Posts

Is Massage Moving Fluids And Causing Dehydration?

February 27, 2017/2 Comments/in Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

I recently listened to a presentation which talked about online arguments and how to handle things appropriately.

One of the points brought up by the presenter is to make sure you actually give credit to a person for putting themselves out there and being vulnerable. Whether the person makes a comment, writes an article or is just sharing information, it is important to recognize their effort.

A week or two ago an article was being circulated arguing that said getting a massage if you’re hungover is probably a bad idea and will make you feel worse because of the massage contributing to dehydration. While the writer made a great effort to inform people, the information isn’t exactly accurate and sadly is something still being taught in our massage education system.

Like so many of the other myths out there, we have to change our understanding and more importantly our patients understanding of what massage does and doesn’t do.

Is Massage Moving Fluid?

We’ve heard so much over the years about how massage increases circulation.

When I first started working in hockey, there was a player on the team who had a major health scare. He had blood clots in his lungs as a result of a Deep Vein Thrombosis and was put on blood thinners as a result. Once the clots were remedied, he went back to playing hockey but had to remain on the blood thinners. According to what we had been taught in school, this would have been a contra-indication to getting a massage. Being a worried student, I asked one of my teachers if a massage would increase his circulation enough to be a concern? His answer was profoundly simple – “no more than playing hockey would.”

That simple answer changed everything for me.

When we look into the research available concerning massage and blood flow, the results are again staggeringly simple. What do most people come in to get massage for? To relax!

Study⁽¹⁾ after study shows that getting a massage actually decreases blood pressure and heart rate. Other studies have shown that massage post exercise actually impairs blood flow and removal of lactic acid (another one of those wonderful myths), not increase it. While focused on the effects of sport massage, another study showed that massage did not increase femoral artery blood flow, but did increase skin temperature and skin blood flow to the area being treated (in this case the anterior quads). This showed a possibility of muscle blood flow being diverted to the skin, but also shows limited possibility of any metabolic change. Or the increase in skin temperature, could just be conduction of heat from the therapists hands?

One review on the subject points out that while some studies support the idea of massage increasing local blood flow it would also depend on the type of stroke used. The squeezing effect of some massage strokes could help to promote venous return (due to effect on skeletal muscle pump), but also points out the same strokes could temporarily occlude arteries causing a temporary reduction of blood flow, which would in turn cause an increase in blood flow when the pressure is released.

Overall there is not much evidence to support the idea of massage increasing circulation, or moving fluids around and certainly doesn’t increase it more than the effort it took for the patient walking into your clinic.

Photo by: RMTBC

Dehydration

There are a few ways to become dehydrated:

Sweating too much (exercise, hot temperature).
Diarrhea or vomiting.
Urinating too much (i.e.: breaking the seal when you’re out drinking).
Fever.
And of course, just not drinking enough fluid.

Now, if someone is coming in after a night out on the town and are a bit (or a lot) hungover, they are probably already a bit dehydrated because alcohol is a diuretic, which in turn causes you to pee a lot. Then water loss is greater than water gain, and if body mass is reduced by 2% because of fluid loss, this causes mild dehydration. When blood volume decreases because of the fluid loss, blood pressure decreases, the kidneys and various nerve impulses trigger the thirst centre in the hypothalamus, telling us to drink fluids.

The other things that stimulate thirst:

Your mouth is dry from decreased amount of saliva.
Baroreceptors in the heart and blood vessels detect lower blood pressure.

I know what you’re thinking: “you just wrote a paragraph on how massage lowers blood pressure and now you’re telling me lower blood pressure causes dehydration!”

Not so fast.

The baroreceptors are sensing lower blood pressure and increasing thirst not dehydration. If your patient had been out drinking the night before, they’re already behind the eight ball as far experiencing some level of dehydration, so their blood pressure is probably already down to some degree because of the decrease in blood osmolarity. When we look at the mechanisms that actually cause dehydration, there is nothing happening in a massage that is causing sweat, diarrhea, urinating or fever. Nor is it possible for a massage to decrease body mass by 2% (otherwise we’d all be a lot busier!). Plus if a treatment could drop blood pressure that much, every person we treat would need to drink after their treatment.

