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

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

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

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

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

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

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

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

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

Well it depends.

Donating Massage Therapy Gift Certificates

This can be a bumpy road.

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

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

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

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

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

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

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

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

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

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

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

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

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

Volunteering With Sport Massage

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

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

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

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

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

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

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

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

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

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

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

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

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

Photo by: Elvert Barnes

Photo by: Elvert Barnes

Fundraising Massage Therapy Outreaches

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

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

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

But choose wisely.

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

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

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

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

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

10 Business Mistakes I’ve Made As A Massage Therapist

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

— Winston Churchill

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

— Colin Powell

I couldn’t wait to get out of school.

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

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

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

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

The following week wasn’t much better.

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

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

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

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

1. Taking The First Job Offer, Without Actually Looking

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

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

I hadn’t yet.

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

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

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

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

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

Then I’d show up and wait.

And wait.

And wait.

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

Other days, there wouldn’t be anyone.

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

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

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

It isn’t.

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

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

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

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

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

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

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

All things I should have learned earlier in my career.

3. Being Timid About Re-booking Patients

I really struggled with this early in my career.

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

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

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

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

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

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

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

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

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

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

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

They are also around who to work with.

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

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

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

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

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

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

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

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

5. Not Getting Proper Accounting Advice

I’m not good with money.

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

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

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

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

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

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

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

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

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

6. Not Having Another Job To Make Ends Meet

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It was terrible.

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

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

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

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

8. Not Networking Properly

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

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

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

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

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

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

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

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

But make sure you return the favour.

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

Photo by: Maryland GovPics

Photo by: Maryland GovPics

9. Not Asking For Referrals

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

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

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

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

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

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

10. Not Being Active On Social Media

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

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

Social media platforms are a free place to do business.

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

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

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

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

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

6 Tips For Getting Involved In Sport Massage

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

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

I stood in awe.

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

Then it was time to get to work.

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

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

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

This is why I wanted to be a Massage Therapist.

Getting Into Working With A Team As A Massage Therapist

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

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

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

Maybe I had an in.

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

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

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

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

6 Tips For Working In Sport Massage

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

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

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

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

Photo By: Brian Cribb

Photo By: Brian Cribb

The Benefits Of Volunteering In Sport Massage

This is where some therapists have a hard time.

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

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

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

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

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

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

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

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

A Massage Therapist Guide To Dealing With A Stroke

 

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

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

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

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

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

“not good”

How was the weekend?

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

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

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

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

Can you lift your arms above your head for me?

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

Can you kick your legs out for me?

The right one kicked out, left one stayed put.

We need to get you to the hospital.

Tips For Recognizing Someone Has Had A Stroke

How To Help A Patient With A Stroke

 

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

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

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

 

 

Separating Fact From Fiction With Pregnancy Massage

 

Walking into the waiting area, my new client is sitting with a smile and a sizeable baby bump. I offer congratulations along with, “If you’re ready, let’s head this way…”

On the short jog to the massage treatment room, I go over my mental checklist of items I’ll want in the room: body pillow, extra bolsters, support wedge. I close the door and ask my standard, “So, what brought you in for massage today?”

She replies, “I’m seven months pregnant, and my feet are killing me. But I’ve heard massaging feet can be risky, so maybe just focus on my shoulders?”

My mood deflates somewhat as I’m faced with a choice I’ve made countless times with pregnant clients: get on my soapbox, or just get on with the massage? Share facts, at the risk of causing friction, or just provide what she requested, and perpetuate fiction?

A spiral of unknowable, anxiety-amping questions pop into my head:

  • What if I make her uncomfortable by “correcting” what she thinks is true?
  • What if instead she’s glad to not have to worry about ankles anymore?
  • What if she’s actually open to learning about what research says?
  • What if she in turn gets really offended and then tells all her friends?
  • What if it’s the ethical thing to do and her reaction doesn’t matter?
    What if she complains to my boss and I’m told to stop educating clients?
  • What if…

As the thoughts spiral, I land back to the original dilemma: do what’s right or stay quiet?

Is Massage Therapy Safe During Pregnancy?

Many Massage Therapists who provide prenatal massage have run into situations like the one above. 

