Myofascial Release And The Frozen Chicken

March 28, 2016/2 Comments/in Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Walt Fritz

I remember taking “Myofascial Release” courses in school and learning how we were affecting the fascia and the restrictions within it.

As time went on, I met several therapists that focused their entire practice on being fascial therapists. Then I started hearing about entire conferences based on fascial research. Then came the facebook threads, dear god, the facebook threads.

As new research developed and understanding changed it was hard to keep up with what was fact and what was fiction. Were all the techniques that I had learned in school no good anymore?

Then from one of those facebook threads I came across something new (well at least new to me), something that helped me understand things a little better. It turns out the techniques were still good, it was just that my understanding of how they worked had to change.

I stumbled upon Walt Fritz.

What Is The Deal With The Frozen Chicken?

Using analogy can be an effective means of teaching new concepts.

Since I started my Foundations in Myofascial Release Seminars in 2006, I have moved in a direction that makes my teaching style unique. Moving away from mysticism and toward plausible explanatory models has been the hallmark of the direction I’ve taken.

The term “disruptive innovator” came across my computer the other day, and I think I can relate to this concept. I read an article describing Southwest Airlines role in the industry and how Southwest was once was a disruptive innovator and has now become one of the “legacy” carriers.

That is pretty much how business often works; a newcomer makes some big waves and is seen as fresh and innovative, but over time this past innovator becomes conventional and less than cutting edge.

Businesses continually attempt to remake themselves to stay current then eventually market shares lessen to those who are bringing in fresh new concepts. This concept is not lost on the therapy community as well. As science and reason advance, previously innovative, groundbreaking therapeutic techniques and thoughts give way to a new generation of thought.

To me, myofascial release was always about connection; connection with the tissue in distress. For a few decades I believed that when I found tightness in the body I was finding fascial restriction, as that was what I was taught. But with a greater knowledge of science and anatomy, I am reasonably sure that what I am effecting is much more than just the fascia. I know now how the nervous system drives much of what we do with our hands.

Whether it is the nervous system/fascial system/muscular system/skeletal system creating pain matters little if the therapist has no way of connecting with the patient’s pain and dysfunction. Over the past ten years it has become more obvious as to what draws me toward a client’s pain while evaluating and treating. What I care about is a simple feedback loop that has simplified my approach. Whenever we touch our patient, we are looking for a sign of their pain or dysfunction. My most reliable sign is a very characteristic tightness, that can take a wide variety of forms. To help therapists learning my approach, I’ve come up with the following very simple analogy.

Imagine that you take a frozen chicken breast out of the freezer and set it on the counter to thaw. You return in an hour or so (I know…not supposed to do this, but this is only an analogy!) to check its status/see if it has thawed. As you touch the meat, allowing your fingers or hand to sink in a bit to check and see how things are progressing. You work your way through the outer, thawed layers, but encounter that central area that is still frozen. It feels quite different from the thawed part, as it is dense and stiff. This is what happens when I reach into the body.

This is what I describe as tissue in distress and is the starting point for intervention.

There are a lot of very effective modalities out there with some very fine teachers; I know, I have learned from many of them.

All have their manner of connecting you with dysfunction. I just think most modalities stress the elaborate process of learning and mastering more than they stress the feel of what should be taught.

If everyone told you how simple manual therapy really can be, there would be little market for all of these teachers and their modalities. Many of you have heard my take on myofascial release and manual therapy and know that I believe many of the explanatory models that are taught today to be complete rubbish.

Even more of you know how I have come to admire folks in various fields who are not afraid to poke holes in the great sacred cows of our therapy world. The ones I admire most are those who are not afraid to say something like “when I put my hands on a person and move in this way, they seem to get better”.

Admitting what one does NOT know is admirable, instead of using false facts and pseudoscience to weave a semi-believable tale of explanation. Since most of the science used to explain our work makes less sense than this statement, why not be honest and say the truth?

Tissue in distress is the term I use to describe how the body reacts to injury, trauma, or surgery.

I believe it is primarily a function of the nervous system, rather than blaming the fascia being the primary culprit. As ischemia or injury effects the nerves, it seems that a characteristic density or tightness envelops the area, creating pain or other dysfunction. This is the felt-sense that I seek out when evaluating and treating and this is the frozen chicken that I send my students in search of.

Once the therapist finds the frozen chicken, I ask them to narrow their focus on the chicken, snagging it, so that both they and their client are in connection with it. Then, the therapists ask for feedback from the client, determining if this tissue is part of the pain/problem. If the client affirms the sensation, the therapist stays in contact with the snagged frozen chicken until they note a change in tone of the area.

As the chicken thaws, so to speak, the normal effect is a lessening of the pain or dysfunction. The therapist continues to seek out the frozen chicken until the area feels clear and loose.

Simplistically, we are engaging the nerve and its surrounding tissue in distress and creating a sensory feedback to the brain, which in turn signals the affected area to change its tone, reducing tightness/pain. While not an explanation to satisfy a neuroscientist, it meets my needs while treating.

I have come to find that most of us have many areas of so-called frozen chicken, but it may have no bearing whatsoever on pain or dysfunction. Paul Ingraham explains this concept in one of my favorite articles of his, Palpatory Pareidolia.

