What We Massage Therapists Know…

Recently in looking for an associate to assist in my practice, I interviewed a bunch of massage therapists with ample experience. I thought I would offer a good step-up to private practice to people who wanted to move in that direction. I looked for experience because I wanted people who understood the economics and challenges of massage practice. The resumes were pretty interesting. 

One resume listed athletes the person had massaged. That’s it. 

I did ask for credentials. People told me they were licensed in my state. We don’t have a state license.

Or they could get it if required, along with insurance. Tell me, how had they worked in the field thus far without the basics?

As I weeded through the applicants, I tried interviewing a few by phone. One hung up when I explained that I would pay minimum wage//click//plus piece-work for massages performed.

I was getting a little bummed out. Then I found someone who I thought was great in person, on the phone and in resume. There was only one problem. She did not want to work on any of the days/shifts I could make available. Turns out she was burned out on her spa job and did not want to take on any more massage time. 

Why was she answering my ad, I thought.

Sigh.

Back to the drawing board.

Tidy Time

With each year end, I like to do two things: tidy up the loose ends of my massage therapy practice and set my sights on the coming year.

         

Tidy time is important in the visceral sense: make sure my tax stuff and books are at least all in one box, if not organized, all set for the tax man. I also like to get some statistics: How many massages have I done, daily and weekly averages, etc.

         

An important part of this look-back is to check and see when I have been feeling good or overworked. I can often see some times when I should have done a little less or spread my duties out more.

         

Gone are the days when I could work straight through an 8-hour spa shift and then see two private clients after hours. I don’t miss that a bit. But when I was foolish enough to have done those things, I learned, as I laid prostrate on my bed the next day, not to do so much in one day. Days off are no fun if they are spent flat out zombie-fied.

         

Days off for a massage therapist are for stretching, tai-chi, family, errands, the beach, all the things that days off are for. I learned not to work so much that I felt drained.

         

Another lesson is to not drown in paperwork. If, like my therapist friend, you use a bookkeeping program, you still have to plunk the numbers in. Amazing how many other things you can find to do before doing the books. To save myself some angst, I found a good bookkeeper.

         

Outsourcing is great for the things you do not want to do. For me, it is the bookkeeping. For others, it might be the laundry. The key is figuring out what you do not want to do, or what you are truly bad at doing, and if you are willing to pay for it.

         

In hindsight, “outsourcing” is what many of us do when we work for employers. We take a pay cut because we don’t want to book clients, make re-appointments, keep track of permits, negotiate leases. There is nothing wrong in that, by the way. Some therapists enjoy being able to leave work at their appointed time and not keep a to-do list. A lot of us have to pick up kids, make dinner and a host of other things for family.

         

When I’ve looked back at my year, I then look forward. More about that next blog.

Care and Greeting of Clients

What are you doing?

         

My therapist friend said that phrase in a tone of voice that implied I was sculpting a stone wheel from a boulder.

         

I’m writing holiday cards to my clients, I replied.

         

Ohh, no, no, no you will get carpal! she said. Let me show you my toys.

         

 Out whipped the tablet. With its apps. This one sends appointment reminders automatically, along with holiday greetings and birthday offers. Au-to-ma-tic, she said, as if it were a word I have never heard before.

         

Yup, that’s me sitting there with my stones knives and bear clubs, sending out cards to people whom I have been seeing for massages for so long they are like family. But no, I am modern. My stamps are self-sticking.

         

I swear it is not age. We are about the same age, my massage therapist friend and I, and we have come up through the ranks into developing our own independent practices.

         

And I still have an appointment book and pencil. And I send holiday cards. Handwritten.

         

As my software engineer client told me one day, those apps. are great. Until all your data gets stuck somewhere in the cloud.

         

Bah Humbug!

        

Massage with an Historic Difference

It is an old law school question: Would you be Hitler’s lawyer?

         

It is a tough one. All people regardless of their crimes are due a spirited defense, law students are taught. Yet what about the worst criminal in recent history? Would you be the one? Could you?

