Category Archives: Massage Techniques

Massage and the Full Sixty…

When I was new to doing massage therapy, I had a habit of getting lost. Lost in the neck, lost on the back, lost in the space-time continuum. I’d glance up at my clock and see that I had spent 40 minutes massaging the back and I had 20 minutes to do the rest of the body. Or worse yet, 40 minutes just on the headache, and had 20 minutes to get hands on everything else!
And, learning point, most massage clients will be unhappy with that schedule. People will rarely complain, but they may decide not to come back. All my enthusiasm to erase that headache would cost me the opportunity to gain a client. Drat!
It happened often enough that I found a couple of solutions, which I will gladly share, and I timedeveloped some hacks – ways to get the client to forget that I had just given an uneven massage.
Fasten your seat belts.
Ask – Let the client decide – “Would you like me to spend all of our time today on your headache or do you also want a full-body massage?” Guess what the answer is 90 percent of the time…Full-body.
The clock – I drew a circle on an index card. The first 30 minutes was blocked in red, the next 10 in blue, the next 8 in yellow, etc. I hid the card behind my oil bottle, right next to my clock. The red zone was for the back and posterior arms. The next 10 minutes for posterior legs and feet. Eight minutes for anterior legs, eight for anterior arms. Four minutes for head and scalp.
Keep the card in view and practice, and you will run on time.
Okay, so what to do when space aliens have stolen your brain and you don’t have enough time to finish a full massage? When fudgsicles happen, make fudge!
Swoop – Big, long, slow, wasting Swedish effleurages. Three swoops to a limb will still trigger the parasympathetic nervous system. A timeless coma will result.
Hide – Stay in the room at the end of the massage and hold up the client’s robe in front of your face and conveniently stand in front of the clock. Offer to assist by holding the robe while they slip in arms and stumble out. “Let me help you with your robe.” It works.
I don’t recommend what one therapist did to me one day at an otherwise nice day spa. She carefully pointed out the clock to me to show that we were running on time. At the end of the session I got up and looked over at an empty space. She had removed the clock!

Adding Magnesium to Massage

Got Magnesium?
Turns out that might be a great slogan for massage therapists – if they look both ways and proceed with caution.
Magnesium as a topical aid, and along with ingested and intravenous magnesium, has been used for a very long time in the treatment of muscular cramps and spasms.
Magnesium is the other side of the calcium formula. The movement of calcium ions out of a cell make muscles contract, while magnesium ions make muscle fibers relax. For people in the relax biz, magnesium could come in very handy.
And many folks seeking a massage are likely deficient in magnesium, possibly because we don’t eat enough of the sources – green leafy veggies, beans and bananas.
Should you add magnesium to a massage?
Well, let’s look at what’s out there.spray
Epsom salt soaks are our most traditional way of introducing topical magnesium. Many therapists make their own retail packages for client to buy or take home after a massage. A few drops of lavender or eucalyptus added to the salts and an organza bag, and the massage therapist has a take-home item for you.
But how many times do you see clients who cannot physically get in or out of a bathtub? Or don’t have a bathtub?
Epsom salt compresses are the next step down – but we all know compliance with this advice may well be zero. What client wants to wrangle wet and dry towels and plastic sheets?
Epsom salt lotions now readily available in most drugstores are another good solution. These do, however, use some pretty synthetic petrochemicals to get the hardy Epsom salts to stay in solution. Some clients don’t want that.
Oh dear, leave it to the healthy marketplace to find solutions.
Now when I head off to the vitamin health food store there’s a little group of magnesium topicals at the ready. And here’s the rub. Some don’t feel real good when applied to the skin.
My favorite one is magnesium oil spray, which is magnesium chloride. Yup, a salt. After a nice vigorous deep tissue massage on my professional test body, my spouse, I added a spritz to a tight shoulder. Immediately producing a stinging feeling described to me as rubbing salt on a wound. Run for the wet towels.
I like to use the magnesium oil spray on myself right after the shower. I tell clients to avoid it after shaving, to avoid the ouch factor.
After that experience with my professional test body I have never sprayed magnesium oil on an area post massage. I notice the makers were suggesting it as a massage oil additive, but after my experience with my unhappy test body, I’m not putting it on freshly massaged skin anytime soon.
Other forms of magnesium abound. I don’t go there with magnesium pills or drinks, largely because that’s not what I do. I massage, and telling someone to take something internally seems a bit out of my expertise area.
But for people who might need it for night cramps or diet deficiency I let them know it is out there, and they need to read and follow directions. Magnesium isn’t good for weak kidneys and in large amounts ingested magnesium is a super-dooper laxative!

