Pain Science And Massage Therapy (What I Learned In Greg Lehman’s Course)

September 29, 2015/9 Comments/in Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

“Exercise is an analgesic” – Greg Lehman

Coming out of college, I felt like I had a pretty good handle on things.

Although the sciences were not my strong suit, I didn’t think I needed to know everything about it. Lately there has been a strong move toward evidence based practice, advanced research and pain science.

With so much information out there, sometimes it gets confusing.

Watching facebook groups, blog posts, social media and other constant influx of information, how much of the information is fact or just opinion?

Ever read posts on Pain Science and feel like you’re looking at authentic frontier gibberish?

Maybe I’m alone on that but I quite often get confused and lost in what I’m reading. Almost like people are trying to make is confusing.

So I figured I had to do something about it. One of my neurology instructors from college posted on Facebook that he was bringing out Greg Lehman to teach on the subject of pain science. I signed up right away.

Last weekend a number of us attended “Reconciling Biomechanics With Pain Science For Healthcare Professionals” and it is one of the more rewarding continuing ed courses I’ve taken.

So here is a few of the things I learned in the course.

How Massage Therapists Can Recognize Pain As An Alarm

Greg used a great analogy that resonated with me (although I’m sure he didn’t know it).

He compared pain to a fire alarm. Do you actually need a fire to make the alarm go off? Does it tell you the severity of the fire?

The answer is no, and I know this firsthand.

When I work as a fire dispatcher, or when I’m responding to an alarm bells call on the truck, 99 times out of a hundred it’s a false alarm. Or the alarm has gone off because someone burnt something on the stove and it’s not actually a fire.

Turns out pain works the same way.

Pain is an alarm in the brain that warns us of the threat of damage, not necessarily that there is damage (although it recognizes that as well). The brain is listening to signals throughout the body, evaluates them and then signals action to protect it. Once the brain recognizes there is a problem it produces pain as a protection mechanism to help you.

However much like that fire alarm it doesn’t always recognize the severity of what’s going on. It is not a great damage indicator.

A year and a half ago I separated my A/C joint. When it initially happened there was a significant amount of pain and it caused a step deformity (brain recognized there was a threat of damage).

I went to the hospital and they determined that putting the shoulder in a sling for a week and no surgery was the only intervention needed. Within a few days the pain diminished and now I just have a funny looking shoulder. It still functions well even though there is torn ligaments and I can hear a grinding noise in my golf swing.

My shoulder is no different now than it was the night I injured it but the brain realizes there is no longer a real or perceived threat, so I’m not experiencing pain. Even with a significant amount of damage there is no pain to indicate a problem.

Photo by: Morgan

Pain And Sensitivity For Massage Therapists

I had always thought that when a patient came in who was experiencing pain it was because something was damaged.

I would give them explanations of what I thought was happening and why their shoulder or low back was experiencing pain. Ie: the muscle is damaged and is creating or making that pain.

Like so many other times in life, I was wrong.

Pain can persist past healing because for some reason the brain still thinks it has to protect something. Pain has more to do with sensitivity, not so much about damage. This means that you hurt but are not harming yourself.

How many times have you treated someone who was concerned about continuing to harm an injury if they kept up with a certain activity? As pain persists after healing we just become more sensitive to the pain. Our pain threshold is lowered so people start to experience pain sooner with less stress placed on the tissue.

It doesn’t even mean that anything has been damaged, we are just becoming more sensitive to the pain.

When we are providing therapy to our patient we are trying to change their thoughts from being fragile and weak to thoughts of strength so the brain no longer thinks the body requires protection.

This is where communication with your patients becomes invaluable. While we would never want to bluntly say “the pain is all in your head”, a good explanation of why the brain is registering pain can go a long way to improving their condition. We are basically just trying to decrease that sensitivity.

Massage Therapists And Smudging

In addition to everything else in the course I got to learn a new word.

Smudging.

Smudging is basically when brain cells become activated easily or become dis-inhibited which spreads pain or makes it move around. Pain is changing the map of the body within the brain making parts of the body poorly defined within the brain.

Smudging can cause a decrease in sense of balance, decrease in proprioception, change in muscle strength and timing.

This is where we come in. Massage Therapy gives feedback to the brain that it needs to help improve those maps in the brain.

Greg showed us a great example of how just altering someone’s position can change the way they are moving and experiencing pain. He showed a video of a therapist treating someone who was experiencing low back pain and couldn’t bend forward. The therapist got the person onto the Massage table and put them into table top position, then had them rock back and forth hinging at the hips.

Once the person saw that they were able to move, it helped re-work that map in the brain and the person was able to move easier getting off the table.

I used that exact same method at the start of a treatment later that week. A new patient came in who had chronic back pain for years.

