5 Misconceptions About Posture That Could Hurt Your Clients


As a Rolfer, I see many people who want to improve their posture. Many are already in the process of applying some questionable advice they may have read on the Internet.

This post summarizes some of the major misconceptions people seem to have about posture.

Bad Idea #1–Bad Posture Is The Cause Of Your Pain

The idea that bad posture will result in pain, or that you can cure pain by improving posture is a myth. You can read these claims everywhere. Sure, they may have an intuitive appeal, but they have no strong evidence support them.

If bad posture is a major cause of pain, you would expect to find that people with measurable postural distortions would have more pain than people who do not. But that is not what studies show. As summarized in a previous blog post, the weight of the evidence is that pain does not correlate very well with measurements of posture such as spinal curvature. This is surprising and somewhat counterintuitive, but it should definitely be kept in mind by anyone who plans on investing considerable time and effort trying to correct posture for purposes of pain relief.

Bad Idea #2–Good Posture Requires Constant Attention

Many of my clients believe their poor posture is the result of failed attention. As a practical matter, we cannot spend all day worrying about our posture. Our bodies are not designed to require conscious monitoring of muscular activity. We can walk without reminding ourselves to activate flexor digitorum longus at the right time, and we can also sit upright without being mindful to activate the core or retract the scapula.

We really have no choice but to allow posture to be dictated by unconscious processes. Even the most vigilant conscious policing of your posture will be abandoned after a second or two, as soon as some other distraction arises. So, if you want good posture, you must somehow make it an unconscious act.

Bad Idea #3–Good Posture Requires Extra Effort

Many of my clients believe their bad posture results from laziness, or possibly poor strength in certain postural muscles. They feel tired after only a few minutes of assuming what they think is a good posture, and then conclude they must increase their endurance at holding the position. This is a losing battle.

The solution is often not to increase your ability to sustain effort, but to find a posture that requires less effort. The sense of effort associated with movement is a good way to determine whether the movement is right for you. In regard to posture, this means your optimal posture should feel easier, not harder, than your current posture.

If a certain posture feels like it requires extra effort, it’s probably not going to work. In any event, your brain, which prefers the most efficient way to do something, will be smart enough to abandon an inefficient postural strategy the very first moment that you stop consciously controlling it. Which should be about three or four seconds.

Bad Idea #4–Posture Means Holding Still

People think of posture as the opposite of movement–as something that you “hold.” This is why people often become stiff when they assume their “good” posture. This is a bad idea because it interferes with all the movements that must occur constantly during any posture.

Every posture requires ongoing breathing, which is a movement that can involve nearly every muscle in the trunk. This fact works against the common advice to suck in the abs as a means to become more upright and stable. Consciously sucking in the abs might make you feel taller, but it also tends to lock in some of the muscles that must move to allow breathing.

In addition to breathing, static posture (especially standing) involves constant oscillatory movement. Standing is actually a highly unstable position–it’s like balancing a fifteen pound bowling ball on top of a stick on top of two other sticks on top of two bony feet. Standing is a continual process of tiny falls and recoveries, where the muscles constantly adjust to tip the body one way and then the other. This results in a very small but perceptible oscillating pattern where the head moves above the feet in a figure eight or circle. So, posture is not about preventing movement, but about allowing very small movements around a central balance point. Try to imagine that you are a bobble head doll and you can feel this subtle process of movement and readjustment happening constantly and involuntarily.

Another important aspect of posture is that it is the place from which the next movement will come. Optimal posture allows the next movement with a minimum of preparation and effort. This is of course vitally important in a sporting context, where players wait for the next move in a posture (usually a crouch) that allows quick movement in any direction with little effort or preparation. But such a consideration also applies to everyday life, and you can be sure that your brain is constantly anticipating your next move no matter how small, and making postural preparations for it.

One movement that occurs almost constantly in most sitting and standing postures is turning the head from side to side to scan the horizon and take in sensory information. Each head movement, when executed optimally, requires movement of the neck and more subtle compensatory movements in the trunk and even pelvis. Turn your head from side to side while sitting and you may feel your sit bones shifting slightly on your seat. Holding the head and trunk in a rigid position will restrict the freedom of these movements and make them stiffer and less comfortable. Try adopting your “good” posture and then see if you need to soften it a little to turn comfortably from side to side. Again, your brain won’t let you adopt a posture that prevents a quick and easy scan of the horizon, and therefore any such posture is doomed to fail.

