Category Archives: Touchy Situations

Massage with Attention and Distraction

Massage therapists know that many clients need to be listened to – really listened to – when they come in for therapy. But during the session there is something else that clients crave – the ability to be distracted away from their focus and relax.

I often use distraction in massage sessions, oddly enough in an attempt to help the client create mindfulness. A paradox? Yes, but it works.

In the anatomical sense, distraction means pulling one bone away from another to reduce contact – without injury to the joint.

In the massage practice sense, sometimes people are getting a massage to stop running ideas through their minds – to stop ruminating on a problem, pain or injury.

This is where as therapists, we can help clients by allowing them some time to put aside their problem or problems. It gives clients some time to divert attention, for example, by focusing on diaphragm breath, or feeling their shoulder as part of their bodies instead of a source of pain.

Surely the switch between sympathetic and parasympathetic nervous systems is in the driver’s seat during this process, but the touch of hands consoles and fosters the release of vigilance.

Giving the brain up to its basic self – respiration, registering the feel of nerves, bones and muscles, these are gifts for clients who have much stress. My biggest compliment can be a sleeping client at the end of a session.

A wise massage therapist can say: Sometimes the act of forgetting can be just as important as remembering.

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Providing Post-Surgery massage to clients

Clients seek massage therapy for many reasons, and one of the most challenging for a therapist is chronic pain following surgery.

It’s a tough spot – here we are dealing with tissues that have had a direct surgical intervention – moved, touched, cut or compressed. We also are dealing with structures altered when the body’s healing response forms scar tissue and adhesions.

Massage therapy, thankfully, is low-tech when it comes to post-surgery pain. When I first began treating clients for this type of problem, I referred to muscular patterns of pain and overlapped them with “dermatome” patterns – meaning areas where disturbed nerves can cause pain.

Often stabbing or sharp pains can come from nerves that have developed adhesions or stress patterns from scar tissue pulling on them. These changes may occur far above the area where pain is felt. The massage is always gentle and soothing, following the course of nerves through plexuses and their redundant branches.

Another technique is pain mapping – each time the client returns we again map the pain areas to see if they have changed. If has altered or lessened the pain then the areas treated may be part of the disturbance.

Abdominal breathing is also an important part of these recovery massages. The diaphragm is inhibited by pain and restoring its function – awakening the “bellows” of the body allows for gentle stretching of muscles, organs and nerves. Ultimately diaphragm breathing is the gentlest massage of all.

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Helping your clients set goals for their massage sessions

I always like to check in with new clients on their goals for massage. Do they want to improve sleep, performance, reduce aches, release stress, etc.

I like to give people a few choices on my intake, plus the opportunity to mark “all of the above.” Lots of “aota’s” later, I have come to see what it truly means to some clients. One such new client put it so well:

“I would like to do what I want to do, when I want to do it.”

His statement made us both laugh, because it often sums up what we all want in life: freedom. We want freedom to enjoy activities without thinking about consequences.

I have to admit that massage cannot deliver that goal.

“When I get to that place myself, I’ll let you know,” I said.

Meanwhile, it made me think about what am I really selling as a massage therapist. When I find, treat and track dysfunction I am perhaps vending exactly the opposite: Allowing people the opportunity to choose after careful consideration of their abilities and consequences.

We all have choices, and we make them sometimes a bit too quickly. Choosing to stay at a job that is no longer fair or fun is a choice: people make those decisions for other kinds of rewards. When they come in for massages, I try to help them survive and feel better about that choice.

Massage can’t fix a lot but it can set the mood for people to adapt and make better choices when it comes to stretching, exercise, foods or sleep.

If I think back to my sandbox days, it was all about trying to have things my way – and I was guided to make a better choice for myself and for the future. Human nature, in deed.

Perhaps I would suggest this goal instead:

I would like to be able to do what is good for me, I would like to enjoy doing good for me, and I would like to do it when it is best for me to do it.

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Starting Choices, Massage Therapists

As they graduate from education programs, massage therapists have many choices for employment. Yet finding that perfect job can be elusive.