They were experiencing a flare up and had never tried Massage Therapy. They were having difficulty walking and couldn’t bend forward at the start. I used the same technique prior to the Massage portion and included it again at the end and recommended it for home care.

They came in four days later for a follow up treatment with no pain and increased range of motion. Getting them moving in a different way helped tremendously in restoring function.

I had a boss years ago who introduced me to the K.I.S.S. rule (keep it simple stupid (well at least that’s how he explained it to me)), and as far as pain science goes, that’s exactly what Greg’s course has done for me.

Understanding that pain involves multiple systems of the body including muscular, immune, nervous and emotional changes has given me a greater understanding of what’s going on with the patients that come and see me. Realizing that pain doesn’t necessarily mean damage but that it is just an alarm the brain is using as a protection mechanism will change the way I communicate and treat my patients. Now, with an understanding of what “smudging” is, I am incorporating more movement therapy, especially with patients who come in dealing with acute pain.

There is so much more that I could blog about in regards to this course but I wouldn’t do it justice. I think it’s better for you to just take Greg’s course when you get the chance. If you don’t get the opportunity, at least download his pain fundamentals workbook to give yourself a better understanding and for better outcomes with your patients.

And hopefully pain science won’t sound like this to me anymore:

“I wash born here, an I wash raished here, and dad gum it, I am gonna die here, an no sidewindin’ bushwackin’, hornswagglin’ cracker croaker is gonna rouin me bishen cutter”

– Gabby Johnson, authentic frontier gibberish

7 Ways A Website Can Improve Your Massage Therapy Business

September 24, 2015/2 Comments/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Justine Sones

When I graduated college, I wanted to work with professional athletes.

I had a background in sports + a keen interest in movement.

To be honest, it also sounded good to say “I worked with professional athletes.”

The day after I got my registration certificate, I started working at a busy chiropractic clinic that treated a lot of athletes and in my mind would be the best place to start. I took continuing ed courses about sports massage, learned as much as I could, worked hard and figured it would just be a matter of time before my practice was full of athletes.

And I waited.

In the meantime, I started treating a lot of patients who had been in car accidents and people who just happened to go to the clinic where I was working. Before I knew it, they ended up being the majority of my clientele instead and I didn’t get to treat many athletes.

You’d think I was happy to be busy but I wasn’t – I was burnt out from working too many hours, doing work that I didn’t love and wasn’t nearly as fulfilled as I’d hoped.

I knew I needed a change.

I moved to Vancouver and started over – with a little more intentionality. I started taking some business courses and really honed in on how I wanted to work and who I wanted to work with. It turns out I didn’t actually want to work with high performance athletes, I wanted to work with the people I call “everyday athletes.”

They’re the ones who are active for the pure joy of it, they run marathons, do yoga, climb mountains and take dance classes.

They were people I could go for coffee with.

They’re creative entrepreneurs with a passion project on the side. They’re dog people. They love adventure, a good book and have a sarcastic sense of humour.

They’re my people.

Knowing who I wanted to work with provided major clarity around the business I wanted to build.

When I was clear on that, I needed a way to connect with the right people, so I started building a website.

It changed everything.

If You Want To Start Marketing + Growing Your Massage Practice, YOU NEED A WEBSITE

A website is crucial because it’s like owning your own little piece of cyber real estate – it’s a home for you online. You can invite people to drop by and visit so they can get to know you a little better and it makes you accessible.

Building my website was a catalyst to growing the business I wanted.

Here are just a few things that have made my site so valuable to my practice that you can implement too.

A Website Makes It Easy For Clients To Find You, No Matter Where You’re Practicing Massage

How can people find your information if it isn’t easily accessible?

This may not be a big deal if you only work out of one space during your entire career, but almost every therapist I know has relocated at least once. Having a website makes it a cinch for clients to find where you work.

It also provides a simple place to refer their friends.

The beauty of having a website, is that clients just need to know your name. If you have good search engine optimization, they don’t even need your full name.

On more than one occasion, clients have typed my name in google and voila! All the ways you can contact me just materialize in front of their eyes. And no, I have never paid someone who randomly called offering to “get me to the first page of Google.”

Please don’t fall for that.

A Website Gives People A Chance To Learn About You Before They Book A Massage

This happens because of the information you share, the word choices you make, and the way you present yourself online.

Within a few minutes of hanging out on my site or social media, people can tell that I’m a dog person, sarcastic, a mom, a coffee drinker, interested in business…the list goes on.

Your website and social media also allow you to share blog posts, articles and pictures that are interesting and of value to your clients. When they book a treatment, they have a general idea of your area of expertise and treatment style.

If you want to work with pregnant women, you’ll share very different information than you would if you want to work with middle-aged men who run ultra marathons.

