seem to respond to active stretching while under compression. Then 20 minutes of ice. Overnight, some sporty stretch tape helps draw lymph from the flexors up through the elbow. Does this work for other massage therapists?

Then I track down parasthesia. For funny feelings on the back of the hand, I flush triceps up into the armpit, followed by Trigger Point Release and Passive Range of Motion. The ants-on-the-hand seems to clear up as soon as I do the TRP.

For the rubber-band around the wrist feeling, I go for massive TRPs in the infraspinatus and teres-ses.

Definitely sideline and definitely slow and easy with lots of Swedish warm-up. I swear the back of the arm rotator TRPs are like Roman Candles.

For the stigmata feeling in the center of the palm, I look to the subscapularis. But on most adults it might take two or three sessions of sideline Swedish and light probing to get near it without killing the client. Once I can get my pinkies in there, I’ll go for light TRP compression. If they are excited by the results, I’ll venture into soft, slow range of motion.

Latissimus, egad, seem to do the last three fingers, while pectoris major does the first three. If I can get permission to get near the pec. minor with just the lightest, touch, it works just dandy in opening the entire thoracic outlet.

Massage for the scalenes, of course, eliminates distal finger tingles.

Now looking back at that list, where exactly is the need to rub the carpal tunnel? Heck, I am a massage therapist, so I always rub them anyways. But come on; is there any real carpal out there?

Support Hose: Stodginess Never Felt So Good

Everyone has her Achilles heel: mine is actually an Achilles vein. Or veins.

Even as a small child, you could track these fine blue veins under this nearly translucent skin. By my early teens, I was getting spider veins around my knees, and the children I babysat made up games involving my legs: "Here's a road, and here's a road, and here's a town . . ." It drove me nuts. I ask my doctor father what I could do to make the spider veins stop. "Walk on your arms," he said unhelpfully. "Or you could go ahead and start wearing support hose." Support hose! So not-sexy. I absolutely would not do it.

Well, I was 25 years younger then. And being sexy was much more important than being comfortable. Oh, and I wasn't 11 weeks pregnant, which I am now. And let me tell you: by week 9, some of the superficial veins in my calves and around my knees were already bumpy and sore, not giving me happy visions of what they might be when I reached 39 weeks pregnant. I bought the damn support hose!

Well, not without some primary research, which can be a little confusing. The good news is, support hose--at least "medical grade" support hose, known as "compression stockings"--really work. The pain was entirely erased by wearing them during the day. The bad news is, they can be pricey, starting out at around $25 and going up to over $100. Also, medical support hose come in about four "tensions": light, medium, firm, and extra firm. All of these tensions have numbers associated with them, and the highest tensioned hose actually require a prescription! That blows my mind, since squirming into my medium tension hose requires about ten minutes and the help of a small construction crane. Finally, they also come in knee-high, thigh-thigh, and waist-high, not to mention foot-less versions of the last two. So you have to find a happy mix of affordability, sizing, etc., though I would definitely just avoid knee-highs (talk about cutting off circulation).

Some medical supply stores will measure you to determine size, though I threw the nice store lady off when I presented her with a large thigh, extra-large waist, and queen calves (no, I don't often get to wear the more stylish boots). But, the extra-large size ended up fitting me just fine. Actually, I have heard that you can get "custom" support hose which are fitted every inch or so all the way up the leg, though I shudder to think what those cost. My pair were about $43, and worth it, since I now have no pain and no (current) worry that my legs are going to cut short my massage work during my pregnancy.

So if you or any of your clients are suffering from leg pain--pregnant or not--due to venous issues, I HIGHLY recommend support hose. Sexy is good, but sometimes stodgy is so much sweeter.

Why Do Men Do What They Do?

Massaging folks who like to exercise and play hard, I have to say that some people amaze me. Well, actually, specifically men who do some of the strangest, most dangerous things in the name of fun and fitness.

Here, direct from the secret hidden files of my massage practice, is a list of the worst, hall-of-fame list of strange things guys have done having fun and staying fit.

While pitching for the local adult baseball league, he threw out his arm at the start on the big regional tournament. No problem. He just pitched with the other arm. All five games.

After working two solid weeks of unreal overtime, he decided to go for a teamwork dinner with the guys. Hey, let’s go to the big family-style Italian restaurant late at night. Let’s eat five courses. Next day, let’s go to the gym to try and burn off 11,000 calories at once by doing lots of snap jerks. Seemed like great ideas at the time.
He picked a balmy, 100-degree day to go bicycling in the hills. A muscle-building, stamina challenge pedaling five miles uphill. Just before he got to the top, he had to find some thick bushes so he could throw up while soiling his pants. I suggested he take identification on his next bike ride so the widow wouldn’t have to wait long for her check.