Another motion that takes place almost constantly while sitting is reaching for a keyboard, mouse, phone, doughnut, remote control, etc. If the scapulae are held to the spine by the conscious retractions recommended by many posture experts, the arm is not ready to reach. And this is again why advice to consciously stiffen certain muscles is likely to fail. The brain knows that sitting at a computer means constant reaching, and it will not allow the scapulae to be constantly pinned back.

The bottom line is that posture is not a static position to be held, but rather a dynamic and constantly changing series of subtle movements that allow breathing, turning and reaching, preserves easy balance, and prepares for the next movement.

Bad Idea #5–Straighter And More Symmetrical Is Always Better

Many people assume their posture will improve if they get “straighter” and more symmetrical. However, it is a bad idea to place too much emphasis on how your posture looks. More important is how it feels and what it can help you do. The visual emphasis on posture probably results from spending too much time looking at pictures of platonically ideal posture shown in books. Trying to deform your body into the shapes in these pictures can be a bad idea.

Every person has a unique bone structure and therefore each person has a unique ideal posture. We all have at least some minor asymmetries in the bones from left to right. If you look closely at a model skeleton you will notice that the ribs on the right side are not the same shape as the ribs on the left. You will also notice places where the spine curves from left to right. Bones are not made by machines like interchangeable pieces of Ikea furniture, they are shaped by years and years of an organic process of growth which responds to tensional and compressive forces. Such forces are bound to be different from side to side and therefore asymmetries are the rule not the exception.

If the bones of your spine naturally tilt a little to the left near the sacrum, they will have to tilt back to the right at some point to keep the head over the pelvis. The resulting curvature is entirely natural and perhaps optimal for that particular person. Trying to straighten out the curves works against the grain of the bone, and is bound to cause unnecessary stress and tension.

The same principles apply to the size of the forward and backward curves in the low and upper back, which are very much determined by the shape of the bones, particularly the sacrum, whose shape varies markedly between different people.

Altogether, the ideal posture is different for everyone, so don’t rely too much on how your posture looks, judge how it feels. If it doesn’t feel natural, it won’t work.

Why Every Massage Therapist Should Be On Twitter


I looked at the person next to me, we couldn’t believe what we just heard.

I did a full on palm slap to the face while shaking my head.

It was during a social media camp while a woman was doing a presentation on how to use twitter for your business. Apparently they didn’t screen the participants.

Someone put up her hand and asked “Is twitter a place I go to, like a coffee shop”?

But some good things did happen that day.

I was fortunate enough to have lunch with one of the presenters. He told stories over lunch about how using social media had benefited his business.

His marketing budget compared to the previous year was cut by ? which also increased their profit margins. And one big difference was they were actually getting more customers through the door. It was fascinating talking to him and seeing the passion he had for this relatively new marketing concept.

College had only ended six months before and I was looking for ways to promote myself, so figured I’d sign up for this social media camp.

The best marketing advice I’d been given in college was “just give each person, the best damn massage you can, because you never know who they’re going to tell”.

While that may be true…how you gonna get them in the door in the first place?


Why Massage Therapists Should Be Tweeting

Massage Therapy is more than than just giving good treatments.

It’s about building relationships.

Twitter is a great tool for doing this. It’s not just about promoting your business, it’s about getting people to interact with it.

Don’t be afraid to show your personality. If there’s one thing that’s true in this industry, there is a VAST array of personalities.

While we all want to project a professional image, people don’t come in to be treated by a robot. Show people what you’re interested in. Retweet what you’re interested in.

If someone is looking for a new Massage Therapist and you’re tweeting about some of their interests, who do you think they’re going to want to talk to while on the table for an hour? You, or the guy who refuses to show they actually have a sense of humor?

I have patients that come in regularly, just to hang out. One patient I’ve had in the past would regularly come in and when I asked why she was in today:

“was at work and thought, I’m gonna go hang out with Jamie for a bit”.

Don’t be afraid to have the personality that keeps them coming in, engaging with them outside of the clinic.

But there is a fine line here.

You don’t want to send out tweets thanking them for coming in today. There is still a professional boundary that should not be crossed. If they tweet out a thanks to you, it’s fine to favorite it or respond but remember that coming for a Massage is still something personal they may not want broadcast to the public.

Leave that communication in their hands.

Connect With Your Clients And Build A Massage Therapy Community On Twitter

Do a little research on twitter on your own and find out what your local community uses to connect.