In keeping with Paul’s piece and views, I am not really labeling the frozen chicken as, for instance, a fascial restriction/trigger point/muscle knot/subluxation/spasm/or pooled metabolites (I heard this from a patient; her therapist said she could feel metabolites pooled in the patient’s lower back!).

The more I have learned, the more I realize what I don’t know. I realize now that while I sounded to my patient’s/students like I knew more five years ago, I was just parroting nonsensical pseudoscience in a manner that sounded science-like. I am completely comfortable now not acting like I know the source of every problem in the body. By the way, my patients seem to appreciate this honesty.

By using the frozen chicken analogy, I in no manner mean to disrespect or bring humor to a patient’s condition, or to try to overly simplify the true problem.

It simply refers to the felt-sense that a therapist seeks out when evaluating for soft tissue dysfunction and seems to be an effective teaching tool, based on the feedback. It is the basis of my teaching approach in the Foundations in Myofascial Release Seminars. Try it yourself; can you find your client’s frozen chicken and make a change?

4 Steps To Building A Successful Therapeutic Relationship With Your Patients

March 22, 2016/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

There was something different about the way she said goodbye.

The lack of communication was strange as her typical six or seven text messages were never sent.

I pulled in the driveway and wondered why she hadn’t gotten home from work yet?

I walked to the top of the stairs and there it was stuck to the fridge, almost glowing because it stood out from everything around it.

That letter told me about the pain she was feeling that I wasn’t able to fix, but really just didn’t know how to. It wasn’t that I didn’t want to, I just didn’t have the ability or maybe the proper tools to.

The last few months had been tough and I guess something I had said, done, or possibly not done was the last straw.

To be honest, I really didn’t know how to deal with our issues and sometimes chose to ignore things because well…it was just easier.

The strong woman that she was had long before decided to move on, since I couldn’t be the man she needed. She put her interests first.

I walked through the house alone.

The relationship we had taken so much time to build up was now gone because I didn’t know how to deal with it.

Why Therapeutic Relationships Are More Important For Massage Therapists

Our careers are built on relationships.

Patients can go to a Chiropractor, Physiotherapist or even their Doctor and sometimes get a total of 15min with them. When a patient comes to you they get you for anywhere from 30min – two hours, of direct contact.

That time is your opportunity, especially when it’s a first time patient. You could be the best therapist in the world but if you don’t take the time to cultivate a relationship with that person, your efforts will be in vain.

So what can we do to build a solid relationship with our patients?

Make a damn good first impression
Read your patient
Build a good foundation through assessment
Build trust

1. Make A Damn Good First Impression

Remember the old saying “you never get a second chance to make a first impression”?

It is quite frankly the start to any good relationship. Even the girl I spoke about at the beginning must have been impressed the first time we met, it turns out I just couldn’t sustain it.

Greet everyone with a big heartfelt smile, they can tell if you’re faking it. This can set the tone for the rest of the treatment.

It’s important to remember that when your patients come in, it’s all about them. They’re paying you and it is their time.

So, no matter what is going on in your life, it’s kind of irrelevant.

The more we can do to set them at ease before the treatment even starts, the better. Your patients have a ton of things going on in their lives stressing them out, including whatever injury they’re coming in for. This is not a time for you to come across in any kind of a frustrated way because you’re not having the best day, remember they’re paying you to help.

I used to work with a guy who was constantly stressed out about home life. He would fly off the handle about anything and could only communicate if he was yelling. Everyone was scared to deal with him. But, if he smoked a joint (yes this was happening in an industrial mill) he was way more approachable and easier to deal with.

The only way you could tell?

You could see him grinning ear to ear from across the mill.

Now in no way am I suggesting that you should smoke a joint at the start of your day in the clinic. But, the only way we could tell if he was going to be easy to deal with (which set us at ease) was when we saw that big grin.

Your patients will read you the same way. Most of the time they are coming in to relieve some stress and deal with a variety of other issues.

Do your best to set them at ease right away.

2. Read Your Patient

This starts to happen as soon as you greet your patient.

Are they in a good mood and happily walking into your room?

Are they slumped forward and feeling down?

Read their body language.

This makes a huge difference in your treatment. If they’re feeling down and in a bad mood, they may not be as happy with your treatment as when they come in with a better frame of mind.

The results of the treatment may reflect that.

Other than getting this massage and relieving some stress, what can be done to elevate their mood?

Change your music to something more upbeat. It doesn’t always have to be new age spa music (in fact if I played that all day in my treatment room, I’d have to jump out the window), throw some 80’s music or something else they like on and elevate the mood a bit.

Try telling them a story or a good (albeit clean) joke to bring their mood up. Recite your favourite part of a a Seinfeld episode to them.

Get them to tell you a story about something great happening in their lives right now. Get them to talk about their kids, another loved one, or some accomplishment they have had in the last while. People love to talk about themselves, so ask them to.

I’ve heard it said that “the only thing we should be talking to our patients about is their healthcare”.

If that was the only thing you ever talked to, or allowed your patient to talk about, I doubt you’d get too many repeat patients. While the conversation should always be kept professional, patients aren’t coming in to be treated by a robot.

Your personality is part of what keeps them coming back.