There are several rooted old wives tales and myths surrounding massage and pregnancy. As Massage Therapists, we have a great opportunity to provide context, debunk pseudoscience, and encourage our clients to enjoy the benefits of massage during their pregnancy.

Yet in doing so, we may cause friction.

Especially with new clients, where rapport has not yet been established, confronting or correcting personal beliefs could be a bit touchy.

Simply put, there’s no evidence that effectively demonstrates massage can induce labor, cause miscarriages, or create complications. Just because someone’s great aunt said so, or a neighbour went into labor after a pedicure, doesn’t make it true.

Physiologically, there’s no reason a pregnant woman couldn’t enjoy the same massage as someone who is not pregnant would. Pregnant women are not sick; nor (in general) do they have a condition that can be worsened through massage.

They are often understandably sore, tired, or uncomfortable, but pregnancy itself is not an illness. Additional pillows, supports, or body positions may be required, but those types of accommodations should come naturally to any client-centered massage practice.

A few times, I’ve been asked if I hold some type of prenatal massage certification?

I reply that I do not, and do not believe it is necessary. Which is normally followed up by, “So what exactly is your prenatal massage?” My honest answer is, “It’s my same great massage… but with more pillows.”

While countless changes occur in the body during pregnancy, in general, the body is not altered to the extent that licensed/registered professional Massage Therapists need additional credentials in order to provide their own same great massage. Muscles are still muscles, joints remain joints, nerves stay nerves. The effects of massage on those tissues remains the same.

However, just as you would with any client, if there’s a health condition, or a known complication, defaulting to having massage ran by their doctor is prudent. 

Examples include diabetes (diagnosed before or during pregnancy); high blood pressure; cancer; and heart, kidney, lung or liver disease. Those conditions are not always contraindications, and clients with them may really benefit from massage, but they may act as cautions and reasons to alter your typical protocol.

What About Massaging The Feet And Ankles?

Do a quick Google search and you’ll come across countless articles, blogs, and opinions that warn pregnant women against ankle massage because it could induce labor. 

Chances are, many women may have at least heard of this myth, and some may become apprehensive or avoidant of massage because of it.

When you try to locate legit sources for such claims, you’ll hear crickets chirping. 

There’s no evidence that applying pressure to points on the feet or ankles will in turn cause uterus contractions. This wide-spread myth stems mostly from Reflexology.

Reflexology is a belief system that points on body relate directly to various internal organs, and by pressing or massaging those points, we can stimulate those organs. The claimed points for the uterus and ovaries are on the ankles.

Two separate systematic reviews in 2009 and 2011 concluded there’s not sufficient evidence to support the use of reflexology for any medical condition, let alone inducing labor.

But if that’s not enough, there was a great study in 2014 where researchers attempted to induce labor in 221 post-due date women by applying acupuncture needles to the specific labor-inducing points. Even when poking these gals every other day for a week, none of the findings supported reflexology claims. If they couldn’t induce labor with that amount of poking, general massage of the ankles is never going to do the trick.

Not only is there no evidence to back up the myth, there’s also no plausible reasoning to explain how it might work. What biological function is present in the ankles that would influence the uterus so? A super long nerve?

If pressing on ankles did influence labor, it would be risky to wear high top shoes, or even walk about daily life, for fear of bumping into or tripping over something with the feet.

Lastly, if it were just that easy to kickstart the birth process, docs and nurses would be spending much more time on women’s feet in the delivery room, and the use of hormones to induce labor would be obsolete.

Benefits Of Massage Therapy During Pregnancy

Moving beyond the fiction and into the facts, research has shown some positive preliminary evidence of the benefits of pregnancy massage.

Everyone can benefit from being less stressed, but for pregnant women in particular, less stress for them also translates into less stress for the growing baby.

A 2010 systematic review concluded that pregnant women reported decreased depression, anxiety, leg and back pain post-massage. Cortisol levels (the stress hormone) also decreased, excessive fetal activity decreased, and the rate of prematurity was lower.

Many of my clients have expressed how taking time to relax has also given them an opportunity to “check in” and more deeply appreciate their changing body. It’s provided time for reflection and appreciation for the child they are eagerly anticipating to meet soon.