While your patient probably wasn’t feeling great when they came in, a massage isn’t necessarily going to make them feel all that much better because their body is basically telling them they’re an idiot from the night before (my body has said this to me several times). The massage isn’t going to make them any more dehydrated than if I was at my buddies place and his kids were climbing on my back while I laid on his couch. But neither one is going to make me feel all that pleasant. So while it is nice to give your patients that bottle or glass of water after their treatment, can we do it just cause it’s nice, feels good and is good for them? And can we please stop telling them it’s because they’re dehydrated or the massage has released toxins that need flushing out?

References:

Alan David Kaye, Aaron J. Kaye, Jan Swinford, Amir Baluch, Brad A. Bawcom, Thomas J. Lambert, and Jason M. Hoover. The Journal of Alternative and Complementary Medicine. March 2008, 14(2): 125-128. doi:10.1089/acm.2007.0665.

5 Habits To Start Your Work Week!

February 13, 2017/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Robert Libbey

1: Reviewing This Week’s Calendar

This is similar to how we end our week. It’s good to have this as a habit at the beginning and ending or the week.

Make note of any business contacts you need to meet with or contact this week. Make a short list of who needs to be contacted and set tentative dates and times to do so.

Photo by: Dafne Cholet

2: Arriving At The Office 30 Minutes Earlier

“But I don’t have time to have the time to get into the office earlier!”

Time Management is Life Management!

The biggest problem most people have is “Time Poverty!”

We perceive that we are short of time in almost all areas of our lives. The truth is, is that everyone has the exact same amount to time to do things within each and every day. It’s what you do with that time that is of most importance!

Developing Time Management Habits enables you to work smarter, not harder.

Managing time for a successful practice goes beyond your practice. It must include all facets of your personal and professional life.

Personal and business lives have a symbiotic relationship. When one suffers or prospers, so does the other.

Getting into the office affords you time to gather your patients files for the day. Review each file and reflect on what was treated, accomplished previously and formulate a game plan for today’s appointment. Even though that plan can be thrown out the window if the patient arrives with new complaints, at least you went through the process of planning and reflecting.

Performing these on a regular basis develops within you the ability to become faster at it.

3: Planning Your Weekly Errands.

Staying with the Time Management topic, reflecting on your weekly calendar allows you the opportunity to best attempt to balance work and life schedules.

Groceries need to be bought, kiddlets need to be picked up and taken to various activities, food needs to be planned and then there is your clinic and all the aspects that go along with it.

Supply runs, and so on all need to be scheduled.

Life can seem overwhelming.

What has been shown to work best is to sit down and plan the week. Sometimes it’s a great way to get the family involved. Everyone gets to plan out the “Family Schedule”. It’s a great bonding time for everyone to come together and recognize each other’s contributions to the family.

Option 1:
Get a big calendar desktop paper that can be posted on the way and start filling it in. Everyone gets a colour.

Option 2:
These days, everyone seems to “Be Connected” through technology. Technology has made it simple to have everyone’s calendars synced to each other. Have a Family Calendar that everyone contributes to and receives updates on.

We all know that “Life Happens” and unplanned events can happen.

Your Stress level during these time will be far less knowing that you have effectively planned your time for the week and altering the planned events will be easier.

Photo by: StartupStockPhotos

4: Planning Your Meals! Meal Plan

Nutrition is more important for manual therapists due to the fact that we have a very physically demanding profession.

Some days it really feels as if we are endurance athletes!

Planning good daily nutritional intake to support our athletic activities (treating patients) is imperative to our performance, our ability to serve our patients to our highest ability!

It’s quite easy to get into the habit of stopping for some quick food somewhere only once. But as the “only once” time happens again and again, before you know it, it’s everyday. NOT the habit we want!