The venues have expanded in the past few years but the economics remain the same: work a lot for less pay, work a lot less for more pay.

For recent graduates looking to pay their bills – and their student loans – the pressure is quite high. How do newbies balance reliable income with recognition of their skills? start

As an experienced massage therapist, I don’t have all the answers. But let me suggest some strategies that can help graduates maneuver through the first years of their massage careers.

Use your Advantages – Most massage therapists are women, and often female therapists who are attractive can build a book of clients more quickly. So put that picture on your resume, business card, website, whatever, and prepare to get busy.

Better yet, Use Your Disadvantages – Male, muscular and big? Men who do massage face discrimination from clients both male and female. The reasons, trust me, are very unfair. But why not make it an advantage? A male can be a strong, resilient chair massage therapist. Chair massages are done fully dressed, often in public places such as conventions. That eliminates a lot of objections clients have to male therapists. Those practices bloom.

Gender politics can be an advantage in other situations. I also know a female therapist who looks and acts non-feminine. Is that a problem? Heck, no, she told me. “No trophy wife ever has to worry about me making a play for her husband.”

Have more than one source of income – My friend’s career strategy was simple – her income was secondary to the family breadwinner. Her husband handled the bills and worked the long hours of a tax accountant. That left her time to groom and select her clientele without a lot of money pressure. She also had time to volunteer and market herself. She worked at high-end spas and targeted her favored client type – professional athletes. It took years to build a clientele, but she got there. She has a great elevator speech, and the more she practiced it, the more it became her practice.

Do more than massage alone – Another of my friends runs her own day spa and has a cosmetology license. along with a massage license. She can wax; do facials and other cosmetic treatments to fill her book. A slow massage day can be a busy wax day, etc. She didn’t like cutting and coloring hair, but she loves doing facials, massage and waxing.

Some therapists can increase incomes by doing administrative and billing work at their chiropractor’s offices. Another friend also works as a personal assistant, running errands for people who are too busy or too old to do errands.

Work in Multiple Massage Venues – A doctor, a chiropractor, a spa, a chain, a physical therapy clinic, a hotel, a mall chair-massage store. You may surprise yourself to discover your best fit. And if one venue becomes slow, another may be busy.

Be Productive No Matter Where You Work – I call this the “Joseph” strategy. Like Joseph in the Bible, maybe your brothers don’t like you and you get sold into slavery but you work hard and do so well you end up running your master’s house and businesses.

Where you start does not have to be where you end up. Use your venue as a learning laboratory. Does your chain want you to sign up members? Practice so you can figure out how to do that. Sell products? You can learn how to do that, too. What about upgrades? Some of the more corporate places have quotas for therapists. Instead of stressing about meeting those quotas, can you figure out how to fill them? boybaseball

I met sales quotas at a spa by asking someone who could sell how to do it. I sucked at it, but kept practicing and asking questions until I go it. You can also read up on sales techniques, and you can observe those who are successful at it. The key is practice. Being a productive massage employee is all about trying multiple times. Kind of like baseball, hitting three out of 10 times makes you a superstar.

Massage for Shingles ‘Ghost’

A new massage client had a request: eight months after an outbreak of shingles, she still had a strip of weird-feeling and painful skin.

“I call it my shingles ghost,” she said. “It’s haunting me still.”

What she described sounded like post-herpetic neuralgia, a sensation that an area afflicted by herpes “chickenpox” virus is still active.

And no, she didn’t need an exorcist. Just a good massage.

As a massage therapist I have seen shingles outbreaks in many clients, and for the most part the clients are older than 50. Occasionally I have seen it in young people, usually after a period of high stress at school or in their family life.

Massage therapists steer clear of active shingles, asking clients to get a doctor’s clearance before having a massage. The reason is not for self-protection. Shingles is not catchy. But massage of an active outbreak area can worsen the attack and slow recovery.

That said I have never had someone with active shingles ask for a massage. They have generally been embarrassed by the outbreak and have called to cancel or beg off massages for a while.

