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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?

Understanding And Managing Groin Pulls

January 10, 2017/2 Comments/in First Responder, Massage, Massage Clinic, Massage Therapist, Massage Therapy, Sport Massage/by Jamie Johnston

I felt a little tweak on the inside of my leg, but kept playing anyway.

It was the final game of the tournament that weekend, so I knew I just had to get through the last period.

As the game continued, the pain in my inner thigh was getting worse.

Each time I pushed off and my skate cut into the ice it felt like a shock going up into my groin.

As soon as the game was over, I pulled some ice out of the beer cooler, wrapped it up and put it on the inside of my leg. It helped a little, (or it could have been the beer) but I had never felt something like this before.

The next day I had a snowboard trip booked for a week.

By the time I got up to the chalet, I could barely lift my leg. Going up a flight of stairs was almost impossible.

Just getting up out of a chair was excruciating. I was basically limping for 5 days.

I have never pulled my groin before, but holy was this painful.

Contributing Factors To A Groin Pull

A groin pull is common among athletes, especially in sports where the athlete is required to change directions quickly or where explosive movement is part of the sport.

Hockey and soccer seem to be the sports where a groin strain/pull is most common with athletes, but are also found in f encing, handball, football, cross country skiing, hurdling and high jumping.

A groin strain can be graded into three classifications and can involve any one of the six adductor muscles:

Grade 1: minor pain but the person still has full function, pain will be more distal.
Grade 2: more muscle involvement and loss of function.
Grade 3: rupture of muscle with complete loss of function, pain will be more proximal.

There has long been a belief that Janda’s lower cross syndrome played a major role in what contributed to groin strains in athletes.

In fact I did a case study in college on a marathon runner experiencing hip pain and based a lot of the treatment on this syndrome. But in talking to many of my pain science friends, it appears that this syndrome is not as accurate as we once thought.

However there are parts to it, which I believe plays a role in an athlete experiencing a groin strain (this is where my pain science friends will probably want to correct me).

Essentially the thought was a muscle imbalance, or strength imbalance between the gluts and adductors and the strength of the gluts was pulling on the adductors, thus causing a groin pull.

Some of the research back then was pointing to this being a specific cause in hockey players (most hockey players have big butts from skating) and this being a major contributor to groin pulls in these athletes, although I couldn’t find any current research to support that, so we’ll just leave it in the past for now.

However there is a strong indication that weak adductors are a major contributor to these injuries.

One systematic review compared 17 studies and found limited evidence to support the theory of weak adductors but it was dependant on positioning. At 45° during a squeeze test there was strong evidence of adductor weakness.

A study done on Australian Rules Footballers demonstrated that weak adductors could be a factor in groin injuries. Their adductor muscle strength was tested weekly. Of the seven players that suffered a groin injury (over a two season period), they all demonstrated decreased strength in hip adduction two weeks prior and the week of their injury.⁽¹⁾

While this is a very small study, it helps to support weak adductors as a possible contributor to groin injuries.

Some other studies have shown there to be several other risk factors involved. With hockey players there was a greater chance of having a groin strain if you had a previous injury to the same area and less likely to suffer the injury if they had practiced in the off season.

When it came to soccer players, previous injury was also a risk factor but so was limited hip abduction. Groin strains were most common during the action of kicking the ball.

Either way it seems that weak adductors can be one of the contributing factors to suffering a groin strain.

I also think (and this is strictly opinion) the motion of skating is also a contributor as the legs are continually going into extension, external rotation and abduction placing a greater strain on the adductors, but again, just opinion.

It would also be interesting to see the significance between player positions, if I even tried doing what the goalie in the picture below is doing, I probably wouldn’t walk for a month.

By Mike Salvucci (Flickr) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

Treatment Of Groin Injuries

During the acute stage you are going to follow your R.I.C.E protocol and rest the area.

R – rest
I – ice
C – compression
E – elevate

As the healing progresses (keep in mind if walking is difficult the person may be on crutches) manual therapy and exercises can begin, in the acute stages the injury will be too painful (depending on grade) to do much in the way of hands on therapy.

