Subpoena’d As An Expert Massage Therapy Witness

I have been fearing this day since I graduated college.

The envelope looked different than any other mail I’d ever gotten.

I opened up the registered letter and there it was, a cheque for $20 and a subpoena.

It read:

“TAKE NOTICE that you are required to attend and testify as a witness in the place, date, and time set out below. You are also required to bring with you all documents in your possession or control relating to the matters in question in this proceeding.”

What was I going to do?

I don’t want to go to court and testify!

At the end of the letter it clearly states:

“if a person, contrary to these Supreme Court Civil Rules and without lawful excuse, refuses or neglects to obey a subpoena or to attend at the time and place appointed for his or her examination, is guilty of contempt of court and subject to the court’s power to punish contempt of court.”

Looks like I have no choice.

I am not looking forward to this.

Compensation For Being A Massage Expert Witness

I really wasn’t sure what to do.

It was quite insulting that a lawyer would send a cheque for $20 (the requisite witness fee) to force you to be a professional witness in an insurance claim that was being fought in order to achieve a settlement for the claimant and themselves.

Not only would I have to take time off work and lose pay, but there is also prep work to be done.

Before I called the lawyer in question, I figured I would talk to our provincial association for some advice first.

The association had some good advice as far as what should be charged in cases like this.

  • Testimony in court $700 per half day
  • Court prep time $93/hour
  • Production of records $100 or $.50 per page.

I had no idea if I was just supposed to demand this or if it was assumed. I was told just talk to the lawyer and explain what was recommended to me.

Calling their office, the lawyers assistant answered.

I laid out what I thought compensation should be.

She responded and said, “okay you can bill us for the $93/hour, but no judge is going to pay you $700, that’s the kind of money they give brain surgeons”.

As we chatted about what would happen, I told her this scared the crap out of me.

Her response set me at ease: “Don’t worry about it, it’s not like TV. You’re a good person, as long as you don’t rob a bank in the meantime you have nothing to worry about. All you have to do is just show up and be honest, they’re not going to try and trip you up.”

Now it’s time to prep.

https://flic.kr/p/9mNxFH

Photo by: Medill DC

Prepping A Massage Therapist For Court

The lawyer had me come in to the office for an hour to prep.

We went through all my notes to make sure he could understand them and of course to see what I could remember.

Scouring over the notes, he asked for explanations on what he was reading. Deciphering what different orthopedic tests meant and what I was testing for. Looking for explanations on why there were missed appointments, why would I work on one area one day and a different area on another.

Some of those treatments were three years ago!

Then it was time to tell me what to expect and what was expected of any Massage Therapist called in as a witness.

Just be honest. If you don’t remember something just be straight up about it.

While the opposing lawyer is working for the insurance company and wants to win, they will not cross examine you like you see on TV. They will ask you questions more to try and discredit the patient, not you as a therapist. Just be honest with them.

If you’re asked a question, you answer the judge. While it may be either lawyer asking, you look at and direct all answers to the judge.

Dress appropriately, wear a suit.

Show up early and look for directions as to which room the case will be argued in.

While you are scheduled to be there, you may not be called. It will depend on how the case goes. If the case is settled before hand, you’ll be informed that you don’t need to show up that day and although the case could go on all week, you will only be called for the scheduled day and time that we ask for.

We discussed compensation.

He confirmed that $700/ half day was more than would be given, he did agree that $100/hour for time spent was appropriate as long as I was fine with that.

Two days before the case went to court, they settled. I was fortunate to not have to go. Although I will admit there was some disappointment, I ended up really wanting to see what it was like. Overall it didn’t end up being as scary an experience as I thought (even though I didn’t have to go to court) and as the lawyer and I talked I thought he was fair. He paid the $100/hour for the hour I spent with him and for the hour to get any extra paperwork together, in addition to the bill I had given them months earlier for sending them my charts.

