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Articles Of The Week March 4, 2018

This one is really interesting as it is several small interviews with different pain experts on different aspects of pain.

“Trust Me, I’m An Expert” – The Conversation

Next isn’t so much an article, it’s a video. But, it’s a great video you could use to help explain pain to patients (or anyone else for that matter). In less than five minutes you could give a simple explanation to patients about what’s going on with them.

“Understanding Pain In Less Than 5 Minutes” – Get PT 1st

Scientists have found “anxiety cells” in the hippocampus which regulate anxious behaviour. They have even found ways to silence them!

“Scientists Just Identified The Physical Source Of Anxiety In The Brain” – Peter Dockrill

It turns out the gut-brain connection is starting to show that certain foods influence the bacteria in our gut, which in turn can influence the mental health. The brain and serotonin are also directly influenced by the gut and dietary improvements may be a strategy for managing mental health.

“Is Your Diet Fighting Depression – Or Intensifying It?” – Natalie Shoemaker

Wow, it seems there’s lots on pain this week, but this is pretty cool! New fitness machines called Jymmin combine a mixture of working out and free musical improvisation, and they make us less sensitive to pain.

“Jymmin, How A Combination Of Exercise And Music Helps Us Feel Less Pain” – Neuroscience News

Massage Therapy, Communication, And Helping Trauma Survivors

 

I’m one of those people that nod and smile to the person next to me on the bus and 15 minutes later I have heard most of their life story. You might be nodding and thinking “mmmhmm” right about now. In fact, I think if there was a group of massage therapists gathered and a similar question was asked, many would raise their hand at being “that person”.

Massage therapists have an intimate connection with their clients. Many of us work on clients who are only one sheet away from being naked in front of us. That means we need to be exemplary in our treatment of someone on the table. It’s not only a body, but a mind with varying experiences we are working with everytime we touch a client.

Let’s go back to questioning a group of MTs. If the question asked was “How many of you are survivors of trauma” there would no doubt be hands in the air.  A lot of MTs came to the profession because of their experience with massage during a traumatic recovery, or, seeing how it positively affected a loved one. 

But for the hands that remained down, does this mean they have not experienced trauma? 

Absolutely not. 

Many people prefer not to share their stories, which is understandable and acceptable. Do not expect that your client will share their personal past or trauma with you. Do treat everyone with the knowledge they may well be in the middle of a traumatic event, or have past event(s) that continue to have an impact on their lives.

When we speak of treating a client with a past trauma we usually think of a physical injury or PTSDPTSD often brings to mind those who served in the military, but in fact many situations may cause PTSD, as well as C-PTSD, Growing up in poverty, being adopted, survivor guilt, sexual abuse/rape, confinement of any sort (prison, residential treatment centersrepeated injury such as childhood physical and sexual abuse

The person currently in the middle of a divorce or custody situation. The one who just found out they cannot birth their own children. The client who spent part of their life living with abuse-whether verbal, physical or both. The one who has been body shamed by loved ones. A person who may have spent time in confinement. A former or current member of the military or someone who has seen the effects of war firsthand.

The stories are different, sometimes similar, but affect every human in a very personal manner, consistent with their other life experiences.

Nurturing, Ethical Standards, And Trauma

A few years ago, a client of mine I thought I knew well opened up after a year of sessions. 

The client told me they were glad that I worked through the sheets when doing gluteal work, as they had always felt uncomfortable having this type of work done, but enjoyed the benefits post massage. 

They told me about being aggressively assaulted by a group of people earlier in their life. This news was of course stunning. All I could do was stutter “I am so sorry” and continue with the session.  At the end of the session, the client thanked me for listening and not offering any advice, and again for providing the additional draping. This incident opened my eyes to the knowledge that as massage therapists we rarely know more than the basic details of a client’s history.

After working so closely with the public, I realized that most people have many hidden faces underneath. 

I changed my outlook to try and recognize that when someone comes in and says they are ‘not doing great’, there is no need for me to ask why. I am here to provide bodywork. If the client decides to share information with me, it stays in the room. I will not bring it up in another session (unless it is health related to their treatment) and will acknowledge that sometimes people need an ear, but that isn’t a request for feedback.

What we do is nurturing, but we are not “healers”. We must hold high ethical standards that go well beyond not dating clients. All clients must be treated equally, and strict adherence to scope of practice is mandatory. With this in mind and the knowledge that we cannot know if someone currently is experiencing, or has been affected in the past by trauma, all clients should be treated as though trauma has affected their life in some way.

When clients do indicate “PTSD” on their health history, do not inquire about specifics. 