Massage Hygiene and the Return Visit

People who give massages hopefully like receiving massages. I know I do. When my therapist friends are out of town or otherwise engaged, I have a few places I will slip into to try their hands.

I found one therapist purely by chance who really knows how to do meridian and nerve-based massages, something my low back appreciates greatly. So I was surprised when I got into the shower one day a few hours after my massage and found large, red welts on my back, suggesting that I had teenage cystic acne.

In the mirror I saw big, red and itchy bumps all over my back, especially on the lines of the sideline meridians. I had either had a reaction to the massage oil or somehow some sort of bacteria had been introduced into the skin during the massage.dirtybottle

I thought, probably like many clients, that I should simply not visit this therapist again. Something had been dirty, the oil, the bottle, the hands, something. I had showered just before the massage, so I did not think it was my skin. Oh well.

Then perhaps, like some clients, I though about the affection I had developed for this particular therapist. I liked her style and her results. I decided to see her again and tell her about my reaction.

Once we were alone in the massage room, I explained that I had some sort of reaction to the massage and had been nursing the bumps with arnica and witch hazel. I showed her the pattern on my back. She looked stunned.

“But I always wash my hands, and I make sure the linens are clean and fresh.” she said. I pointed at the oil bottle. “Do you wash it? Wipe it? Does anyone else use it?”

Hmm. That was possible, she said.

As massage therapists we see a lot of people and often use the same bottles and oils on each client. Can someone have sensitive skin? Sure. But what if it was the oil layer on the outside of the bottle? What if the oil itself was contaminated with bacteria?

No sure answers there. But here are the basics of keeping clean between massages and during successive massages in a busy practice or clinic.


  • Always wash hands after and before a session. Washing hands at the end of a session is a half-measure. You will handle materials, perhaps dirty linens, doorknobs, credit card machines, etc. before your next massage. Wash hands again before you start.
  • Wash the exterior of your oil bottle as well, especially if someone else is using your room and supplies on your days off. Slick bottles can transfer bacteria to all of your clients that day and beyond. I wash oil bottle every day and use anti-bacterial wet wipes to clean bottles between clients.
  • Never stack linens for more than one client. Some therapists think they have found a great way to avoid scrambling for linens by putting five or six settings on the table. Well, no certain infections, such as scabies, can be passed from one sheet to another. You don’t want to be explaining your timesaving system to an inspector from the health department.
  • Hand washing is done with warm to hot water and soap and requires rubbing both hands together for at least 15 seconds. Rinsing, one-handed washings, or other half-measures don’t count. Over the years I have learned to follow-up my hand washing with a cold-water rinse. Good for my poor paws.
  • When using a jar or tub of massage cream, use a clean or disposable spatula to scoop from the jar. If you stick your fingers in the jar, you are cross-contaminating any bacteria to your whole client book for that day and as long as you use that jar. Cover the jar in between scoops. Better yet, use oil with a pump or flip-top.
  • Use cleaning cloths with hot water and a cleanser or anti-bacterial wet wipes on common surfaces such as towel warmers, crock pots, essential oil bottles, anything in the room that might be touched by oily hands. If you only clean when it is slow, or you rely on a cleaning crew for these details, you may be spreading bacteria and other germs.
    • Some massages start with a foot massage, either because of the client’s symptoms, wishes or the therapist’s training. Tell your client as you finish their feet you are going to wash your hands and will be back in a moment. Some people have fungal infections, bacteria, etc., or go barefoot, and your foot massage can spread skin infections to other areas of the body.