Planning food can be incredibly easy as long as you keep it simple. Plan out your daily eating habits for each day of the week. Copy and past that week into the next week and so on. You have just created your grocery-shopping list for the week.

5: Look Ahead To Your Weekend!

Think about something fun to arrange.

Something that gets you out of your routine.

Something that surrounds you with positive people and activities.

Too often we do not effectively plan our weeks, work becomes all-consuming and by the time the weekend roles around, we are exhausted. By planning your week efficiently, you create a life where you are energized throughout each and every day and when the weekend is reached, you have planned exciting events and activities to look forward to and positive people to spend time with.

Remember that sometimes we all need some down time and taking a weekend to relax, reflect and re-energize is prescribed. Take those times and enjoy them.

Be sure to include some outdoors activities just to keep you moving!

Don’t feel bad if you don’t get through all of these. This exercise is to get you into the habit of beginning your week productively and positively!

How Can You Change Client Expectations In Order To Be Most Effective?

January 17, 2017/2 Comments/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Walt Fritz

As a physical therapist, I face certain expectations when a client first comes to see me for treatment.

When they walk in my treatment room, a few may look around, wondering where the exercise equipment is hidden, as my room is a 9’ X 13” room with a massage table and little else. But most have been prepared in advance that their experience at my clinic, the Pain Relief Center, may be quite different than what they may have experienced in the past with other physical therapists.

How did I prepare them before they walked in my door?

I set the tone before they ever met me, both through the information contained on my website and through the packet of information they downloaded from my website (or I emailed to them prior to their first visit).

I long ago changed my client’s expectations for what physical therapy can look like, as I had already changed that expectation for myself.

People are referred to me due to my skill set; I am quite good at reducing/eliminating pain.

My business name sets that intention and my website reinforces that fact.

My referral sources speak of my skills and clients typically come to see me showing little shock at the altered nature of my physical therapy practice model.

But what about you and your practice; is it time to change the rules so that client expectations are realistic?

Massage therapists make up a good percentage of the folks who take my Foundations in Myofascial Release Seminars and many of these therapists speak to the expectations that their clients hold.

Expectations include; using oil/lotion during sessions, being relatively undressed under a drape sheet, and having the entire body attended to during a session.

These expectations are valid, as this is the mindset of many when they think of massage therapy.

But are your clients (or you!) so rigid that they are not willing to bend these expectations?

If they are coming to you for relief from pain in an isolated area, does the elimination of pain in this area take precedence over the desire/expectation to have the entire body addressed in a single session?

Is it you, the massage therapist, who is feeding these expectations? Are you simply unwilling to change the rules?

Myofascial release (MFR) tends to be considered a “dry modality”, contrasted with wet modalities where a lubricant is used. While there are exceptions to this generalization, most forms of MFR are performed on dry skin. MFR happens to be one of many very good modalities for the relief of pain and the improvement of function.

Your license, as a massage therapist (or PT/OT/SLP), allows you to utilize a wide range of modalities and techniques, all which fall under the category of having a “license to touch”.

My clients come to me to rid themselves of pain, no matter my choice of modalities. If you have skills and tools at your disposal to help meet your client’s goals, it may be up to you to change their expectations.

Education is the key to all of this and it is your duty to educate your clients.

Here are some things you can do to start changing the expectations of your clients:

1. I am a strong advocate of having a website to allow potential clients to find you and learn about you and your practice/goals. I began my do-it-yourself website in 2005 and allowed it to develop over the course of a few years. In 2010 I paid a website designer to craft me a more professional looking site that links together my private practice, my seminars, and my blog.

My website begins to lay out the expectations for my clients, whether they are interested in becoming a client or interested in taking one of my seminars.

If you don’t have a website, get one, even if it a free one-page site provided by the various professional organizations. Your website’s message should not be about what modalities you use or who you trained with; it should be about what you can do for a client.