A 2015 randomized control trial concluded that massage therapy can reduce lower back pain during the first postpartum month.

Narratively, I have treated pregnant clients for symptoms also expressed by the vast majority of my non-pregnant clients. Swelling, achy joints, nerve pain, sore muscles and compensation due to shifts in weight and posture, tension headaches, etc.

By applying the same anatomy and evidence-based training we would with any client, Massage Therapists can effectively address the aches and pains pregnancy can bring.

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Effective Communication About Pregnancy Massage Myths

Back to the example with my client at the beginning of this article, that day I did opt for the soapbox.

I took a long deep breath and rolled the dice, “Before we begin your massage, can you tell me a bit more about why massaging your feet may be risky? If they’re causing discomfort, I may be able to provide you with some relief today…”

I’ve found it’s helpful to ask a client to clarify their concern. Their response gives me more information to work with when attempting to tactfully dispelling potential myths:

What have they heard?

  • Are they concerned about the entire foot or just specific points? If only specific points, perhaps there’s room to compromise. I can offer a massage of the foot but avoid ankles.

Where have they heard it from?

  • What’s the context? If a client saw a Facebook post warning about ankles and pregnancy, information in that context is typically much easier to confront as false.

How convinced are they?

  • Can they be persuaded or not? If their source is a favorite reflexology practitioner they’ve been seeing for various ailments for years, I may cause considerable friction attempting to counter those beliefs. However, if their source or conviction is uncertain or weak, that may be a door open for continued conversation.

In the few cases I’ve experienced where a client is just not convinced, it has carried some friction (not the beneficial kind) into the massage and I did not see those clients again. Although I hate to lose a client, I take some comfort in knowing perhaps they will at least second guess the myth, maybe do research of their own, and in a best case scenario, perhaps allow another Massage Therapist to relieve their achy feet in the future. I hope others will join me in leaving this particular massage myth behind, continue to help women feel better, and support the on-going pursuit of further evidence to advance massage. In the case I’ve cited, my client’s source and conviction was weak, so I took the chance and briefly recapped the evidence-informed perspective I had to share. I’ll never forget her response: “Then this isn’t an old wives tale, it’s an old husband’s tale. My husband’s got a foot massage backlog to catch up on now.”

Self Care For Massage Therapists With Shoulder Injuries

 

My shoulder started to hurt.

Was this actually happening to ME? Was this the beginning of nagging symptoms leading to the end of my favourite career?

Those thoughts certainly crept into my mind.

One of the most frustrating things a Massage Therapist can experience: an injury.

I imagine a lot of Massage Therapists, as well as many other hands-on health care professionals, experience some form of discomfort or injury during their career. We spend hours each week using our body: our strength, our endurance, our flexibility, our knowledge, our emotion and our passion to help others feel better.

But what do we do for ourselves?

How do we keep ourselves healthy and able to help others?

Those of us who have been therapists for a few years have probably figured out the maximum amount of people we can massage in a day or week and other ways to keep ourselves healthy.

But even when you think you’re keeping yourself healthy, injuries occur.

So what do you do when a nagging, overuse injury creeps up on you?

Possible Reasons For Massage Therapists To Have Shoulder Pain

About two years ago the front of my right shoulder started to burn while I was working, especially when providing downward pressure and while moving client’s limbs.

It also hurt whenever I flexed or abducted my shoulder joint and when I lifted anything with my right arm (groceries, weights). It didn’t get bad enough that I couldn’t work but it didn’t get better either.

After a week I started feeling nervous. After two weeks I was annoyed. I received a few massage therapy treatments that were focused mostly on my pectoralis, deltoid and bicep muscles. While the treatments felt amazing and alleviated some symptoms for a day or two, it didn’t change my problem.  

After a month, the symptoms were no better so I decided to start using my own knowledge to rehab myself!

Thinking about my symptoms, I came up with three main reasons why I might have been getting this injury:

  • I had been feeling tight and stiff through my upper back. Perhaps this was creating dysfunction in my shoulder?
  • I was using a lot of strength during pushing movements and a lot less during pulling movements. Was there some imbalance between the front and back of my body?
  • I had been working hard for many years. Maybe I just needed a bit of a break?