         

Here’s how the question could be posed to a massage therapist: Could you be Hitler’s massage therapist? Would you? Would it make Hitler more human? Or make him a more efficient Hitler?

Some thoughts to ponder. I have not found any evidence that Hitler ever got a massage, although the treatment was very popular in the late 19^th and early 20^th century for many ills.

 

But I did find some history about a “doctor” of massage in western Europe who was tapped to be the therapist for Heinrich Himmler, the head of the Nazi SS, the elite and brutal militia that perpetrated many atrocities against Jews and others on the hit list in the Nazi era.

         

Felix Kersten was a gifted therapist popular with the European elite who was “asked” to be Himmler’s personal masseur. He took the job, perhaps because it was an offer he could not refuse, and used his relationship with Himmler to spare some of the intended victims of the Third Reich.

         

The breadth of his exact contribution to saving lives is debatable. He got his client, who suffered from severe gastric problems relieved by massage, to sign documents sparing people from death. He also claimed to have softened the SS’s plans to kill subjugated civilians in Denmark and Finland.

Others disputed his claims to saving civilian populations, but his ability to entice Himmler spare some individuals is not in doubt.

If you would like to read more about Kersten and his times, I suggest:

The Kersten Memoirs, by Felix Kersten.

The Man with the Miraculous Hands, by Joseph Kessel.

Massages’Greatest Humanitarian, excerpt in Massage Magazine by Robert Noah Calvert, from The History of Massage.

The Devil’s Doctor, by John H. Waller.

 

Whys and What Knots

Knots have the element of surprise. Massage clients are often very perturbed that they have a knot, and then the inevitable question…why is that knot there?

         

I try to offer some explanations – to much time using a mouse, too many repeat micro-movements of muscles in a static hold, etc. Working under too much deadline pressure is a very common circumstance.

         

But why do knots occur and stick around for so long?

         

Massage therapists see thousands of knots over the years, and yes, I think they each have their own unique origins.

         

For reasons I cannot easily explain, I can feel when knots are old – from a long-gone by car accident for example – these older knots are more established and habituated to the body’s daily existence. They need some extra attention and therapeutic touch to loosen and return their host tissues to normal.

That said these older knots seem to be more than simply forgotten dysfunctional areas of muscle. Something has happened along with the formation of the knot to make it last. Perhaps, if knots form like memories, they become more robust when a person is excited or energized.

Having read and seen many interviews of people who remember what they were doing 50 years ago when they heard President John F. Kennedy was assassinated, I suspect the major knots also had a sudden, sharp focus of attention.


Perhaps the chemicals of surprise or fear also help muscles retain knots, as people retain memories of the JFK assassination in more vivid detail than any other days in 1964 or beyond.

Could some knots have a date-and-time stamp?

Sometimes I wonder. I know my massage clients do.

Too Big for Massage or Too Dark?

 

The question comes up. A caller on the phone, looking for a massage. I had no openings. Let this massage therapist say for the record that I really had no openings.

         

We talked for a while, a male voice on the phone, pretty husky voice. A Carolina accent.

         

Sometimes you wonder, the caller said. You wonder if when I call and there’s no openings, if someone calls later who sounds white and there are plenty of openings. I’ve heard it happens.

         

I’m not like that, I said. But I have heard it from another client, a large, deep-voiced African-American actor. It just might happen. He told me he had a hard time finding someone who would do a good massage on him, you know, the kind of massage that makes you want to come back.

         

Oh yeah, I’ve had those, too, he said. Massages so bad they feel like an oil slick. Terrible. You wonder if the massage is bad because they don’t want to see you again.

         

That’s not me, nor my practice. But I do wonder. Are men, particularly ethnic-sounding or looking men, on an avoid list because of the difficulty of the massage - or therapists’ unfamiliarity with them?

         

Hope not. Massage therapists are free, of course, to choose their clients. It is a skill. But a professional therapist cannot discourage a client for a discriminatory reason – sex, race or religion. Even if those things might imply that a person might be harder to work on.

         

Yeah, my caller said. One time a lady told me to change my voice because it was probably scaring some massage therapists. I just sound like I sound, he said. That’s me.