My original website was a painful attempt at trying to convert the masses into believing that MFR was the greatest modality out there, and I went into great detail discussing why I thought it was so, including old worn out explanations of how fascia is the primary culprit responsible for most pain.

People don’t care about this.

Most, including myself, are somewhat selfish. I care about what you can do for me, not how you will go about doing it. I care that if I have a problem, you are the person to see for this problem. Later, I may ask about how you go about doing this (the modality), but not at the onset. If I cannot find out what you can do for me in the first few seconds of reading your website, I will move on to the next person’s website. What is seen when they first land on your website is key. For more information on this, please check out a post I made titled Above The E-Fold™.

2. If someone is coming to see you for your expertise, then tell/teach them what they will need to do to allow you to be most effective. With MFR, I am best able to work when a client is wearing shorts and a tank top or T-shirt, rather than them being fully clothed or undressed under a drape sheet.

My introductory materials outline this need, as well as why it is important.

I tell them to bring along an appropriate change of clothing to facilitate receiving the maximum benefit from my services. Additionally, I keep a drawer full of shorts and tank tops of various sizes, in case someone forgets their “uniform”.

Educating your clients that having a drape sheet to maneuver around/over their undressed body may not be in their best interest is important to set expectations, both with MFR treatment and similar modalities.

I tell them what I need in order to do my job and best meet their goals and that these are my expectations. If the person is seeing me based on my reputation, etc., they typically have no trouble working within these expectations.

3. Opinions vary widely as to how best accomplish pain relief, as is evident by the large number of named modalities available to each of us as manual therapists.

With the type of myofascial release I practice and teach it is not necessary to treat the entire body or both sides of the body in order to reduce/eliminate an issue. However, if the commonly held expectation is that a client will receive a full-body treatment, then this expectations needs to be addressed before treatment is commenced.

You can actually take care of this issue before you ever meet this person by including the information on your website and new client handouts.

My handouts have a number of purposes.

They collect the basic demographics I need in order to treat a person. They also set the rules in terms of my cancellation policy/No-Show policy.

New clients read and sign a release, stating that they will abide by these rules.

Set your expectations early on, through your website or handouts, so that there are no surprises or disappointments. If someone comes to you for a longstanding issue, neck pain for example, and after you have performed your evaluation, take a moment and ask them how they would like the session to flow.

If the neck is their primary concern, ask if they have any objection with you spending the entire session working the neck issue. If they have issues with this, they need to let you know and not be mad when the session time is up and you have not gotten to the rest of their body.

Set the expectation.

4. I am very punctual with my sessions. I start on-time 99% of the time and I finish promptly at the originally scheduled time. In my new client handouts, I state:

An appointment is a commitment to our work and a contract between us. On rare occasions we may not be able to start on time. This is usually because a treatment is taking slightly longer than expected. For this we ask for your understanding and assure you that you will receive a full treatment. Also be assured that at some point if you need a longer session, you will always be afforded the same consideration. In order for all of this to work, you need to be on time for your appointment. If you arrive late, your session will need to end at its originally scheduled time with the fee equal to the original length of the scheduled session. If you need to cancel, please call as soon as possible so that I can attempt to fill the vacant appointment. A 24-hour notice is required for cancellations to avoid payment of a $50 fee.

We teach people how we wish to be treated, both professionally and personally. I believe in firm, clear boundaries in all aspects of my practice.

I expect you to be on time.

If you are late, I will not extend the session to give you the “extra” time. I expect the full payment, whether or not you received the full session. If I am late starting, you will receive your full session length. Some may feel this is harsh.

I feel that it is about having good boundaries.

5. Be clear with your intentions and always get verbal permission.

At times I will wish to place a hand in areas of the body that may be misconstrued by someone not knowing my intentions.

If I need to place my hand in any area where there may be questions, I will always:

Tell them what I am hoping to accomplish
Tell them where I will need to place my hand(s).
Ask for verbal permission and wait for the reply.
I use simple language and layman’s terms. My client may not know what the sacrum or sternum is, so I will both use layman’s terms (tailbone/breast bone) as well as point to the area on myself or them.
I speak clearly and with confidence. Client’s easily pick up if you sound shy or timid.