Usually, boxes for anxiety, depression and insomnia are also checked as PTSD comes with a host of comorbidities.  Some, such as depression and anxiety, have been shown to be alleviated by massage therapy to some degree. Other symptoms like sleep disturbances may also benefit from the use of massage. 

A common side effect of PTSD are panic attacks. Some of us have already experienced a friend, family member or coworker have a panic attack. It is a scary and debilitating experience both for the person having the attack and the others present. I have personally witnessed several clients experience a panic attack during a session. I have found it is best to stop the bodywork, redrape the client and allow them the opportunity to end the session at that time. Every experience is different. Some clients need a few minutes, a sip of water, some need to have the therapist leave the room so they can regroup, or get dressed and end the session for that day.

Be sure to ask them if they are aware if this is a panic attack. If not, symptoms can be similar to cardiac events, so familiarize yourself with the symptoms of each, or call for emergency assistance if necessary. 

While studies suggest that massage therapy may be beneficial for symptom management of PTSD, it is a priority to ask all clients about their comfort of level of undress, areas of the body to be worked or not touched- and informed consent. Remind each client this is their session, and as a therapist, you are willing to work within their boundaries.

As discussed, we cannot identify trauma in a client and many clients may not feel comfortable enough to discuss trauma, especially during early sessions, so we must do our best to avoid triggers which may result in panic attacks or other symptoms of distress. As your therapeutic relationship develops, it may be more appropriate to discuss things as the patient opens up to you, but when starting out, try to avoid those triggers. 

Some suggestions are below.

Do’s And Dont’s 

Do: Create and maintain boundaries in your practice

Don’t: Deviate from boundaries

 

Do: Allow time for a thorough intake

Don’t: Rush your client

 

Do: Ask for emergency contact

Don’t: Ask marital status

 

Do: Have a box to check for pregnancy

Don’t: Ask about children

 

Do: Ask for preferred name & pronoun

Don’t: Assume nicknames or gender

 

Do: Request current health information

Don’t: Ask about heritage, accents

 

Do: Ask for surgical/accident history

Don’t: Set time limits (ie: 10 yrs)

 

Do: Add a box for PTSD

Don’t: Expect full disclosure

 

Do: Discuss levels of undress

Don’t: Ever adjust bras/underwear

 

Do: Ask clients about working gluteal areas

Don’t: Ask when client on table

 

Do: Discuss Informed Consent

Don’t: Make assumptions

 

Do: Avoid negative words & phrases

Don’t: Talk down to clients

 

Do: Greet every client with a smile & nod

Don’t: Force a handshake

 

Do: Respect personal space

Don’t: Initiate a hug

 

Do: Give advance warning of animals in practice

Don’t: Assume a client likes animals

 

Do: Ask client about music preference or none

Don’t: Play what you want to hear

 

Do: Appreciate client’s religious preference

Don’t: Display religious emblems

 

Do: Treat a body with respect

Don’t: Ask about scars or tattoos

 

Do: Provide appropriate draping

Don’t: Discuss client weight/height

 

Do: Acknowledge each client is an individual

Don’t: Council/compare clients

 

Do: Work in scope of practice

Don’t: Offer nutrition advice or sell other services you provide

Remember, we do not need to walk on eggshells, just work within our scope of practice, treat each client as an individual and understand there are many context layers in each person’s life experience.

 

Articles Of The Week February 25, 2018

 

It can be a bit stressful when we think about treating patients with chronic pain as there is a lack of understanding and tools for treating this population. However, the biopsychosocial approach is a framework that can be effective, and this post shows why.

“A Plea To Providers: This Is Why Biopsychosocial Treatment Of Pain Works” – Devra Sheldon

I know there is some research being done at our local university on this exact topic, but can a blood test actually diagnose a concussion? Well, not yet, and this post shows four reasons why.

“Can A Blood Test Diagnose A Concussion?” – Complete Concussion Management

I hate paying taxes, but unfortunately, it’s that time of year again. Maybe next year I will have to use some of the advice from this post to make sure I’m ready at tax time.

“Tis The Season For Taxes (Again)” – Cath Cox

It seems as though the real learning in our industry happens after college and in continuing education courses. However, we need to be careful when choosing which courses to take because they can actually reduce our credibility.

“Fantasy Physiology And The Post Hoc Fallacy” – Whitney Lowe

Have you ever looked at the cost difference between getting a new client, or retaining the ones you have? Over the long term, you’re better off to build solid relationships with your current patients, and since they love your treatments and trust you, they’re more likely to refer their friends to you. While this post is directed at personal trainers, there’s some solid advice in there for therapists too.