The experience also made me realize that my charting should be better than it was. The lawyer wasn’t totally sure if he’d be able to use them. Some treatment notes were more detailed than others and not all of them were specific enough. Make sure that if you’re ever working with patients who are involved with insurance companies that your note taking is top notch. This is another way for us to prove not only our worth as Massage Therapists, but also our professionalism as one.

A Summit On Massage Therapy

 

When I got the invitation I didn’t know what to expect.

I was even more surprised that I was the only one in the clinic who got one.

When I phoned the association to find out what it was about, I was told:

“We are hosting a summit where there will be a roundtable discussion on what needs to change and what can be done to improve the profession. There will be several other RMT’s and members of the public participating.”

Okay, I’m in.

I walked into the room on Saturday morning and started to see faces I had only ever met online.

More and more people started to look familiar.

I’ll admit, I was a little star struck.

There were between 40-50 people in the room. We were told that the invite was because those in attendance were considered to be thought leaders in the province.

There were no ego’s in the room and everyone was there for one purpose.

Improving the profession.

Massage Therapy In Patient Centered Care

The BC Ministry of Health is setting new priorities for our health system by setting eight new priorities.

While I understand that if you don’t live in British Columbia, it doesn’t really matter to you there are still take-aways from this that can apply to the profession everywhere.

  1. Provide patient-centered care.
  2. Implement targeted and effective primary prevention and health promotion through a co-ordinated delivery system.
  3. Implement a provincial system of primary and community care built around inter-professional teams and functions.
  4. Strengthen the interface between primary and specialist care and treatment.
  5. Provide timely access to quality diagnostics.
  6. Drive evidence-informed access to clinically effective and cost-effective pharmaceuticals.
  7. Examine the role and functioning of the acute care system, focused on driving inter-professional teams and functions with better linkages to community health care.
  8. Increase access to an appropriate continuum of residential care services.

I don’t think anyone can argue, these are great priorities (especially the portions that are in bold) and we as Massage Therapists should be involved.

However the sad truth is that we are not.

When we looked at the BC labour market for therapists and talked about the Provincial Priority Health Professions, this is what the list looks like:

  • Audiologist
  • Medical Laboratory Technologist
  • Medical Radiation Technologist
  • Occupational Therapist
  • Physical Therapist
  • Physician-General/Specialist
  • Registered Nurse
  • Registered Nurse-Specialty
  • Speech Language Pathologist
  • Ultrasonographer

We didn’t even make the list as a Priority Health Profession.

When you look at the National Occupation Classification we are under “Major Group 32 Technical occupations in health” and within that grouping are classified as “323 Other technical occupations in health care.” Within that group we are listed along with Opticians, Practitioners of natural healing, Licensed practical nurses, Paramedical occupations and Other technical occupations in therapy and assessment.

Under Major Group 31 Professional occupations in health (except nursing) is the realm and classification given to Occupational Therapists, Physiotherapists, Chiropractors and are called “Therapy and assessment professionals”

RMT’s and Physiotherapists in the BC labour market both are in demand, but RMT’s are listed as having “Some Post Secondary” education and  Physiotherapists are listed as having a “Masters Degree”.

The group we are in has significantly less education than we do and with some of those occupations the schooling can be done online. Really!?

In order for us to be recognized as a priority health profession some things need to change.

We need to establish our legitimacy as a profession.

Level of education has been an issue since I became a Massage Therapist and I’m sure it started long before. If we want to be recognized and given increased legitimacy we need to start looking at improvements to our education.

One of the big issues is price of education. For a Physiotherapist or an Occupational Therapist the average tuition is only $13,000 but we know to become a RMT it’s around $30,000.

All because their programs are offered through public universities instead of private schools.

There is a significant decrease in the amount of physical therapists and occupational therapists in the province that are able to fill necessary jobs within the public sector. Most are working in private practice, which creates a substantial need in the public sector working within the health authority.

So where can we start to help fill that gap and be involved?

First off the government needs to fully understand what we do. They are projecting our annual salaries to be in the range of $11,000 – $33,000 a year.