Here’s how I addressed each of these questions and how it helped.

Therapeutic Exercises For Increasing Thoracic Spine Mobility

Have you heard of the stability vs. mobility joint by joint approach?

Michael Boyle (Strength and Conditioning coach) and Grey Cook (Functional Movement Systems) have promoted the idea of the joints of the body needing to be either stable or mobile. Starting from the lower limb and working superior here are some of the main joints and their basic need:

  • Ankle – mobility
  • Knee – stability
  • Hip (Acetabulofemoral joint) – mobility
  • Lumbar spine – stability
  • Thoracic spine – mobility
  • Scapulothoracic – stability
  • Shoulder (Glenohumeral joint) – mobility

If you think about it, this approach makes sense. For example the hip and the shoulder are very mobile joints, while the lumbar spine does not have much range of motion and therefore should be stable.

From the list above you can see the joint requirements alternate. Now think about what happens if one of the mobile joints loses some of that mobility. For the body to move there will be some compensation occurring. Where is the necessary movement going to come from?

It’s probably going to cause the joint(s) above and/or below to be more mobile that they should be. Here are a few examples:

Decreased ankle mobility -> Increased movement through the knee -> knee pain

Decreased hip mobility -> Increased movement through knee and/or lumbar spine -> knee and/or lumbar spine pain

Could it have been in my case that the tightness I was feeling through my thoracic spine was causing pain in my shoulder? With the stability vs. mobility approach in mind here was my thought on my own situation:

Decreased mobility in my thoracic spine -> decreased stability in my scapulothoracic joint -> dysfunction in my Glenohumeral joint -> shoulder pain

From this thought, I decided to spend time working on increasing thoracic spine range of motion.

Each day before I went to work, and each time I warmed up for a workout, I would go through these mobility drills for my thoracic spine: Thoracic spine windmill, Quadruped extension and rotation, Lunge with touch down and rotation.

Here are the descriptions and pictures for these three exercises.

Thoracic Spine Windmill:

    • Lie on your Left side, a pillow placed under your head, arms out in front
    • Bend Right hip and knee and place on a pillow, bolster, foam roller, etc.
    • Right hip should be above 90 degrees of flexion
    • Take a deep breath in
    • When breathing out, rotate through the thoracic spine bringing your arm across your body to the other side
    • Both shoulders should be in contact with the ground
    • Return to starting position and repeat 6-8 times on each side

 

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This is a great exercise you can do with massage therapy clients right on your massage table. I have had success with clients in increasing their thoracic spine mobility by massaging through the thoracic and pectoralis areas and then adding this exercise at the end of their massage session.

Quadruped extension and rotation:

  • Begin in a quadruped position – on hands and knees with hips placed above the knees and shoulders above the hands
  • Place Right hand on the back of your head
  • Rotate your thoracic spine bringing your Right elbow towards your Left elbow
  • With a smooth movement, Extend and rotate leading the elbow towards the ceiling
  • Return to the start position and repeat 8-10 times on each side

 

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Lunge with Touch Down and Rotation:

    • Take a large step back with the Right leg into a lunge position
    • Reach down with your Right hand and place it on the ground beside your Left (front) foot
    • Rotate towards your Left side bringing the Left arm up
    • Rotate your head to follow your hand
    • Hold for a breath
    • Return to the lunge position and stand up tall
    • Repeat, taking a large step back with the Left leg
    • Alternate legs for 6-8 repetitions on each side

*Bonus – you get some great hip mobility in this drill as well!

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Along with these three thoracic mobility exercises, I also worked on scapular stability through drills such as wall slides, windmills, Turkish getups and scapular push-ups.

I highly suggest being trained on these exercises if you’ve never done them before as they have a lot of important cues. Perhaps this will be in a future blog post! Stay tuned!

Strengthening A Massage Therapist Back To Help Correct Overuse

I’ve loved going to the gym since about 13 years old and have had a passion for strength training for over 10 years. I enjoy being strong and fit.

Strength training is important to me because it allows me to be strong for my career as a massage therapist, and it also is an amazing outlet for any stress or emotions I pick up. I love everything about strength training!