I speak at length to this topic in a blog post (here).

During any of my Foundations in Myofascial Release Seminars, I ask therapists to practice wording these concepts with their lab partners throughout the seminar, in order to take the awkwardness out of the interaction.

“In order to try to reduce the tightness/pain in your lower back, I would like to be able to place a hand directly under your sacrum/tailbone. It is not necessary for me to be directly on your skin. Are you OK with this?”

This interaction becomes quite easy, once you have done it a few times. It takes any ambiguity out of the situation, protecting both you as well as your client.

If you work for someone else, many of these topics may be non-negotiable. But if clients come to you for your expertise, you may have a say in these matters. If that expertise includes MFR, you need to change the rules that your client believes exist. It is in their best interest to change their expectations, if they are interested in being helped by you. Don’t be shy about changing the rules. It may take some time before you are confident enough with MFR (or any other new modality) but act now to change the rules/expectations. It is your practice; treat it as such.

How do you set expectations?

Do you state the “rules” of your practice upfront?

How to Simultaneously Empower and Manage Your Therapists

December 5, 2016/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Dominic Iafigliola

Managing a massage therapy practice can be challenging; especially when some, or all, of your therapists are independent workers that get paid by appointment.

To confuse matters further, each therapist has their personal schedule, and often a schedule at another clinic or spa to accommodate.

So how do you ensure your business runs smoothly under these awkward conditions all while being professional in the eye of the customer?

Luckily, there are a wide range of cloud-based software applications that can help you manage your massage clinic more efficiently, and boost results. In particular, online scheduling applications have tons of useful features that streamline the appointment booking process between you, your receptionist, and your Massage Therapists.

Here’s a list of 4 pain points commonly faced by massage clinic owners and things you should look for when choosing a scheduling application.

1. Managing Your Therapists Sporadic Schedules

Massage therapists are frequently hired as independent contractors on an appointment basis and only come in when they are booked.

As you may not be able to provide them with enough appointments, often times they will also work for themselves and/or another massage practice. Knowing when they are available to work can be an overwhelming task.

Do any of these situations sound familiar?

The therapist isn’t actually available on the given date and time, you must then scramble to find another therapist to fill the already booked appointment.
You may have no choice but to call back the client and embarrassingly ask to reschedule the appointment if he or she absolutely wanted the specific therapist or you cannot find a therapist for that slot.
The therapist may just, not show up if there is a conflict in his or her schedule that you were not aware of.

Making sure you know if and when a therapist is available to work is essential.

Many scheduling applications allow you to configure a regular, recurring weekly staff schedule.

However, you should also inquire whether it is possible to program irregular and/or upcoming schedules.

It is also a huge time saver if therapists can update their own schedules through their unique user login for last minute changes to specific calendar dates.

2. Educating Your Therapists About the Client While Protecting Your Client List

From talking to massage therapy business owners, it is clear that protecting client data is a tremendous concern as therapists need to easily access data to better serve clients.

However, depending on the employment relationship, (and depending on rules and regulations with your specific college) therapists may not have the right to solicit clients post employment and/or automatically walk out with client files.

You can therefore take steps to ensure therapists don’t just leave with your entire client list including phone numbers and e-mail addresses.

Even when therapists are not employees, you can protect data and ensure confidentiality of personal information by limiting access to their patients only – not the entire clinic’s database (again, depending on rules and regulations in your area).

Some features to look for in a software that help protect your client data:

Make sure you can create different types of users with different levels of access and privileges.
Absolutely make sure only administrators can export your client database.
If allowing therapists to book their own appointments, see if you can limit client database access to their clients only.
See if you can also hide client info like telephone numbers and e-mail addresses.
Verify if there are any logs available to track general user actiity.