What Good Would Massage Do?

A friend shared an experience with me. His stiff back had become worse recently. After sitting for a while at his desk, if he turned the wrong way when getting up or reached too far, ZAP! A pain would

shoot down his leg from the low back to the knee.

           

“It just takes my breath away,” he said. “It really gets my attention.”

           

This gentleman has played football, fought in the war, and built suburbs. If the pain is bad enough to rob his breath, I am on alert.

           

A few trips to the doctor and he was diagnosed with foramen stenosis, a term that means osteoarthritis – calcifications and inflammation - were taking up residence in the area where spinal nerves exit L4-L5. The osteoarthritis pushed against the nerve bundle as he tried to move. Hence the ZAP!

           

I inquired about the plan.

           

“Well, I went to p.t. and at first the stretches seemed to help, but then they made things worse. It’s not bad enough to operate on yet. I am just trying to move my back as little as possible.”

Good heavens. I had to speak.

“Have you considered doing some massage?”

“What good would massage do?”

Oh yes, sometimes this question comes up. I happily urge all massage therapists to answer it when it does.

           

Too often people think inflammation and calcifications of osteoarthritis are set in stone. They move less and less, giving the condition a wide-open opportunity to get much, much, worse.

           

Well, massage therapy alleviates back pain, inflammation and swelling. It is why we train to do what we do. I mentioned a recent study that found general, non-specific massage helped reduce stenosis pain.

           

He asked if massage could fix the problem.

           

The study didn’t go long enough to figure that out, I explained. The big result is that people felt better and thus did more and felt healthier.

           

Do massage therapists think gentle rubbing can reduce osteoarthritis? Or “just“relieve it? I think we know the answer, don’t we?

Jump Out of the Recycle Bin: Work-Finding Tips for Massage Therapists…

Most job hunts for massage therapists starts with the cover letter

email and attached resume. It’s the first introduction to a potential employer.

Grab this opportunity to make a great impression!

I have come up with some tips based on my experience interviewing and hiring therapists. These may seem elemental, but many people will be surprised how often applicants skip these steps, sending their first contact into the trash bin folder.

 

1. When an ad for employment lists requirements such as insurance, licensing, certification, etc., the applicant should be specific in listing those credentials. This means including the proper title, registrant number, issuance date and expiration. Believe it or not, I have seen resumes claiming “state license” in states that do not have licenses. Also, a massage class certificate is not a “license.”

 

2. Be clear if you do not have a credential. You can always say you qualify - if you really qualify - and will get the credential before starting work.

 

3. Please use spell check. When an applicant spells their title as “theraspit” it suggests lack of diligence and care, qualities many employers value highly.

 

4. List prior work experience even if it is in another field. Many massage therapists are on their second or third career, and unrelated work experience boosts applicant credibility.

 

5. Pictures are optional. Applications are not dating ads. That being said, if you think a picture will get you on top of the list, use it.

6. If you don’t get interviews, ask if there is anything you could do to improve your application for the next potential interview. Many employers will be happy to give you tips. It might also signal a willingness to learn, a quality that will get you noticed.

 

Good Luck!

Massage Up or Down?

At the risk of hearing some strong opinions, or not, I would like to ask the question: is it proper to massage up or down?

         

I have had many massages, and I am always baffled by the selection. I have had massage up the back, down the back, diagonally and sideways. Does it matter?

         

Some folks have very fixed ideas on this, particularly teachers who are trying to herd cats (massage students) into some semblance of a class. For every rule to never be broken, however, I find more classes and higher learning invite rules changes with ease.

Personally, I do not enjoy effleurages or neural strokes that go down the arm, although my energetic therapist friends use those to clear energy and swear by it. They seem a little pent up if I ask them not to do that.

I’m happy to offer my palm for some airy, off-skin swirly-dibbles to clear energy, so that seems to keep the peace. But what about those skin riders?

Shudder.

In a discussion, I would avoid answering my own question, but this is a blog and the rules are fluid.