My website has played a huge role in helping attract clients I work really well with. The way I write and things I share online resonate with a certain type of person and because that information is accessible, these people are more likely to book with me.

Having A Website Can Make Your Massage Treatments More Effective

True story – because it connects you with the right people.

I have had appointments where my style of treatment did not work for the client. She just couldn’t relax, conversation was awkward, we were both a little uncomfortable.

And this is a good thing.

Because on the other hand, I have people who come in and say:

“I booked an appointment with you because I read your website and it mentioned you do deep, relaxing work. It also said that you treat active people. That’s great because I’m a runner and a yoga teacher. Lately, I’ve been having some trouble with my right hip. I really need to feel better because I have a triathalon in a couple of weeks. So if you have any stretches or exercises I can do on my own, that would be great. By the way, your dog is adorable. I have a dog too!”

If you read the “about me” section on my website, that type of interaction makes a lot of sense.

These appointments usually go really, really well. The client has a great treatment, feels better and will tell other like-minded people she knows about that experience.

When you have an effective online presence, you don’t have to chase the clients you want – they find you.

A Website Lets You Keep Your Massage Schedule Up-To-Date

Since moving my practice to Vancouver my schedule has been constantly shifting, depending on life, business and the season. I keep my days and hours updated on my website, so my clients can check there to see when I’m working.

“But can’t they just call the clinic or check the clinic’s website?”

Totally!

But it is easier to keep your own stuff up-to-date than expecting that the clinic will get website updates done immediately. Some places are really great about it; others aren’t.

I’m a huge advocate for keeping the business side of your practice under your control and a huge key to that is having your own website.

Your Website And Social Media Make It Easy To Book A Massage

Can’t afford a 24/7 receptionist? Neither can I.

Luckily, my website takes care of that for me because it directs clients to where they can book. One of the most positive pieces of feedback I hear, is how much people love the convenience of online booking.

I also share on social media when I have last-minute appointment opportunities and those appointments usually end up booking right away. Fewer gaps in my schedule = a good thing.

Everytime.

WARNING: make sure “available appointments” aren’t the ONLY thing you’re posting from social media. That can come across as spammy.

If you don’t have online booking yet, the clinic I work at uses Click4Time. I have also heard great reviews about JaneApp and ClinicWise.

Photo by: Jason Howie

When Clients Want To Book A Massage, Keep The Information On Your Site Accurate

If I come home from an awesome workshop on fascial release, I can add that information to my bio or write a blog post about it.

If I’ve read a book that has changed my perspective about an area of treatment, I can share that information.

The more you refine your message, the more you’ll connect with the right people.

I can change my hours and availability.

I can update the photo in my bio.

I can choose the colours, fonts and words I use because those play a huge role in influencing the way people perceive me.

A Website Can Give You Insane Clarity About Your Work And Make You A Better Massage Therapist

The best thing about building my website is, the work I put into expressing myself transformed my massage practice in the best way possible.

As I did the work, I learned so much about the things that set me apart as a therapist and how I can use those skills to help people.

Learning how to communicate your strengths and the way your treatment philosophies influence the work you do, will be invaluable to the way you run your business and the impact you have in the lives of your patients.

You have a specific set of skills and knowledge that will help some people more than others. If you aren’t sharing the things that set you apart and truly represent who you are, those people won’t be able to find you and know you’re the right therapist to see. To portray the most accurate picture of who you are and how you work, you need to be in control of your online presence. Doing the work to get clarity around your practice will connect you with the people you can help most and having a website gives those people a way to find you.

I’d love to hear from you. Let me know in the comments if you have a website, I want to check it out!

If you don’t have a website, share what’s holding you back.

How Imposter Syndrome Could Affect Massage Therapists

September 22, 2015/7 Comments/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

“I have written eleven books, but each time I think, ‘uh oh, they’re going to find out now. I’ve run a game on everybody, and they’re going to find me out.’ “ – Maya Angelou

“There are an awful lot of people out there who think I’m an expert. How do these people believe all this about me? I’m so much aware of all the things I don’t know.” Dr. Chan, Chief of the World Health Organization

Sometimes I feel like I don’t know what the hell I’m doing.

And it doesn’t just apply to one aspect of life, with each activity I’m involved in, I question myself.

When I first started supervising at the college, students would sit down and rattle off orthopaedic tests they were doing and while I know I had heard learned those tests, I hadn’t done many of them since I was in college. I sat there and nodded, hoping I’d look like I knew what I was doing.

The first couple times I had to rush to help one of our players get off the ice after a big hit, all I could think was “there’s 1200 people, the team and three students watching, don’t mess this up”.

I’m guilty of comparing how busy I am at the Massage clinic to the other practitioners and wonder why some weeks, I’m just not as busy even though it fills up by the end of the week.