The acute phase should be getting better in about five days. If there is no progress, they should be referred to their doctor to check for other possible injuries like osteitis pubi s, myositis ossificans or nerve entrapment.

Once it settles down, then try and determine which muscles specifically are having the issue by doing some manual muscle tests, although it may be tough to determine as it could be a group of muscles, not just one.

There aren’t many research articles I could find that specify exact methods or provide a treatment outline.

One recommends using muscle energy techniques, but it was referring to the sacrum for an anterior rotated innominate because of a positive standing flexion test, but research has since shown us that doesn’t happen.(2)

Another one demonstrated placing tension on the muscle with one hand while the other hand is used to take the leg into abduction and external rotation while the knee is fully extended, for use with chronic injuries.⁽³⁾

With the management of strains once the pain of the acute phase is gone, doing some manual therapy along with pain free stretching is recommended. As we have seen, some strengthening is going to have to happen as well. Having the patient begin some strengthening (if it is within your scope of practice) will be crucial in getting over the injury. Doing some balance exercises, lunges or walking up and down stairs pain free are some easy ones to start with. One of our biggest goals is to prevent this from becoming a chronic injury. As we have seen in some of the research, once someone experiences a groin pull it is then easier to re-injure the area again. Although I haven’t pulled my groin since that hockey tournament, I will never forget how painful it was. If I had gone somewhere for manual therapy, there is no way I would have let someone work on it during that first five days. Fortunately it didn’t become a chronic issue. And even though some may disagree, I’m still going to work into my hockey players gluts if they pull their groin!

References

Turk P. IS THERE A RELATIONSHIP BETWEEN HIP ADDUCTOR STRENGTH AND GROIN INJURIES IN AUSTRALIAN FOOTBALL LEAGUE FOOTBALLERS?. Journal Of Australian Strength & Conditioning [serial on the Internet]. (2016, Oct), [cited January 9, 2017]; 24(5): 21-28. Available from: SPORTDiscus with Full Text.
Brumm L, Carrier D, Nogle S, Johnson S. Looking beyond the soft tissue: illustrative case studies of groin injuries. Athletic Therapy Today [serial on the Internet]. (2001, July), [cited January 9, 2017]; 6(4): 24-64. Available from: CINAHL Complete.
Weir A, Veger S, Van de Sande H, Bakker E, de Jonge S, Tol J. A manual therapy technique for chronic adductor-related groin pain in athletes: a case series. Scandinavian Journal Of Medicine & Science In Sports [serial on the Internet]. (2009, Oct), [cited January 9, 2017]; 19(5): 616-620. Available from: SPORTDiscus with Full Text.

Graded Exposure

January 2, 2017/1 Comment/in Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Todd Hargrove

Graded exposure is a key concept in understanding how to reduce pain caused by movement.It’s a very common sense idea, and one that most people kind of know at some level, because there is profound truth to it.

But it’s also an idea that most people will probably fail to put into practice in a systematic way. Here’s a brief discussion of what it is, why it works and how to do it.

What is graded exposure?

Graded exposure is a process by which you slowly and progressively expose yourself to some form of stress, in order to make you less sensitive to that form of stress.

In the context of movement, it means the progressive introduction of threatening movements, in the right dosage and timing, in a way that makes them less painful. This might happen in one of two ways – through causing a change in the body, or a change in the way the nervous system perceives threats to the body.

Tissue Adaptation – Make Your Body Stronger

There is some physiological truth to the idea that what doesn’t kill you makes you stronger.

According to the SAID principle, the body will adapt to get better at withstanding specific forms of stress, provided they are experienced to a sufficient degree.

For example, when the muscles are stressed enough by lifting weight, this causes micro damage that stimulates changes in muscle physiology. These changes will make the muscles stronger and less likely to get damaged by the same weight in the future.

With this principle in mind, you can get stronger and stronger by progressively overloading your muscles over time.

