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!

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.

Emergency Action Planning For Sport Massage Therapists

I felt like a deer in the headlights when she asked me.

“Can I get a copy of your Emergency Plan to give to the other team’s trainer?”

My what?

“Your Emergency Plan, you’re supposed to have one ready, or on file before each game to give to the other trainer.”

I had NO idea.

I had volunteered with the team for the previous five years and had never heard of this. However this time I was the head trainer, which came with a whole group of responsibilities I didn’t yet know about.

Part of the league rules were that each team head trainer had to have an Emergency Plan in place in the event that a player was badly injured and needed medical attention beyond what we could provide.

I had yet to do my first road trip and receive one of these documents from another trainer.

All I could do was apologize and promise to have one ready for the next game.

I felt like an idiot.

Massage Therapists As Part Of The Team Within A Team

Even though I felt like an idiot, I was fortunate.

I’ve had to do this kind of thing before and have some experience with it.

There is more to this than just printing up a document. It designates you as a leader, a professional, an expert and a damn good communicator.

When it comes to working in sport, your athletes are your responsibility, but there are times when trainers of opposing teams must work together (actually most of the time it’s important to work together).

I won’t go so far as to speak for other sports (although I’d assume it’s much the same), but in hockey the trainers are almost like their own little team, within the teams. On road trips, it’s not uncommon to forget equipment and have to borrow tools or get help with injuries from the other team’s medical staff. There are constant favors being done back and forth to help each other, whether it’s laundry, equipment trades or holding coaches back from attacking each other (yes it happens).

The same applies when someone is hurt in a game. While your athletes are your responsibility, if they get hurt bad enough that you have to go out on the field, ice or playing surface to help, everyone is on edge.

If the trainer puts their fist up into the air, that’s typically the signal they need more help. At this point, what team you’re on doesn’t matter, it’s all about THAT athletes safety. When it’s done right, it can be seamless, when it’s done wrong it can be a complete cluster…well you know.

There has to be one person in charge and it’s not a time to start second guessing things. When the trainers are working together as a team, in the best interest of the athlete, there can’t be any ego’s. If the athlete is on the other trainers team, they have started first aid protocols before you get there and you may get assigned a somewhat menial task.

If all you are asked to do is call 9-1-1 or go and direct paramedics to the scene, that’s all you need to do.

Why You Need To Develop An EAP

The preparation for these kinds of emergencies starts long before the injury or the game even starts.

Making sure you have a well prepared Emergency Action Plan will give the proper steps to ensure a positive outcome for both trainers and athlete. Also making sure your medical equipment is in good working order and properly stocked prior to game time is crucial.

Like I mentioned before when it’s done properly it can be seamless almost like watching an orchestra of movement. The people who are really good at it, can direct with confidence, which in turn instills confidence in the people they are directing.

I’ve been fortunate to watch several people who excel at it and watch how seamlessly they can direct people to do what they need while still tending to injuries and dealing with a patient.

Being able to direct one person to help deal with injuries, one to lead paramedics in and others to get extra equipment doesn’t come naturally, or easily and it must be practiced.

Part of the reason why it’s important to develop an Emergency Action Plan is because of your knowledge of your environment. When teams come from other towns or cities they don’t have the intricate knowledge of the area like you do. Nor do they have the knowledge of the idiosyncracies of your building or area of play.

Every little thing you know that could possibly delay more advanced medical help arriving is crucial information to be able to share with the other trainer.

For instance:

  • Is there a preferred entrance for paramedics to use?
  • Is there a better entrance/exit to take the athlete away from the playing surface?
  • Are there gates or doors that would have to be unlocked for paramedics to gain access?
  • Where do you keep extra medical equipment stored?
  • Are there more staff/people on hand trained for medical emergencies that can help?
  • Is there an AED stored close by?
  • Where is the closest hospital or medical clinic?
  • Are there any slang names that are used for common areas of the building/sport area?

While these things might seem simple, to someone who isn’t familiar with the area, it can be crucial.

