Category Archives: Touchy Situations

Goals and Perceptions

Massage therapists need enough information from our clients to understand where we are heading in a massage session.

Working at spas, therapists get used to brief intakes and a question or two before starting a massage. In my practice, I get to take the time to do a longer intake and get more detail.

Yet I have learned not to ask the P-word upfront. The P-word is a big turn-off for clients, and makes them associate massage with illness instead of wellness. Even though it is very important to know about it before starting a session, it is very delicate to handle.

The P-word? Pain.

I like to list some goals on my intake sheet. I ask clients to circle their choices: recovery from stress, recovery from work, relax/improve sleep, reduce soreness from sports/exercise, reduce headaches and all of the above.

What I don’t list as a goal is relief of pain, largely because many people do not like the word itself. For some, admission of pain is some sort of failing. I see this particularly in men, but not exclusively. Later in the intake, after asking about discomfort and tense areas, I do ask if there is an area of pain.

Many people, no matter how ice-picked they feel, admit to discomfort and tension only. The P-word is off limits to them. On the other hand, for people whose primary complaint really is pain, they have answered enough questions to allow an admission that there is pain they want addressed.

It’s a bit tucked away in the middle of the intake, where I think I can get a heads-up on pain issues without the psychological politics involved in using the word. It helps get the conversation about the session going, and allows people in pain to step out with more safety.

When pain is an issue I will ask about pain on the 1-10 scale used in medical settings, with 10 being unbearable and 4 just being annoying. When doing trigger point work and follow-up questions after sessions, I use the scale to note any increase or reductions in perception of pain.

The scale gets people to realize if the pain is up or down and opens the door to the idea that the pain can decrease with treatment. The only time I find the pain scale unreliable is when the person is also habituated to opiates. These drugs are known to create pain arcs in the body to satisfy a craving for more drugs.

(Note: Research has shown this pain is real. In the past, there has been a mistaken assumption that the habituated person is lying just to get drugs. Obviously it affects the healing relationship for a therapist to assume someone is not truthful.)

So dealing with the P-word is an important part of massage work, but it is best tread with empathy and kindness. It carries a lot of baggage for some folks and can get in the way of a healing touch.

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Offering Reassurance and Hope to Your Clients

When will this get better? When will my pain be gone? When can I do what I want to do – when I want to?

Tough questions for us massage therapists to handle. Truth, we don’t usually know. Massage does marvelous things for the mind, body and soul – but what it does is often entirely up to the person receiving the massage – and the intent and skill of the person giving the massage.

The timeline? That may be set by many other things – perhaps even a higher authority.

When clients drop these questions on me I look them right in the eye and tell them all I can do is try to help them feel better. As pain drops, function returns. One can’t predict the time involved in healing.

It’s not a very satisfactory answer for some clients impatient to going back to doing the exact thing that brought them in feeling wounded. With as soft a tread as possible, as we develop a therapeutic relationship, I have a few ways to explain further. These come in handy with sticky troubles such as fibromyalgia or other conditions that vary day by day.

Answer # 1: You will turn the corner, but you may not realize it. Often you realize it afterward. You will discover that some pain or restriction has been gone for a while.

The body really heals itself in its own time. All we can do is try to make it easier to get there.

Is that fair to clients? I think so. I have rarely ever seen someone making no progress from massage. But I have often observed one factor in common with the impatient client: A chronic problem has often been ignored for so long it takes time to create an awareness of how to heal and avoid re-injury.

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Nail It!

We massage therapists pride ourselves on our abilities in touch – and that’s why I am so surprised when clients give me an earful about fingernails!

This is a touchy issue for massage therapists – we figure we’re doing things like avoiding perfumes and warming our oils so we can facilitate relaxation in our clients. And then they complain about fingernails?

Yup.

Actual Client Complaint Case #1: This guy must have been doing construction on the side or something. His fingernails were cracked and broken and his hands were covered with calluses. It was like being sanded!

Case #2: My massage started with a scrape-y hangnail across my feet. For the next hour, every time the masseuse did a stroke, I was dreading a re-appearance of The Claw!

Case #3: I’m slipping under the sheets and I hear the therapist out in the hallway clipping her nails. She comes in and jams these sharp edges in every time she works a knot. I expected to see little red half-moons all over my skin!

Case #4: Is it possible to do a massage with acrylic nails? These things were long – and she was more concerned with breaking one than doing a good job. It was the lightest massage of my life. I can put oil on myself, thank you.