The trick is to expose yourself to stress in a graded manner – enough to stimulate adaptation, but not enough to cause injury or prevent healing.

The same principle can be applied to rehab injuries, especially overuse injuries like tendonosis.

The difference is that in this context, getting the right timing and dosage is much more difficult, because the likelihood of injury or incomplete recovery is greatly increased. This makes it harder to find the “sweet spot” where you apply enough stress to cause adaptation, but not enough to cause or worsen injury.

A careful and systematic approach is required.

For example, if you are currently experiencing pain in your foot after running a mile, you could try running just short of a mile, and then slowly inching your way upwards in distance, making sure that you are not making the pain worse.

If you succeed, this might be a sign that you are applying enough stress to the tissues to get them to beneficially adapt, but not enough to cause injury or prevent them from healing.

Most clients find this strategy fairly easy to understand, if not to apply.

The more complicated explanation for why graded exposure might reduce pain associated with a particular movement is that it makes the nervous system less threatened by the movement, even though the tissues are not really adapting in any meaningful way.

Nervous System Adaptation – Disassociate Pain And Movement

We experience pain in relation to movement when the nervous system perceives that the movement is threatening to the body.

Like other perceptions, the perception of threat is an interpretation that is subject to change based on a wide variety of information. A program for graded exposure can offer the nervous system new information about a movement that might cause a change in perception.

If you can find a way to perform a currently painful movement at a low enough intensity that it does not hurt, you are sending the nervous system feedback that the movement is safe.

If you do this repeatedly, perhaps the nervous system will start to disassociate the movement from the pain.

This is the same rationale underlying many treatments for anxiety and phobias.

Here’s an analogy to illustrate. If a child wanted to convince his overprotective mother that it was safe to play at the playground, he would first need to show her that he can play without getting hurt.

A good strategy would be to start slowly with the safest activities, and then move to more dangerous ones, all the while showing Mom he is safe from injury or threat.

Hopefully Mom will eventually chill out.

You can go through a similar process of graded exposure to show your nervous system that a particular movement is safe. If running three miles causes panic, try running just one and see if that is acceptable.

Then slowly inch the mileage upward and monitor the response.

Summary: Graded Exposure Sends Good News

A major goal of any program for movement health should be to send as much “good news” to the nervous system as possible about the state of the body, and its ability to withstand the stress of movement.

Whether this is done by making the body stronger, or making the nervous system less concerned about the strength of the body is sometimes irrelevant.

Either way, the formula for movement success is the same.

Start moving how you want to move, make sure you’re not in pain during the process, and then move a little more next time. That’s graded exposure, and it’s how we get better at anything. Like many other ways to improve health, it’s simple but not easy.

Can Massage Therapy Help Scoliosis?

December 19, 2016/2 Comments/in Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

Her text read: “Hey old man, I’m going to invoke my ‘you’re family so I need your professional opinion’ rite”

My cousins’ oldest daughter was diagnosed with scoliosis and was told that spinal fusion surgery was the only option, it was progressing fast.

On a daily basis her pain was a 6-7 out of 10.

She was experiencing a lot of hip pain and had issues raising her arms above her head.

The scoliosis had gone undetected until she started having some TMJ issues and the family chiropractor discovered it.

At the time of diagnosis she said it was a 41/43 curve.

When I asked if they were told the cause, they said it’s usually hereditary but there is no family history, so it may just be a random condition.

In her case it is a curve to the left (levoscoliosis), however the most common is a curve to the right (dextroscoliosis) which is another reason why doctors had chalked it up to a random occurrence.

Types Of Scoliosis And Surgery

There are six different types of scoliosis and most of the time the cause is unknown (as in my cousins case) but can also come on because of a neuromuscular condition or as part of a separate syndrome a person is dealing with.

They will typically present where the spine has “S” curve or a “C” to the right or left side.