Better safe than sorry. By the way, I decided to stick with my therapist, largely because she was concerned and eager to learn how to prevent more skin reactions. Just like a client, I appreciated her attitude and its promise for future reaction-free massages. Cleanliness fills your book.


Massage with the Eyes in Your Fingers

There is a time in every massage when the therapist begins to rub the posterior neck. For many of our computer-burdened clients, it presents an opportunity to relieve the congestion of technology.

The head is supported by these many muscles, embedded with many layers, often adhesed, and near the source of many functions from sleep to mood to respiration.

Headaches emerge from these groups, as do disorders such as head-forward posture, and as some suspect even problems such as chronic fatigue.

So what do many of us do when we approach the root of these many complex problems? We effluerage upward, in the direction of the cranial vault and away from the shoulders.

Medical Illustrations by Patrick Lynch, generated for multimedia teaching projects by the Yale University School of Medicine, Center for Advanced Instructional Media, 1987-2000.

Medical Illustrations by Patrick Lynch, generated for multimedia teaching projects by the Yale University School of Medicine, Center for Advanced Instructional Media, 1987-2000.

Let me make a case that we are drawing our hands in the wrong direction. Take a look at the accompanying picture from Wikipedia. See all the muscular origins? The SCMs, the traps, the cervical erectors?

The upward effluerage comes from the general direction of Swedish massage, which is in the direction of the heart, following venous flow.

But at the shoulders, we are no longer drawing toward the heart, but away from it. This draws thumbs and hands into the great space at the under-cranium, the place where those headaches and balanced-head issues hide.

With congestion disorders from headaches to fibromyalgia, we may do much good for our clients by drawing down from the hairline toward the mid-trapezius.

Try drawing congestion away from the source, toward the crux of the trapezius. You might be surprised by the results.


The Good Massage Therapist

Here’s my shortlist for what a good massage therapist needs to know:

Talk to the client first, not during a session. Get enough information to know what the client seeks, whether they want a complete massage or spot work, and if they have medical conditions that should not be massaged. This communication takes only a few seconds. A good massage therapist always has time to communicate.

Know Contra-indications: A client with a cold or kidney infection can develop much more serious infections if massaged. A good massage therapist knows the reasons not to massage and how to explain that so the client doesn’t get angry.goodtherapist

Practice Universal Precautions: Protect your clients and yourself. If you don’t know what universal precautions are, you are not practicing safely. Good massage therapists know how to practice without spreading disease – or going overboard and putting on gloves when there is no rational need.

Pressure: The point of an effluerage is to soothe, not startle. Pressure with a first effluerage should be mild and stay the same all the way up. Therapists who start light on less sensitive areas and then suddenly drill sensitive tissue at the end of an effleurage could be called grinders. Not a good rep.

Timing: Twenty minutes on the feet because you like foot massage is not a good opening if the client wants a full body treatment. A person with a headache usually wants their head rubbed first.

Encouragement: We don’t fix, we soothe. A positive word goes a long way in helping people feel better.

Goals: What you want to practice that day may not be what the client wants. They may just want to fall asleep. Check-in. Ask before doing unusual techniques For example: whiplash clients can be very afraid of having someone traction their neck by suddenly lifting their head with a towel. If they don’t understand or agree, they will tense up.

Massage to Measures

Massage therapists like to think we help people deal with stress, injuries and fatigue. But how do we know we help?

Massage is, after all one-on-one. We are stars or idiots one hour at a time, and we often don’t take much credit for our clients’ successes or failures. Is a massage therapist a facilitator or a game-changer? Do we really know?

I’m reminded of the times I thought I had no clue what I was doing, only to have the client hop off the table and give me a compliment and a big tip.