3. Build A Good Foundation Through Assessment

I didn’t completely understand what my teachers were harping on me so much about when I was in college.

They would get after me about “make sure you do three different assessments with each patient”. Then I became one of those teachers harping on the students.

Assessment is your foundation.

A good assessment isn’t just to give you an idea of what’s going on with your patient, to tell you what areas to treat.

It’s your proof.

It is your opportunity to prove that you know what you’re doing and that you did a good job, that you made a difference. When you can perform the same orthopaedic tests after their treatment and demonstrate the greater range of motion, decrease in pain or freedom of movement, it instills faith in you and what you do.

Even if you’re a little stumped on what assessment to do, make something up, figure something out. Then look up what test you could do while they are getting on the table. You can always do more tests during the treatment.

In fact, get them moving on the table, so that you both get feedback about how the treatment is going.

It’s amazing the difference it makes when part way through a treatment someone can only move a certain amount and it continues to get better as the treatment progresses because you continually assess.

Photo by: Roger Mommaerts

4. Build Trust

This is one of those areas where we are pretty privileged.

There is an assumed trust before our patients event get there. They know coming in that they are going to be naked on a table. That’s a pretty huge thing for anyone to give to us. Think about it, even before meeting us, they have enough faith to take their clothes off and just lay there, assuming we will be professional and bring no harm to them.

It’s our job to in still that trust immediately.

For me as a male therapist this is huge. Not everyone is comfortable coming in to see me, and some do it reluctantly. There are times I have to put people at ease before even starting an assessment (although I think I have an advantage from dealing with people in emergency settings) and let them voice how they’re not overly comfortable being treated by a guy, but they just need treatment.

Fair enough.

Let them talk. This is a big opportunity to build trust. After the treatment, when they realize nothing bad happened or was going to happen, they’re usually happy to book in again.

In a conversation with someone a couple of weeks ago, they told me that their spouse had asked:

“What is so wrong with you, that you have to go for a massage once a week?”

The response:

“It’s more than just a massage, It’s my therapy. I get to unload about life, I get a good belly laugh and I get to de-stress”

Sometimes people need a non-judgemental ear. Allowing them to unload about the stress of life can me more valuable than the actual treatment (while of course keeping our professional boundaries in check without offering advice or counselling).

When people know that what they say in the room stays in the room, (think of your room like Vegas, okay maybe not all of Vegas, but you get what I mean), it builds their trust in coming back to see you again. Especially when different family members come in and talk about home life. We definitely don’t want to cross a line and say something to another family member that was said to you in confidence.

If someone comes in with a condition or injury you’re not sure how to deal with, refer them to someone who can. It’s okay to admit you’re not sure how to deal with something, just get them to someone who does. Trust me they’ll respect you for it.

Use these four steps to build a therapeutic relationship with your patients. Although some of these suggestions may seem like common sense, sometimes it’s easy to become complacent in practice. Even though I named the fourth one building trust, using the first three steps are a good way to set up the foundation to build trust. Communicate effectively with your patients when they describe their pain to you, figure out how to deal with it. Refer out and collaborate if necessary. A patient can pick any Massage Therapist in their community to use for their healthcare, being engaged and building relationships with the people who come to see you is what will keep them coming back. Be the therapist they need so that you never get a “goodbye letter” from your patient. Now if someone could just tell me how to get the TV and the Netflix account back that would be awesome.

Is Volunteering Massage Therapy Worth The R.O.I?

March 15, 2016/1 Comment/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy, Sport Massage/by Jamie Johnston

“Contact us and we’ll get you to the first page on Google”

We’ve all seen the emails come into our clinics (and maybe even personal accounts).

Then there’s the other emails. You know the ones.

“Our organization is doing a fundraising event and would like to give you the opportunity to donate some gift certificates to help raise money for our charity”.

Every year as business owners Massage Therapists must decide how they are going to spend their marketing dollars.

Where is the best place to spend money and what will the Return On Investment be?

Is volunteering our time really worth the effort it takes to provide free treatments?

As it is with any marketing venture, you have to ask “is there a return on investment of my time if I donate”?

Well it depends.

Donating Massage Therapy Gift Certificates

This can be a bumpy road.

Every year our clinic gets several requests via email, phone and our regular patients that come in, to donate a gift certificate to some sort of cause or function.

One of the interesting things about this (and I know from doing fundraising with the fire dept) is that once you say yes, the same organization is coming at you next year to ask again. While there is nothing wrong with them doing that, just make sure that wherever you are donating gift certificates is worthwhile.

Make sure to check that your donation is going to something you can actually help with.

I’m always more than happy to donate to local hockey teams, or different events that I can at least relate to. If there is a request to donate to an organization where I know the recipients are people who actually use massage therapy, then yeah I’ll donate.

For instance in our community, hospital workers (ie: nurses, pharmacy tech’s etc.) have amazing benefits when it comes to massage. So if I can manage to get one of them in the door, where there’s a really good chance they’ll rebook, I’m happy to help.

If the request comes from one of my current patients, again I’m happy to help. They support me in my business, so the least I can do is help them out with whatever endeavor they are putting their efforts toward.

If the request comes from someone or something that I don’t connect with, I’ll be far more reluctant to donate anything. Although from being involved in fundraising on the other side of the table, there’s something I’ve learned from making requests for donations.