I live in Victoria BC and the most common hashtag I see here is people using #yyj because it’s the code for the local airport. Each community will have their own thing they are using.

Just do a simple search of the name of your town/city and you will see some of the hashtags and commentary used to identify what’s going on.

If you can’t find one, start one. Develop something you think people in your community would connect with and promote it. You never know, it just might catch on.

Are there upcoming events that maybe you can contribute to or get involved in? Do you see opportunities where your knowledge would be an asset? For instance, if there were some local marathons, Run For The Cure, or other events where people could use Massage?

If you see things like this trending within your community, try and join the conversation and give some information to the people tweeting about it. As it is with any conversation, the more value you can add the more welcome you’ll be.

As I do a #yyj search writing this post, I see three tweets about coupons to a local gym, one about WWE wrestlers in town and one about our local football team carrying momentum. With each one of these, it would be easy to make up a quick comment about how Massage Therapy could help anyone involved.

Offer up some quality information about how Massage Therapy can help, not just a link to your website. The more information you can give back the better, it’s all a method of building trust in your community.

Building trust isn’t done by just providing great content.

It’s also in the mentions, the retweets, the favorites, the thank you’s. When others in your community see these interactions, you are starting to build yourself up as a trusted source.

Refer For Other Businesses

Remember that content has become currency.

As you scroll through your twitter feed, there are endless ways to have it be a benefit.

If you see people in your community asking questions, try to be an answer. Be a curator of information.

Know some great businesses out there? Promote them. Use them as an answer to people’s questions.

Someone asking where’s good to eat?, tell them about your favorite restaurant.

Need a good place to workout?, recommend your gym.

Someone looking for a chiropractor?, refer them to whoever you have a professional relationship with.

It doesn’t always have to be about marketing yourself. If you become that curator of information, you will build trust with present and potential customers. But you’ll also start being recognized by those other businesses and get the same in return.

You have an opportunity to add value, not only to your customers, but to other businesses in the area. You’re in the same boat as those other businesses, why not give a helping hand to each of them and support local?

Use Twitter To Gain Intel On Your Competition

There is a general theme among Massage Therapists where we don’t really talk about competing for business.

However, it’s the reality of what we do.

We are all usually pretty good about referring to each other when we can and generally getting along and making space for each other. The reality is we are all competing to have a busy practice and need to make a living.

Use twitter to find out what others are doing. Use it as a tool to learn.

Watch and see if people are griping about some of the other businesses in town.

What things are those patients complaining about? Customer service? Lack of direct billing? Difficult to get booked in at certain hours?

Use those complaints to see if it’s something your practice can offer.

If you can offer some of those things, send out some tweets to your followers about it.

Here’s a great example of a Massage clinic doing just that:


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Anybody who follows them gets to see the great new service they are offering and it may get some people to book in since they know that it’s now less hassle to submit their insurance claims.

However (and I can’t stress this enough) DO NOT negatively call out other businesses or people on twitter, or any other social media for that matter.

If you see gripes about another business don’t respond to the gripe saying that you’ll offer a better service at your clinic.

It’s unprofessional and does not represent you well.

The bottom line is we all care about our patients. But shouldn’t we care just as much about getting more patients? Marketing is hard, especially when you don’t have a ton of money to spend on it. But the biggest thing you have to market is YOU. Make who you are known and connect with like minded patients. Engage with them, like them, thank them, refer them. The more you give, the more trust you will gain, the more trust you gain, the more you will be a fixture in your community.

How Massage Therapists Can Deal With Acute Shoulder Injuries


I knew it was bad when I heard a “pop”.

I’ve given and taken several hits playing hockey over the years, but this one was different.

I got flipped over and landed directly on my shoulder and heard that “pop” on my right side.

I was slow getting up and immediately felt pain in that shoulder.

At first it didn’t seem that bad, the pain was manageable.

Skating back to the bench it started getting worse. Moving the shoulder got more difficult.

Once in the dressing room it became more painful to move. I slowly got my gear off and cracked a beer. I got up and looked in the mirror, it looked gross.

Having a shower was difficult, it got to the point I could barely move the arm and cradling it was the only way it felt comfortable. I packed up my equipment, slowly got dressed with one arm and made my way to the emergency room.

They sent me in for x-rays immediately.

I could see the guys taking the x-ray and the look on their face was terrible. I actually heard them say “oh man, that’s bad”, umm I’m right here.

Recognizing The Degree Of Shoulder Injuries

After the x-ray I sat and waited impatiently for the on-call doctor to come in and give me the bad news.