But I also remember that once on vacation – after one particularly hideous massage from someone who thought they were fantastic – that I said thank you and left a tip anyway. I made a mental note of the therapist’s name in case I ever happened to go to this resort again so I could get someone else.measure

How we measure ourselves and our effectiveness in massage therapy is something of an emerging issue. In a practice that is more art than science, can we really measure ourselves?

People have often received treatments for medical conditions that have no proof or promise – but the treatments are tried in the belief that they may relieve suffering or repair the underlying condition. That is the art of medicine.

Can we also preserve the art of massage while some therapists attempt to move into the medical – and the reimbursed – field?

A recent post by long-time and very respected massage instructor Noel Norwick of Los Angeles asked the question on Facebook.

His question on group referred to a study. It found that soothing talk – reassurance – worked just as well as physical therapy treatment after whiplash. Here’s the link:

It appears to say that treatment versus soothing talk have the same results. My comment was that it might say much about the quality or delivery of treatment instead of its effectiveness in the right hands.

Would that be the case if reassuring talk were compared to massage? I think not. Hope not. But let us ask this question another way – if we could offer nothing hands-on, would we offer reassuring speech? Isn’t that sometimes the de facto treatment for stress disorders – even though many of us would propose that massage would be much better?

Heavy Hearts, Light Touch

A massage therapist’s toolbox is crowd with all kinds of fancy techniques to address troubles in the body.

Yet one of the most effective techniques one can use to release tension is to say something. Just a little something to put the client at ease.

A small joke is letting clients know your empathy for their stress. Yes, the inmates are running the asylum. The Red Queen has lost her head. Welcome to the “e.r. for p.r.” Some people drive like they think –not. It is part of life to acknowledge the crazy and nonsensical.

Life teaches us that the way to release tension is to laugh, and sometimes it is the best solution to release thoracic tension during a massage.Transversus_thoracis

For people who have recently been through the wringer, and back again, it is good to remind ourselves that we can laugh at the strange things in life.

It gets clients ready to relax. It says you understand, that you have been there, and no matter what else transpires in the next hour, you have met a friend who gets it.

Not a bad way to start? It will not work for everyone, but it often is a great opening to healing energy. If the body can laugh, it can raise and lower the rib cage, it can expand and contract the diaphragm. It can liberate itself from the heavy weights of life.


The Downs of Stress Breath

bellowsMy client had tremendous pain – 12 on a scale of 10 – in the area between the shoulder blades. She begged for deep pressure massage, and that did lessen it temporarily. But after 2 days the pain remained a 12.

How many times has a client begged for a tough massage in hopes of relieving pain? And how many times has that solution been temporary at best?

Upon this client’s return visit we had a talk. I explained that no amount of pressure would budge the pain pattern because it was originating from the front – the area where the rib cage meets the sternum — the costochondrals.

A leak had been discovered in her condo and a fairly heated fight had ensued with the homeowner’s association over who was responsible. It was several weeks before repairs were finally done. My client had been breathing shallow, from fear of mold spores, and fear of a huge repair bill.

After many massages, therapists come to understand how fundamental relaxed breathing is to health. Clients who are stressed breathe less deeply; they develop problems over time from shallow patterns of breath.

My acupuncturist friends tell me that in terms of energy, the diaphragm is the bellows of the body. If it is tight or dysfunctional, the energy stagnates. Acupuncture looks to relieve the traffic jam and restore the diaphragm’s natural movement.

If this seems technical or not applicable to most massages, think of the upper posterior serratus right at the apex of the shoulder and neck…how many times do people seek massage for distress in that area? I can’t imagine the last time a new client didn’t point to that spot.

Stress breath is what we treat whether we are doing basic Swedish or more complex massage techniques. It’s all in the core of the body’s energy.

My client, by the way, was much relieved by massage of the sternum, costochondrals and rib cage. (This is done with proper draping and avoiding the breast tissue.) Perhaps next time she might even let me massage the diaphragm.