I’ve jumped on a firetruck and responded to hundreds of calls over the years, but there’s always questions in the back of my head coupled with a little bit of fear as we roll down the road, sirens blazing and wondering what we’re going to see when we get there.

Little did I realize that I’m not alone. In fact someone who is well respected (and who I respect) in the physical therapy community posted on Facebook a couple weeks ago that sometimes he feels like a pretender.

I was shocked.

Turns out this whole thing has a name.

“Imposter Syndrome”

Imposter Syndrome Defined

The Cal Tech Counselling Centre defines Imposter Syndrome as:

“A collection of feelings of inadequacy that persist even in face of information that indicates that the opposite is true. It is experienced internally as chronic self-doubt, and feelings of intellectual fraudulence.”

The worst part of this is when people are experiencing Imposter Syndrome, they don’t believe they deserve the success they are achieving. Accomplishments and accolades are often dismissed as luck or good timing.

But here’s the thing, people dealing with this are achieving success, they are just downplaying the difficulty, time and effort that went into achieving it.

I know that I’m not alone in feeling like this sometimes, in fact over 70% of people have experienced this at some point in their lives.

Even the likes of Albert Einstein, Kate Winslet and Tina Fey have experienced this.

But luckily there are ways to overcome and have confidence in your worth.

Ways For Massage Therapists To Overcome Imposter Syndrome

It’s time to let go of the voices in your head (especially if they’re answering), or at least acknowledge and realize they are there.

It’s a common tendency that if we feel passionate about something, then we think it must be true. Limiting questions will come up in practice and in life, but what can you do to reframe those questions? When these types of feelings come up, try to switch and reframe those thoughts.

“Why aren’t I busier this week in clinic?” = “What can I do to get busier this week in clinic?”

“I don’t belong here” = “I do belong here, look what I’m doing”

There is a drastic difference between feelings and reality. Just because you feel strongly about something doesn’t make it real. Your feelings can trick you about reality. Shift your focus to what you have done and what you have accomplished.

I remember sitting in College and thinking that if I’d known school was that hard I wouldn’t have taken the course. But, I passed.

Then came board exams.

I stared at the clinical science exam, completely frustrated about half way through and shaking my head, saying out loud “I’m gonna f&*#ing fail this”. The girl beside me probably thought I’d lost it. But I passed those too.

Take the time to make a list of your accomplishments and successes, then keep adding to it as you continue to progress.

When was the last time you paused to celebrate and appreciate all you have done? After you make that list, celebrate and enjoy it. Take a day off, go for a hike, go for a nice dinner, enjoy a good scotch, do something to recognize all you’ve done.

Too often nowadays we accomplish something and immediately look for the next problem we need to defeat, rather than focusing on what we have done to be successful.

Focus on what you HAVE done versus what you haven’t done.

You Don’t Have To Know Every Aspect Of Massage Therapy

Be confident in what you are doing.

Humility is a great thing, and has its purpose. But it can also help to reinforce imposter feelings.

When we avoid showing confidence in our abilities, we can persuade ourselves that we don’t deserve a positive outcome or success.

As I read through Facebook threads in Massage Therapy groups, the one thing that always gets me feeling negative is all of the topics on science. I’m not an overly scientific guy and struggled with some of the Anatomy and Physiology classes in college. Some of the other MT’s seem like they have it all together and talk fluently about their knowledge.

Sometimes I just stare at the screen and think “why can’t I be more scientific”? (Honestly I say sciencey, but I don’t think that’s a word).

But here’s the thing, science is just one aspect of Massage Therapy. So is experience, techniques, first aid (yeah I snuck it in there), education and so many other things. Just like you learn new techniques as your career grows, you can also learn more about these other aspects.

The pounding drive to improve can wear you down. The need to make things happen feeds the sense that you are faking it. Develop the awareness that you can get things done without pushing, forcing and going harder.

You are living evidence of your success.

You don’t have to overcompensate so that others believe you. You are the only one that needs convincing.

There will always be things that you do not know, there are things that you will never know and there are things that you can decide to learn.

When I see those Facebook threads, I’m essentially comparing myself to those MT’s who have spent so much more time researching and putting effort into learning a science based practice.

If you find that you’re comparing yourself to others, don’t compare forwards, compare backwards. If you must compare at all, look at the people behind you, or look at where you were one, two, three years ago. How much more do you know now? Think about all the expertise you have gained through life, practice and your experiences.

Look at those behind you as those you can teach, your peers as your peers and those ahead of you as mentors. You can learn from each group.

Photo by: Sylvia Duckworth

Your Failures And Mistakes Make You A Better Massage Therapist

We all make mistakes in life and in our Massage practice.