Most of the time when we’re fundraising and ask stores for donations (especially the big box stores) they’ll donate just enough that it requires the recipient to spend more money.

Rarely do they donate a material prize, it will be a gift card for say $25-$50 so that the person will buy a bigger ticket item and just put the gift card toward the cost. It ends up being a win-win for both parties.

The other thing most of these places do, is ask for a tax receipt. At least this way, they are not losing out on the money, they will actually get a tax deduction at the end of the year which lowers their bottom line.

Before you just randomly donate to the next charity that calls, ask yourself (and the person asking) a few questions first:

What is my possible return on investment?
Can I get a proper tax receipt?
Is it better to give a discount rather than a full treatment, so I at least make some money?
Is the charity or cause something I actually believe in and can connect with?
Does my clinic schedule actually allow for someone to book in?

Gift certificates can be a great way to promote your business and be a great marketing tool, just make sure you donate wisely so it is still profitable for you in the end.

Volunteering With Sport Massage

When it comes to working in sports this is a bit of a vicious cycle.

So many sports organizations don’t have the funding or the money to be able to pay for the services of a Massage Therapist. Depending on the size of the community you live in this can be almost painful if you want to get involved.

Your average high school basketball team obviously can’t afford full, or even part time therapy and if there aren’t any teams in the area that can afford it and you want sport experience, what do you do?

One of the other issues with sport, is that if you do volunteer and decide that the organization should start to pay for your services and put up a hard stance with the team, there is someone around the corner who is willing to take your spot and start volunteering, just to get an opportunity.

Most teams are going to do whatever they can to save money, so if you’re not willing to volunteer your time anymore the general attitude can be (and I’ve heard this from team managers) “no biggie, we’ll just get someone else”.

While there are teams that can afford to hire a full or part time therapist, those spots are tougher and tougher to get into. It also completely depends on where a team gets their funding from or if the team is privately owned. Usually if a Massage Therapist gets one of these spots, they’re reluctant to give it up and they hold onto it like Donald Trump grabbing his hair in a windstorm.

I’ve debated giving up one of my sports volunteer positions but hesitate because I always wonder if I’ll get the chance again.

If you decide you’re going to volunteer your time, make sure it’s worth your while.

At a minimum, make sure the team is willing to promote you. In return for your donated time, the athletes should be willing to come and see you in your clinic as well. If the athletes are minors, their parents should be made aware of who you are and that if they need treatment, your clinic is where they should go.

Check to see what kind of insurance the athlete or team carries.

I used to do one day a week at the rink with the hockey team where I would bill hockey canada. If a player was injured, the team doctor would sign off on the insurance form recommending massage therapy so I could then fill out the form and submit it for payment from the insurer.

Find out what other healthcare practitioners the team uses and see if you can set them up as a referral base. I still have a steady stream of people who come in from the team chiropractor and we refer back and forth for each other regularly.

Just make sure that if you’re volunteering your time with sports you get more from it than just experience.

Photo by: Elvert Barnes

Fundraising Massage Therapy Outreaches

Every year in our city there are charity 10K’s, Run For The Cure’s, Goddess Run’s and various other charity events looking for Massage Therapists to volunteer.

They can all be great events to volunteer at and hopefully generate some business for you.

Just like the gift certificates, if you volunteer one year you can bet the event is going to call you next year to see if you’ll come out again.

But choose wisely.

I have done some volunteer work for events like this in the past, both as a student and as a registered therapist. I’m much more likely to spend my time at a half ironman or a 10K because most of the people involved in these are going to look for more therapy after the race day.

If they have spent enough time training to get ready, they’re more likely to keep exercising as a regular habit, thus needing more therapy. This is where I’m more confident that I can turn a couple of them into a regular patient with a little education and discussion on race day.

I’m far less likely to volunteer at a Run For The Cure, or a Goddess run. Not because I don’t think they’re great causes or that the athletes won’t need further therapy. It’s because it’s harder for me to connect with the participants (which is my own issue). I worked a couple of these kinds of events as a student and had a tough time watching people crying as they crossed the finish line. I hate seeing women cry!

If you decide to volunteer at one of these events for the first time, keep track for the rest of the year and see how many people come to your clinic as a result of your attendance. If you get a few new people, then you’re getting a return on your time investment.

I’m not saying that volunteering your time is a bad thing. I volunteer hundreds of hours a year between the fire department and sports. Both have their own set of rewards and both have given me some great opportunities. However our time is valuable, maybe the most valuable thing we have. While volunteering can help give you better community engagement as a business person your time shouldn’t be given away randomly. As you should with any marketing you do, track how successful the marketing strategy was. Track how much business comes your way from your volunteer time and weigh out whether it was worth the investment. I mean you paid a lot of money to go to school and learn how to be a therapist, you should at least get paid for it!

10 Business Mistakes I’ve Made As A Massage Therapist

March 8, 2016/8 Comments/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

“Success is walking from failure to failure with no loss of enthusiasm.”

— Winston Churchill

“There are no secrets to success. It is the result of preparation, hard work, and learning from failure.”

— Colin Powell

I couldn’t wait to get out of school.