“The Importance Of Client Retention” – Michael Anderson

The Difficulty Of Challenging Our Beliefs

Growing up I was raised with a certain belief system.

It worked well for my parents, family, and most of our friends. However, I always felt like a bit of an outsider. I tended to question things, and couldn’t always get a good answer (or at least an answer that satisfied me).

Quite often when I asked questions, I was told not to question things (and was sometimes reprimanded for it), that there were some things we just didn’t know the answer to. It rarely felt right to me, not to be able to get, or find those answers, to just accept things as they were.

It got to the point, I would just stop asking. Sometimes out of mere frustration, sometimes out of fear, sometimes because I just got fed up with feeling out of place. It was probably just easier to follow along and not try to push the envelope as it were.

Later in life, I took a different direction.

I went back to school to learn something new and would be the first one in my family to go to college. It seemed pretty daunting, but I took the same approach. Don’t ask questions!

I went through college assuming that everything I was being taught was correct, so there was no reason to question it. I knew all the things I was learning was what I would be examined on both in school and at our board exams, so really there seemed to be no reason to question the information.

Challenging More Beliefs

For some reason, I’ve been seeing a lot more discussion online lately about some of the old theories around Massage Therapy (specifically about pregnancy and massage for some reason). I’ve even heard of a patient being denied treatment because they were pregnant and a therapist thought it was contraindicated.

I still find it remarkable that some of those ‘myths’ are still being spread around and believed.

But then I think back and realize just how hard it is to challenge our beliefs. If there are certain modalities or contraindications we have been using for long periods of time and we’re having a reasonable amount of success treating this way, why would we ever question it?

The difficulty isn’t just within our own practice, sometimes it means challenging the establishment, and even other colleagues. There can be significant kickback from those same colleagues, especially if you’re starting to challenge their belief system.

Part of the issue is that when our beliefs are challenged, we feel threatened. Look at any of the many facebook groups about massage therapy, and watch how people react when certain modalities are challenged (and even proven wrong with research). It is usually met with harsh denial from some parties, quite often to the point of getting quite angry.

Regularly I have people comment on blog posts or unsubscribe, then send emails citing their complete disagreement with an article, and their years of experience proving the article wrong as the reason. And for a long time, I was that guy! I took it as a personal attack when going through various facebook threads, or seeing comments challenging what I had learned in school. I had to leave some of those facebook groups because they got me so angry.

Then for some reason, I started to reflect on those experiences growing up when I would ask questions and people would get upset. It didn’t seem reasonable to me then, so why was I reacting like this?

I started taking courses where the instructors were challenging the old ways of thinking and didn’t mind being challenged by students in the class. Usually, they were able to come back with reasonable explanations to the students who were challenging them. And the best part was, they never got upset. They took it in stride and were able to change the students view with updated relevant information.

I started to go back to some of those groups watch, learn, and try not to take things personally. Turns out lots of good information was being shared and there was never any ill intent behind the discussions taking place, they were just that…discussions. While some debate takes place, I came to realize there is such a thing as healthy debate, and debate causes progress. What I always thought was just people arguing and puffing their chest out, was actually just people challenging beliefs and literally trying to help advance professionally. While sometimes better language and communication could have been used, I don’t think anyone was ever trying to personally attack anyone.

Rather than expecting others to change, I had to step back, look at those groups and say “it’s not you, it’s me,” but rather than it being a break-up, I was trying to stay in!

The Results

While there is always the chance of repercussions when we start to challenge things, there is a positive side to it as well.

If I hadn’t challenged my beliefs all those years ago, I would have never gone back to college, never gotten the chance to work in sport, and most certainly wouldn’t be sitting here writing this blog. However, there were major repercussions I had to consider when challenging things, mainly around relationships with family and friends. Even though there was a real possibility those relationships would fade away or end, to my surprise (for the most part) they didn’t. The ones who mattered are still around today.

The same thing happened over my concerns with colleagues. The more I started to challenge ideas within our profession, the more relationships actually grew, became stronger, and new ones developed. The kickback I expected (because of the way I was interpreting things online) didn’t really happen, and I noticed more people started questioning things as well.

The other thing that happened…my interaction with my patients got better.

When we start to challenge things and leave those old ideas in the past, there is a certain amount of freedom that comes with it. So many of the things I thought were contraindications with massage aren’t, so I don’t have to worry about those things anymore. I also don’t have to give my patients fancy explanations around what I do, because I’m not wrapped up in explaining biomechanical things that aren’t relative to a treatment, or trigger points, innominate rotations, and certainly not worried about touching a pregnant woman’s ankles! What’s even better is the simpler explanations I give now, make more sense to the patient.