In cases of idiopathic (unknown) scoliosis they are grouped into three different categories:

Congenital
- you are born with the condition
Early onset
- occurs between birth and 10 years of age
Adolescent idiopathic
- happens between the ages of 10 and 18

Now when she told me the curve was a 41/43 I didn’t know what that meant, so I reached out to a couple of chiropractor buddies of mine to see how this they come up with that number and what it means.

This is done by using an assessment tool called the “Cobb Angle” and according to clear-institute.org this is how the measurement is done:

Lines are drawn along the top of the superior tilted vertebra and the bottom of the inferior tilted vertebra. Two more lines are drawn at an angle of 90 degrees to these lines, perpendicular so that they intersect. The resulting angle is measured, and the number is expressed in degrees.

The main methods of treatment in these cases is through bracing or surgery.

Bracing is used when the curve is small in children that are still growing.

Surgery is recommended when the curve is 45-50 degrees or more and depends on how much growing is left for the child to do. Metal rods are fused to the spine to limit the how far the curve can further develop and the use of bone grafts fuses together with the existing bone to form one unit with the spine.

There are two types of surgery, one is done from the back of the spine and the other is done from the front.

One review of scoliosis surgery showed that idiopathic had an average of 6.3% complications, 0.8% neurologic deficits and a 0.02% mortality rate and encouraged this data to be used in the decision making process before agreeing to surgery. ⁽¹⁾

New developments in surgery have seen the use of growth friendly implants instead of a full spine fusion, which allows the spine to grow while correcting the deformity, however it requires multiple surgeries and in turn more complications. ⁽²⁾

But is surgery the only solution?

https://upload.wikimedia.org/wikipedia/commons/3/3b/Medical_X-Ray_imaging_AOX02_nevit.jpg

Photo by: © Nevit Dilmen [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons

Scoliosis And Massage Therapy

There is definitely some differing opinions on the best form of treatment, especially as the scoliotic curve progresses.

Some research says the only solution is surgery as it is the most permanent form of intervention and physical therapy will be a constant work in progress.⁽³⁾

However there is an argument being made that a more conservative approach that would include observation, scoliosis specific exercises and bracing is effective. The mini review showed that the use of exercise and proper bracing can reduce a curve larger than 45 degrees in 70% of adolescents which could alter surgery indication to above 50 degrees.⁽⁴⁾

There is a great resource outlining exercise and bracing approach from seven different scoliosis schools and their approach, which you can look at here.

Overall there isn’t a ton of research I could find based on massage therapy and scoliosis, dealing with treatment around the adolescent idiopathic level. However there is strong evidence on the use of massage and reduction in pain with adults who have scoliosis.

We won’t be able to correct a curvature, but providing pain relief and improving quality of life is important to anyone who has this condition. In college we were taught massage should be provided to the concave side of the curve, due to the tightness and tension of the muscles pulling the spine in that direction. Stimulatory techniques were to be applied to the convex side to promote strengthening those muscles to assist in correcting the curve. Overall the use of massage/physical therapy and exercises can be a beneficial treatment which could possibly delay a surgery, or possibly prevent surgery. However as the Scoliosis Association of the UK points out, the need for surgery usually isn’t urgent and the more important consideration is how the child and the family feel moving forward. If we can be a source of pain relief through the use of massage and movement exercises, as well as a source of information for anyone dealing with this, then perhaps we can help improve that quality of life whether the family chooses surgery or not, because no kid should have to live with pain everyday.

References:

Reames D, Smith J, Fu K, Polly D, Ames C, Shaffrey C, et al. Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine [serial on the Internet]. (2011, Aug 15), [cited December 18, 2016]; 36(18): 1484-1491. Available from: MEDLINE with Full Text.
Yang S, Andras L, Redding G, Skaggs D. Early-Onset Scoliosis: A Review of History, Current Treatment, and Future Directions. Pediatrics [serial on the Internet]. (2016, Jan), [cited December 18, 2016]; 137(1): Available from: MEDLINE with Full Text.
Greene J, Sallee D. Scoliosis in teenagers and common treatment and intervention methods – a systematic review of SportDiscus and AMED literature. Virginia Journal [serial on the Internet]. (2015, Fall2015), [cited December 18, 2016]; 36(2): 13-18. Available from: SPORTDiscus with Full Text.
Sy N, Bettany-Saltikov J, Moramarco M. Evidence for Conservative Treatment of Adolescent Idiopathic Scoliosis – Update 2015 (Mini-Review). Current Pediatric Reviews [serial on the Internet]. (2016), [cited December 18, 2016]; 12(1): 6-11. Available from: MEDLINE with Full Text.