“You’ve got a third degree separation of your A/C joint”.

He called the local Orthopedic shoulder specialist, who got mad at the doc for waking him up and was informed they don’t do surgery, just put the shoulder in a sling.

With an Acromioclavicular separation they are classed from Type I – III with more severe cases being Types IV – VI.

According to the Foundations of Athletic Training, a Type I separation the ligaments are still intact and there is minimal deformity. Type II starts to show some deformity, the A/C ligaments are damaged but the coracoclavicular one is still fine. Type III shows obvious deformity and all the ligaments are damaged.

There is also more pain and restricted range of motion with a Type III compared to Type I or II.

When it comes to a Type IV – VI there is total disruption of the supporting ligaments and where surgery is necessary.

If you’ve never seen a separated shoulder injury when it happens, it can be difficult to figure out if it’s a separation or a dislocation. Magee gives some good information on how to tell the difference. There’s a few indicators that would point to a dislocation:

While it’s important to know the difference between the two, it’s not going to change how you deal with it.

First Aid For A Separated Shoulder

Whether it’s a dislocation or separation, we just want to stabilize the shoulder until we can get more advanced medical attention.

Chances are the person will be holding their arm/shoulder in the position that is most comfortable for them, you just need to work around it.

As it is with a fracture, dislocation or separation there are a few principles to keep in mind.

  • Immobilize in the position found.
  • Always check distal to the injured area for circulation.
  • Put ice on the injury to help with pain and inflammation.
  • Stabilize the injured joint or area as much as possible.
  • Keep the injured area above the heart as much as possible (but only if it can be done pain free)

The easiest way to remember is with the mnemonic RICE


R – Rest, stop whatever activity the person was doing.

I  – Immobilize

C – Cold, cool the area for 20 minutes

E – Elevate

When it comes to applying a sling to immobilize and stabilize a shoulder, the most common thing used is a triangular bandage. Some people hate these things, but I think they’re great because they may be the most versatile tool in a First Responder kit.

Not only can you make a sling, you can turn them into broad bandages, donut rings, stabilizing ties and various other things. One of the other reason they’re in most First Responder kits is because they’re cheap.

You can buy premade shoulder slings and braces but they cost ten to thirty dollars and when you send someone to the hospital with one, its doubtful you’re getting it back. A triangular costs anywhere from twenty five cents to a dollar.

No big deal if you never get it back.

If you ever have to deal with it, here’s some instructions on how to put the shoulder in a sling:

Anatomy Knowledge

An article published in 2012 used 24 articles to draw information from on the best practice for treating A/C separations.

For a Grade I – III range of motion and strengthening exercises within pain tolerances were recommended. Exercises were mainly to provide stability to the shoulder blade and rotator cuff. Grade IV – VI are typically dealt with by surgery.

There wasn’t much information as far as any treatment protocols. The advice was to use your  knowledge of anatomy, movement and healing process to develop the best plan for you patient.

What I can tell you from personal experience is that for that first week, having one of my buddies that is an Athletic Therapist tape the joint helped with pain management and providing stability.

Getting regular Massage Therapy to treat the muscles connected around the AC joint also helped with pain management and function. Even a year and a half later it feels like there is constant tension from the joint all the way through the shoulder.

If ever dealing with something like this, it’s important to remember that patient comfort is key. Applying a sling, icing the injured area and stabilizing the joint not only provides more comfort but also prevents further injury. Your anatomy and movement knowledge is critical not only in the acute treatment but also in the rehab of this injury. If the separation is severe enough, the person will be left with a step deformity at the joint. But because you helped take care of them properly when it happened, they should be able to get full function back. If nothing else came from this, at least I get to show students what a step deformity looks like.

Why Facebook Is Better Than A Website For Your Massage Therapy Business

“Facebook’s greatest priority is making the platform valuable to the consumer, not to you, the marketer” – Gary Vaynerchuk

I was fresh out of College and had no money.

I knew nothing about marketing, advertising or how to set up a website.

I made an appointment with a local marketing/web design company to talk about setting up a site. Spent an hour in their office and talked to two designers about what I needed and wanted.

They got back to me about a week later with a quote of $5000.

Um, okay I can’t afford that.

I went on about my way and about six months later one of the designers (Doug Brown) gave me a call out of the blue. He had taken over the company and invited me to come down for a visit to talk about what I was doing.

He sat me down for an hour or so and instructed me on what I really needed.