With their stats of 3,200 RMT’s where only 26% are working full time (a total of 832 full time RMT’s in the province?) I think we’d all venture to say those stats aren’t accurate.

Here are the stats from RMTBC on a survey that was done regarding income 

It’s time to start lobbying government to educate them on what an RMT does. Show them what our current education consists of and also how effective Massage can be for the patients in hospitals or extended care facilities.

The encouraging side is there are some places where Massage Therapy is being offered in the public sector.

We heard from Liza Dion.

She is a Massage Therapist at the Mayo Clinic. She told us about how surgeons wanted Massage Therapy performed for their cardiac surgery patients. They ran randomized control studies and proved Massage Therapy was effective in helping these patients.

They now have regular Massage Therapy happening in the hospital and is a primary part of the care given. However it’s not just in cardiac patients, they have also done studies with Colorectal surgery, Thoracic surgery, Breast surgery and Cardiology patients. It has even gotten to the point that they have a hospital based Massage Therapy course that is offered twice a year for Massage Therapists to come in and learn how to offer care in the hospital.

Liza also mentioned that she regularly has to educate new nurses and other practitioners in the hospital about what Massage Therapy does.

What if these other practitioners already knew what we did because we all went to university together? At least started out in the same programs and then decided which avenue we were going to pursue.

If we want to join these other therapies in the public sector work, we should also join them in the public sector schools.

https://flic.kr/p/qL2wPW

Photo by: NEC

Massage Therapy Education, Professionalism, Practice Support and Resources

As part of the summit we were divided into groups to discuss these topics.

I was fortunate to be part of the Education group.

As expected, there was a lot of discussion and passion on the topic.

Everyone there believed more education was crucial to our advancement as a profession. The common belief (as discussed earlier) was that a bachelor’s or master’s degree in massage was the direction we should start looking at.

I’m sure there are just as many people against the idea as there are people for it, but think about what this could do for us.

We have never been able to say that we specialize in something. I’m sure there are a number of therapists out there that focus their practice into something specific or some particular modality. Having more education is one way to lift this type of boundary on the profession. As we start to set up Professional Practice Groups here in the province, why shouldn’t we be able to say that we specialize in something or some area of interest?

Expanded scope of practice. I get frustrated that we are not allowed to use modalities like IMS, Shock Wave, Ultrasound or any other electrical stimulation. I know that in other provinces Massage Therapists are fully licensed and allowed to use these types of modalities. I think it’s time to make these options standard practice in regulated provinces.

Part of the problem with this goes back to lobbying government and making them aware that this should be within our scope (even though I think it already should be). Having a bachelor program in place, would help take away any doubt on their part.

As someone who loves working in sport, I believe there are many things we could do with our curriculum that would support students who have this interest. I spent last year working with some Athletic Therapy students and there are things we could learn from their program.

Those students come out of school with a few different certifications. Since it is a bachelor degree program, they come out with a list of exercise certifications on top of the AT certification. Right now we could start incorporating a CPT (Certified Personal Trainer) certification into the program. It would give students a much better grasp of exercise prescription for their patients and also give them an extra avenue of making money once done school.

For those that are interested they could have a combination Personal Training and Massage Therapy practice. It would also give those students interested in working with athletes or sports teams a better chance of getting involved.

There were so many other topics that were brought up in that discussion, but I’m writing this from memory so I can’t remember it all.

However when each group came back and talked again, every group mentioned that education had come up as a priority.

The Future Of Massage Therapy In Mainstream Healthcare

Dr. Gurdeep Parhar presented to us a new idea on how we could identify what we want from our profession and how we fit into the healthcare system.

canmeds 1

He talked about the CanMeds framework that physicians had put into practice to see what is expected of a medical expert. This framework has been adopted around the world, where students and medical professionals are graded on the six branches of the model. But the same model has been adopted in Physiotherapy and Occupational Therapy groups as well.