Well, I am sure it was not these folks intention to make their fingernails the central memory of their massages. Most massage therapists know to keep nails trimmed, clean and gently filed and beveled to a soft edge. It perhaps slipped their minds those days…

…So I am off to check my manicure!

Best Intentions? Massage and Permission

Is it OK to stretch a client’s adductors? What if the client is female, the therapist male, and the wind is whistling through openings in the drape?

Oh my, the topics that come up for question in a massage clinic. One of my friends had a complaint from the husband of a couple whom had simultaneous massages. The female client had a massage from a male therapist, and during the massage he stretched her adductors.

The client complained to her husband that there was something wrong about it. The therapist stretched her, said nothing before, during and after the stretch. She could feel an air gap between her draping and her crotch. First, it is unusual for people to complain about such tactics in a massage. Often the response is simply to never use that clinic or spa again.

My friend noted that she received the complaint because the husband was a long-time client and they had a good professional relationship. When my therapist friend talked to the male therapist about the massage, he just said that he felt her adductors needed stretching and did not consider it a big deal. The client said nothing, and the massage continued as usual. It can happen that we may have the best of intentions in a massage, but our efforts are interpreted differently. It is also quite possible that someone doing a massage is not being honest about intentions.

The therapist may be using the massage as an opportunity to play games, such as intimidation games, sexual games, etc. Those games – and the appearance of games – have no place on a massage table under any circumstances. A good way to make sure your intentions are clear is to ask permission of the client first. Explain what you want to do, why, and emphasize the person’s draping will not be revealing. Then wait for an audible answer and accept the answer. No means no.

My friend decided not to call in the male therapist, a contractor, again to her clinic. His answers about the massage were not satisfying, and she told him that. Hopefully he was not playing games and learned something from the experience. It cost him an opportunity to work.

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Dizzy Chair Massage

A client stopped in last week a bit worried about her neck. She had been on vacation, feeling very tight in the neck and shoulders and stopped for a chair massage.
Eager to get rid of the tension, she asked for a 30-minute massage. Toward the end of the massage, she started to feel faint and had an overall feeling of serious un-wellness.
“I thought I was going to die,” she said. “I felt terrible. It took several minutes of just sitting to feel like I was getting better.”
She wanted to know if I had any idea why she felt so bad.
Oh boy. Great. Just ask me. I have never seen anyone get sick from a chair massage. During classes the instructors have mentioned that rarely a few folks might experience a low blood sugar after a chair massage. But that’s really it.
And my client had eaten about a half-hour before her massage.
I suggested that if the massage was the cause of her spell, perhaps the headrest was in a tilted back or too far forward position, compressing her suboccipitals.
But the client said the position of the face cradle felt fine.
Another problem might have been if the therapist was using pressure directly into the neck, rather than at an oblique angle, and pressed on the vertebral artery. Stepping off the massage chair and sitting down in a chair for a few minutes would dissipate the feelings.
But heck, I really have no idea because I wasn’t there. Her experience was odd.
Her therapist, she said, was very attentive and very surprised that she didn’t feel well. She sat with her, gave her some water, and offered to call an ambulance. My client said no, she would be fine. And in a few minutes she was. But what happened?
I would like to know if any therapists have ever seen this sort of reaction from a chair massage. Or is it possible it was not related to the massage?
Here’s my very speculative guess as to what happened, barring other causes. This particular client has a very prominent bilateral knot at C2-C3, a souvenir of an old car accident. If pressure was placed directly into the neck from a standing position, it is possible the vertebral artery was compressed. Vaso-compression can cause a myriad of sickly feelings.
My only experience with this was with another therapist when I worked at a spa. Her client came out of her session and had to sit in the hallway for about 20 minutes to recover. She also had a knotty laminal groove near C-3.
After we both helped the client recover and she left, the other therapist and I went over the work done on the neck. My therapist co-worker had stood over the table and with her arms straight down had pressed directly down into the knot in an effort to release it, a method she used on other knots in the back and legs.
This stance is not only bad for the client; it also loads tension on the therapist at about C-6-C-7. Done often enough, it can create numb arms and hands in the therapist as well as unpleasant symptoms in the client.
My co-worker, of course, had just adapted a way of treating knots in one area to another and wasn’t very studied on neck release techniques. I showed her how to treat the neck with oblique angles, anywhere from 35 to 55 degrees to the prone client. This technique, of course, requires the therapist to bend knees and unlock joints in the arms and back.
The oblique approach is healthy body mechanics for the therapist and client as well, and it applies to chair or table treatments. Oblique pressure rises from the feet pushing on the floor, with the joints relaxed rather than locked. Basic? Yes.

