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Can Saline Injections Augment Massage Therapy?

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“I’m not going to be able to get a massage for a few weeks because I’m getting saline injections done”.

For some reason I’ve been hearing this a lot lately, mostly from patients who have been in a car accident.

I get the feeling it’s being promoted as a “cure all” when I talk to patients about it, especially for those who are experiencing pain from a complicated issue (ie: car accident) for the first time.

So far I have seen patients who are experiencing chronic pain (a year or two post accident) to those who are only a few weeks/months after, who are giving this a try.

It has been described a few different ways as well, saline injections, sugar injections and nerve blocking but could never make heads or tails as to what was actually going on, or whether it actually works.

Some patients have had the therapy done and I don’t see them again for ages, while others are back within weeks for more massage.

So I figured it was time to take a hard look at what’s happening.

Saline Injections And Prolotherapy

Like most of you I’m sure, the first I heard of saline injections was from the Travell & Simons textbooks we got in school to learn trigger point therapy.

Most of what I remember in those books were images of trigger point injections with referral patterns etc., and as we know our understanding of what trigger points are has changed.

But the use of saline injections is still being used and has developed into further applications called Prolotherapy.

Turns out there are three different types of Prolotherapy:

  1. Growth factor injection: injecting a growth factor (plasma) to stimulate growth of certain cells.
  2. Growth factor stimulation: injecting something in the body that produces growth factors.
  3. Inflammatory prolotherapy: inject something that causes inflammation and tricks the body into thinking there is an injury and begin healing again.

From looking into research and checking things out online, it looks as though Prolotherapy is used more to work on ligaments and tendons (is also being used with osteoarthritis), compared to trigger point therapy which is focusing more on muscle.

So my question is whether these kinds of therapy are actually effective for the patients who are being referred out to have it done?

Well, like so many other things in therapy…it depends.

Low Back Pain And Whiplash

There are frequent statements in the research I could find that mentioned the effectiveness of these treatments as “unclear”, and tough to find any resounding positive studies to prove the effectiveness of injections.

One systematic review showed that in the case of whiplash, symptoms were better when sterile water was used compared to saline and was more effective in the short term (3 months) compared to long term (8 months).

It showed that trigger point injection was successful at reliving symptoms when used as the sole treatment, but could be better used as something to augment additional therapy like stretching. But since there wasn’t an additional study group that did stretching alone, it is hard to determine how much of a difference trigger point injection would make.

One study showed that intracutaneous injections of sterile water was beneficial both in pain reduction and improving function in patients with acute low back pain.

The study ruled out anyone who had any major back injury or condition like fracture, stenosis or osteoporosis as it would be inappropriate. Another study with the same exclusion criteria showed that saline injections are not recommended for patients with chronic low back pain due to nerve issues.

Those with chronic non-specific low back pain there can be a reduction in pain when injections are made into ligaments, but it does not appear to matter if saline or another prolotherapy solution is used.(1)

When an epidural is done to manage spinal pain, a saline injection is shown to have a lack of effectiveness when compared to using local anesthetic alone and when local anesthetic is used in conjunction with steroid. (2)

However research has been done to show that saline injections are equally as effective as conventional drugs for treating low back pain and other myofascial pain syndromes in a hospital emergency room setting.(3)

Now I know this is a lot of different types of low back pain to discuss, but research is showing that sterile water and saline injections are helpful in acute stages of injury, but not as effective in chronic conditions.

Photo by: Army Medicine

Photo by: Army Medicine

Tendinopathy And Arthritis

The best information I could find was for treatment of tennis elbow as far as a tendinopathy.

One study compared the use of a saline injection against a corticosteroid. It showed that in the short term there was better pain reduction with the corticosteroid, but after 24 weeks the saline injections were working better.

In a comparison between corticosteroid, autologous blood injection and saline for tennis elbow, there was no real improvement compared to the placebo saline injections.

When it comes to arthritis, I found a study and a systematic review on the affect of saline injections for knee Osteoarthritis.