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.

Treating A Diabetic Reaction In Your Massage Clinic

November 28, 2016/10 Comments/in First Aid, First Responder, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

It was a few years ago and we were having a great conversation about our favourite topic, hockey.

Being a big Jets fan, he excitedly told me the news that Winnipeg was approved to get their team back.

You could feel the excitement come across the phone: “did you hear the Jets are coming back!?”

Not 30 seconds later, he said it again: “did you hear the Jets are coming back!?”

Umm yeah, we just talked about that.

Then he repeated it again, this time his speech was a little slurred.

Something was off.

Then I clued in and asked: “did you take your insulin this morning?”

“Why would I do that”, his speech was getting more slurred.

“When was the last time you ate?”

“Why would I do that, I don’t need anything!?”

I hung up and started phoning every extension in the office, no one was answering.

I drove to the office and found him slumped over his desk, looking and sounding very confused.

The small sugar drink he had taken wasn’t working, or more likely just wasn’t enough.

I ran next door to the coffee shop and grabbed some food, Coke and orange juice.

When I got back, I held everything up and asked what would work best.

He pointed at the Coke.

I took the top off, handed it to him and he took a sip. He sat up a little, then took another drink. The third drink perked him up some more, with each drink his condition improved.

Then he looked at me and said: “what the hell were we talking about!?”

“Hockey”

“Oh yeah, did you hear the Jets are coming back!?”

Understanding Types Of Diabetes

I’m sure we all know someone and have at least a few patients who have diabetes. However it is important to know which type of diabetes they have.

There are two different classifications, although one kind doesn’t get talked about or recognized as much.

Diabetes Insipidus:
- Results because of dysfunction of the posterior pituitary.
- Causes defects in antidiuretic hormone (ADH) receptors or can’t secrete it.
- Neurogenic Diabetes Insipidus makes too much ADH because of a brain injury.
- Nephrogenic Diabetes Insipidus the kidneys do not respond to ADH which results in too much urination leading to dehydration.
- This type of diabetes is typically treated with hormone therapy.
Diabetes Mellitus:
- The more common form of diabetes, with classification of Type 1 and Type 2 resulting from an inability to make or use insulin.
- Type 1 referred to as juvenile diabetes or insulin dependent, the persons immune system destroys the beta cells in the pancreas, so they don’t produce insulin.
- People with Type 1 typically have to take insulin injections to deal with the condition.
- Type 2 aka: non-insulin dependent diabetes or adult onset diabetes most commonly caused by cells becoming less sensitive to insulin.
- Type 2 diabetics may need insulin injections but it is typically managed with checking blood sugar and regulating with diet.

Diabetes Mellitus is the condition we are most likely going to be faced with in our clinic, so it is important for us to understand what is happening and how to deal with this if we are ever faced with someone having a diabetic emergency before or after a treatment.

If someone who requires the use of insulin takes too much (hyperinsulinism) this can cause the body to use up any extra glucose in the blood (hypoglycemia), which then deprives the brain of the sugar it needs.

When this happens the brain cannot function properly and the body begins to shut down.

If someone is having this kind of a diabetic reaction, it can eventually lead into a diabetic coma and eventually death if it is not dealt with appropriately.

It is then our responsibility as healthcare professionals to be able to recognize and deal with this, preventing the coma and reversing the reaction.

Signs And Symptoms Of A Diabetic Reaction

If we have a patient with diabetes, chances are it is going to be Type 1 or 2.