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Therapist Notes from a Low-Slung Sports Car

Sometimes when I am square in between someone’s shoulder blades, I find myself thinking about how some of these knots got there.

Most are whiplashes and hard work – a traffic encounter followed by running a lathe at the machine shop, or writing some intensely detailed thesis. No fun involved.

Once in a while somebody has a different combination.

This gentleman had back pain. He told me he had a brand new promotion and lots of extra stress with it. As I worked on massaging his muscles, he told me the one fun thing about the promotion. He celebrated by getting the dream car. Not that I know that much about cars, he was clearly having a ball driving his super-charged, T-topped Corvette.

“Have any trouble getting in and out of the car?“ I asked.

There followed a long pause. His back stiffened. “Some.”

Never mess with a dream.

“Tell you what, I bet you will love that car even more when I show you a couple of tricks on getting in and out that will help your back.”

“Um. OK.” He started to relax. After his massage, we went out to the car and I demonstrated how to sit first and then swing both legs in at the same time, eliminating the sciatic effects of one-legged entry. Once in, I showed how to get the car seat to drop back and up before exiting. The slinky bucket seats? Umm. “Sometimes it helps to adjust the seat up a little,” I said, trying to be tactful.

Should this client be driving a roller skate with jet packs? Heck no.

But oh heck, when I stood looking at the Cherry-red (never maroon) super-finish of this slinky corvette I had to say: “Some people have all the toys!”

“Want a ride?” he asked.

“You bet!”

Hair flying in the wind, I had to wonder: How am I going to get out of this car?

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Tremors

We massage therapists sometimes see the un-doctored, the folks who are big believers in the preservation of health by staying far, far, away from anything medical.

I respect people’s beliefs, especially when they are dearly held, but I also know that I have a duty to at least bring up the subject of finding explanation of symptoms that may be significant. My personal and professional life intersected, once again, within the last week.

A good long-time friend who had become strangely distant in the past few months died unexpectedly. And I had two new clients – back to back – whose presentations suggested to me that something was afoot. All three situations were difficult. I hope I did the right things…

My friend had always had a bit of a nervous side. When excited his hands would tremble and he had trouble with seemingly simple things. I fixed his vacuum cleaner once simply be emptying it.

Looking back, those were early signs that he was having difficulties with simple tasks. When I asked about the tremor, he told me he had always had it and not to mind it. He pleaded lack of handy skills with the vacuum cleaner. Odd. I have lost my keys plenty of times; I can’t find a street now and then. I wonder if I am losing it, and then I find things and turn the right corner.

But this was different. My friend used to go with honey-buns and I to breakfast or lunch after church Sundays. Suddenly, he had too many places to go, too many things to do. I chalked it up to his schedule, with the odd feeling that was not quite the entire explanation.

When his family came into town and went to his home, they found piles of clutter, food dated 2005-2009 in the fridge, a mess of old bills and a hoard of dirty clothes, furniture with an inch of dust and grime. He had been a neat-freak. His home was not like him anymore.

As his survivors and I compared notes over lunch, it came together. He had mental changes, and fearing he was losing it, he was avoiding people including myself, who would know better. I feel so sad to know that he had lived in fear in his last days.

My clients came in just an hour apart. The first had a slight tremor to her hands, shaky writing on the intake. Lots of health problems she seemed unable to shake. Perhaps a massage would help. I asked her after the massage if she felt the slight shake and tension in her hands. No, what shaking? Everything is as it has always been.

Trouble was, this client had plenty of doctors and things going on, just no answers as to why she felt so tired and sore. I suggested a lot of massage and persistence with her doctors. Sometimes we don’t realize we are tense, I said, until we start to relax.

My next client couldn’t stop talking. He had injured his back more than 10 years ago, and it was getting worse. This fellow had been to about four chiropractors in the past week. Had trigger point injections, adjustments, machine stretching and strengthening and active release.

I listened to his story, which hopscotched around quite a bit, and wondered if massage could help him. We can help tension, but what if the tension is not from injury but from a condition of the mind? I didn’t think that was my place to broach that. Could I refer?

I asked more questions, he gave me a long list of injuries and re-injuries. It had gotten so bad the night before he had rolled his back on some metal air tanks to get relief. I suggested he stop doing that and proposed he seek the care of an osteopath with experience in cranio-sacral therapy. Osteopaths also do general medical practice, I thought, and perhaps would have some ideas on how to deal with reducing the cause of his his pain and anxiety.

I certainly don’t know if I did the right things with these folks, but I did try to help. With my hands and my heart. – By Sue Peterson

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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.

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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.

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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.

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