Having a face-to-face with the other trainer before game time to review your Emergency Action Plan is not only beneficial but can be life saving.

https://flic.kr/p/afL5Fn

Photo by: Jon Candy

Setting Up An Emergency Action Plan For Sport Massage Therapists

I’ll never forget the first time I was in command of an accident scene with the fire department.

I was beyond nervous.

On the way a senior officer was driving and giving me tips on what to do before we got there. But I had never been in command before and was totally unsure of myself.

Midway through the call, one of the chiefs arrived on scene. He calmly came up, grabbed me and pulled me out of the accident. We walked up a hill about 15 feet from the accident and he told me “here is where you need to start”.

His point was to take a deep breath, take a step back and look at the entire scene, not just the middle of it. Look at what things could possibly go wrong, take a broader view to make sure everything is safe.

Undoubtedly, you will be in the middle of the emergency if this is your scene. Before anything ever happens, take a step back. When you’re making up your Emergency Action Plan, try to envision everything that could possibly go wrong when your athlete has to be taken off the playing surface, or is seriously hurt on it. Anticipate as much as possible. While you will never be able to come up with everything, it’s a good start. If an emergency does happen and something you didn’t think of occurs, go back, review and update your EAP.

There are several things that need to be included on your Emergency Action Plan. Remember, this should be shared with the visiting trainer before game time:

  • Level of First Aid that is available during the game (team doctors, first responders, paramedics, and how many of each).
  • Location of any First Aid equipment and supplies (AED, spine board, clamshell).
  • How to get more help if needed (the fist in the air is fairly common).
  • How you will respond if needed.
  • Methods of transport if needed.
  • Any prearranged routes out of the area and to medical treatment (you can just copy and paste in a picture from google maps).
  • The role you want the trainer to follow.
  • The roles other team members will follow (ie: equipment managers, coaches)

If possible, make this a one page plan that can be handed off to anyone. You can make it as detailed or as simple as you want, but the above points should all be included. I’ve heard some trainers say theirs is a 4-5 page document. It’s fine if you want to be that detailed, but in an emergency situation, it’s not practical to have to review something that long.

You can download the one I made up by clicking here, if you want to see a simple example of one.

Whether you’re the head trainer or there strictly as the team Massage Therapist, you should have a working knowledge of the EAP. If you’re not the head trainer, ask if you can review it and ask what role you can play if there is an emergency. More importantly ask if you can be part of a practice to make sure things run smoothly if you are going to be part of the emergency medical team. If you are the main medical person for a team, make sure you conduct a practice every once in a while to make sure all staff members are familiar with their role in the case of an emergency. Go back and review your EAP every once in awhile. Every year, equipment needs, First Responder protocols and athlete medical conditions will change. Make sure the EAP reflects everyone of those changes. Just try to avoid being like me and feeling like an idiot!

 

Acute Quadricep Contusion Management For Massage Therapists

He was a little slow getting up.

An opposing player tripped him, he fell to his knees and slid into the boards.

I was following the rest of the play and the student working with me pointed out he was hurt.

Looking down at the end of the bench, he was standing and shifting his weight back and forth from leg to leg and was bearing weight on the leg no problem. The whistle blew, so he went out for a quick skate to test it while there was a stop in play.

When he came back to the bench he was wincing and gave me a look that said he wanted some help.

As we walked into the dressing room, he had a bit of a limp.

Once he sat down, I started taking his gear off and there wasn’t much of an issue pain wise.

There was some tenderness just above the knee cap and his range of motion was pretty good, a bit of pain with muscle testing and some minor swelling in the area. We pulled him from the game and had him ice the quadriceps.

After the game he came into the treatment room and asked what he should do that night? Since we had a game the next night, I advised him to ice the quad, elevate it and take some ibuprofen.

Then the discussion started.

The student I was working with thought it was better to get inflammation to the area rather than prevent it.

After we discussed it, we still decided to go with ice and anti-inflammatories.