The study said that using a saline injection did not significantly reduce pain in the knee compared to a saline placebo. (4)

Whereas the systematic review makes the argument that due to the pain relief shown in the studies, we should be considering the effectiveness of saline injections.

32 studies involving 1705 patients showed improvement in short term knee pain from saline injections. And 19 studies involving 1445 patients showed improvement in long term knee pain.

While saline injections were originally used as a control or placebo in studies, research is starting to challenge that it does have a therapeutic benefit. Most of the studies cited in this post argued that in the acute stages there is a pain relief and functional benefit to using saline injections. While this isn’t something we are going to be doing as massage therapists, it is important for us to know what could be happening with some of our patients. Any one of our patients who is dealing with chronic pain, whiplash, osteoarthritis or a tendinopathy could be referred by their doctor to have some of these treatments done. It is important for us to understand what and how this is done, so we can better support and stay informed with our patients. Remember, one of the studies showed that trigger point injection might be better as a way to augment additional therapy…like maybe massage therapy!?

 

References:

  1. Yelland M, Glasziou P, Bogduk N, Schluter P, McKernon M. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine [serial on the Internet]. (2004, Jan 1), [cited December 12, 2016]; 29(1): 9-16. Available from: MEDLINE with Full Text.
  2. Manchikanti L, Nampiaparampil D, Manchikanti K, Falco F, Singh V, Hirsch J, et al. Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: A systematic review of randomized controlled trials. Surgical Neurology International [serial on the Internet]. (2015, May 7), [cited December 12, 2016]; 6(Suppl 4): S194-S235. Available from: MEDLINE with Full Text.

  3. Bakunas C, Bayona A, Roldan C, Rehrer S, Leoni J, Hu N, Banuelos R/ University of Texas Health Science Center at Houston, Houston, TX

  4. Lundsgaard C, Dufour N, Fallentin E, Winkel P, Gluud C. Intra-articular sodium hyaluronate 2 mL versus physiological saline 20 mL versus physiological saline 2 mL for painful knee osteoarthritis: a randomized clinical trial. Scandinavian Journal Of Rheumatology [serial on the Internet]. (2008, Mar), [cited December 12, 2016]; 37(2): 142-150. Available from: MEDLINE with Full Text.

How to Simultaneously Empower and Manage Your Therapists

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Managing a massage therapy practice can be challenging; especially when some, or all, of your therapists are independent workers that get paid by appointment.

To confuse matters further, each therapist has their personal schedule, and often a schedule at another clinic or spa to accommodate.

So how do you ensure your business runs smoothly under these awkward conditions all while being professional in the eye of the customer?

Luckily, there are a wide range of cloud-based software applications that can help you manage your massage clinic more efficiently, and boost results. In particular, online scheduling applications have tons of useful features that streamline the appointment booking process between you, your receptionist, and your Massage Therapists.

Here’s a list of 4 pain points commonly faced by massage clinic owners and things you should look for when choosing a scheduling application.

1. Managing Your Therapists Sporadic Schedules

Massage therapists are frequently hired as independent contractors on an appointment basis and only come in when they are booked.

As you may not be able to provide them with enough appointments, often times they will also work for themselves and/or another massage practice. Knowing when they are available to work can be an overwhelming task.

Do any of these situations sound familiar?

  • The therapist isn’t actually available on the given date and time, you must then scramble to find another therapist to fill the already booked appointment.
  • You may have no choice but to call back the client and embarrassingly ask to reschedule the appointment if he or she absolutely wanted the specific therapist or you cannot find a therapist for that slot.
  • The therapist may just, not show up if there is a conflict in his or her schedule that you were not aware of.

Making sure you know if and when a therapist is available to work is essential.

Many scheduling applications allow you to configure a regular, recurring weekly staff schedule.

However, you should also inquire whether it is possible to program irregular and/or upcoming schedules.

It is also a huge time saver if therapists can update their own schedules through their unique user login for last minute changes to specific calendar dates.

 

2. Educating Your Therapists About the Client While Protecting Your Client List

From talking to massage therapy business owners, it is clear that protecting client data is a tremendous concern as therapists need to easily access data to better serve clients.