The Snooze Button

It’s a great compliment to a massage therapist when the person receiving falls asleep during a session.

Those little zzz’s say trust, relief, serenity and healing. And for this massage therapist, it most often happens during the Swedish portion of the treatment, when long flowing strokes push dream-like consciousness over the line into sleep.

So what on earth is going on when the therapist finds a knot to end all knots and the client takes a snooze?

Let me explain. In the midst of a treatment combining myofascial release and TrP release for adhesions and tension in the temporalis and masseter group. My client went from “that’s it”…” to total zzzz’s. During trigger point release!

I hit the Travell & Simons (not Simons & Travell) trigger point chart – I had touched, very lightly, above anterior TrP1 of the temporalis. Whatever happened next was totally weird.Pterion

The client went into sleep, snoring lightly and diaphragm breathing for perhaps the first time since I’ve been treating her. Y-reka! A minute later it was gone.

“I don’t know where I went,” she said. “No idea. But it was nice.”

“I’m not sure either,” I said. “But you relaxed beautifully. I think your whole body just did a reboot.”

I’ve been looking in a lot of my massage books, but only finding general points to induce sleep. I flipped to Wikipedia for help. In this region the skull bones are thinnest. It is the junction of the coronal, sphenoid-parietal and squamous sutures. This area is certainly a big player in the TMJ patterns of jaw clenching and imbalanced sutures. Craniosacral anyone? Polarity?

Baffling. This little spot is called the Pterion. Uhuh. Try saying that with a mouthful of granola.

Exploring the Body’s Bermuda Triangles

Massage as therapy can be pretty basic. Therapists compress and glide along major muscle groups in the direction of the heart. The effort requires skill and practice. It reduces tension and boosts circulation of blood, taking some load off the heart.

That kind of therapy is refreshing and soothing. But what about the spots that make the tension return and impede circulation?

I have come to think of these areas as the Bermuda Triangles of the body. Stuff flies in, and it never flies out. Inside the stress of life is found: Too many hours at the computer, the unpleasant anger of a loved one, the contracted fear of an old injury.bermuda triangle

For myself, and I suspect most therapists, the challenge in massage is to identify and release these zones so the person has a massage outcome that lasts and gradually heals the area. Easier said than done.

My most frequent triangle is at the posterior shoulder, roughly the area of the infraspinatus. This area tends to get skipped in general massage that focuses on major muscle such as trapezius.

In this area I often find near stone like contractions, loads of trigger points and for whatever reason, unresolved grief. Slow gentle work from Swedish to rolling to restore circulation leads to light and gradual TRP work and lymphatic drainage. When this area feels “normal” again – that is its temperature and texture feel like the rest of the body, headaches, chronic shoulder pains and even thoracic outlet symptoms fade.

My next Bermuda Triangle is the upper posterior shoulder/neck. Here lay a number of stuck structures: posterior scalenes, the oft-forgotten serrate posterior superior among them. What lies beneath? Treatment here often opens the diaphragm, perhaps by inhibiting reverse breathing.

For the stuck pelvis, along with referral hip and lumbar pain, I find the next triangle at the posterior-medial thigh. Here hamstrings often stick to neighboring adductors, pulling the legs inward and affecting balance. This area seems to be directly connected to unexplained pelvic pain in women. Hmmm.

My next fun zone is the medial calf. Here lies the only area of the soleus and posterior tibialis accessible to massaging hands. Here lies also a lot of leg stiffness, ankle dysfunction and lack of stability. Even simple effluerage help in this no-man’s land of the leg. With major lymphatic channels deep to the soleus, virtually on the posterior tibia, this is an action zone for swollen feet.

Some themes arise from the patterns. The lower body triangles are very protected and core supporting. The uppers are surprisingly accessible but daunting. It is very difficult to apply techniques there because of a combination of pain and sensitivity there. Some first massages are simply spent making the brain aware of these spots.

As ever I am curious how therapists deal with these areas and how they identify ”Bermuda Triangles” in their clients….