Treatment for Acute Quadriceps Contusion

There has been so much debate over this for the last while, it’s no wonder there was some confusion for treatment protocol.

I think Paul Ingraham explained it better than I could with his article titled “The Great Ice vs Heat Confusion Debacle”.

We use ice as a treatment application to reduce pain with acute injuries as well as reduce inflammation. While there is much debate on whether to reduce inflammation, the body has a tendency to over do it, so in the acute stages (in order to manage pain and mobility) ice is a good thing.

As with any other injury, you want to make sure you do a thorough assessment to determine its severity.

If you’re working on the sidelines in sport, your assessment happens immediately on impact or collision that causes the contusion.

Running through a quick checklist in your head can help:

  • Was the collision severe enough to cause a fracture?
  • Can the player bear weight?
  • Did they need help to get off the ice or playing surface?
  • If they can bear weight, are they walking with a limp?
  • Are they able to bend the knee?

Once you get them into your treatment room, or away from play, your more concise assessment can start.

In the case of a Quad contusion, they are divided into three grades:

  • Grade I (mild)
    • Mild swelling and pain and able to walk without a limp.
    • Passive movement beyond 90° may cause pain.
    • A muscle test for knee extension may cause minimal discomfort.
  • Grade II (moderate)
    • Walks with a limp.
    • Can bend the knee between 45°-90°.
    • Swelling prevents full knee flexion.
  • Grade III (severe)
    • Progressive bleeding and swelling occur within 24 hours.
    • Swelling won’t allow knee flexion past 45°.
    • Flexing the quads is also painful or not possible.
    • They will need to see a doctor.

The easiest way to do this is just by having the person lay prone on your treatment table (if possible) and you’re essentially going to perform an Ely’s test.

Once they are face down on the table just passively flex the knee (within pain tolerance) as much as possible to see what grade you get. Anything past 90° is mild, anything less than 90° is moderate to severe, the person should not bear weight and should be given crutches.

In order to treat a mild contusion an application of ice while the knee is braced in full flexion (this can be done using a large tensor bandage), puts a stretch on the muscle and helps maintain range of motion but the bracing should not be done for extended periods of time because it can weaken the tissues. One study showed that bracing for 24 hours immediately after injury (in addition to stretching and strengthening exercises after brace removal) had people back to full athletic function in 3.5 days.

For the first day or two continue with ice and anti-inflammatories to keep the swelling down. Use passive and active range of motion to keep the surrounding joints moving as well as preventing tissue changes.

With any hip or thigh injury, if the person can’t bear weight (grade II or III) they should be sent for more advanced medical care.

https://flic.kr/p/5xd2TQ

Photo by: The US Army

 

Return To Play For Massage Therapists

Once past that initial 24-48 hours and swelling has started to go down you can look at getting your athlete involved in their sport again.

Massage Therapy treatments can start in addition to functional exercises. As long as the athlete can do the functional movements associated with their sport, pass all functional tests, and range of motion is within 10° of the other leg, they should be good to go.

In the case of a Grade I, this could be the next day, Grades II-III will take longer and if the athlete has been sent for more advanced medical care, their return to play should be coordinated with feedback from the doctor.

There are a couple of complications that should be ruled out with Grade II-III (possible compartment syndrome and myositis ossificans) and this requires a doctor’s care.

It will be rare to see an acute quadricep contusion in a clinical setting, but if you are interested in or are already working in sport, there is the potential to see this all the time. While there are many guidelines that can be used, good clinical reasoning on your part will be the best guideline for whether an athlete can return to play again. The player treated in this story was back on the ice and in the game the next night. Using some ice and anti-inflammatories helped manage his pain when he got home that night, so that he could get a decent sleep. The next day, the swelling had gone down, he was functioning well and we put a bit of extra padding in place for protection. Athletes are a bit of a different breed compared to the general population in cases like this, they will do whatever they can to get back in the game and sometimes to their own detriment. In his most recent book Ron MacLean tells a story about Trent McCleary, a former NHL player who repeatedly used his body to block shots which meant constant swollen and bruised ankles and knees, and the odd charley horse that took him out of a game or two. But he didn’t like to get out of the way because he thought that was putting himself ahead of the team. Besides, he was getting good at managing contusions with ice and flexing.