Those with Type 2 typically manage their blood sugar with diet and monitoring blood sugar levels (sometimes they use insulin as well). This comes on later in life, usually past the age of 35.

However those with Type 1 (who use insulin) can end up suffering from hyper or hypoglycemia.

If they are experiencing hyperglycemia, there is sugar in their blood, but not enough insulin to allow their cells to be receptive to the sugar.

When this happens the body attempts to get the sugar from other sources, such as fats from within the body. This produces increased waste in the body and knocks pH balance off and the person starts to feel ill.

When the person is experiencing hypoglycemia (not enough sugar), the sugar in the body is used up and in turn affects brain function which can be life threatening.

This can be caused by a few different things:

Takes too much insulin.
Hasn’t eaten enough, or regularly enough.
Exercise has burned off their blood sugar faster than normal.
Great emotional stress.

In order to recognize a possible emergency, there are similarities between the hyper and hypoglycemic conditions:

An altered level of consciousness, dizzy, drowsy and confused.
Rapid breathing.
Rapid pulse.
Feeling ill as well as looking ill.

If you know one of your patients has diabetes and starts to show any of these symptoms, it is essential to provide the appropriate care.

Photo by: stevepb

Providing Care During A Diabetic Emergency

There are some specific steps to take when trying to help someone during a diabetic emergency.

If you’re not sure why the person is having an issue, we do what is called a Primary Survey. Check to see if they have their ABCs (Airway, Breathing, Circulation). If they are unconscious, call 911.

If they are conscious and speaking to you, then the ABCs are present and you can go into your Secondary Survey.

During the Secondary Survey we do a quick check of the rest of the body to see if there are any injuries that could be causing the issue. It’s just a quick rapid scan of the persons body from head to toe looking for possible injuries.

This is where you could possibly find a medic alert bracelet or necklace that could tell you they are diabetic. Nowadays some people are also getting them as tattoos, so you may see this as well.

Assuming the person can talk to you, then there is a series of questions to use called the SAMPLE questions. It is just a simple mnemonic which can help you determine what is going on:

S – signs and symptoms?
A – allergies?
M – medications?
P – past medical history?
L – last meal?
E – events leading up to the emergency?

In the case of a diabetic emergency, there are a few questions that can really help you out.

If you didn’t already know it was a diabetic emergency, knowing their medication (insulin), past medical history (diabetes) and their last meal can give you great insight into what is going on.

The person might tell you right away what is wrong and ask for something to help, but just in case they don’t, asking those questions can get you the information you need.

Now that you have determined the emergency, we need to get sugar into their system.

Keeping fruit juice, candy or non-diet soft drinks in your clinic are all great resources to help someone in this condition. After they have some sugar, it will help quickly, actually it’s surprising how quickly it can turn things around.

If the person is unconscious, do not give them anything, you could end up compromising the airway and making things worse.

Just monitor their ABCs until further help arrives.

There is a bit of controversy about determining the difference between hyper and hypoglycemic conditions as there could be a concern about giving someone sugar who already has too much sugar in their system.

While this could cause some more damage, it is not going be as life threatening as it is for someone who has low blood sugar and needs to get sugar in their system.

For our purposes in a clinical setting, we are going to treat the person with sugar because it will be difficult to know which condition is causing a problem.

Since we are not authorized to give medications we don’t inject insulin for people. If this happens before a treatment, you cannot carry on with the massage even if the patient has some sugar and starts to feel better. They need to go eat a proper meal to help balance out blood sugar. It doesn’t mean they need to go to the hospital (unless they don’t start to feel better within five minutes of getting sugar in their system), remember this is something they deal with on a regular basis (if they go unconscious, call 911). Since 9.3% of the population has diabetes and a large population remains undiagnosed, as well as the prevalence of gestational diabetes affecting 9.2% of pregnant women, there is a strong chance you will have to deal with this kind of an emergency in your clinic one day. Knowing the signs, symptoms and ways to deal with it will be the biggest way you can help any one of your patients should this happen. And yes, the Jets came back and I still get to talk to my buddy about it regularly.