25 hours a week was all I was going to have to work to make a great living.

It would be so easy, this is why I spent two years in school.

Then I got my first job and went to work. I think I had three patients my first week. Why wasn’t everyone just lining up to get a massage?

I worked in a room adjacent to a gym. All these healthy people that were into fitness and taking care of themselves, why weren’t they booking in?

The following week wasn’t much better.

Why wasn’t it just happening instantly like I thought it would?

Because assuming it would just magically happen was my first mistake. Unfortunately I made other business mistakes along the way. Some big, some small but they were all mistakes that I was clearly not ready for.

Here’s 10 business mistakes I’ve made along the way.

I’m sure there’s a lot more, but these are the ones I can remember.

1. Taking The First Job Offer, Without Actually Looking

I couldn’t believe my luck. I bumped into my sport massage instructor one afternoon and asked about getting involved in sports.

As the conversation progressed, she asked if I had a job lined up after school was done.

I hadn’t yet.

She told me about a great opportunity at a local rec-center. I would have full access to the gym, steam room, equipment, pool, everything. I’d also be working with a kinesiologist who had been at the rec centre for 15 years and had a great client base.

He would also be more than happy to refer people to me.

This was awesome, I don’t even have to look for my first job.

I was set and couldn’t wait to get started.

Once I got out there and got all set up, I had to start networking with the employees. None of them knew who I was, what I was doing, or really knew anything about Massage Therapy. They were willing to put an ad about me in their newsletter that went out every quarter, so there I had a bit of advertising. A friend of mine who owns a decal company made me up a sign for the treatment room, to show people in the gym what was being offered.

Then I’d show up and wait.

And wait.

Some days people would come in and ask questions, sometimes they’d book in for a massage. I ended up getting one or two regulars that would come in once a week. Some days I would get super excited that I’d have three people booked in.

Other days, there wouldn’t be anyone.

I worked there for about nine months before I had to move on. And it was MY fault. The kinesiologist was a great guy, who did his best to help, my former teacher did everything she could to help, it just wasn’t a good fit for someone fresh out of school with no business experience.

Or maybe it was for someone else, I just couldn’t make it work.

I was so excited to get that first job out of school, I just assumed it would come easily. I didn’t even bother to look for another job at another clinic. I didn’t look to see if maybe there were other places that would be a good fit, where I could be busy right off the bat. I just assumed it would be easy.

It isn’t.

2. Not Starting In A Busy Clinic To Actually Learn The Business Of Massage Therapy

Since starting in the clinic I work at now, it has been a constant learning experience.

Compared to that first job, I have gotten to learn more about the “business” of Massage Therapy as opposed to being a Massage Therapist.

Actually signing a contract with the clinic and realizing the importance of that for both parties involved.

Understanding the mix of personalities in a clinic and how that affects not only the running of the clinic, but also how different people book in.

Getting into billing insurance companies directly and realizing the convenience it brings to patients. And this one is huge. I have seen a significant increase in patients ever since we started doing this. When the patient realizes that they don’t have to pay anything out of pocket and you handle the billing, they will choose your clinic over one that doesn’t.

Taking the time to understand how rent, tax and other deductions are all calculated has been a steep learning curve since starting there.

All things I should have learned earlier in my career.

3. Being Timid About Re-booking Patients

I really struggled with this early in my career.

Then one day I had a conversation with a local Chiropractor who runs a very successful clinic and has Massage Therapists working there.

He told me that one of the biggest mistakes he sees Massage Therapists make is when they concern themselves with what a patient can afford. Our job as therapists is to lay out the best treatment plan possible for the patient. If you say they need to see you twice a week for the next three weeks and then tell you they can’t afford it, alter the plan.

He backed that up with a story about a patient that had gone to a specialty clinic for some specific work. When they layed out the treatment plan it was very sporadic. Once they found out the patient had insurance coverage, the treatment plan changed dramatically and the patient was given better care.

The patient was understandably confused and didn’t go back to that clinic again.

Our concern (especially in patient centred care) is what’s best for their health, so give them the best possible plan for their recovery.

All too often I would be concerned about the patient’s finances when considering re-booking them. I’d say things like “well if you can afford it, I’d like to have you come back next week”.

Little did I realize that by communicating like this, I was losing the patients confidence in me.

Remember, you are the therapist and the patient is coming to you for your skills and knowledge.

Only worry about their pocket book if they bring it up.

4. Listening To The “Myths” I Heard From Other Therapists

The myths in Massage Therapy aren’t just around the therapy end of things.

They are also around who to work with.

All too often I’ve heard about therapists who had bad experiences in dealing with insurance, lawyers and workers compensation companies.

While the stories are true and some therapists have been stung by not getting paid, it doesn’t mean this happens every time. I know some clinics around town who are very successful in dealing with some of these insurance companies and make a good living off of referrals coming in from them.

Early in my career I would avoid these type of things like the plague because of the stories I’d heard.

Last year for the first time I entered into a “Direction To Pay” agreement with a local lawyer. The agreement is between the lawyer and myself, not between me and the patient. When he has people come in who have been in a car accident, he refers them out to healthcare professionals that he uses exclusively.

When the patient comes in to see me, they sign a contract which is then signed by the lawyer. When their claim is settled, the lawyer (not the patient) pays me out of the settlement.