Opportunity knocks, however, after the outbreak has ceased. The outbreaks are painful, screwing up sleep patterns and requiring odd sleeping positions to avoid a painful side or back area. When the client is cleared to come on for a massage, he/she is more than ready.

As was this client, who had suffered through an outbreak that crawled along a spinal nerve from T-5 or t-6, circling the left side from spine to sternum, roughly even with her lower bra-line.

This presentation is classic in shingles, and very painful. Somehow this client had mustered on through a huge deadline at work. When she told me about this determination I had my first clue about how to massage her.

With the client prone, I checked the area of the outbreak for any reddish, hive-looking sores. None. The left side looked same as the right side. I palpated along the spine and asked her to let me know when I was on the spot. I began at T-2, and she pinpointed the spot roughly over T-6. Sometimes the lightest technique can be the most freeing. I tried to skin-roll the section, listening for a pop or some other sign of release.

Lucky for us all it seemed to release the sensation. I suspect the feelings were the result of an adhesion over the area, probably aggravated by the bra. I massaged the length of the T-6 dermatome, under the bra line and to the sternum.

All the area really needed was some TLC. Massage after a shingles outbreak is good indeed. She told me next time she came in that the “shingles ghost” was gone for good.

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Stress Experts Love Massage

At this time in my massage therapy career, I think I have got the whole stress thing down.

Then something pops up that tells me: HA! Yes, HA! A very karmic and cosmic and pulse-wave HA!

My family and i have been living in a hotel for nearly a month following flooding at my home. A simple toilet clog and my house was drenched with watery pooh. Men in white mooon suits put big hair dryers in every room, and me, the dog and my 90-year-old mother-in-law were off to the land of free hot breakfasts. Oh, did I mention that hunnybuns went to the emergency room? In all the rush for towels, my dear one fell and snapped a thumb ligament.

All together, we are very lucky. Lucky insurance is covering almost everything, lucky the damage was mostly to floors and drywall, lucky hunnybun’s injury was not worse. We are sleeping in nice beds. I don’t have to wash my massage sheets by banging them on a wet rock. During this I have found the stress meter running into the red zone. Yes, that stress meter, the scale I thought I had zenned my way through emerging on the other side a massage therapist for all seasons. I have managed to get to the office and clear my head before sessions, but with a new respect for abrupt chaotic change.

One of my regular clients is also a stress expert. A tax-time CPA and stock market man. He knows what it is like to let the car inch along a half-mile line for the late-open post office on April 15. Those fun moments in the life of a tax guy have diminished now that one can file electronically, but the neck knots are souvenirs. I had to call him to change his appointment time. (Did you know that all the flooring stores close Nt 5? And cabinet stores are all closed on Mondays? I found out.)

We gotta get you out of the hotel, he said. Thanks for understanding and letting me change your appointment, I said. No problem, he said. Trust me I know how bad stress can get. I used to have a small office at the house. I didn’t use it much but occassionaly especially at tax time. I was working 18-hour days one year because I took on too much. I was at the house and getting ready to go to the office when I could not find my wallet. I looked everywhere. It took hours and I went through everything, the car, the house, the office, and no wallet. Finally I had to cancel all my cards and make an appointment for a new ID. I was so upset.

Next day I go into the home office right after my wife was in there getting something and I see the wallet sitting there right in the middle of the desk. I’m like, you just put the wallet there, right? She says no, and I can’t believe it. I’m like you are playing a joke, right? And she starts to get mad at me and says she didn’t go near the desk. The wallet must have been sitting there in plain sight the whole time I was looking for it and I couldn’t see it.

Well, I got stressed out too, I said. This week I convinced a cabinet guy to open the door of his closed shop so I could pick out a vanity. I took hunnybuns for outpatient surgery and played nurse. Do you know you cannot tie shoes with one hand? Or open jars, shower, or fold laundry, or get the leash on the dog?

The kicker is I went over to the house to get the mail after work one evening. I spent 30 minutes trying to squeeze through stacked furniture to get to the mailbox key hung in the kitchen until I gave up and went back to the hotel. Frustration!

