Tag Archives: clients

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.

Leave a reply

Tips for Bringing Muscles Back to Life

As mysterious as the workings of the human body is, we massage therapists have learned a few tricks to bring errant, dysfunctional muscles back to working order.

I continue to be impressed by the methods of active release, also known as myofascial release, in reviving elements of structure and function to certain muscles.

I recently had the fun of trying to extricate a “burning” sensation in the left lumbar area over the area we associate with discs L-5 and S-1. This is a frequent complaint of people coming in for massage, and sometimes restoring circulation and tone don’t quite fix this problem.

Active release involves allowing the therapist to palpate the errant muscle and drawing it through a complete range of motion. What people sometimes forget in this venue is that complete range of motion must be done by the client, not the therapist, to truly meet the definition of active release.

This took a good trusting relationship between me, the therapist, and my client. It helped that it was not the first time I have seen this client. It also helped that the client was suffering enough to be gung-ho about trying the step.

First, I demonstrated the full motion range to the client, then I asked the client to go through the motion with my verbal prompts. The actions of the suspected muscle, the multifidus, are varied between spinal stabilization in standing and bending, especially while holding a weight in front of the spine. I usually re-discover the aaaargh-factor of the multifidus muscle when I am trying to lift boxes onto a shelf in the garage. Or take them out.

Clients will come in and report such activity as garage-cleaning, house-cleaning, tub-cleaning, etc., followed by pain in the area later in the evening. If it has been a bad lift, the pain is immediate.

Once in a while a client will report trauma, such as falling off a ladder, or a fall during gymnastics, that will make me believe the mutlifidus is now stabilizing a spinous process or transverse process fracture. Off to the doctor they go. I can do active release for the multifidus after the fracture has healed.

This client was sitting on the massage table, back to me, while I palpated the area of the multifidus, just lateral to the spine and about a half-inch into the myofascial bundle. I kept constant pressure on the multifidus as the client bent forward, bent back and then rotated to the opposite side and bent forward. When the multifidus is particularly out of sync, I may do this with the client on their side and asking them to arch the back in this wobble-toy motion.

Give this technique a try with your massage-trading partner to see how it works for you. It’s another trick to hang onto when the clients present with a big pain in a very small area. Do you have your own version of this technique? I would love to hear some more….

Leave a reply

The Price of Comfort

Recently I walked into a raging discussion among massage therapists over discount pricing. To discount or not to discount is a huge bugaboo for massage therapists.

Prices are subjective, of course, and one can only wonder why people ask for a discount from a single massage therapist when they wouldn’t dream of asking at a big spa. I came up with a list of concerns about prices:

Overhead: Discounting is tough for all therapists, really, because our stated prices and what we get paid are quite different. My asking price includes things that support my practice, such as office rent, website, phones, supplies, education and licensing. A friend who does house calls only has the expenses of phone, linens and oil. Another therapist has few expenses as an independent contractor, other than insurance and licensing, but taxes take a much bigger bite out of her paycheck and she rarely makes tips at her chiropractor’s office. At the end of the year, we all make radically different bottom lines, and our prices are quite different.

Perception: Most of the huffy comments from my friends on this topic come from the feeling that clients who ask for discounts are insulting them or their skills. People don’t haggle over many items, but they do haggle over personal services. My feeling is: do you want to be paid like the maid or the accountant?

Need: We all have clients who come in with limited means and in need of massage. How do you handle these? I have given people discounts for multiple sessions when they clearly have a need and lack resources. However, there are always a few people who ask for discounts and don’t have a need. In my experience, they are either thrifty or culturally used to haggling. I don’t take offense. If they really want a discount for the sake of a discount, I refer them to one of the $39 chains.

Desire: Another therapist friend had a home-based practice, (sub-rosa, no licensing or insurance) and needed clients, so she offered massages for $25 an hour, cash only. It worked. She did not have to leave her house She is also now very burned out and has no savings.

My friend who is a hair stylist put it this way: when she started her practice, her prices were low. As she built clientele, her prices rose. The clients who stayed valued her services. The others, well, one or two come in every year so she can fix their $8 haircut.

Massage Finger Maps Helps Reduce Numbness

Massage therapists will often have clients ask about foot or finger pain, or a strip of tightness around the knees or hips, but when is this a symptom of something gone wrong?

As we rub away with our talented hands, we may have an opportunity to assess if a nerve root or disc has been pinched or altered by time or trauma.