Most of the stories I heard where this goes bad is when the patient calls the therapist and wants to negotiate a reduction in pay after the settlement. In these cases it is usually the patient who has made the agreement with the therapist, not the lawyer.

While it does take time to get paid from these agreements, it has filled my practice and made me busier than ever before.

I truly wish I had started doing this right out of school. It would have brought me more patients and I would have a steady stream of recurring income from a consistent source.

5. Not Getting Proper Accounting Advice

I’m not good with money.

I find managing money, balance sheets and accounting software confusing and frustrating.

I’m five years into my career and am just now starting to look at how to properly budget to make sure my finances are completely taken care of. Back when I first started I would just take my books to an accountant once a year to get my taxes done.

I am ALWAYS shocked at how much I end up owing.

At the start it wasn’t quite as important because I wasn’t busy. It was simpler to just take things in at the end of the year and have someone deal with it.

It was a terrible approach. It never made me understand where money was going, or where money was coming in from and I was never prepared to pay that tax bill.

Using a proper accountant and book keeper has helped to change all that. Now I can delegate a lot of that work and the accountant keeps me up to date on when things are due. I get regular communication about when quarterly taxes coming, how much is due and what things are good to spend money on business wise.

I’m also fortunate as I can just email back and forth with the book keeper regarding business questions, email receipts and she doesn’t tear me a new one when I walk into her office with a pile of unorganized junk that she has to figure out.

Now that we are working on a proper budget it should keep me in better financial shape for the future.

Had I started doing this from day one, I would be in much better financial and business shape today.

6. Not Having Another Job To Make Ends Meet

This is especially important if you’re just starting out.

Things are going to be slow while you build your practice. Even if you start in a busy clinic, you’re not going to be booked solid right from the start. Plus you have the added stress of student loans and the fact that you probably haven’t made a dime while you were in school.

There is no shame in having another job to support you while you build your practice.

When I first started in that rec-centre half the time I had do idea where I was going to get the money to pay the bills for that month and even had to borrow money from my parents at the start (and I hated that).

Then an opportunity came and I got my job working in dispatch with the fire department.

You have no idea the relief that brought. I was working construction on the weekend, just to get enough money to pay bills for that month when I found out I got the job. It was like I had just hit the jackpot.

I could schedule my clinic hours to work both jobs and this way had some money coming in while my practice was building. Even after starting at the busier clinic I kept working the dispatch job. Fortunately my clinic owner was understanding and would help me work around those shifts.

On average I would work 36 hours a week in dispatch and about 30 in the clinic.

Every Friday for about two years I would work in the clinic from 11am – 5pm, then head straight to the dispatch job and work 6pm-6am. Then another two shifts in dispatch between the weekend or during the week.

It was a lot of work, but eventually I was able to back off the hours at the other job as my practice grew.

Now I just work the dispatch job one or two shifts a month, and more because it interests me, not because I have to.

Don’t be afraid to pick up extra work while your practice builds, it will make you appreciate things when you’re busy that much more.

7. Thinking “Giving Away Free Massages” Was Good Marketing

This may be one of the worst things I did when I started out.

I would put up posters around the rec-centre promoting coming in for half price massages and did a bunch of them for free. My thinking was that I just needed to get people through the door, no matter how much the treatment cost.

It was terrible.

While I thought it was a good marketing ploy, all it did was open the door to people who didn’t want to actually pay for anything. One man during the treatment asked how long my schooling was. When I told him it was two years, he said “my son went to school for four years to be a welder and only gets $30 an hour, how the hell do you think you’re worth $90 with only two years of school?”

Most of the people I treated at a discount, expected their next massage to be the same price or cheaper and refused to pay full price.

While I still donate some time to sports teams and am willing to give out gift certificates for fundraisers when requested, I won’t market myself by doing discount massage ever again.

I also believe I was just cheapening the profession by doing that.

8. Not Networking Properly

A friend of mine invited me to a networking breakfast that he went to every week to see if it could help drum up some business.

I went to my first BNI meeting. There was a cost for breakfast (and for membership if you sign up), but there was a large group of people there who met regularly to refer and create business for one another. I thought it was a good enough idea, so I signed up for a year with a chapter closer to where I worked.

While I made some great friendships, it didn’t end up creating a lot of business for me (however I know several people who swear by it for their business).

I should have been trying to network with local healthcare professionals instead.

Reaching out to local Chiropractors, Physiotherapists and Doctors would have brought greater returns than what I was doing. Once I started dealing with other healthcare professionals and communicating with them effectively, I started having more patients referred to me.

Now when I say networking properly, this doesn’t just mean the initial introduction. It’s an on-going process. Following up on the referrals and reporting back what you found and what you did with each patient grows a stronger relationship with those other practitioners.

If one of them sends you a patient, send back a thanks along with a report of what you did.

When you start comparing notes back and forth, they will be more likely to keep referring to you.

But make sure you return the favour.

If you get someone in who could use the help of a Chiro or Physio, make sure you refer back to them as well.

Photo by: Maryland GovPics

9. Not Asking For Referrals

This is something I still struggle with, but continue to work on.