While injured I was probably over using my body, massaging 5 days a week and strength training 4-5 days a week. Since my career required a lot of pushing strength, I needed to compensate by spending more time in the gym on pulling strength.

I increased the amount of time and energy spent on large pulling movements such as deadlifts, hip thrusts, chin-ups and rows.

Four days a week I would do a rowing type exercise: band pull-aparts, dumbbell rows, face pulls, seated cable rows. I would only choose one rowing exercise each day, but made sure to incorporate them into my workout to fix or prevent any imbalances occurring between the front and back of my body.

A rowing movement targets the rhomboid, trapezius, latissimus dorsi and biceps muscles.

Here’s an example of how I would incorporate more exercises to target my posterior body, and especially rowing movements, into my workout each week:

Day 1: 

  • Assisted Pull-ups – 3-4 sets of 10-12 repetitions (reps)
  • Heavy single arm dumbbell row – 3-4 sets of 5-8 reps

Day 2: 

  • Deadlifts – 5 sets of 5 reps  
  • TRX, or other suspension trainer, rows – 4 sets of 15-20 reps

Day 3:

  • Body weight Chin-ups – as many as possible (usually only 2-3 reps)
  • Face pulls – 4 sets of 15-20 reps

Day 4:

  • Hip Thrusts 4 sets of 10-12 reps   
  • Bent over Dumbbell or Barbell rows – 3 sets of 10-12 reps

*Note: these are not my complete workouts, but an example of specific exercises (deadlifts, hip thrusts, pull-ups and rows) that I used.

There are many ways to add exercises that strengthen the back of your body.

This is what worked best for me! The take away from my experiment: if you have anterior shoulder pain (or even if you don’t) and work in a job that requires you to have your arms in front of you or overhead often, it is beneficial to work the back of your body far more frequently in the gym then your pecs and shoulders!

Massaging Less

Something I did not do at the beginning of my symptoms, or even before having symptoms, was give myself sufficient rest.

I would massage for many hours a day and still work out. Wasn’t massaging someone a workout in itself?! However, I didn’t want to give up my love for strength training, so I just changed how I trained, as explained above.

The change in training certainly helped, but I would notice if I had a few busy weeks that the pain would creep back again.

Last May, I moved to Iqaluit, Nunavut to spend an adventurous year in the Arctic with my fiancé. I am taking a short break from massaging full time and have been using previous schooling, training and skills in a different job. I still massage part time and also have gotten back into personal training and teaching fitness classes at the local gym. It has been wonderful using my previous education while still being able to practice what I love.

Since moving and massaging less I have felt AMAZING! No pain and no worrying about my body breaking down. Perhaps all I needed was a break?

But what happens when you can’t afford to take a break?

I remember constantly feeling like I couldn’t take time off. I wouldn’t be getting paid for any days off, I was paying off students loans and didn’t have any other income. How do we manage to take some well deserved rest?

Try to find other avenues of income. I started supervising the student clinic and assisting a teacher at the local massage therapy college. Soon I was lucky enough to teach some of the courses myself. I also taught anatomy courses for fitness professionals on weekends. There are lots of ways we can use our knowledge to gain other or extra income.

While I am looking forward to moving back to my hometown and being back into massage therapy full time, I am also going to be more aware of needing rest or time off.

So What Worked?

As mentioned above, I spent a lot of time working on increasing and, now, maintaining my thoracic spine mobility.

I added more strength exercises for the back of my body to compensate for the amount of pushing I did during massage work. I took a break from massaging full time.  

I still do the same, or similar, mobility drills for my thoracic spine daily. I still work on scapular stability. I still deadlift, hip thrust, row and try hard to perform chin-ups (Why are they so challenging!?!!). I still massage and hope to for many years to come.

Since incorporating thoracic mobility exercises into my daily routine I have found that I no longer feel tight through my back nor through my neck (an added bonus!). More movement through my thoracic spine allows for my other joints around it to function as they are intended. As hands-on therapists we need to figure out what is best for our own health so that we can continue to help others. Use your own knowledge to create a plan to keep yourself healthy and injury free so you can have a long, rewarding career. Don’t give up on what you love!