And DO NOT SHARE YOUR ACCOUNT OWNER ACCESS with any of your staff.

Take the time to create an additional profile for your receptionists and therapists. This makes it easier to terminate access to your client data when someone leaves.

3. Enabling Therapists to Manage Their Own Appointments

If you own a multi-practice clinic whose main services are not massage therapy, but still want to offer massage therapy as an added service without adding to your administrative workload, then empowering your therapists as much as possible can save you a lot of time and make you more money.

Many software applications with different user types include a profile that allows the therapist to book, cancel and/or modify appointments for themselves.

This enables the therapist to fully manage his/her schedule and appointments securely while allowing you to still oversee everything.

In addition, why not encourage a therapist to book the client’s next appointment after their massage treatment has been completed by using a tablet connected to your cloud-based software application.

Photo by: FirmBee

4. Reducing No-Shows

No-shows are another major issue for any massage therapy business as this leads to lost revenue and idle time for your therapists.

The no-show rate can easily be reduced by implementing a software application that sends out automated appointment reminders.

It is incredible how a simple e-mail or text message reminder sent out a couple of days before the appointment allows clients to inform you in a timely manner of changes to their availability and eliminates forgotten appointments.

Also, stop wasting time calling all your clients to confirm their appointment as many people of today’s generation do not even answer their phone calls.

Instead find a system that lets clients confirm their appointments themselves either by e-mail or text message. Automating appointment confirmations is a great feature giving you and your therapists the certainty that your client will be attending his/her appointment with minimal to no intervention on your part.

Other features that can reduce no-shows include asking for a credit card number or deposit at the time of the booking. If people know they will lose money, they will think twice about skipping out on their appointment.

All in all, if you are still using paper or an outdated software application, look into a web-based appointment booking system. This will allow you to run your business more efficiently and stay connected with your therapists. The entire team will be happier and experience fewer administrative frustrations. Even Massage Therapists need less stress in their lives.

How Not To Rub Your Patients The Wrong Way

November 22, 2016/1 Comment/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by David Trounce

Your client is coming to you in order to feel better. They want an experience that is going to relax them or perhaps even energize them. They’re not coming to you to be rubbed the wrong way.

A good client consultation requires more than just technique in massage and the administration of physical therapies.

Your goal should be to give them a complete therapeutic experience not only for their body but their mind as well.

Here are three ways you can avoid rubbing your client’s body and mind the wrong way.

Ask Questions

One of the things I did as a matter of routine at the beginning of any client session was to ask them what they enjoy most about massage.

This might seem like a redundant question when you’re there to provide therapy, but your clients are looking for a rewarding experience.

Knowing their pain points as well as their pleasure points will make you much more sensitive to their needs and far more likely to result in the satisfying massage experience for your clients.

I have been massaged many times by professionals who never asked me anything beyond how I was feeling. All you have to do to win me over is massage my legs.

You can do that all day long, and I would walk out feeling great.

But if you fail to ask questions and just move on assumptions you’re probably going to spend an hour on my neck, and I’m just going to be irritated.

Sure, my neck may be the presenting problem, but part of remedial therapy is to bring the entire body back into a harmonic state.

And one of the best ways to bring the body back into a harmonic state is to compensate the discomfort with a positive experience.

Be Dedicated to Your Client

Your clients want your attention. They want a commitment from you.

A single-minded passion and focus on your profession and your client can take you a long way in the therapeutic and massage industry.

Robert Granter, a leading educator in soft tissue dysfunction and a trainer at the Melbourne Institute of Massage in Australia, entered the profession as a patient. Robert says he was so impressed by the effectiveness of the treatment that he decided to enter into the field himself.

His dedication, which includes a dedication to the clients themselves, has taken him to several Olympics and Commonwealth Games events as a therapist and opened up many doors for him in his profession.

Commitment means a willingness to not only improve your therapeutic and remedial skills, but it also means being entirely focused on the client right in front of you.