In a conversation I had with Alice Sanvito last week, she made a really great point about this kind of communication. If we are using the explanations around some of these old beliefs we aren’t actually getting proper consent from our patients when treating them. How could they consent to treatment when what we’re describing isn’t actually an issue, or the modality isn’t backed by evidence?

I hope as a profession we start to question things more, in fact, to become more respected and evidence-based, we HAVE to start challenging information more. While there will be resistance from some (and probably some anger), with any hope it will also bring us all a little bit more freedom. I also hope no one will be left feeling like an outsider, worried about the reactions of others, but rather open to asking questions and finding appropriate answers.

Articles Of The Week February 18, 2018

I may be partial, but I gotta say I love this post. It might be because I think this has happened to all of us. We have a patient come in who has been told by another practitioner that they will never get better, or they’ve been given some false information. Well, this is an open letter to everyone in our industry to do better.

“An Open Letter To My Patients Previous Therapists” – Sarah Haag

We all treat patients with low back pain. But, what are the appropriate guidelines for treatment? Well, some pretty reliable practitioners teamed up to look at the evidence, and explain the difference in guidelines, implementation, and controversies.

“Low Back Pain, A Ride Through The Guidelines” – Body In Mind

I don’t know about you, but I LOVE sleep. But how much do we really need? Well, that may vary, but it’s important to pay attention to our own individual needs, as well as looking at how to make sleep a priority.

“How Much Sleep Do We Really Need?” – National Sleep Foundation

One of the great things about massage therapy is the many ways we can focus on certain conditions or populations. If you’d like to focus on cancer treatment, this site has some good info. They present different recommendations as far as altering your treatment when someone is going through chemotherapy, and their reasoning seems pretty sound.

“Cold Caps, Frozen Feet, And Massage During Chemotherapy” – Tracy Walton & Associates

Our communication with patients is so important. So how do you present new ideas or research to them when you learn it? How about when it comes to your pain education? It doesn’t have to be complicated (in fact it’s probably a lot better if it isn’t), just explaining that certain areas of their body may be a bit more sensitive, is probably a lot better than a complicated description.

“Pain Science Education” – Lynita White

 

6 Ways To Develop Leadership As A Massage Therapist

 

As I observe the current status of our industry, I find myself wanting more for us. I want massage therapy to be viewed with higher esteem, receive greater respect, and as an integral part of our society’s wellness.

The next thought, logically, is how does this happen? What do we need to do to grow our field?

We need to become leaders; all of us, in our own special ways, need to lead. There’s a quote that has been attributed to many, in fact, it’s even a book title…” you don’t need a title to be a leader.”

I fell into the trap of believing a title was required to lead. I cannot say I ever had aspirations of positioning myself as a leader in the industry, but when you’re gently volun-told by a highly respected colleague, it is, sometimes, difficult to say no. I become involved, first at a local level, then a state level.

Working on a local and state level provided me with the opportunity and challenge of creating engaging events and garnering participation, and I didn’t feel any substantive change was created. There was a discussion about the future of the industry and the direction within the state; the ability to create substantive change or make measurable progress was lacking. This created frustration for me because I believed we would have the opportunity to truly influence the field.

After these experiences, I can tell you, I didn’t feel like a leader.

This experience left me wondering…how do we then create change? How do we lead? Where are all the leaders?

The leaders, I’ve discovered are right in front of us.

We have the daily opportunity to create change by the influence we have on our clients, the professionalism of our behaviours, and the respectable image we perpetuate in our practices. We can be effective in every aspect of our practices. It depends on how our clients feel when they walk out the door. Did we meet their expectations? Have we treated them with the respect and dignity they deserve? Did we give them our full attention? What will they tell their friends and family about their experience?

We have a very unique industry. While we can work in environments with multiple therapists, we are often left to our own devices in the execution of our sessions. Not only do we tend to work in an isolated environment, massage therapy is, for most, a second, if not a third career. I believe our field has such an incredible array of talent, knowledge, and skill I wonder why we aren’t doing more to mine and utilize this valuable resource.

Why do some of our colleagues feel threatened by other therapists? Why are we so unwilling to share our expertise and talents with each other?  Even further, why are we intimidated to share our knowledge? I’ve decided, instead of passively wondering, it’s time to take action…and here are some thoughts on simple things we can do every day.

1. Learn More

There are over 100 modalities in massage therapy.

What have you learned lately?

If your practice and bodywork are starting to feel stale and you’re getting bored, trust me, your clients know.