The difference is what we do with it. Rather than being hard on yourself about it, work with them. Use it as a lesson and research in the name of personal and professional growth.

Get support from others. Talking with a more experienced Massage Therapist might help you understand that you are not alone and can give you the reality check you need. Just because you might need some help doesn’t mean you are inferior or unintelligent. In fact, knowing when to ask for help is one of the smartest things you can do.

The reality is, we will all have ups and downs within our career. While we all need to continue improving, taking CEC’s and expanding our education, you don’t have to do it all. Reaching out for help when needed, having confidence in our abilities and embracing our success are all steps we can take to overcome imposter syndrome. You do not have to attain perfection to make a difference in your practice or to be worthy of success. Question any negative thoughts that come into your head and reshape them to shift your thoughts into a positive state. It’s not about lowering the bar, it’s about resetting it to a realistic level that doesn’t leave you forever striving and feeling inadequate.

What Massage Therapists Need To Know About Cerebral Palsy

September 16, 2015/7 Comments/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Meaghan Mounce

“See the person, not the disorder” – Meaghan Mounce RMT

I stood holding a client health history file, suddenly nervous with my mind racing.

I had never massaged someone with this condition before.

It was my first week at a new massage therapy clinic. I had just moved to the city and stepped into a busy clinic where my first week was booked solid. The second day of work I was reviewing the files of the clients I was going to see that day.

My last client of the day was a young lady in her mid twenties. I read through her file and health history form and immediately felt the butterflies I used to get when I was a student!

My client had cerebral palsy (CP), was nonverbal, used a motorized wheelchair to get around and had a care aid with her at all times. No other RMT’s on shift at the clinic worked with this girl before and I so I had no one to ask advice!

A million questions flooded my brain at once. In my four years of massage therapy practice I had not worked with anyone with a severe disability.

How would I communicate with her?

How would I know if I was hurting her?

Is she able to move around on the table?

Do I have to help with lifting and transferring her to the massage table?

Dealing With Spastic, Ataxic And Athetoid Cerebral Palsy

Luckily, I had just taught the section on cerebral palsy in the Pathology course at the massage therapy college in Victoria, BC so I had some recent information on the condition. However, as we all know, dealing with a real life patient is far different than reading about it in a text book!

Cerebral palsy is a non-progressive neurological disorder caused by abnormal development of or damage to the brain. This damage usually occurs in utero and can be caused by exposure to radiation, infections or lack of oxygen to the brain. Less commonly, CP can be caused from trauma during birth or serious infections during infancy.

There are three main types of cerebral palsy, as well as mixed CP which presents as a combination of the other three. There seems to be a wide spectrum of how the symptoms can present, from mild to severe.

Spastic CP is the most common type and causes symptoms of an upper motor neuron lesion of the brain, such as hypertonia of affected limbs .

Ataxic CP shows symptoms of damage to the cerebellum. Patients with ataxic CP often have difficulty with balance, walking and fine motor skills such as writing or typing.

The final type of CP is Athetoid and has symptoms associated with damage to the basal ganglia and to the neurological structures that affect involuntary movements. These patients will present with a mixture of hypertonia and hypotonia and will experience involuntary movements.

Learning about the Condition Beyond a Textbook

From my knowledge of the subject, I decided my lovely client had athetoid type cerebral palsy. It was not stated which specific type of CP she had on her health history form.

She was bound to a wheelchair, had hypotonia (no muscle contractions) in her lower limbs. Her legs and feet had no voluntary movement, were very thin and cold to the touch. Her upper limbs were spastic. Her fingers were curled around the thumb in flexion. While she had some voluntary control of her arms, the movements were very jerky and she often had flailing limbs that were out of her control.

She could not speak, but had an amazing computer that she could press a button and it would say a few programmed sentences for her.

On the day I was to massage her, I waited patiently, nervous but also excited for a new challenge.

Get To Know Your Client And See Beyond Types Of Cerebral Palsy

She rolled into the clinic on her motorized wheelchair, controlling it herself with her head. Her care aid walked behind her encouraging her in a relaxed manner to drive the wheelchair forward.

The first thing I saw was a huge smile on the client’s face. After I said ‘Hello’, she quickly pressed a button on her computer and an electronic voice replied, “Nice to meet you!”.

I quickly had a huge smile on my face too and some tightness in my throat from emotion.

The care aid placed my client on the massage table on her side with a pillow between her thin legs, another under her head and one for the client to hug.

I was told that she usually feels good, but often suffers from constipation. She had a feeding tube directly inserted into her abdomen, so I was shown where that was.

After the quick run down we were left alone for an hour to get acquainted. My nerves went away quickly and were replaced with admiration.