Your clients know when you are inattentive. They will sometimes twitch and move in discomfort on the table. Too shy to say anything, they are hoping you will respond by either adjusting your method or asking a question.

If your mind is distracted with the cares of this world and your other responsibilities, that disinterest in your client will filter down into your fingers, and your client will notice it.

They may not say anything but their feet will do the talking and you won’t see them again.

Continue to Develop Your Communication Skills

One of the motivations your clients may have in coming to see you is to unwind through communication. Others want complete silence so that they can let their minds rest.

Your job as a therapist is to know, when, what and how much verbal communication to engage in.

Not only that but when you do speak you want your words to further the therapeutic process, not detract from it.

There are countless therapeutic schools which provide training in the technical aspects of Massage Therapy but nothing else. If you want a thriving practice, one that grows over time, then it is in your best interest to continue your training.

One of the ways that you can do that is to develop your therapeutic communication skills.

I have found the study of things like neuro-linguistic programming (NLP) and other similar therapeutic modalities to greatly enrich my clients experience as well as my effectiveness as a therapist.

Whatever form of remedial massage therapy you are involved in, your goal is to provide the most satisfying experience for your customers and your clients.

Take these tips and find ways to implement them and perhaps even adjust your mode of operation so that both your professional expertise and your business will grow.

Improved Listening Skills For Massage Therapists

November 7, 2016/6 Comments/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Kimen Petersen

I took this amazing course on communication a few years back and I have never forgotten the first thing the gentleman said… you don’t really listen now, you never have and you probably never will.

Wow what a harsh way to start a communication course, but in a sense and for the most part it’s true.

But when I learned all the things that were preventing me from really listening, I actually started to hear more clearly what the people in my life were trying to say and sometimes I really noticed the things that were missing in the conversation.

It’s been said, and I believe it to be true, that most of communication is in the listening.

Now in order to really understand this statement we need to include not only the words being said but also the tone of voice, the pitch and rhythm and although it may be controversial in some circles I believe real listening requires visual cues like body language, posture and the physical response to questions especially when you are looking at communication from the therapist – patient relationship.

To really understand what our patients are trying to communicate we first need to understand how (in the context of communication) the majority of the message is relayed by the patient.

Remember that different experts break down things in different ways so the exact numbers may be slightly different but the idea is very similar.

We can break it down like this

– Only 7% of the total message is found in the words

– Up to 38% of is in the paralanguage (this is the pitch, tone and rhythm of the voice)

– The remaining 55% of the message is found in the body language (mostly facial expressions)

Now this does not mean we should ignore the words, it just means, to get the full picture we must be present and pay attention to a number of different cues while our patients are talking.

Blocks To Listening

Are you really listening to the other person when you already have an opinion about the person?

It’s kind of like looking at life through rose colored glasses.

We have so many opinions and preconceived notions about how things are and how people are that it completely invades our listening and hence how we relate to other people.

Some of the blocks to listening:

Mind reading: assumptions do not help us hear what the other person is actually saying, they are self-confirming beliefs.
Judging: Do I agree, do I disagree with what this person is saying are they right or wrong… these thoughts pull you away from listening they don’t help you hear what the person is saying.
Identifying: This is when you relate the speaker’s story to something similar in your life. This is a block to listening because you are not actually listening to their story so you may miss important details that are not in your story.
Filtering: This is only listening to the parts of the story that resonate with you and skipping over the parts that don’t.
Placating: Bypassing the tough parts of the conversation or saying things like “at least they passed at home or they are no longer in pain”… this is what we sometime do, not for the speaker but for ourselves to avoid our discomfort.
Advising: Thinking about advice we can give to help the person while they are talking is noble, but it can take us away from listening to what is actually being said.

These are just a few of the blocks to listening, there are many more.

But if you look honestly, you may see yourself in a few of these examples.

It is not bad and wrong to do these things, it’s just not an effective way of listening to other people.

Pseudo Listening

Pseudo listening is basically pretending to listen but not really listening to what the other person is trying to say.