Recently a client sought help for numbness in the fingertips of the thumb, index and middle finger. Massage therapists are aware that numbness or weakness calls for evaluation by a doctor. This client had already seen her doctor, and an evaluation had shown disc problems in the neck.

My client was hoping for some improvement brought about by massage instead of more drastic measures.

A quick frisk of Google for numbness in these areas yields lots of articles regards dermatomes and myotomes, showing the body sliced into grids labeled with the common nerve root/disc source. The thumb, index and middle fingers are associated with the medial and radial nerves, and with C5-C6. Tingles in these areas might be caused anywhere from the spine and disc to the carpal tunnel.

By tracking the radial nerve from neck to fingers, I used several techniques to warm, stretch and free the nerve from adhesions. I also massaged the scalenes and applied light traction to the head, in hopes of opening the pinched off areas.

Her symptoms were greatly reduced, and my client is hopeful that massages and some physical therapy will keep her out of the operating room. Will my client have neck surgery? I don’t know, but her symptoms took a turn for the better, and that is what clients seek.

If dermatomes and myotomes are new to you, try a Google of them for some great information that will help your massage practice. I also keep a printed chart handy in my massage appointment book.

1 Reply

A Degree from Massage University

My education in massage did not stop with graduation from a massage school. If anything, it intensified. Now a practicing therapist, I was learning every day from the most prolific of authors, the best logisticians, the brightest of the best.

It has been hard to keep up sometimes, but very rewarding. The classroom has been my therapy room, the teachers: my clients. Lessons learned go from the obvious to the subtle.

Some favorites:

Don’t smack your hands together like humpy honeymooners to warm your oil. (Can we get that one on a billboard?)

Don’t breathe on your clients face while doing neck stretches. (Again, billboard?)

Do listen to a client without distractions when they are speaking to you, even if you are getting a text.

Do ask every client to return. A genuine invitation goes a long way in a society where millions of people don’t mean what they say.

I was pondering some of the big lessons I garnered from clients the other day, after I heard that a former client, a very prominent man, had died at age 91.

Sad, yes, for I was thinking he would reach 100. But I remembered what he taught me about massage. He was a connoisseur, having had massages all over the world for many years.

He told me he liked me because I did “real” massages. He never told me how many therapists he had interviewed, but one day the house manager let it slip that a parade of therapists had come, once, and gone before he picked me.

That was good for my ego, of course.

So what did I learn? These were big lessons and small.

He always apologized if he was late. Always.

It’s important to take time for oneself.

And always buy the best seat at the ballpark that you can afford. Otherwise why go to the game?

Hmmm. Is it April yet?

Leave a reply

The Push

Massage therapists know that when a client has been pulling something – wire or cable, storage boxes, dogs, etc. that they will find a host of sore and overstretched muscles.

Ergonomically, it is not good to pull, but to push. Push we can do much more easily and with much less fatigue. Somehow the design of things and the human body makes push much better than pull.

This concept gets forgotten, here and there, by otherwise wise, experienced and intuitive massage therapists, in this case me. push

Oh my, something was up. I went for my weekly massage, which I hadn’t had for three weeks because my schedule got crazy, and felt what seemed like a loop of fatigued tissue running from my traps to posterior rotators to lats to triceps to forearms to my thumbs.

Funny I didn’t know that bad patch was there until the massage therapist starting rubbing there. How many times has a client told me that they had no idea something hurt until it was touched? It was especially bad on my left side. Lo, I am left-handed.

As my friend and massage therapist trade-partner tried to get the angst out of this area, I suddenly became aware that I had been doing something wrong. Oh so very wrong. Me? In the biz now for 20 years and I have found a new way to feel yucky?

Hey, it happens.

After three massages that week, I began to feel a lot better. The drilled-in fatigue dropped, I felt less looped in the shoulders and back.

But I needed to find out for myself what I had been doing that had run me off the boards.

I was working with a client who had a habit of clutching items – files, purses, children, and etc. when the dawn finally broke over Marblehead.

I had been working on rotator cuffs from the opposite side of the client, pulling up and back on trigger points in the lats / tereses / infraspinatus muscles. One can massage from the opposite side, on occasion, of course without ending up sore. But one must use the weight of the body, mainly one’s assets, to create the pull. Somehow in the frenzy of the past month I had forgotten this and started using my pulling muscles instead of leverage. What are the pulling muscles? Traps, lats, triceps, etc. Somehow I had forgotten to bend my knees and use weight instead of muscle.