The biggest marketing advice I was given in school was: “just give the best damn massage you can to every patient, you never know who they’re going to tell”.

While we live in a digital age now, word of mouth is still one of the best marketing tools out there.

Don’t be afraid to ask your current patients for referrals. If they start talking about a friend who’s injured, explain what you can do to help, tell them a story about how you helped someone else with the same issue.

If they’re a regular patient, they obviously have faith in you and what you can do. So let them tell their friends about you.

Usually people are only too happy to make the referral, sometimes they just need a little nudge to remember to do it.

10. Not Being Active On Social Media

I’ve been studying and reading a ton about this over the past couple of years.

Social media is probably the most cost-effective tool you can use to promote yourself and your business. The only real cost is time and when you’re just starting out, you have lots of it.

Social media platforms are a free place to do business.

Facebook is the place to start connecting with your patients, it allows them to communicate directly with you as a therapist. Every time they interact on your business page with shares and likes, it opens you up to be able to market to their friends when they see this interaction taking place.

You can also set up ads and messages to reach a target audience, which you can structure to appeal to certain demographics. So you can actually aim your marketing at specific groups that you would like to have as patients.

Twitter is a great way to start interacting with local businesses and potential customers. Be a curator of content and provide useful information about Massage Therapy to start building a following in your community.

Use Linkedin to start connecting with local professionals in your area. Use it to grow business to business associations. You can also use it to blog about your practice and grow awareness about it in the business community.

There is so much more to being a Massage Therapist than just giving a great massage. You have to be a business person, marketer, accountant, networker and social media personality. It is just as important to learn how to run a business and be a sole proprietor as it is to learn a new technique at your next continuing ed course. In fact, there should be some solid continuing ed courses just on being in business. I’ve made lots of mistakes in my career, but at least with every mistake there is also a learning opportunity. Take the time to track what you’re doing for marketing and make sure you’re getting a solid return, whether it’s attending networking functions, volunteering your time or working directly with insurance companies. And even if you have a busy practice, you should still continue to market yourself. Even McDonalds still has to advertise.

6 Tips For Getting Involved In Sport Massage

March 1, 2016/in Massage, Massage Clinic, Massage Therapist, Massage Therapy, Sport Massage/by Jamie Johnston

I was so excited to get my first chance to work in sport.

Walking through the staff entrance to the rink, players were running around getting equipment, doing their warm ups and reporting to medical staff. I remember it like it was yesterday.

I stood in awe.

One by one, the training staff introduced themselves to me. Chiropractor, Sport Med Doctors and equipment managers all welcomed me to the team.

Then it was time to get to work.

Sport Med Doc was assessing a player with a concussion, the AT was doing some taping and players were popping in to get some work done from the Chiro. As the Chiropractor was getting ready to do some manipulation, he introduced me to another player and asked me to work through his low back before he did any work with him.

Player after player worked their way through before the game started. There was almost a pageantry to it in my mind. Watching each health care person work together in combination with the equipment managers to get everything and everyone ready before the game.

It felt so amazing being around the team and seeing what happens behind the scenes. As a student, sitting there watching and listening to those healthcare professionals doing their assessments and talking about what was going on with each player (and actually understanding them) made it that much more amazing.

This is why I wanted to be a Massage Therapist.

Getting Into Working With A Team As A Massage Therapist

When I decided to become a Massage Therapist, one of my main goals was to work with athletes and be involved in sport.

I talked to a few of my teachers in college about their experience. Some had been to olympics, some worked with specific teams and some worked with everyday athletes in their clinics.

While in term two of college, a buddy from my hometown was playing on the local Junior A hockey team. So, I gave him a call to see if they had a Massage Therapist on the team, he said they had an Athletic Therapist, Chiropractor and Sport Med Doctors, but no Massage.

Maybe I had an in.

Talking with one of my teachers who works in sports and is heavily involved in the X games, I asked for his advice on how to approach the team. The advice he gave, helped me to have a better outlook on how different Athletic Therapists look at roles on teams and where everyone should fit in.

His advice was to find out what kind of work the A.T. was doing with the team. Some like to do their own massage and don’t want to outsource it or have someone else do it for them. “Find out if he does his own massage, so that you’re not going to step on his toes or take something away from him by getting involved”. He told me to use my First Responder background as another manner in which I could help the team, in case he did his own massage.

Armed with his advice I approached the team A.T. one night after their game was over.

I explained that I was a student looking to get some experience. He was pretty happy to hear about my First Responder background and was gracious enough to have me start coming to games and helping out.

6 Tips For Working In Sport Massage

Working in sport can be a tough scene to get into.

Some people have to work their but off to get into it and others can end up just falling into it. Either way, if it’s something you’re interested in, here’s a few tips to help you get started.