The intention is NOT to listen, but to have some other needs met.

I know I am guilty of this from to time in my personal life and it has even entered my professional life occasionally.

This is something to be aware of, because only when we are consciously aware of something we have the opportunity to shift.

Some of the reasons we may be pseudo listening:

Sometimes we just want to be liked, so we try to give the appearance of listening intently.
In social situations we may be checking for signs of rejection.
With a spouse or an adversary we could be hunting for a specific piece of information.
Sometimes we are buying time or rehearsing our response.
From time it is Quid Pro Quo I am listening to you, so you will be listened to.
During arguments we may be listening for weak points; gathering ammunition.
Trying to be or look good or nice.
Sometimes it’s as simple as not knowing how to leave without offending.

Think about the times you are doing this, were you really listening to the other person or were you so distracted by your own thoughts and motives that you completely missed what the other person was trying to say?

Real Listening

So what, you may ask, is real listening?

The Messages Workbook (a text we used to use in PD100), says that being quiet when someone talks does not constitute REAL LISTENING.

REAL LISTENING is based on the intention to do one of the four following things:

Understand someone.
To enjoy someone.
To learn something.
To give help or solace.

Intention has a big role to play in real listening, when you get out of the way, listen and watch the person in front of you listening will come easy.

Active Listening

In order to not only hear what the person is saying but also let them know you heard and understood what they said. You can use a three step process called active listening.

1 Paraphrasing

Paraphrasing is simply repeating what you heard back to your patient, but in your words.

In other words ….

So basically how you felt was…

Did you mean…?

Paraphrasing should be used any time your patients say something of importance about their pain, accident, injury etc.

2 Clarifying

We use clarifying to make sure we have understood not only what the person said but also the context.

When we take the time to clarify we show our patients that we want to fully understand the communication, we understand the impact of the situation and we are willing to put in the work to fully know and understand the person and the impact the condition is having on them.

3 Feedback

When we understand what has been said and we have clarified that we understand the context we can now give feedback.

This can be in the form of a treatment plan, a referral to another healthcare professional when the issue is out of our scope, or it may be reminding someone that compliance to home care is vital to the treatment plan.

Listening With Openness

Have you ever heard the phrase “ looking at the world through rose colored glasses”?

I have always believed that this points to the fact that we all have some idea of the way things should be.

This is right and that is wrong, this is good and that is bad.

All of these strong beliefs, thoughts and opinions change the way we listen to others. In fact, when we come from this place we are not really listening to the other person, we are just listing to our own opinion of what the other person is saying.

To really listen to other people we need to stop “shoulding” on ourselves and others, let go of our personal opinions and really objectively listen to what the other person is saying.

Photo by: Unsplash

Listening With Empathy

When I teach this type of listening at VCMT I usually feel like I am preaching to the choir.

I really believe that the vast majority of people who have entered the massage therapy profession have done so as an expression of the empathy and compassion they already have.

Listening with empathy comes from an understanding that people, for the most part, are just doing their best to survive and all the crazy things they do are an expression of this.

I remember a few years back when a patient came into my office in severe pain, very short and almost angry.

He kept saying get me on the table we don’t have to do all this other stuff. I realized this man was just in pain and he really did not mean to be rude or short. I calmly explained that the interview and special testing was necessary to determine the approach I would be taking with the treatment and that the better I understood exactly what was causing the pain the more effective I could be in treating him.

To make a long story short, the treatment went quite wall and the man could not shake my hand enough at the end of the treatment.

Remember, no matter what the patient is expressing, its not personal.

People in pain can sometimes say things they don’t mean. Always come from a place of understanding, a place of empathy. Try to put yourself in their shoes, how would you feel if you were on the other side of the room? How would you want to be listened to and treated? I always tell my students that true success is not just about being the best technical Massage Therapist. True success is becoming a well rounded therapist with excellent communication, listening, knowledge and technical skills. I believe that a present compassionate therapist will achieve measurably better outcomes with all their patients.