Tag Archives: massage classes

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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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.

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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?

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Muscles or Tendons?

Massage therapists have their favorite spots to approach changing patterns of movement and improving function.

Over the years, I have asked the question often: Muscles or tendons?

My early experience dictated muscles. There we find bunched-up, dysfunctional fibers and endplates. Trigger point theory called for a full cleansing of these scatterbrains, along with their associates and satellites. Follow with a stretch, and the trigger points are gone from the muscles.

Unless they come back.

More recent experience leans toward the tendons. If the tension returns to the muscle, it must be from a higher direction. First up, the tendons. Treat tendons and the muscles will unfurl like the Stars & Stripes on the Fourth of July.

Illustrious massage leader Ida Rolf squares off against tendons more often than muscle bellies. Her first run tends to be the big guys: TFLs, ITBs, ligamentum nuchaes, thoracolumbar aponeuroses and raffe. Stretch and function returns.

Sometimes after a full run at tendons I have pulled back and checked muscles. Are they clear? Have they found their function again? Will it last?

I try not to doubt my work, but there are those folks who have chronic patterns. Sometimes they seem to have more than enough fuel from stress at work and home for muscle/tendon function to recur. Yet I wonder, is it the structure touched or the touch itself? And is it perhaps different based on the massage therapist’s own personal tuner?

Perhaps the site of intervention is like a menu. You pick what you like. Hmmm. That might explain why I often begin a session with a bright: “Happy to see you today!”

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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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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.

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Yearly Goals, Triumphs, and Mulligans

Right about the end of the year, or sometimes the beginning of the year, I do an audit of my massage therapy practice.

Years ago I started doing because I found it was easy to slip into a groove – also called a rut – and because I usually take at least a few days off during Christmas and New Year’s.

My list includes things I think went well, things that sucked and things I need to take more seriously, as well as look toward some goals for the next calendar year.

By setting these things down on paper, I was able to take some mega-steps in my massage therapy career. My status as a spa employee helped me buy a home, but once that was done – and I had two years of spa experience learning about massage, people, management, etc. – it was time to move on.

Picking up the skills I needed to move on took some practice. All the while I had minor and major goals to help me along – how to book a private client was a mini-goal. Once I could book one private client, I learned enough to give myself a goal of three private clients a week, and so on.

I like big goals for the end of the year, but little chunks at a time to avoid discouragement. Making the goals is not so important as learning how to get there. If I am off by five massages, who cares? At least I figured out how to get a few clients.

As you may notice, lots of these goals are not the purview of massage schools. They have a hard enough time teaching people the basics of techniques and body mechanics without turning themselves into business schools as well. We had a class or two on basic business skills and that was it.

The odds are probably good, too, that most massage students would not need business skills because few go into business for themselves. What they needed were skills at getting jobs working for others, and learning how to survive in the environments of places such as spas, clinics and chiropractic offices. Some of those skills could not be taught they had to be earned. One of my classmates was great at interviewing, but couldn’t show up for work. Another gave a terrible interview, but was rock solid and loved by the clients.

A spa manager I liked a lot confessed to me once that she often hired people solely based on whether they were on time for the interview. She had long ago given up on the idea of figuring massage therapists out.

Now, in my 20^th year of massage, I’m looking at the nuts and bolts of what I am doing and asking myself: Is this where I want to be? Am I working enough, too much? Going in the right direction? Are my clients benefiting from my work? Where do I want to go from here?

These are great questions to ask – in past years my questions would be how can I get more clients or make more money. Or how I could better use my energy – doing massage or managing or training those who do? Not easy questions or answers but this helps in my sense of satisfaction from work.

Wherever a massage therapist is on his/her career I urge this time of year for some self-reflection and goal setting. It really makes a difference in the long run.

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Practice Makes Perfect – Learn Your Craft

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Practice Makes Perfect – Learn Your Craft

Sometimes we massage therapists have to step up, as in try to pick up some massage skill fast because we have a looming assignment ahead of us. Hopefully we are at least leaning on our basic skills and quick-mindedness in developing a demanded specialty quickly.

One hopes.

A friends got stuck in “I do that” hell recently. The interviewer asked if she did myofascial release, and before she knew it, yes had popped out of her mouth. Yes, she really needed the job.

She went home and looked on You-Tube for some examples. An hour later she called me in a panic. She had lots of competing ideas off of the tube, and wanted a practice dummy. The web is a wonderful tool, yes, for massage therapists looking for ideas and starting points. But if you watch someone play the piano, do you think that your attempts to copy those moves on your own will result in the same music? kitties

I tried to stay off the table: “Well, all massage is myofascial release when you look at it. If someone has taken a formal class and been deemed certified by the teacher because of their attendance, they have probably learned something about special techniques, but we massage folks are all about moving muscle and connective tissue from stuck to unstuck.”

My friend was desperate. “I at least have to look like I know what I’m doing by tomorrow. I have a practical. And I know you will tell me straight.”

The ability to say “that sucked” has never been in short supply in my family, but some myth out there says that some family, even friends, might be afraid of hurting your feelings and discouraging you, so they get off the massage table with great deliberation and croak: “That was great.”

That leaves you to find out the awful truth on your own, from some less-inclined-to-kindness stranger, or your first boss, or your interviewer, or the dust gathering on your sheets….

I’ve seen that effect enough to know it is not so kind. “I’ll come over,” I said, “But can we practice on your cat?”

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?

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