Oh, I have been very good this week. Now I work trapped shoulder blades from the same side. I take care to move the arm into flexion to expose the shoulder. And I vow to never, ever, to pull again. Time for another Epsom soak.

Zombies vs. Massage Therapists

One of my most fun massage therapy clients likes to update me on his activities and the connection between what he has been doing and what is going on in his neck, back, hands, etc.

I don’t get a laundry list of precarious Christmas lights installations or kneecaps wondering off by themselves on Audubon bird-sighting missions. He gets all of his angst from the mouse.

The past three years have been spent trying to write a non-fiction book. Ahhh, three years of the highs, the lows, the numbing tundras of white screens and spell-checks that cannot tell the difference between wet and whet.

Sometimes it has been the mouse-side shoulder. Deltoids, pecs, infraspinatus and the dreaded Bermuda Triangle of the human body: posterior scalene/trapezius/levator scapula. Oh the pain.

The bulk of writing the book merely took a toll in terms of pain and stiffness. The editing process involved sweaty panic anticipation that flowed up the neck into the sub occipitals, parietals and jaw. Pop goes the tempo-mandibular joint.

Rewrite heck followed. If it is possible for a man to ever experience the pains of childbirth, this author did. I spent several sessions reminding him to breathe through the pain. At one point we even held hands while he practiced.

All told, he has now emerged from the haze and is undergoing the butterflies of seminars and speaking engagements. I am, too, a bit off to the sideline. Dare I say I feel his pain?

He often talked about ideas on solving structural problems in his book while I rubbed a forearm. Sometimes he found the solutions on the middle of the session, when he would slow-breathe like a sleeper, though awake enough to feel my touch and hear the I-Pod.

All told, he has now emerged from the haze and is undergoing the butterflies of seminars and speaking engagements. I am, too, a bit off to the sideline. Dare I say I feel his pain?

The subject of his book, by the way, is the result of a lot of experience and research in the field of education. I asked him to sum it up.

Don’t be a zombie, he said. Be human, care, do the best you can do to touch people’s lives. Stick your finger in the water. You do not know where the ripples will go but they will go far beyond where you will see.

I had to pause. That just might apply to massage, eh?

Leave a reply

Stalking the Numb Thumb

Sometimes massage therapists are faced with a whodunit – and it takes a good bit of detective work to unveil the unusual suspect.

The fun of massage therapy, I find, is solving these puzzles and giving a client not only relief but also the confidence that they will get better.

Recently a client came in looking frazzled and tired. A friend had referred her and she didn’t expect much. While she sat in the waiting room, she clutched her purse in front of her midsection with both arms.

A recent trip to the doctor and some bad X-rays had revealed some pretty bulgy discs in her neck. Her MRI was scheduled. She had known about the discs for a while, but these pictures looked worse and her left arm had experienced shooting pains. Now her thumb was numb, and the numbness seemed to be creeping up her thumb toward the wrist.

When a massage therapist listens to a client’s history and observes the posture, it tells a story. I was not sure what was going on yet, but I had a pretty good working theory. But puzzles can be tricky.

Cautiously, I warmed up her anterior shoulder and neck with Swedish massage. The skin was sore to the touch, and the muscles underneath were rock-hard. Working within her tolerance, I drew a flat forearm across her left anterior shoulder to gently press the suspects: subclavius, anterior trapezius, pectoralis major and pectoralis minor.

The thumb and forearm tingled a bit but the numbness remained. I took the shadow referrals to the arm as a hopeful sign. Erik Dalton teaches the forearm sweep as a great way to bust up sludge, adhesions and gummy bears stuck to the muscles and fascia just below the coracoid process. I used his inspiration and started down the shoulder girdle toward the arm.

Technically, my trigger point charts tell me subclavius should be the bad boy in this hunt for thumb-numb. But the constant pressure of rounded shoulders, stress, poor circulation, etc. had brought all these muscles to the table. Just picking one out would not do. Too many other players were jammed into the small space beneath the acromium to pick them apart.

All of these players were so stuck they were acting in a clump. Her numbness and pain gradually subsided. I then spent a long time doing Swedish warming massage up and down the arm, shoulder and neck.

My reward?

“It feels like my arm again,” the client said.

I feel like Nancy Drew.