“Jamie, you don’t need a website, you just need Facebook and Twitter”.

Why Every Massage Therapist Is A Social Media Marketer And Entrepreneur

I wish someone had told me in college that I was going to be an entrepreneur.

While we talked a little bit about being self employed, I didn’t realize that I would come out of college being my own business.

As great an education as it was, I think this is one area that is really lacking. You walk out piled up with student loans, hoping to get a job with grandiose ideas in your head that you’re going to make X amount of dollars your first year.

You’re lucky enough to get hired in a clinic, but have no idea how to market yourself.

Much less do you know how to set yourself apart from the other practitioners in your clinic. You need to find a way to set yourself apart so that when people call or book online, they’re looking for YOU.

How To Use Facebook To Increase Your Massage Therapy Business

Like it or not, Facebook is here to stay and can be one of the greatest marketing tools you can use.

What’s more important is that Facebook continues to increase it’s exposure for mobile viewing as opposed to laptop or PC viewing. In fact it has become their main focus.

Most mornings when I wake up, (and I hate mornings) the first thing I do is roll over, grab my phone and open Facebook. I doubt I’m the only one, in fact I’m willing to bet it’s what most people do.

That’s one of the reasons that Facebook is focusing more on mobile viewing, our phones have become an extension of us, so why not capitalize on it?

Rather than spend a fortune on a website (especially if you don’t have any programming credentials) you can set up a Facebook business page for free, and really it can do everything you need and more.


You can register your FB page under your business name, and I’ll give a shoutout to my buddy Alicia Doll on the way she set up her page.

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Here Alicia did a great job. (go give it a like)

A great personable picture of her (I mean really, who wouldn’t want to book in with her?) as well as a clear picture of her logo which represents her brand.

This is how you want your page setup because as people scroll through their Facebook feed, they will connect with your logo and any post you put up, giving you an opportunity to make your brand more recognizable.

Online Booking For Massage Therapists

Just under her picture is a tab labelled “book now” where she has integrated an online booking system so that anyone looking is able to book in with her immediately. I’m not sure there is a better way for a clinic to spend money than on an online booking system.

There are a couple things this does for you.

Facebook likes clicks. The more activity there is on your page the more Facebook will rank you in your customers news feed. So each time someone clicks to book in with you, Facebook recognizes the activity and makes your page more recognizable to customers.

It also gives people easy access and increased choice when attempting to book in.

If I’ve heard it once I’ve heard it a hundred times at our clinic:

“I booked in because I loved the online booking system”. Probably the easiest way to generate new customers is giving them an option that puts control in their hands.

Not having to make a phone call, be put on hold or navigate a schedule with another person also helps to build a greater patient relationship.

Massage Content On Your Facebook Timeline

This is where you get to connect with present and potential patients.

Use your timeline to engage by telling stories, linking to valuable information or uploading videos.

What better way to engage than by giving a potential patient information they can connect with?

Let’s say you want to focus on Pregnancy Massage. Give out as much info on the value of Massage during pregnancy but also on various topics associated with healthy pregnancy so that you become a go-to for valuable information on the topic.

Content is key, and the more of it you can give, the bigger following you will get. Attention has become more valuable than money. You could be the best Massage Therapist in your community, but if no one knows about you, you limit your chances of success.

Do a little bit of research each week and you’ll be able to tell a story and continually give information that will keep your patients engaged and connected to you.

One of the great features that Facebook gives you is the ability to schedule your posts. You can pick a time that’s good for you, sit down and schedule your posts for the week, freeing up time during the week to focus on Massage.

Using Your Facebook About Page To Promote Your Massage Therapy Services

This is where patients can get to know you, so make it authentic.

It’s personal connections that matter so make sure to try and make a connection to your potential patients here. Don’t put up something simplistic.

Write things that you’re passionate about. Write specific things you want to focus your practice on and why. Nobody cares that you do Swedish Massage, Trigger Point Therapy and Fascial work. That’s what the majority does.

Separate yourself from the majority and give people something to connect with.

Are you passionate about Sports Therapy? Then explain why. Give people a story to relate to. Tell them how your Massage Therapist helped you recover from an injury. People will connect with that story and realize that you know where they’re coming from.

Remember, this is your chance to start building a relationship so start by making it a strong one.

Get Your Fan Page Raving

Use the “Reviews” tab and don’t be shy.

Get some of your newly acquired or long standing patients to give you a review.