Intent, I think may be the answer. If the intent is Swedish, to move both lymph and blood, then massage upward toward the heart. If the intent is neural, massage down the spine toward the sacrum. If lymphatic, massage in the direction of the lymphatic watershed. If aruveydic, well, then it depends. Well, is that as clear as it gets? 

Carpal! Foiled again!

Oh yes, it can be so much fun to be in the soft-tissue massage biz. A new client asked for help with numbness at night in the thumb, forefinger and ring-finger.

As part of the overall massage, I did a bit of cross-fiber, compression and MFR on the pronater and supinator.
       

We massage therapists know those are the muscles that turn your palms up or down while doing tasks. For instance, if you are typing on a computer, your pronator is pulling your radius bone over the ulna bone – compressing a whole bunch of stuff in the forearm. When it gets too hot and too inflamed, your wrist hurts and/or your first three fingers go numb.

        

Elementary, to a massage therapist, but for some reason this is often unknown to the client.

     

The forearm muscles felt like bone, hard, adhesed, starved and chronically contracted. Massage strokes help separate the muscles and tendons, opening the area up to circulation.

       

Unknown to me at the time, this client had the testing for carpal tunnel syndrome a week earlier. A few days after her massage, she got the results. Her doctor told her she needed surgery.

“I told him I didn’t need to have surgery because I had a massage and my hands are fine now,” she said.

I felt a bit puffed up with such a nice compliment. Most important, though is proof of the power of doing hands-on therapy before invasive solutions.

The medical literature says carpal surgery works in about 30 percent of carpal diagnoses. Why? Most likely because the tests do not specifically confirm carpal tunnel syndrome but other myofascial problems in the forearm, triceps, even the neck.

Bright Lights, Big Spin

A new massage client had a history of vertigo and migraines. After about $20,000 worth of tests, she had been diagnosed with post-viral balance disorder and sent to a balance clinic. Her therapy was consistent: Flashing lights, juggling balls and teeter-totter devices.

         

She kept mentioning how the migraines and vertigo got much worse during each session.

         

By the time she came in, her vertigo approximated the deck of a rolling ship. The migraines were overwhelming and she had not slept for more than three hours a night. When she did sleep, it was on a mound of pillows to keep the vertigo down.

         

“I’m getting worse!”

Hey, I offered, the important thing is that all the scary things had been checked and ruled out (there’s a big scary list that goes with vertigo and migraines, stuff such as brain tumors and multiple sclerosis,) info I did not share.

I went right for her history. Any car accidents? Yes, a big one 8 years ago with lots of whiplash and torsion. No soft tissue therapy. The fractures took priority.

Ok. Let’s give this a try.

I put the lower half of the massage table down two notches, and she was able to get on the table supine. I went after the anterior trapezial “nausea points” and the headaches points in the ligamentum nuchae. Her vertigo retreated, as did the migraines. Encouraged, I also massaged the masseter and infra-hyoids.

“I think we may be on to something,” I said.
      

Picture This

Massage therapists undergoing postural correction or structural integration often take pictures to show themselves their “befores” and “afters.”

I have been tempted to try this with clients, but on the occasions it has seemed right, the clients seemed apprehensive.

         

“You want to take my picture?” Sounding pretty doubtful, especially early in the therapeutic relationship, about having a photo done.

With so much online media, I thought this question would get easier to fly. Not quite.

With a recent client who had severe gait, lumbar and foot distortions, but seemed totally unaware of them other than the pain they caused, I suggested she have her husband take a cell phone video (on her cell phone) of her walking. Just so she could see why we were working on some areas and to make the tai chi walking exercises seem more worthwhile.

Trying a video at home was more comfortable for her; although she disliked seeing herself try to walk so much she erased it right away.

Tough stuff, I told her, but helpful in seeing how much the altered gait and injuries were affecting her energy.

When we are done, I told her, I bet you will like your walking pictures much better.

Core Strength and Armor

When we speak of “core strength” do we all mean the same thing? I recently experienced a very different version with a client.

Core strength is a current buzzword, with therapists and trainers giving tips on how to develop core, keep core, activate core, etc. as a panacea for injuries and prevention.