Hey, running those big hoses off the fire truck all day can be pretty tiring. Why don’t we all go to the new trampoline place after work? A bunch of stressed middle-aged firefighters playing team dodge-ball on trampolines? What could possibly go wrong?

I just don’t understand that behavior. Why would anyone play dodge-ball on trampolines when they could relax after work with a bubble bath and a gossip magazine?

It Never Rains in Southern California – That’s Why Everything Leaks

Ok, it is my turn to whine about weather and keeping the office dry. This time we had an inch of rain – nothing to most folks outside of my little slice of heaven, but it was a positive drenching in parched Southern California.

And I thought all was well. I popped into the office to set up for a string of clients, the rain soaking my little-used rain jacket – and I noticed the door seemed a little sticky. The threshold was wet. Hmm. Well, it was raining out.

I made some phone calls and realized while I was talking to my favorite acupuncturist that the doormat inside was dark with wet. Hmm. It should just have a footprint or two….

Oh Dear! The rain was flooding in from the soaked threshold right onto the wood floor. The laminate wood floor.

Thank heavens I had a nice batch of freshly laundered hand towels. I mopped up the entryway only to see the water flood in again. I stepped over to the sink. And heard a squish. As I walked across the office, water sprang up in between the laminate planks. Not good. Apparently when I opened the door that morning, I had broken the seal between the door and threshold. All that water was wicking in underneath the floor jamb and soaking the laminate.

I  had a new set of designer bath sheet towels (off the screaming discount aisle, dontcha know) and I put them to use. The landlady and super came over and clucked. Fans. We need fans.
My first client was in the middle of a book tour and had done six conventions in like five days. “We can still do the massage, right?”

Ah, sure. We’ll be fine. I did massages while the super sopped incessantly in the reception area. At the end of the day, I felt a bit frazzled as I loaded my soaked, now-brown towels into the hamper in my car. The building crew would take care of it.

The next day my first client was a new client. I escorted her over the towel dam and through half-removed sponge-bob oak floor and the giant hair-dryer fans. She filled out the intake. I realized I could not talk to her about why she was seeking massage with the fellows there.

“We’re going to use the office next door while the guys sort this out,” I told her. The acupuncturist next to me graciously donated the use of a room. Nice table. A face cradle from about 1980, the kind with three hard pads on a square fixed frame. I don’t think they use the prone position much. My fancy-adjustable-memory-foam face cradle didn’t fit the holes.

Lucky for me (!!!) she was coming in for chest pains. After running up a nice bill at the doctors, this lady was here to find out if trigger point could get rid of her chest pain, which radiated down her left arm.

“I’m beginning to think I’m crazy,” she said. “They can’t find anything wrong.”

“Well, you might be crazy,” I told her, “And it is quite possible I’m crazy too. But it may have nothing to do with this pain.”

Cane and Able

Ok, I admit it. Like a lot of massage therapists, I have a vast collection of self-massaging tools. There are vibrators that can twist around to the upper back, magnetic chi vibrators, full back shiatsu rollers, tennis balls in hosiery, and of course heat pads, ice packs, moist heat packs, liniments and therapeutic salts.

Hey, I don’t really need all that stuff, it is market research! Uh-huh. That’s it. Market research. My clients need advice on what helps and what doesn’t, sure.

Well, having been in the spa biz and now independent practice for 11 years, I’ve got a big bunch of white storage boxes full of payroll records, receipts, etc. that have been looming in the garage for quite a while now. Supposedly you only have to keep the stuff for seven years, and I have never cleaned out the crud.

Sunday morning spouse and I, and a good friend, reached out to the crud, dragging it out from the back of the garage and filling bags for the shredder service. Of course, first we had to move a bunch of stuff to get to the boxes, and organize the Christmas stuff and pull out the herbal wrap system I bought used (and never used because of the huge linen sheets) and shift tons of other stuff including my mother-in-law’s collection of folded happy meal boxes and paper dolls.

We stretched first; we had water and chairs in the shade; and we took breaks.

Five hours later we looked like an assisted living glee club.

Which brings me back to my personal massage tool collection: I’m proud of it, having spent hours foraging at massage conventions, gadget stores, garage sales, etc. First I used my neck-holder, called the Real-Ease, which provides passive traction and restores the cervical curve. I drew a bath and tossed in Epsom salts and Kniepp Herbal bath. I highly recommend the Melissa variety.

Then I sprawled on the yoga mat, running my tennis-balls-in-hosiery up and down the spinal lamina grooves. Then I hit the knots in the levator scapula and rotator cuff with the magnetic chi vibrator. As I write this, sort of sitting up, I’m thinking about using all of my ice packs. I like the gel ones with the Velcro straps best. Where did I put the MSM/Arnica cream?