Get your First Responder license. It is almost worth its weight in gold. Not only do most teams need someone to act as a First Responder, it will add to your clinic experience as well. Being able to recognize and deal with medical emergencies in a confident manner not only adds to a patients confidence in you, but can literally be a life saver in the clinic or in the sport environment. In fact some leagues require teams to have a certain number of First Responders at every game, it could be one of the things that gets you in the door. Over the years I have done far more First Responder work than Massage Therapy working with the team.
Volunteer in a sport you’re passionate about. If you’re passionate about the sport, you won’t even feel like you’re working when you go there, you will actually look forward to it. There is also a reward in knowing that you are one of the people who contributed to the athletes and team success.
When approaching a team, go directly to the head trainer. Little did I know (until someone else on the team told me), the biggest reason the A.T. welcomed me to the team is because I approached him directly and not the front office staff. The head trainer is in charge of all medical and therapy issues with the team and they are in control. Having someone come in the back door because another team person brought you in isn’t going to go over very well. Always try to contact the head trainer and talk to them.
Look to see if you have any local Sport Massage organizations you can join up with. Once I joined CSMTA (Canadian Sport Massage Therapy Association) I was given the chance to work with the Rugby Canada National Men’s 7’s team because their main Massage Therapist wanted to use therapists from that organization. Here in BC we recently started a Sport Professional Practice Group that is focusing on Massage Therapists becoming more recognized in sport. Reach out to these types of organizations to see if there are opportunities in your area to get involved.
Be willing to help with things other than massage. Need water bottles filled?, towels for the athletes?, equipment issues? Be there to help out with all aspects of what happens behind the scenes. As much as the athletes are a team, so is the background staff, make sure you’re an important part of the team.
Always be willing to learn from the other medical professionals you’re working with, you will learn a lot which will add to your experience and make it more positive.

If you’re interested in sport massage, get out in your community and see what’s available. It doesn’t matter what level the team is, it will be a way to get experience, build your network and help increase business.

Photo By: Brian Cribb

The Benefits Of Volunteering In Sport Massage

This is where some therapists have a hard time.

Getting paid in Sport Massage can take some time. There are some organizations out there that are willing to pay and others that are regulated by governing bodies who decide on funding and what gets paid for.

For instance, in Canada OTP (Own The Podium) decides on funding for Olympic athletes and organizations as well as where the funding is spent. So some teams may be bound by whatever funding is given as far as therapy.

In private teams, the team will typically have a budget they work in and will decide whether having a Massage Therapist is something they can afford.

As difficult as it may be to find the time to volunteer, there are other benefits.

In the past I have taken days at the rink to work on players where the team doctor signed insurance documents for whenever a player needed some Massage Therapy. I would then fill out the signed document, submit it and get paid via the league’s insurance policy. The turn around to get paid is a little slow but hey, I was working in the sport I love.

The team Chiropractor sends me more referrals to the clinic than any other source the clinic uses, or any marketing I have ever done. I counted up one week a little while ago and in a five day period, half of the patients I saw, came from that Chiropractor. So even though the majority of my work with the team is on a volunteer basis, he has sent me a lot of business over the years.

Being able to say you work with a local team changes the way patients look at you, especially new ones. A number of times I have had people book in with me because they see that I work with the team and they want a therapist that can help with athletic injuries. The hockey team’s front office even tries their best to refer people to me and some even bring family members in.

I get asked several times a year by other therapists interested in working in sport if I know of opportunities for them. I still think the best way to get in is just by marketing yourself to different teams and volunteering your time to get started. The paid positions will come, but they don’t always come easy. By taking continuing ed courses based around sport (like First Responder), making sure to approach team head trainers, joining Sport Massage organizations, volunteering where you’re passionate and having a great work ethic are all steps that will get you closer to being able to work in sport. But whatever sport you’re passionate about and decide to get into, (keep in mind I’m Canadian) it’s just not as cool as hockey.

A Massage Therapist Guide To Dealing With A Stroke

February 23, 2016/2 Comments/in First Aid, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

Every time I teach a First Aid course, I use the story about an old workmate who had a stroke.

I use it because it’s effective in painting the picture of how a person presents when this happens.

It was around 1am Monday morning, when I realized there was an issue.

That night, something seemed different but nobody else really noticed. Standing with his arms crossed almost supporting one arm with the other, our conversation seemed confused as he constantly gazed at the floor.

As we walked to the First Aid shack for a coffee, I asked how he was feeling:

“not good”

How was the weekend?

“I don’t remember, apparently I didn’t show up to work on Friday”

Did you leave the house to go to work that day?

“I remember dropping the kids off at school Friday morning, but that’s really the last thing I remember”

As we kept talking, his slurred speech became more noticeable. When he relaxed, those crossed arms became one crossed arm and one seemingly limp arm. Looking into the eyes and face of this normally strong, athletic man there was something missing. His left side was almost motionless, wilted.

Can you lift your arms above your head for me?

The right arm went up, left one didn’t move.

Can you kick your legs out for me?

The right one kicked out, left one stayed put.

We need to get you to the hospital.

Tips For Recognizing Someone Has Had A Stroke

How To Help A Patient With A Stroke

One of the reasons this is so important for us as healthcare professionals is because we see our patients so regularly. In my friends case in the story, he went the entire weekend and not one friend or family member picked up that anything was wrong. I saw him about five years later and he was a shell of the man he once was. If only someone would have recognized his situation sooner, the damage from the stroke could have been significantly less than what he went on to live with. Later that morning I went to the hospital to check on him. As I walked in the room he looked at me and shouted to the nurse:

“Hey nurse there’s the little jerk that sent me in here” (they had him on some pretty good stuff)

“You should thank that little jerk, he saved your life”