However, depending on the employment relationship, (and depending on rules and regulations with your specific college) therapists may not have the right to solicit clients post employment and/or automatically walk out with client files.

You can therefore take steps to ensure therapists don’t just leave with your entire client list including phone numbers and e-mail addresses.

Even when therapists are not employees, you can protect data and ensure confidentiality of personal information by limiting access to their patients only – not the entire clinic’s database (again, depending on rules and regulations in your area).

Some features to look for in a software that help protect your client data:

  • Make sure you can create different types of users with different levels of access and privileges.
  • Absolutely make sure only administrators can export your client database.
  • If allowing therapists to book their own appointments, see if you can limit client database access to their clients only.
  • See if you can also hide client info like telephone numbers and e-mail addresses.
  • Verify if there are any logs available to track general user actiity.

And DO NOT SHARE YOUR ACCOUNT OWNER ACCESS with any of your staff.

Take the time to create an additional profile for your receptionists and therapists. This makes it easier to terminate access to your client data when someone leaves.

3. Enabling Therapists to Manage Their Own Appointments

If you own a multi-practice clinic whose main services are not massage therapy, but still want to offer massage therapy as an added service without adding to your administrative workload, then empowering your therapists as much as possible can save you a lot of time and make you more money.

Many software applications with different user types include a profile that allows the therapist to book, cancel and/or modify appointments for themselves.

This enables the therapist to fully manage his/her schedule and appointments securely while allowing you to still oversee everything.

In addition, why not encourage a therapist to book the client’s next appointment after their massage treatment has been completed by using a tablet connected to your cloud-based software application.

Photo by: FirmBee

Photo by: FirmBee

4. Reducing No-Shows

No-shows are another major issue for any massage therapy business as this leads to lost revenue and idle time for your therapists.

The no-show rate can easily be reduced by implementing a software application that sends out automated appointment reminders.

It is incredible how a simple e-mail or text message reminder sent out a couple of days before the appointment allows clients to inform you in a timely manner of changes to their availability and eliminates forgotten appointments.

Also, stop wasting time calling all your clients to confirm their appointment as many people of today’s generation do not even answer their phone calls.

Instead find a system that lets clients confirm their appointments themselves either by e-mail or text message. Automating appointment confirmations is a great feature giving you and your therapists the certainty that your client will be attending his/her appointment with minimal to no intervention on your part.

Other features that can reduce no-shows include asking for a credit card number or deposit at the time of the booking. If people know they will lose money, they will think twice about skipping out on their appointment.

All in all, if you are still using paper or an outdated software application, look into a web-based appointment booking system. This will allow you to run your business more efficiently and stay connected with your therapists. The entire team will be happier and experience fewer administrative frustrations. Even Massage Therapists need less stress in their lives.

Treating A Diabetic Reaction In Your Massage Clinic

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It was a few years ago and we were having a great conversation about our favourite topic, hockey.

Being a big Jets fan, he excitedly told me the news that Winnipeg was approved to get their team back.

You could feel the excitement come across the phone: “did you hear the Jets are coming back!?”

Not 30 seconds later, he said it again: “did you hear the Jets are coming back!?”

Umm yeah, we just talked about that.

Then he repeated it again, this time his speech was a little slurred.

Something was off.

Then I clued in and asked: “did you take your insulin this morning?”

“Why would I do that”, his speech was getting more slurred.

“When was the last time you ate?”

“Why would I do that, I don’t need anything!?”

I hung up and started phoning every extension in the office, no one was answering.

I drove to the office and found him slumped over his desk, looking and sounding very confused.

The small sugar drink he had taken wasn’t working, or more likely just wasn’t enough.

I ran next door to the coffee shop and grabbed some food, Coke and orange juice.

When I got back, I held everything up and asked what would work best.

He pointed at the Coke.

I took the top off, handed it to him and he took a sip. He sat up a little, then took another drink. The third drink perked him up some more, with each drink his condition improved.