Next day we’re having coffee and hunnybuns looks at my car keys and holds them up. What are these?

When we left from the flood I must have put the mailbox keys on my car key chain and forgot. I am so use to having everything in its place i didn’t even check my car keys. Hiding in plain sight!

Stress really can do bad things to your brain….HA!

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Massage and the Great Flood

I was enjoying the evening air, checking the massage therapy schedule book to review next week’s bookings when my 90-year-old mother-in-law asked for help.

Help?

I dashed in from the patio and stared. A little tsunami of water was spreading down the hallway into the living room, and all the bedrooms. Oh, and it was pooh water.

Well, that was a week and a day ago. In the past week I somehow managed to get to work and massage my clients, but darn it was tough.

I had six giant hair dryers in my house and had to find a hotel suite that would also take us (and the dog) on a Saturday night. In the midst of the chaos, my spouse slipped and needed a ride to the emergency room with what looked like a broken thumb.

Swea’pea is going to be OK, but the injury meant I am the dishwasher, shower assistant, jar opener and lifter of all boxes and items heavier than 10 pounds.

Well, somehow we managed to find shelter and get the house dried out. And somehow I managed to get to work this past week and be all nurturing. Walking the talk. No migraines. It was pretty interesting.

Massage therapists really don’t have a lot of stress. Once your practice is going and you have some moderate competency there is not a whole lot hand wringing to do. Persistence and consistency pay off. Usually if I feel the need to fret, I have to watch the Lakers.

But my meter was running hot all week with all this multitasking. I used my own massage advice. I did navel breathing as much as I could – car, just before a client, just after. I called a good friend to share and ask favors. I asked a neighbor to feed the cat and keep an eye on my house while we were gone. Child pose and kitty-cat. MSM liniment.

We have managed to survive what appears to be the first week of about a month out of the house. And I need a massage.

The best part of the week: One morning I was running late for work, so my mother-in-law offered to give my spouse a sponge bath. That look of horror was better than any Jamie Lee Curtis scream ever.

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Smart Phones and the Rectus Gang

Smart phones have created an endless employment opportunity for massage therapists – we can relieve the head and neck aches they foster and show clients how to reduce their sting.

At best the glare-y screens will make a users neck stiff and tight to flexion on the side holding the phone. So many people peer down at their screens for hours – often during their breaks from the big screen pc’s used for work – that the smart phone has its own “pathology” when it comes to massage therapy.

Addressing problems of smart phones requires a good touch on one of the neck’s most strident muscles – the rectus capitis and spinalis group.

The rectus guys are holding the rappelling ropes of the cranium when people flex down to reduce smart phone glare. They work quite painlessly for hours until the ultimate protest – a tension headache spreading across the occiput and up over the ear and to the vortex of the skull.

A quick fix is to give a “thumbs-up” in the cranial vault. Fingers braced on the opposite side of the spine, thumb gently pressing upward at 45 degrees into the vault.

But the thumb can be an instrument of further strain if that is all we do. When prone, the upper regions of the capitis can be collected between thumb and forefingers and drawn lateral to open bunched fibers.

To use the natural relief of lymph flow, try massage cups from the vault to the thoracic vertebrae. This draws congestion from the occiput to a more forgiving landscape. I like to add the concentric circles of fingertips along the lateral sides of the rectus capitis.

There is a special place in heaven for therapists who take the time to try and convince people not to do the straight-down stare of cell phone addiction. I like to suggest people put the phone at least 15 inches in front of their face, with the phone centered just below the eyes.

We all await a redesign, of course, that will keep our heads from looking like flowers drooping in a vase. One wonders what is next. Projection cell phones? Just point it at a wall and read? Hmmm.

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They are Called Trigger Points for a Reason…

The nice man who likes to run every day came into my massage therapy office looking for some relief.

I thought I was going to do a massage – but it turned out to be an intervention.