I was able to communicate easily with this client through yes or no questions. A ‘no’ response was given with a lowering of her eyes and chin towards her chest. A ‘yes’ response was shown through raising her eyes and chin. An excited ‘yes’ was accentuated with a cry of ‘yeaaaahhhhh’, which made me laugh every time!

I quickly found out about how many siblings and pets she had and that she really loved when she got to ski at the local skill hill the month before!

Massage Treatment For Cerebral Palsy

I massaged her in her side lying position the entire treatment. She confirmed she was comfortable the entire time.

I did a full body massage to all the areas I had access too. Through her lower and upper back I performed mostly general swedish massage with some gentle muscle stripping through the erector spinae and upper trapezius muscles.

On her lower limbs, I did mostly circulatory work. I started distally and used small, but broad strokes to help encourage blood flow. I massaged her feet, which were very cold, and moved her ankles through passive range of motion.

I also did some abdominal massage to help with her constipation issues, while avoiding the feeding tube.

Her arms were the trickiest to massage. With any quick movements her arms would jerk into a flexor pattern (internal rotation of the shoulder and flexion of the elbow, wrist and fingers). I used slow strokes moving from proximal to distal to relax the muscles of the upper limb.

She watched thoughtfully as I slowly opened up her palm to allow some kneading to her hands.

The client seemed to relax easily and I noticed her eyes drooping a few times into almost sleep.

Once the hour treatment was up, her care aid dressed her and situated her back into her wheelchair. She steered herself out of the treatment room and pressed a button on her computer that said, “Thank you! See you in a month”.

I was thankful she was my final client of the day because I was fairly emotional after the treatment.

Photo by: Incase

Using Conditions Like Cerebral Palsy To Find A Learning Experience Anywhere

I felt extremely grateful that I got to be a small part of her health care plan. I learned how to communicate with someone who doesn’t speak the same way you and I do. I got to experience outside of school what hypertonia, spasticity and hypotonia really feel like.

Most of all I got to see what an amazing personality she had.

I was lucky enough to work with her a few more times before I moved away. Even though she no longer is my client, I will never forget her.

Working with her was one of the best experiences of my life.

From this experience, I learned to not shy away but embrace situations that may be challenging. You can communicate easily with someone even if they cannot verbally tell you their thoughts. You can use vision to see someone relax and feel tension ease. I always figured I would learn more once I was out of school and working with people. I thought I would gain this knowledge from continuing education or from the opinions of other health care practitioners. What I didn’t know is how much I would learn about each client’s view of their own condition, disease, injury or how they see themselves in the world; knowledge that you cannot find in school or a textbook. Embrace every client and experience you can! You never know what you will learn!

Massage Therapist Treatment For An Achilles Tendon Rupture

September 14, 2015/3 Comments/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy, Sport Massage/by Jamie Johnston

“I heard a loud pop and it felt like somebody hit me in the heel.”

I’ve had a few friends and patients over the years that ruptured their achilles tendon.

It just sounds terrible and I hope I never have to experience it.

The last time I heard a story about it, the guy was playing tennis and lunged after a ball. He just dropped to the ground.

He knew he shouldn’t move because the foot didn’t feel right and when you hear something like that, the last thing you want to do is move the injury.

Fortunately keeping still was the right thing to do.

First Aid For An Achilles Tear

I would treat this the same as I would for a fracture.

The person may still be able to limp or walk because the peroneals and other muscles deep in the leg compartment that remain in tact do not require push off with the superficial calf muscles.

Once that tendon is ruptured, immobilize as soon as possible, you want to do everything possible to prevent the calves from balling up.

Make sure to immobilize in the position found. Since the gastrocs cross the knee, do not straighten it because that motion would place more tension on the calf muscles and could further complicate the injury. However this is just my opinion from experience in dealing with things like this on an acute level (this study says that knee position does not affect the tendon gap at the injury site).

Once immobilized check the pulse distal to the injury to make sure circulation is okay.

If you’re not sure whether the injury is a rupture there is a few signs and symptoms to look for:

visible separation in the tendon
unable to stand or balance on the affected leg
swelling and bruising around the ankle
excessive dorsiflexion of the ankle
positive Thompson’s test.

While all of those signs and symptoms and the Thompson’s test are quality things to look for, I would be hesitant to have someone try to stand on the injured side or perform the test for fear of causing further damage. You are much better off to look at the mechanism of injury and let the doctors at the hospital perform any further testing that is required.

Achilles Tendon Rupture: Surgical Or Non-Surgical

I had no idea that there was a non-surgical procedure for this injury until just recently.

In doing research, there is quite the debate over which is better between surgical and non-surgical procedure and both have their advantages and disadvantages. It seemed like I could find just as many pro or against for either treatment.