Leave a reply

Stalking those Darn SCMs

The massage client who can’t turn the head, the headache that arcs over the ear to the ridge of the eyebrow, the sensation of steel cables squeezing the anterior neck: These are all signs of those darn sternal-cleido-mastoids.

We massage therapists see these symptoms frequently, and I have made a hobby of asking other therapists how they try to free the dreaded SCMs. There must be dozens of techniques, dozens of approaches, and yet I still seek one method that won’t make a client levitate.

Lucky for us, clients with taut SCMs are so miserable they will tolerate our fingers making an attempt to unwind these two-headed sticklers. They will try anything to get the eyebrow to stop pounding.

My first experience with unlocking SCMs was with a fairly invasive technique I learned in school: Lifting the sternal and clavicular heads of the SCMs together, on one side, and sifting the TrPs between thumb and forefinger, careful to exclude the pulsating nearby artery.

Well, that does work, but my experience with clients leaving skid marks led me to believe it might be better to learn a softer approach.

It does help to lift the head and shorten the side being palpated by turning the head to the opposite side. An MFR technique I tried to lengthen the SCM from short to long with pincing fingers also left me cold. If the client has any fear of neck constriction, this technique will make it a full-blown phobia.

One time I encountered a client who had survived an attempted strangulation. These SCMs had gone over the moon to protect her. There was no way in heck I was going to lift, sift or pince while twisting.

A class with Erik Dalton saved my hands on that one. He showed, with his usual complete relaxation, a non-threatening way to cross one hand over the front of the neck, palpating the anterior edges of the SCMs with soft finger-pads. The other hand, from behind the head, brought soft finger-pads to the posterior side. A few moments of light touch and patience, the SCMs unwound. No twisting necessary, and no skid marks.

Believe me, that client was able to enjoy a good night’s sleep for the first time in a long time.

What about the chronic phone holder? With today’s tiny phones, and with the old-timey, clodhopper phone handsets, many people have ground in one tight SCM. This pattern creates one-sided headaches and can persist for years. Enough stress and people come in looking like they are holding an invisible violin in their neck.

Well, when challenged, I look to topical magnesium lotions to help. Magnesium oil from seawater stings cut skin so it can be used only if the area has not been shaved. Otherwise, Epsom lotion. A light coating and then leave the client with that side in a light stretch while doing arms and legs.

By the time I return to the neck (20 or 30 minutes) the SCM at least knows it can stretch. If it lets me, I will do whisper-light TrP release on the surface followed by lymphatic circles toward the thoracic duct at the clavicular notch. You don’t have to get fancy, however, light Swedish in direction of the duct works also.

I send clients home with instruction not to turn quickly or whip their heads to either side. Use a little heat if sore. And hold the phone to an ear only looking straightforward and holding the phone in the opposite hand.

There are probably a many more good SCM secrets out there. Anyone?

Leave a reply

Touching the Masses

Chair massage is a great way to deliver massage services – and it offers independence for many therapists who don’t want to be limited to table services.

This new era of chair massage is a big step forward. When it started more than 25 years ago, chair was seen by some traditional massage therapists as a Cinderella stepchild.

Chair was viewed solely as a marketing introduction for table service. Interesting, some massage therapists felt the need to label chair massage as fluff, non-therapeutic, even gulp, recreational – and let me say this fuddy-duddy crowd gave the chair pioneers some grief.

All is forgiven now as chair massage has garnered respect as both therapeutic and a regular form of massage. Chair is found in airports, conventions, employee health fairs, malls and at my local car wash.

For the massage therapist, chair offers some freedoms. Most chair massage at workplaces has the advantage of being held during working hours. A chair therapist can get home in time to pick up the kids from school. They can take nights and weekends off!

Some of the barriers to male therapists melt on the chair squad. Male therapists often have to endure bruised egos in spas when men and women clients refuse them. But male therapists are very accepted in chair massage. They even have an advantage with a bit more upper-body strength, which helps in chair techniques.

Chair also lets therapists do more invigorating techniques such as tapotement. By the way, how many kinds of tapotement are there?

I’ve seen at least five, and there are probably more. I can do two of them without looking like an industrial accident.

Check out some of the leaders in this field: David Palmer, founder of TouchPro, offers many online and in person courses in chair massage, as does Boris Prilutsky. Another chair pioneer, Ralph Stephens, offers a medical chair massage class.

Sure, you can watch these folks and their video how-to chair massage, but you will not know how to do chair massage from a video any more than it will teach you to play the violin.

Take some classes.

Leave a reply