This man had gotten a hold of a trigger point therapy workbook. He had been doing his own trigger points at home – now his aches and pains were so bad he couldn’t sleep.

The points had been overworked to the point that his body was now so tight and armored this was going to be a tough massage.

With his knee bent, I tried to distract the femur from the hip capsule. Nothing doing. The psoas was so tight it wouldn’t move.

I took a teaching moment. “You go through this at massage school,” I said. “You discover trigger points, see them as the answer to all ills, and you come into class one day having set them all afire with your own merciless fingers. You learn the hard way.”

I took another moment to demonstrate a trigger point release on his common extensor. “Really?” he said. “Is that all the pressure you use?”

Uh-huh.

It took a while, but I was able to get some of the psoas unlocked. I see a lot of Swedish in his future.

With some massage therapy clients, assigning a little homework on their own trigger points may be a good thing. But (oh no please!) don’t try this at home without some instruction.

If home trigger point therapy seems like a good idea, I like to tell clients: “You will be very tempted to be much meaner to your trigger points than I am.”

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Massage Relief for Reflux and Indigestion

So many people work on computers and in hunched positions that massage therapists are seeing more clients for acid reflux and heartburn problems.

Recently I doctors have referred clients for massage to relieve reflux, and the results seem good. I wanted to offer some treatment tips.

First, reflux symptoms – burning in the throat, burping or stomach discomfort, especially at night, need to be evaluated by a doctor for other conditions. Clients I have seen for this problem have been to the doctor and had various tests to rule out other troubles. Most are taking medicine and avoiding certain foods to relieve their discomfort.

Second, I assess the client’s posture and ask questions about their body mechanics at work. Hunched shoulders and thoracic kyphosis are common. Some have had car accidents where their chest was compressed by seat belts. Many work on computers for long hours or have jobs where bending and lifting are frequent, for example, nurses or bartenders. I have also observed some cyclists who use racing-style bikes requiring bent posture.

These observations tell me that when I do the massage, chances are their backs and shoulders will be very sore from overstretching and the abdominals will be flaccid and shortened. Often the shoulder girdle is quite high and forward, the thoracic flexed, creating shallow, upper-chest breathing.

Lying flat on a table is often very difficult, so I like to start with the client prone. A back and neck massage comes first to relieve back and neck soreness and also to assess the stiffness in ribs and spine and specifically the scalenes and serrati. After massage I like to gently mobilize the shoulders toward their anatomical positions.

Many clients have had doubts about getting any massage on their abdomen, fearing tickling or invasive techniques. I assure them that as a ticklish person myself; I use slow, firm touch to avoid triggering tickle reactions. I also assure them that the techniques are not invasive and I can lighten them at any time without tickling.

If a client is still averse to tummy massage, I will suggest that they allow it over the sheet as a demonstration. If the answer is still no, I move on to breath work and ask them to let me know if they feel comfortable getting tummy massage later.

As you may infer, permission to treat is important. If the client is defensive, the massage will not work.

The actual massage for reflux is fairly simple. Slow Swedish-circles in the direction of the colon (counter-clock-wise) followed by slow half-circles over the solar plexus just under the rib cage. The stomach is on the client’s left side of the abdomen, immediately under and to the left of the xyphoid process. Gentle effluerage away from the rib cage; this encourages the stomach to drop down into its anatomical position.

Then I suggest they fill the area under their navel with air as they breathe in. This encourages diaphragm breath and releases the thoracic area from paradoxical chest breathing.

Let me emphasize that a doctor’s exam and diagnosis are important before starting this work. Some very serious illnesses such as cancers and heart disease can masquerade as heartburn.

With the occasional client who refuses to get medical exams, I ask them to write in their own hand a release for massage, in which they specifically state that they understand they could have serious medical conditions. Not seeing a doctor could cause death or disability. They should specifically state they do not hold the massage therapist liable. (I have never seen a client finish such a note.)

The joy of massage for reflux is that as the clients unwind and practice diaphragm breath, their reflux lessens and often disappears. If it does not, I refer to an osteopathic who practices visceral manipulation.

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