In the non-surgical treatment the foot is braced in plantar flexion and three weeks later progresses to weight bearing exercise and manual therapy. Scar tissue fills the space between the ends of the torn tendon, which lengthens it and gives the patient less push off strength. It takes longer to recover, longer immobilization time and has a higher risk of a deep vein thrombosis.

There are a few different methods to the surgery but it comes with the risk of wound closure problems, infection and nerve damage.

One systematic review looked at seven articles from the last ten years and found:

there wasn’t a significant difference in re-ruptures of the tendon
more soft tissue injuries from the surgery (we could probably help out here)
better function after surgery
quicker rehab after surgery

The review also points out the difference between surgical and non-surgical treatments were minor so the importance lies in the rehab.

Photo by: Bob~Barely Time

How To Rehabilitate An Achilles Rupture In The Massage Clinic

Your approach to helping rehab this injury is going to vary depending on when the patient comes to see you and what type of repair was done to the tendon.

There are two approaches to rehab, the conventional approach and an early remobilization approach.

Getting a good history from your patient will be crucial to providing the appropriate care (as it always is).

When the conventional approach is used, somewhere around the 4 week point (after the operation) the person is usually put into a walking cast (ankle is placed in neutral) with some weight bearing exercises are started. Around the 8-10 week mark, the walking cast is taken away and range of motion exercises begin. After 12 weeks things are getting back to normal and full weight bearing activities are okay again.

When the early remobilization approach is used, weight bearing and range of motion exercise starts immediately (or within 2 weeks) after surgery while wearing a brace that holds the ankle in plantar flexion. Full weight bearing happens gradually at 3-6 weeks with orthotics in place that allow more dorsiflexion.

With either approach, weight bearing exercises are used around that 6 week mark. At this point it is also okay to start some Massage Therapy work around the tendon and the calf muscles. The biggest thing we want to do is help with increasing the ankle range of motion. Using some techniques like joint mobilizations, mild stretching, active and passive range of motion and manually stripping out the gastrocs will all help contribute to these goals.

The next goal should be strengthening the calf muscles. After being in a splint, brace or cast for that long there will be some wasting of the muscle. I had a knee surgery back in 2005 and had to wear a full length leg splint for 3 months after the surgery. My leg looked like it belonged to a 10 year old kid compared to the other one.

Because weight bearing is allowed in both approaches at the 6 week mark, strengthening should be tolerated as well. If you’re not comfortable setting up exercise programs, reach out to someone in your network that is and get some help with it. Chances are the patient will already have exercises in place, either prescribed by the surgeon or from a physio they have been referred to.

Whichever rehab approach is being used will be dictated by the doctor or surgeon. Reach out to them and find out which approach is being used and get some feedback on what they have seen success with. Sometimes with surgery structures are taken from flexor hallucis longus, plantaris, peroneus brevis or parts of the fascia from the gastrocs. Getting that kind of information from their doctor is valuable information and may alter your treatment. If you’re dealing with an acute achilles rupture, even though they may be able to limp on it, get them down on the ground and splint the ankle in place. Do whatever you can to prevent any further injury or complications. When a person is coming in to your clinic for rehab, do a little research on what works best for a successful outcome and have some open communication with the persons other practitioners. And hopefully the next time you’re out exercising it never feels like someone kicked you in the back of the heel.

Why Every Massage Therapist Should Be Using Linkedin

September 6, 2015/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

“Help the people in your network, and let them help you” – Reid Hoffman, founder of Linkedin.

“James, please add me to your Linkedin network”

Why do I keep getting these requests from people?

I finally gave in and signed up for a Linkedin profile.

I just sat there, blankly looking at the screen like someone was trying to explain astrophysics to me. I just didn’t get it.

Is this like a new facebook? But it’s for business right?

I didn’t understand what I was supposed to do with it. After some reading and research it finally started making more sense.

It was originally created for job seekers and has evolved into a tool for any business owner.

Some of the biggest companies in the world are using it as a major part of their social media and recruiting campaigns. It has become the biggest social networking site that is strictly for professionals.

You use facebook to connect with your fans, twitter to connect within your community, but you use Linkedin to connect with your client (B2C) and other businesses (B2B).

Linkedin For B2C Marketing

Most people only think of Linkedin for B2B marketing and connecting with other professionals.

However there are ways to use it to market to customers. If I’ve heard it once I’ve heard it 1000 times, “content is the new currency”. Linkedin provides a great platform for this because you can use it as a method to post blogs.

Imagine that you are regularly generating content for your current patients that are following you on your facebook page. Why not use the same posts to engage with possible new customers?

There’s a higher level of trust when potential customers are reading your posts on Linkedin because it is THE social media platform for professionals.

Another interesting statistic is that 41% of internet users in the U.S. that are on Linkedin have an average income of over $75,000. So guess what?, they can afford to come in for a Massage.