The public expects a doctor to be a medical professional (obviously) but the above six qualities are expected as well.

Communicators. We are judged by other professions and the public on how we communicate. This includes writing reports in response to doctors and other practitioners that we refer to and from. Dr. Parhar also sat in with the professionalism group and spoke with them on how important it was to implement report or communication writing back to doctors.

It is an area that we are not very good at. During discussions later in the day, the feeling was that most thought a report to a doctor had to be complicated and frequent. Dr. Parhar spoke about how much he as a physician appreciates getting communication from RMT’s, but it just needs to be a report at the beginning of treatment and one at the end. Just a report that informs the doctor in areas of treatment and how treatment progressed, so they know what has been done with the patient.

That’s it.

Collaborators. This works with our communication. How are we interacting with the rest of the healthcare team? We can’t work in isolation, we should be communicating with our patients other practitioners and contributing to their healthcare plan.

Manager. Why can’t we be a case manager on behalf of a patient? We can see a recently injured patient 2-3 times a week for an hour at a time. A doctor will see this person once every 4-6 weeks for maybe half an hour. So why aren’t we a piece of this puzzle, or even the primary case managers?

Health Advocate. Access to care is so crucial, especially in a “patient centred” model of care. There is still a difficulty for doctor’s to explain to their patients why Registered Massage Therapy isn’t approved by their insurance company when it is needed. We need to help advocate for the patients because society trusts us as professionals based on our guidelines and standards of care.

Scholar. This is a difficult area for us. There was plenty of discussion throughout the day on research (in fact a guest speaker Dr. Martha Brown-Menard LMT, spoke to us specifically on research) and how important it is. The problem is that research is done at universities and big companies don’t necessarily want to fund research for massage.

As much as we are pushing for evidence based practice, qualitative studies are just as important. But we need to start doing the research if we want to advocate for more resources to back up our profession.

Professionalism. Is Massage Therapy going to continue to have an artistic side to it, or do we start to present ourselves in a more professional manner? Should there be a standardization so that when someone comes in for treatment a person feels like they are dealing with clinicians?

I’m as guilty of this as anyone, I like just going to work in what I’m comfortable in (which is usually cargo shorts and a t-shirt), but would I be more presentable or respected if I made sure to wear a golf shirt instead? While I don’t think this is something that will ever be mandated, it may just be some food for thought when it comes to your own practice.

Listening to all of those points coming from a doctor was more than rewarding. Knowing there are doctors out there that are also advocates for Massage Therapy says that we are at least on the right track.

When I started this blog, the whole intent was to have other therapists collaborate information on how to improve the profession and share knowledge. I was excited when each one of the coaches agreed to be part of it because they were willing to share.

Sitting in a room of other RMT’s that are passionate about their profession and improving it was impressive. It also showed that we have a ways to go in order for our profession to gain more respect. While it is leaps and bounds ahead of where it was 10, 15 or 20 years ago, we can never stop improving. As the CanMeds model increases throughout the world, Massage Therapists need to continue working on being Professionals, Communicators, Collaborators, Scholars, Managers and Health Advocates. As mainstream healthcare continues to develop we need to make Massage Therapy prominent in patient centred care.

No one is going to this for us, it is only through our efforts that we can prove to government and other practitioners that we belong in the public sector and mainstream healthcare. I realize as I write this post that it seems pretty heavy on the education side of things. There was so much more that came out of the discussions that day, it’s just hard to put it all down in one place. If nothing else, I think the discussion was a step in the right direction.

We were asked to bring the excitement that we were all feeling that day back to our colleagues and share in order to keep the momentum going. I hope I have at least managed to do that, although I know it’s just the beginning.

7 Ways A Website Can Improve Your Massage Therapy Business

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.

https://flic.kr/p/d41HES

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

“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.

https://flic.kr/p/v6xRKS

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

 

“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.

https://flic.kr/p/dJJmA9

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

“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.

https://flic.kr/p/u8XA22

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.