You’re good at what you do, don’t be afraid to let others help you. Most of us are willing to ask people for referrals in the form of telling their friends/colleagues/family, so why not do it publicly as well.

People like to be recognition and I’d venture to say most of your loyal patients would be only too happy to write something up for you to post online. It gives them ownership and a sense of belonging, not only to exchange with you but also because they respect and trust you.

Massage Therapy Techniques And Exercise Pictures

Use the “Pictures” tab to show people what you do.

Attempt to build a library of demonstrations for people to expect when they come and see you. While it can be beneficial to have pictures of your nice treatment room, remember they’re coming to see YOU.

Get a friend and shoot a couple of pictures demonstrating what a treatment will look like from you. Have your friend take pictures of you doing some stretches or home care exercises.

Ryan Hoyme does a great job of this and gives away free pictures to his subscribers as well as free ebooks on how to use photos and videos for marketing. Here’s a few examples of his work:










These are a few good examples of what you could use, but make sure you get a few that have your face beaming with a big smile in them too.

Try and build up a stock, so that in turn you have images to refer people to for home care. Use apps like instaquote or canva and you can create great images with exercise instructions to upload on your page.

Remember that giving away content is a great way to earn trust and a great way to advertise.

Social Media Lessons For Your Massage Therapy Business

I was fortunate enough to get a job in a clinic where I didn’t have to use social media much as it was already a busy clinic.

However I have been reading and studying a lot about it over the past couple years.

I’ll always be indebted to Doug Brown for that day, not just because he got my interest started in social media. But because he taught me the first and most valuable lesson of being in business and using social media.

After we were done I asked “what do I owe you?”

His response “nothing, don’t worry about it”.

Since then I’ve bumped into Doug repeatedly in town, kept in touch on twitter and watched his career continue to flourish as he is featured in local magazines. He’s always been willing to give back, help out and be a generally good guy.

What I learned from Doug back then still applies today and I think it always will. He was willing to share his knowledge, show me how to do something new and follow up with me afterward. These are all things you can do to make your business better and grow relationships with your patients.

As much as we all got into Massage Therapy to help people, it is still a business and we are all an entrepreneur. There’s nothing shameful about that and we need to embrace it. Facebook is possibly your best and most cost effective marketing tool. Being able to use it to promote yourself, your content, online booking and a host of other applications it provides, will help you build long lasting relationships with your patients.

Use Facebook effectively, share knowledge with your patients and they will remember you as much as I remember Doug.

The One Thing Every Massage Therapist Should Have In Their First Responder Bag

Blood is leaking from his left leg.

The players get him to the bench and throw one arm over the AT’s shoulder, I grab the other one and we hobble him down to the treatment room.

Once he’s on the treatment table we start cutting gear off.

He’s been cut by a skate over the Extensor Retinaculum on his left ankle with the tendons exposed. The AT immediately grabs gauze and puts pressure over the cut to control the bleed. He’s gonna need to go to the hospital.

Let’s back up a few hours.

Pregame Warmup, Massage And Treatment

That day started like a  typical Saturday afternoon.

Stop at Tim Horton’s to grab coffee’s around 4:45, at the rink by 5pm.

Step into the dressing room, talk with a few of the players, then into the treatment room.

Have a quick chat with the Athletic Therapist about some injuries etc. going on with players and have our coffee’s.

One by one players came in for treatment.

I do some pre-event massage and help players with their warm up. The A.T. gets to work taping and working on some nagging injuries.

One of the management team comes down to inform us there will be a first aid company in the stands tonight, since none of the Dr’s could make it to the game (it was league rules to have a doctor or a certain number of First Responders in the building for every game).

The first aid company is there to help with any fans at the game and back us up if we need any help.

Pregame skate starts at 6:35, we go and watch one of the players to see how he’s skating with a chronic groin injury.

7:15 puck drop.

Halfway through the 1st period there’s a crash into the boards that resulted in the injury from the beginning. But dealing with the injury wasn’t the difficult part.

The Inexperienced First Aid Attendant

In walks a young man who works for the first aid company, he looks about 18 years old, accompanied by an older gentlemen that just kind of sits back and watches.

The young man immediately attempts to take control of the situation pushing his way around. Me and the AT look at each other somewhat dumbfounded by what’s going on.

He tries to take a pulse (dorsalis pedis) on the injured side. He can’t get it and exclaims “we need to cut the other skate off so that he can compare”.

Of course he can’t get a pulse, the AT is holding pressure on the injury right above to stop the bleeding. He cuts the other skate off while we tend to the injured leg.

