Category Archives: Touchy Situations

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.

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.

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Real Practice for Real Massage

On a massage therapist’s first day at work, the training starts with how to say hello to a client. Easy?

Oh heavens. I have had massage trainees stare at the floor. Roll eyes in a complete circle looking everywhere but at the client. Worst, a brief nanosecond of eye contact followed by staring over the head.

How would you feel to be greeted these ways? Would you go into a room, take your clothes off and figure everything is going to be fine?

Yes, sometime before massage therapists become overnight successes because of their fabulous hands, they need to learn the art of eye contact. Yet for many of the massage community, we’re introverts, looking for a quiet place to work in harmony. We didn’t think about developing eye contact because we are not social divas, by and large.

That first day of looking a stranger in the eye can bring out insecurity for a walk right across your face.

Here is the really bad news. When you cannot look someone in the eye they don’t see shy and humble. They see sneaky, dishonest, and even incompetent. Fear or loathing. Aloofness. Distance. Not the first impression anyone would want to make with a client, ever. The last impression a therapist wants is a wrong one.

With two or more trainees, it is fairly easy to practice greetings with each other. You do not know each other, but you are in this life raft together. We will go over it about a dozen times, and toss out those little things in our expressions and eyes that say the opposite of the greeting we speak.

It takes some doing especially when the new trainee is solo. One of my solo newbies was getting great feedback on her massage, but her surveys indicated that her greetings were getting in the way. The telling question – would you request this person again – was not going her way. If the survey says the massage was great, what to do?

We had a talk over mocha bobas, a drink invented by people who want to make me feel old.

It went something like this:

How are things going?

Great! I love my job!

Fantastic. How are you doing with building your client list?

I’m getting some people back. Not as many as I thought I would. It seems to take time.

Is there anything that you think would help you?

The dreaded open-ended question. A pause. This is the most uncomfortable time. But this new therapist was intelligent and gifted. She knew what I was asking.

I think I need more help with greetings.

Let’s practice now. Go up to the barista and ask for something more. Look her in the eye. Greet her like a client. See if you can connect with just your eye contact.

She tried it, and came back.

That was tough. I felt like I was staring at her, invading her space. It was very uncomfortable. I don’t like it.

Suppose that is the only way to get your coffee, or anything else in your life that you want. Can you make eye contact? Can you practice enough in the next week to get comfortable with it?

Yes, it was an assignment. When we met for coffee the next week, her discomfort was less, her confidence more. We can still both be shy, I said, we just have to learn how to connect with our eyes and our hands.

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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.

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 medicalmassage@groups.facebook.com 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: http://www.bodyinmind.org/treating-whiplash

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?

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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.

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.

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The Downs of Stress Breath

My 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.

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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.

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.

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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.

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….

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Have you tried giving a massage using silk instead of oil?

We massage therapists love our helpers, be they oils, warm stones or essential oils. Lately I’ve come to totally enjoy something I at first thought would be a bust.

Massage on silk is a method of gliding the hands across skin or clothes without the use of oil. Silks provide glide, like oil, but without the drag or irritation.

My first acquaintance was with an educational video on chair massage by Boris Prilutsky a Massage Hall of Fame member and long-time instructor and therapist.

silks2

Prilutsky notes that silks have been used in ancient Chinese massage not only for glide but also for positive energetic properties. Interested now?

My own experience was highlighted when I began looking at how to make workplace chair massage easier on the therapist and recipient. A silk square tossed over the back gave me not only additional leverage but also the ability to effluerage as if using oil.

Since then I have introduced a few therapists to silks as a means of chair massage, much to their delight. Instead of using only rolling compressions or static pressure, the silks provide the glide that clients crave and that we love to provide.

Here’s a quick primer on using silk: Buy a yard at the fabric store. It can be cut and hemmed into at least two back-sized squares. I went to the alterations shop to have my silks done.

There is also a commercial product on several of the massage supply websites that is already for use.

But I like finding my own nice massage color: healing green, warm blue, healthy pink, patterns, whatever strikes my energy and disposition. If you have a favorite silk shirt that has snagged or is somehow on its way out, you can cut out the back and use it as a massage silk.

Silks don’t have to be washed much especially when used over clothes. Cleanse in warm, not hot, water and hang dry. I like to keep a couple of silks handy, especially when I know I may be faced with an area that needs its facile touch. Enjoy!

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Field Trips, Diaries and Memoirs

The day after the Fourth of July I took time off from massage to see the Museum of Tolerance in Los Angeles. The museum is a living testimony – every day a survivor of a death camp speaks to visitors. Pictures, old films and recordings bring those times alive.

I was not thinking about massage, really, as we made our way through an exhibit on the life and death of Anne Frank. Our tour guide pointed out that Jews were one percent of the European population at the time, but were made scapegoats for many problems that occurred after World War I.

As the noose of fascism closed around their necks, no country would take them. No religious or political leaders spoke up for them. They were isolated and stripped of their humanity. What started as simple bullying transformed into organized genocide.

So what did it have to do with massage?

Pardon me while I answer my own question. I often see a substantial number of clients who have been bullied – something about them or their appearance or heritage – something brings out predatory behavior in some people. Often the bullying is public, and most people just stand by and observe.

It’s an unhappy facet of human nature and one that we all know and see at some point during our lives. And what of the ones who are bullied?

They often have chronic pain and stiffness leading them to the massage table. Sure it is not everyone who has ever been bullied, but a substantial number. I suppose some people who are made targets punch back and defeat their bullies.

Some thoughts to think about: Can people suffer the effects of aggression for many years after it occurs? Can we do something about it?

As a massage therapist, I think I already have those answers. Would it require changing the world? No, just letting people know when picking on others is not acceptable. I’d like to see fewer people for chronic tightness and pain caused by bullying and fear….

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A Massage Therapist’s Top Ten

Debates roar among massage therapists about which are the best oils, the best draping, and the most effective techniques. Yet never have so many argued so passionately about this question: whether to start clients in the supine or prone position. O the polarity!

So many have crusaded with passionate arguments about breath patterns, face-cradle wrinkles, sinuses, etc. But we all know the real reasons to start up or down is exigency.

Let’s hope the clients never find out.

Sue’s Top Ten Reasons to Start Massage Clients Facedown:

(Guaranteed to be from actual experiences in the Wild Wacky World of Hurry Up and Relax!)

10. My neighbor upstairs likes to stomp on the way to and from her hourly cigarette break.

9. Whatever you had for lunch, I’m investing in a dab of peppermint under the face cradle.

8. Your assistant called ahead and asked me to put you in a coma.

7. I am hoping you won’t notice the sudden appearance of wet stains on the ceiling.

6. Your spouse made this appointment and asked me to keep you here for at least two hours so she can get in a nap.

5. We can’t get the flashing-light fire alarm to stay off. Perhaps it has to do with someone’s bright idea to dry body brushes in the microwave.

4. The rips in the sheets might not be as noticeable.

3. I don’t want to listen to the rest of your multi-level-marketing pitch.

2. I went to lunch at the taco joint – beans!

1. Is that a hernia?

Of course, there is always the competing Number One Reason to Start Massaging Clients Face-Up: I can’t find the face cradle.

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