If your clients know, will they keep coming back or will they start looking for something else? I would take the initiative and become the something they need that they don’t know they need; let that weird sentence rattle around your brain for a little bit. This can be tricky though. I know many therapists who become CEU junkies or end up following some of the modality empires. They go from one workshop to the next without truly applying the knowledge and integrating their new-found skills into their sessions.

There is great power in understanding the concepts of skilled touch. Once we have mastered the skill of varying angles of entry into muscle, communicating effectively with our clients, understanding the anatomical and physiological repercussions of our work, we can elevate ourselves, and our practice to better serve our clients and the profession.

Once we fully understand concepts rather than just modalities, they can be easily applied and integrated with our previous knowledge. While I am a strong proponent of education; there are light years between book learning and practical learning. We have to strive to find the balance to truly become exceptional; through that example alone, we can lead our profession.

2. Share Your Knowledge

I suffer from imposter syndrome. I often ask, “why would anyone want to hear from me?” or “who am I to tell people what to do?”

As an educator, I’ve learned, those that are interested will find useful information in anything you share; those that aren’t motivated won’t; ultimately, it isn’t our responsibility to get everyone on board.

Those of us with experience have gained a vast amount of knowledge and wisdom. This information can always be shared with new therapists. If you’re working in an environment with other therapists, take the time to reach out to those that are new and share with them some of the knowledge you’ve gained.

It can be as simple as how to maintain a client base; a solid technique to use for someone’s shoulder; how to build a strong rapport with clients. Sharing knowledge doesn’t always mean leading a workshop or a huge event; it’s the little things we can do every day to help our colleagues grow and improve; this, in turn, has a direct, positive effect on our industry.

3. Network

When was the last time you were able to refer a client to another therapist?

We all have those clients that don’t necessarily fit in our treatment style, or are our ideal client; why not collaborate with another therapist that can meet their needs? Personally, I do not perform prenatal massage well. I have colleagues to whom I can refer those clients during their pregnancy.

It is not important if the client returns to my practice. The focus is the service to their needs. If they know my goal is their well being, they will be willing to refer friends and family because there is comfort in the knowledge that the client’s needs are the priority and every effort will be made to ensure their satisfaction.

Photo by Tim Gouw from Pexels

4. Lead By Example

Let’s be honest, some of us don’t like public speaking.

If we behave in a manner that demonstrates professional behaviour, confidence, and understanding, others will begin to emulate those characteristics. These can be very subtle and natural practices.

Show up on time, speak respectfully to your clients, listen intently to others, treat others the way you’d like to be treated. It can manifest as sharing your experiences in a workshop or class, talking about an article/blog/social media post that you read and sharing it with your colleagues, showing enthusiasm and excitement for the field, and smile and say hello to everyone along your path.

5. Appreciate Others

Acknowledge a colleague’s accomplishments. It doesn’t have to be a significant accomplishment; it can be something as simple as a full schedule or handling a difficult client with grace.

Always say thank you.

I liked to thank my colleague that properly prepared the treatment room at the end of their shift; it made the transition into my shift so much easier and, because of the way I was treated, I wanted to make sure I left the room in the same condition.

We can all agree that people enjoy talking about themselves the most, so ask them about their interests; find out what’s important to them, or what I like to do…ask them about their favourite food or candy and randomly bring it to them for absolutely no reason. I’d also suggest giving a random or well-placed compliment; we could all use a pick me up in the middle of a tough shift; find the opportunity to put a smile on someone’s face.

And most importantly…

6. Choose To Lead

All of these actions have one thing in common…we have to make the conscious decision to take on these challenges. As Mahatma Gandhi said, “Be the change that you wish to see in the world.”

I’ve noticed that as I’ve decided to take on some of these actions, my own perceptions of my colleagues and workplace have changed. If we provide positive energy and optimism, it begins to infuse us, as well as our environment. The best part; this can go beyond the workplace. All of these actions can easily be translated into our personal lives.

Reviewing these options reinforces the idea that we don’t need a title to be a leader; we just have to make a conscious choice to make a positive impact on our clients’ and colleagues’ lives. We have to decide what we want in our workplace and community. Once that is identified, the actions required to influence change will become apparent. Frustration was my motivation to seek change; I hope your inspiration comes from a more positive space. Leadership comes from within…are you ready to be the one to inspire growth and change? Warren Bennis, widely regarded as the pioneer of contemporary leadership said, “Becoming a leader is synonymous with becoming yourself. It is precisely that simple and it is also that difficult.” It appears the fundamental question begs…who then, are you?