Once he gets the skate off he continues to follow protocol, takes the pulse and has the player wiggle the toes on his good leg. He continues to follow protocol and asks the player to wiggle the toes on his bad leg.

Now we’re getting angry!

In as stern a voice as possible I yell out “DO NOT WIGGLE YOUR TOES!”.

The kid looks at me like I’m from outer space (since I’m not following his first aid protocol), the AT looks at him and says: “who the hell is in charge here?”

A little stunned the kid looks and says “well I’m the first aider” (meanwhile his partner, the older gentlemen is just standing watching).

The AT says “there’s over 30 years experience between the two of us, now smarten up and get the hell out of our room”.

I had a big grin on my face.

After he leaves, another team volunteer comes down and we ask him to call an ambulance. The first aid kid comes back and tells the volunteer (who is at least three times his age) to go outside and wait for the ambulance and direct them in.

If looks could kill, he would have been dead three times over.

He was directed to go outside and wait for the ambulance and was shocked that he would have to do such a thing.

Ambulance arrives and we package the player up and pass on all the information they need. The first aid kid continually tries to put his two cents in while the ambulance attendants give him a look like they wanted to pat him on the head and feed him a cookie for a good job.

The player is sent off and we are cleaning up the room.

The kid comes back in and says “good job guys, thanks a lot”. I’m pretty sure I had to restrain my AT buddy… and yet the kid never did thank me for saving his life that night.

As much as I know the kid was just trying to help, it taught me a valuable lesson.

Our anatomy knowledge is one valuable tool. When he took his First Aid course he never had to memorize the Origin, Insertion, Action of muscles.

Your average First Responder isn’t going to know terms and structures like:

Things just aren’t taught that much in detail in a First Responder course (heck I had to open the textbook, just to make sure I was naming things right).

I went through three of my First Responder Instructor books and the best I could find is that students would learn:

I don’t say all of this as an insult to First Responders or the program, it’s just they don’t need to know that much (even though some go on to higher level paramedics and learn more) because their biggest job is to stabilize someone until more advanced help arrives.


Your Massage Knowledge Makes You A Better First Responder

When the player got to the hospital he immediately went into surgery. I don’t recall which tendons were repaired but it required surgery nonetheless.

It’s hard to know if it was just the initial skate blade cut that did it, or if it was once the player started wiggling his toes that caused the most damage.

If you’re working at sports events (or anywhere else for that matter) remember:

  • The people you are there for are YOUR responsibility  and you are in charge (along with other AT’s, Chiro’s, Physio’s that are working)
  • The average first responder or paramedic does not have the anatomical knowledge that you have
  • Put your knowledge to good use and don’t be afraid to help out, even when things are a little unsettling
  • Always keep your first responder license up to date

At most emergency scenes paramedics are in charge but in this case, when it comes to your players, you are the first line of care.

You have probably noticed at most big sporting events, the team trainers and doctors rush out onto the field, ice or track before any ambulance is there.

This is your scene and you pass it off to the paramedics or first aid team after your assessment and treatment, or when you need more help.

Remember to always be respectful when you’re dealing with first responders at these kind of events, it’s best to work together for the safety and outcome of your patients.

Knowledge is a powerful thing. Using your anatomical knowledge will make for greater success in any emergency medical situation. However there should always be one person in charge of a scene. Usually whoever is most experienced should take control and direct the other medical team members what to do. Or whoever’s license is higher (I’m not about to tell one of the team Doctors what to do) since they will have far more training and experience. If you’re dealing with people who are less experienced, don’t be afraid to respectfully take control.

Looking at them and saying “who the hell is in charge here?” may not win you any points with them, but sometimes you just need to get your point across!

How Massage Therapists Can Deal With Compartment Syndrome

The cracking sound echoed through the arena.

He went down to block a shot and when the puck hit him, we knew it was bad.

He couldn’t put any weight on one leg. Once he started to get up a teammate helped him to the bench.

We carried him to the treatment room and started stripping and cutting gear off.

He had severe pain around his shin, where he had blocked the shot. We carefully cut away his shin pads and compression socks.

The area was getting swollen and red throughout his shin. We couldn’t feel a pulse in his foot.

I thought it looked bad, but didn’t realize just how bad. Fortunately I was surrounded by people with more experience who are much smarter than me (yes I know, that’s not difficult to find!). They immediately realized that the player had to go to the hospital.