But remember, don’t just use it for self promotion also look into groups to see how you can be of help and provide service.

Linkedin For B2B Marketing

Linkedin is different than using facebook and twitter.

Although facebook does have the option of business pages, those are meant more to engage with your customers. Twitter is meant more to engage with your community.

Linkedin is all about business.

According to this graph, hospital and healthcare make up 8.2% of the users on Linkedin. As we try and use Linkedin for B2B (business to business) marketing this is valuable information.

While 8.2% may not seem like a big number, their membership has grown consistently from 37 million in 2009, to 380 million in 2015. That’s over 31 million members working in healthcare.

This creates a huge opportunity for referring and getting referrals in business.

If you haven’t started creating relationships with other practitioners, here’s your chance. Use Linkedin to do a little bit of a background check on some of the Chiro’s, Physio’s, AT’s and other complimentary therapists in your area.

If you see some that are close to you or one you seem to have something in common with, start reaching out to them.

Ask them some questions about issues one of your patients is having and see if they come back with any recommendations. Ask about their treatment style. Ask what they would do to help.

Start building a bit of trust and then send one of your patients their way. Don’t be afraid to break some new ground being the one who is reaching out to others.

Using Linkedin To Get Referrals

If you look at your Linkedin profile (assuming you are using it, if not start) you’ll see that some in your network are 1st, 2nd connections etc.

Too often people think they should just reach out to people who they know directly (1st connection) instead of others who are also in their industry or similar to their industry (2nd connection).

Linkedin is there to be used, so use it to leverage yourself and start generating referrals.

Think about what happens if you were looking for someone to refer to and they only had a handful of connections. You’re going to question if they’re actually worthwhile doing business with, especially if you’re considering referring one of your value patients to them.

Open up and add as many people as possible, grow that network. Once you do it will help you to be found more often when people are doing searches.

As you begin to grow that network you will start to see other people who maybe you didn’t realize were on the site. Also having more connections makes you more approachable for those looking to network and so does the more recommendations people have made about you.

I used to think it was redundant to hit those endorsement buttons for my connections. But each time you do that (or someone does it for you) it increases your credibility. If someone is looking to refer to you and a lot of your connections have endorsed you, it reflects to the person looking at your profile that you’re good at what you do.

Start building up that network so people can refer to you. Build your business.

The Ultimate Pyramid Scheme

Connecting with people on Linkedin is kind of like a pyramid scheme or similar.

I tried one of these things in my early 20’s.

All I had to do was get ten of my friends to sign up to a company and use their long distance services.

Then get ten of my friends to sign up ten of their friends to sign up ten of their friends and so on. I went to some of their conferences and tried to drink their Kool-Aid.

I hated it.

But Linkedin is a place where this could actually work (and it’s legitimate). Think of each of your 1st connections as ways to develop relationships with 2nd and 3rd connections.

Looking at the above example, for every 6 connections you have on Linkedin there is an opportunity for them to introduce you to 6 more people (36 second connections) and for each one of those, they could introduce you to 6 more people (216 third connections) and so on.

I’m not sure that you could get down to a 13th level of connections, but you get the point.

While your 1st degree connections are important, they’re not as important as those 2nd and 3rd degree. You’re already doing business with your 1st degree connections, so you want to dig deeper and create more business opportunities further down the line.

You need to develop relationships with people outside your direct network in order to increase your Massage Therapy business.

Remember it’s all about networking and that is the essence of the value in Linkedin, networking with other professionals.

Linkedin Profiles For Massage Therapists

You want to make sure that your profile is going to be seen by as many people as possible.

Do a quick google search of the top Registered Massage Therapists on Linkedin.

What do these profiles have in common?

Each one has a welcoming picture (except one) of the therapist, which is immediately engaging for anyone who is doing a search (possible potential clients). When someone does a search they don’t see your complete profile, they see an abbreviated one like the ones in the link. You have to try and engage right away.

They each have a great headline that represents them and their purpose well. Notice that they all have specific keywords related to Massage Therapy which increases their visibility.

Each one has at a minimum which province they are in, but even better is to put which city you’re in. This is crucial as it helps to narrow down searches when someone is looking for a Massage Therapist in their area. They also have the name of the clinic they work at listed making them easier to find.

Do an advanced search on Linkedin and see who comes up as the top Massage Therapists and use their profiles as a guide to setting up your own profile (just click on “advanced” beside the search box).

There’s a reason they’re ranking high in searches.

Linkedin is the place you want to start making business connections. Use it to start connecting with other businesses and practitioners in your area to generate referrals and build relationships. Unlike other social media applications this one is truly about generating business, so make sure your profile is easy to find and engaging for anyone who is searching. Just don’t try and convince any of them to sign up for long distance phone plans.