Concussion Management For Massage Therapists

“The tricky part is that concussion signs and symptoms are not always straightforward and the effects and severity of injury and safe return-to-play can be difficult to determine”

– Mark Lovell

“That’s kind o the line I’ve got to walk now. I think the difference is the post-concussion is light-headedness, where I get that disconnect. Anything else is working and getting your heart rate up. I’m still a little nervous. It’s still a little scary”

– Keith Primeau

The sound from the hit echoed through the arena.

He laid there motionless on the ice.

The other players stared at us with a look of disbelief on their face.

As we opened the door to the bench to step on the ice, two players grabbed me and the AT to help get us to their team mate.

We crouched down beside him trying to get as good of an assessment as possible.

Thank god…he’s breathing.

Getting as close as I could to him to speak, to block out what was happening around us I simply asked “are you there?”.

He responded “yeah my head hurts, I just got my bell rung”.

“Can you move your legs?” Glancing down, they moved.

“Does it hurt if you try to move your neck?”

“No, it’s good, just my head”

As we stood him up and took him back to the bench, it was immediately noticeable, he wasn’t acting like himself.

Once in the treatment room, we could set up for a better more thorough assessment.

He was groggy and lathargic. He lost his usual jovial attitude.

Everything bothered him and his headache was getting worse.

Even the lights in the room were causing an issue.

So was it just a headache? Does he remember what happened? Is there something more going on?

The AT went to work with his assessment. He started asking the player a bunch of questions as I sat back and watched.

Some of the questions made sense.

Do you remember the hit?

Do you know what day it is?

Do you know approximately what time it is?

Then he gave the player a list of words and asked him to repeat it back.

Elbow, apple, carpet, baby, saddle, bubble.

I sat there with a dumb look on my face trying to remember the words too, couldn’t do it.

Afterwards the AT explained what he was doing and showed me this document called SCAT2. I had never seen it before.

First Aid Protocols For Acute Concussion

As research develops so does concussion protocols.

People of my generation probably remember as kids the only thing we were asked was: “how many fingers am I holding up” as if we were Billy Bob on Varsity Blues.

Back then there was talk about “degrees, grades or severity” of concussions, but that thinking is out the window now. There is no such thing as a “minor” concussion anymore.

When I started working in sport the SCAT2 document was the more commonly used method for concussion protocols. It has since evolved into the SCAT3.

Part of the SCAT3 is using the Glasgow Coma Scale (GCS) to assess level of consciousness before you decide to move an injured person. The GCS has been around as an assessment tool for years and if you take advanced levels of First Aid it is incorporated into those courses.

The GCS is used to decide if an injured person requires immediate transport to advanced medical care. It assesses the person on three different types of response (eye, verbal and motor) and gives them a numbered grade according to response.  It looks something like this:

Eye Opening

Open Spontaneously (4)

Open To Speech (3)

Open In Response To Pain (2)

Do Not Open (1)

Verbal Response

Communicates Normally (5)

Confused (4)

Inappropriate Words (swearing) (3)

Confused Sounds (groaning etc) (2)

No verbal response (1)

Motor Response

Obeys Commands (6)

Localizes Pain (swats your hand away) (5)

Flexion To Pain (elbow flexes in direction of pain) (4)

Abnormal Flexion To Pain  (3)

Extension To Pain (2)

No Response (1)

Once you designate a score for each level of response you add the scores together for a total. If it comes out to less than 15, the person should be transported to hospital for more advanced care due to the possibility of a brain injury. There is a great video you can watch here to see how it is done.

The player in the story above scored a 15, his eyes opened spontaneously, he obeyed movement commands and could communicate just fine so we were okay to take him to the dressing room.