I recently read Erik Dalton’s most recent explanation of different cores and massage, with “medium core” as splinting in the quadratus lumborem and obliques to shore up lack of spinal muscular core.

I’ve also been in those martial arts classes when they instruct students to make their surface areas “hard” (external core!) to deflect the blows of others.

My experience with a client recently was a bit different “core” in terms of protecting oneself from assault. This client has been dealing with a very difficult time in life. Her mother has to be in a nursing home because she can no longer keep track of her meals and medications, along with dementia and a terminal illness.

The family first tried to care for her themselves, and then brought in elder helpers, but those solutions did not work.

Now mother is in a home, she has been scheming day and night to find a way to get out, including engineering her escape through a naïve relative.

The bottom line here is that mother has always gotten her way, no matter what, and the penalties for not going along are very, very high. While the positive side of that energy is that mother always got things done, the icky side is that a lot of mean things come out of her mouth when she does not get her way, and the abuse escalates until she wins.

This client prepared herself, rehearsing in the mirror and coming up with answers to her mom’s presumed objections ahead of time.

The next time Mom started to protest her living situation, she was ready.

“I really am trying my best to make sure you are well-cared for, and when you say mean things it stabs me right in the heart,” she told her.

Did it help? “I feel a lot better that I was finally able to say something,” my client said.

The affected muscles?

I massaged her masseter and other jaw muscles, rubbed her tummy to restore diaphragm breathing and also worked with the thoracic spine to release the erectors and neural supply to the diaphragm.

She felt better to the core. But was it core? Or a girding of the loins?

Save Your Hands

Hands are the best tools in a massage therapist’s toolbox and the most likely to be injured.

         

It happens to even the most careful therapists: a burn from a hot pan, a scratch that gets oily, a bit of tendonitis that turns into a raging case of nerve inflammation.

         

Plan A for most therapists is don’t do stuff that can hurt your hands. Hopefully we learned these things in school:

No unsupported thumb work, glide with the whole hand, wrist straight when using pressure. Push with the entire body from the feet, not the shoulders, neck or back. Avoid radial and ulnar deviation during effleurages.

Prudence in off-hours helps, too. No ATV riding, no mountain-biking, no rock-climbing, wear gloves while gardening, etc.

Plan B for many therapists is a few forced weeks off, with the resulting flat wallet. Few of us have disability benefits or the inclination to sit idle.

So there is a need for therapists to tap some resources from our wiser colleagues. Books are helpful, such as “Save Your Hands!” by Lauriann Greene et al.

Most conventions have one if not two classes in ergonomics for therapists, yoga for therapists, Tai Chi for therapists, etc.

I have enjoyed Val Guin’s classes and her DVD “Forearm Dance” that demonstrates the principles of working with a Tai Chi stance and avoiding use of the hands as much as possible.

One good self-audit for your work is to video yourself while performing basic massage moves. You will see when you lose form or go off track.

The resources are there for us to use before injury. Hopefully we can practice prevention and recovery as much as we preach it to clients….

Reward: Used Maroon Astra-Lite Table with Wheeled Black Carry Case….

Other than a rare bad check, my massage practice and business has never been ripped off – until last month. Armed with a pizza, the dog, my phone and laundry, I neglected to make sure all the doors were securely closed on my car that Sunday night.

           

Monday, after doing about 10 errands, I noticed things looked different in my car. The console was light on pennies, dimes and nickels; the papers usually on the glove box shelf were on the floor.  Where is my gum?

I stopped at the next errand and looked in the trunk. My massage table was gone. Along with a nice big bag of clean laundry (they left the bag of dirty sheets) and my coffee can full of pens, cheater glasses and odd bits.

          

“Aren’t you mad somebody ripped you off?” a friend said. “Don’t you feel violated?”

           

Well, actually I didn’t feel that way. I thought about putting a $100 bill in the middle of a bear trap in the driveway, but it seemed like it might create too much paperwork. I don’t look good in an orange jumpsuit. Who does?