What I thought was a contusion, could actually have been a life threatening emergency if not handled properly. After things calmed down and we got him sent to the hospital, I asked why this was such a big deal. In unison the team Doctor and head Therapist looked at me and said:

“Compartment Syndrome”

Recognizing Increased Compartment Pressure

When this happened I was still a student and honestly a pretty fresh student Massage Therapist.

I was fortunate enough to be able to start volunteering with a hockey team to get some sports experience. I had never heard the term “Compartment Syndrome” (aka: Volkmann’s Ischemia) at that point, or if I had, I didn’t remember it.

Later in Massage school we briefly talked about it, but more from the standpoint of how to treat it post surgery.

When we learned about it in school, we only talked about Compartment Syndrome happening around the shin. Turns out that it can happen in other compartments as well.

I learned that the forearm is another common place for it to happen because the Athletic Therapist used to quiz me on things like that.

Also, did you know that part of Scaphoid doesn’t have vascular supply, so if it gets broken the bone can die? More things he used to quiz me on.

Anyway, in researching for this article, I came to find out that any osteofascial compartment can have a Compartment Syndrome. Areas with deep fascia that is very strong that enclose compartments can be subject to a Compartment Syndrome.

The most common areas are the flexor compartment of the forearm and anterior tibial compartment of the leg. The hand, abdomen, glutes, thigh and upper arm can also be affected.

Acute Compartment Syndrome is a buildup of pressure in one of these compartments due to an injury. It can be both limb threatening and life threatening if not treated properly and in a timely fashion.

As swelling increases in a compartment, blood flow creates more pressure on the structures inside, causing capillaries to collapse and begins to starve the area of oxygen and nutrients.  The nerves can hold up for two to four hours and the muscles can only survive for six hours before becoming permanently damaged.  

Photo by: Hernan Pinera

Photo by: Hernan Pinera

What Causes Compartment Syndrome

There are a number of things that can cause Compartment Syndrome to take place. So having a good knowledge of the mechanism of injury is our biggest help in recognizing what’s going on:

If any of these things have happened and you’re not quite sure if this is a medical emergency, better safe than sorry, have the person sent to the hospital.

But there are some tell tale signs to look for that will help make your decision.

Pain is going to be your first indication that something is wrong. But the pain may not seem to be normal compared to the injury.

Now that you’ve established that this is a medical emergency, it can’t be treated the same way you would typically think to do it.

If there is a long bone fracture in place you can’t put a splint in place as you normally would for a fracture. Anything restricting the area must be cut away to allow the area to swell. Putting on a splint or bandage is only going to make the Compartment Syndrome worse.

However any movement is going to aggravate the pain, so you will have to manually support the injured limb/area as best you can with the help of others around you.

If there is no fracture to the area then it can be treated as you would other soft tissue injuries.

Immobilize the limb as best you can (without bandaging it) and apply ice to the area. If possible, elevate the limb above the heart to help decrease circulation to the area.

But the most important thing you can do is call 9-1-1 and get the person to more advanced medical care as soon as possible.

Once in the care of the hospital, surgical interventions will take place in order to relieve the pressure. A “fasciotomy” is performed, where surgeons cut the muscle and fascia in order to back off the pressure and hopefully save the surrounding tissues.

Massage Therapy And Compartment Syndrome

I actually wrote this article with some encouragement from a former student (thanks, Chelsea).

I wasn’t sure what topic to write on and she told me Compartment Syndrome would be a good topic because we didn’t learn a lot about it in college.

Holy was she right!

Just in doing research on this one I came to learn more about the different compartments that can be affected. I had no idea that the glutes, thigh and upper arm were also at risk. Nor did I know much about Chronic Compartment Syndrome and how it is an overuse injury from excessive vigorous exercise.

The biggest takeaways are just to remember the mechanisms of injury that can create a Compartment Syndrome. Much like the player in the story at the beginning, blocking that shot caused a bad bruise that led to Compartment Syndrome of the anterior lower leg. Always be careful and check (especially with traumatic injuries) if there is a long bone fracture or circulation impingement.

As you assess the injured area, look for pain that doesn’t seem suitable to the injury, increases with muscle stretching and burning/tingling sensations around the area. If you follow your First Aid protocols and take things step by step, you should have no problem figuring out exactly what is wrong. 

Recognizing all of the above could possibly save a limb or a life, the next time you have to treat a Compartment Syndrome.

Now if I could just get that Athletic Therapist to keep quizzing me on things, I might get a little smarter!