SCAT3 A Valuable Tool For Massage Therapists

 Once the GCS is complete and determined it is okay to move someone, the rest of the SCAT3 can be used for assessment.

The document goes through several other assessment tools that include symptom evaluation, cognitive assessment, neck examination, balance and coordination examinations.

This is where those memory techniques of saying five words to the athlete and having them repeat the words back is completed to get an idea of their cognitive function.

Symptom evaluation is assessed by noting things like headaches, pressure in the head, sensitivities to light and noise along with feelings of anxiousness and sadness. Few things are tougher than watching a young athlete cry uncontrollably because of a head injury and being frustrated by not being able to understand what’s going on.

The SCAT3 also goes through return to play protocols for athletes. Most importantly is that once an athlete (or anyone for that matter) has been diagnosed with or assessed a concussion, they must be referred to a doctor (preferably a sport med doctor) to receive clearance to start physical activity again.

Typically with a sports team each player is evaluated on the SCAT3 at the start of the season. This gives training staff a baseline to compare in case someone sustains a head injury. If the original is kept on file, it can then be used as a comparison during the acute injury and also as part of the return to play.

While this document was intended for athletes, it could be a valuable tool to be used in a clinical setting with anyone who comes in that has suffered a head injury whether in the workplace, MVI, or as the result of a fall.

Making the SCAT3 part of your intake, combined with regular communication with the patients doctor could give you a better idea how the patient is progressing.

https://flic.kr/p/fpZHhE

Photo by: University of the Fraser Valley

Massage Therapy Treatment For Concussions

Most people dealing with Post Concussion Syndrome will experience a variety of symptoms ranging from dizziness to headaches and balance issues as well as depression.

In order to help any patient that comes to you who has suffered a concussion, one of the biggest things we need to understand is the Mechanism of Injury that caused the concussion.

Was it a car accident?

Sports injury?

A fall?

Has the person suffered a concussion before?

Which direction did impact come from?

Most concussion treatment revolve around aerobic exercise (after periods of complete physical and mental rest) and then return to play protocols for athletes working up to full contact practices (depending on which sport).

When a patient suffers an injury significant enough to cause a concussion it is likely that they have also suffered an injury to the neck which can contribute to headaches as well as dizziness. It is important for us to try and differentiate where the patients dizziness is coming to discern if it is cervicogenic dizziness or a vestibular issue.

I asked a sportmed doctor why they always refer their concussion patients to a Massage Therapist and he said “it’s because there is usually a whiplash injury associated with the concussion, so getting treatment for anything associated with the neck helps in the concussion treatment”. One study showed that Massage Therapy helped a 23 year old athlete by having two 45minute treatments focused around the pelvic girdle, neck and atlanto-occipital and atlanto-axial joints one month after injury.

The SCAT3 (or any other acute concussion assessment tool) is important for Massage Therapists to understand because it will give the therapist better insight, not only on what was done to help a person immediately, but also as a tool to see how a patient is progressing. Above all when it comes to treatment, your clinical experience is going to be the best guide on how to treat someone with post concussion syndrome. While these tools were intended for athletes, it can also be a great tool in dealing with MVI and workplace injured people who are referred to you. Quite often these ones will be dealing with issues like depression, lack of focus, irritability and not understand why they feel this way. Using these tools can be a great method of tracking their progress and helping you refine or change your treatments according to their needs. There is always a concern around Second-Impact Syndrome where someone sustains a second head injury before the initial concussion symptoms are gone. There are companies starting to develop new protocols and services to help with concussion management like imPACT, King-Devick Test, Shift and axonsports but these all come with a cost. Using free resources like the SCAT3 and CATTonline are widely recognized and may be more suitable for sideline and clinical settings for you until the others are more affordable. Take it from someone who has suffered major head injuries in the past, this needs to be managed properly for successful outcomes, the delay in recovery can be frustrating and depressing. But hey, at least when it happened to me I thought I was in Hawaii, and my dad said it knocked some sense into me!

 

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.