           

Revenge takes too much effort. A cracked-open door with a wrapped birthday present on the front seat loaded with exploding skunk stink packs would be too elaborate. Plus, burglars and thieves injured on or by other folks property can sue their homeowner’s insurance and often win. Plus-plus, I can’t wrap presents very well.

Back to the $100 bill fantasy, this time coated with herpes simplex virus, itching powder and dog floop.

Things happen, especially when you don’t make sure to lock the car. I was thinking about a new table anyway.

Meanwhile, if someone tries to sell you a used maroon Astra-lite with wheeled black case….

Forever Gifts

Gift certificates for a massage are always welcome, and if the massage therapist who wrote them is lucky, the certificates are used and result in a new client; if the massage therapist is lucky in another way the certificate is never used.

           

Heck, in California, and possibly a few other states, gift certificates never expire. Once, I had an ancient gift certificate redeemed, after our prices had gone up. The certificate read for a 90-minute massage, and the client had paid $20 less than our current fee. After that I learned to put a dollar amount rather than only a timed service on the gift line.

          

The banks, ever enterprising, have figured out that while certificates don’t expire they can add fees. If the certificate or card is never used, it is eventually swallowed by those fees. They have the fine print to support it. I just can’t see doing that on a slip that says Happy Birthday or Merry Christmas.

Some gift certificates pop back up, mysteriously coffee-stained or crinkly, years later. Did I already mention that they never expire?

           

A couple I had not seen for eight years wandered in this past weekend. The children had bought mom a gift certificate for Mother’s Day – in 2005. She had gotten him one for Christmas in 2006.

          

 “Ooh, this expired yesterday,” I cooed. He grinned back, a little embarrassed, but not enough. “Of course this is still good,” I said. “Always.”

          

Glad for the opportunity, I suggested they were both overdue for massages. “I can’t believe you haven’t had a massage since 2006,” I said. “This is good for you.”

           

This couple was a little tight, a little tired and a lot stressed.

“What is the occasion?” I asked.

“We are going to Costa Rica for three weeks.”

  

 Oooh, speechless am I.

The Diabetic Foot

Some regular massage therapy is a good thing for most diabetics. Swedish strokes tend to help lower blood sugar, and structures suffering from loss of blood – from bones to the soft tissues, enjoy a boost of circulation.

         

Most people think of diabetes as an imbalance of insulin hormones, but we massage therapists see the true disease – lack of circulation throughout the system as cells struggle with basic movement of nutrients.

         

With many clients this massage therapist works intently to improve circulation, especially in areas of the hands and feet. Such detail as massaging each toe can help prevent diabetic ulcers and other skin breakdowns. I am always on the lookout for any signs of skin compromise so it can be evaluated quickly.

         

With insulin-resistant diabetics, Type 2, I also look for ways to improve their ability to walk moderately to lessen the effects of the disease. Some diabetics, however, who have had the disease for a long time can develop a softening of the foot bones that can lead to collapse of the structures. The condition is called “Charcot foot.“

         

I had seen Charcot only in books until a recent client came in hoping to relieve some back pain. Massage for the back pain and hip muscles relieved her troubles for a few days, but as time passed her lumbar pain returned.

         

When I looked to her feet, I found bumpy surface lacking all three arches. The main medial arch was flat and had a very hard, round spot dead center – a foot bone had possibly dropped down through the arch. The lateral arch was also flat with another dropped bone. The last arch at the base of the big toe and second toes was also flattened and most of the toes had hammered down in response.

         

Her ambition to walk 30 minutes a day on the line, she checked with her doctors, and they diagnosed the Charcot foot.

         

Her doctors have advised her to wear orthotic, supportive shoes at all times – not just when out of the house. Also, she has to wear supportive arched wet shoes when doing pool exercises.

         

As massage therapists, we are often telling people with arch problems to make sure their feet are supported around the house and patio in addition to when they walk outside.

         

With this and other diabetic clients, we massage folks can help not only with suggesting people have their feet checked closely for ulcers and skin breaks, but also for structural problems worsened by the disease.