Then he looked at me and said: “what the hell were we talking about!?”

“Hockey”

“Oh yeah, did you hear the Jets are coming back!?”

Understanding Types Of Diabetes

I’m sure we all know someone and have at least a few patients who have diabetes. However it is important to know which type of diabetes they have.

There are two different classifications, although one kind doesn’t get talked about or recognized as much.

  • Diabetes Insipidus:
    • Results because of dysfunction of the posterior pituitary.
    • Causes defects in antidiuretic hormone (ADH) receptors or can’t secrete it.
    • Neurogenic Diabetes Insipidus makes too much ADH because of a brain injury.
    • Nephrogenic Diabetes Insipidus the kidneys do not respond to ADH which results in too much urination leading to dehydration.
    • This type of diabetes is typically treated with hormone therapy.
  • Diabetes Mellitus:
    • The more common form of diabetes, with classification of Type 1 and Type 2 resulting from an inability to make or use insulin.
    • Type 1 referred to as juvenile diabetes or insulin dependent, the persons immune system destroys the beta cells in the pancreas, so they don’t produce insulin.
    • People with Type 1 typically have to take insulin injections to deal with the condition.
    • Type 2 aka: non-insulin dependent diabetes or adult onset diabetes most commonly caused by cells becoming less sensitive to insulin.
    • Type 2 diabetics may need insulin injections but it is typically managed with checking blood sugar and regulating with diet.

Diabetes Mellitus is the condition we are most likely going to be faced with in our clinic, so it is important for us to understand what is happening and how to deal with this if we are ever faced with someone having a diabetic emergency before or after a treatment.

If someone who requires the use of insulin takes too much (hyperinsulinism) this can cause the body to use up any extra glucose in the blood (hypoglycemia), which then deprives the brain of the sugar it needs.

When this happens the brain cannot function properly and the body begins to shut down.

If someone is having this kind of a diabetic reaction, it can eventually lead into a diabetic coma and eventually death if it is not dealt with appropriately.

It is then our responsibility as healthcare professionals to be able to recognize and deal with this, preventing the coma and reversing the reaction.

Signs And Symptoms Of A Diabetic Reaction

If we have a patient with diabetes, chances are it is going to be Type 1 or 2.

Those with Type 2 typically manage their blood sugar with diet and monitoring blood sugar levels (sometimes they use insulin as well). This comes on later in life, usually past the age of 35.

However those with Type 1 (who use insulin) can end up suffering from hyper or hypoglycemia.

If they are experiencing hyperglycemia, there is sugar in their blood, but not enough insulin to allow their cells to be receptive to the sugar.

When this happens the body attempts to get the sugar from other sources, such as fats from within the body. This produces increased waste in the body and knocks pH balance off and the person starts to feel ill.

When the person is experiencing hypoglycemia (not enough sugar), the sugar in the body is used up and in turn affects brain function which can be life threatening.

This can be caused by a few different things:

  • Takes too much insulin.
  • Hasn’t eaten enough, or regularly enough.
  • Exercise has burned off their blood sugar faster than normal.
  • Great emotional stress.

In order to recognize a possible emergency, there are similarities between the hyper and hypoglycemic conditions:

  • An altered level of consciousness, dizzy, drowsy and confused.
  • Rapid breathing.
  • Rapid pulse.
  • Feeling ill as well as looking ill.

If you know one of your patients has diabetes and starts to show any of these symptoms, it is essential to provide the appropriate care.

Photo by: stevepb

Photo by: stevepb

Providing Care During A Diabetic Emergency

There are some specific steps to take when trying to help someone during a diabetic emergency.

If you’re not sure why the person is having an issue, we do what is called a Primary Survey. Check to see if they have their ABCs (Airway, Breathing, Circulation). If they are unconscious, call 911.

If they are conscious and speaking to you, then the ABCs are present and you can go into your Secondary Survey.

During the Secondary Survey we do a quick check of the rest of the body to see if there are any injuries that could be causing the issue. It’s just a quick rapid scan of the persons body from head to toe looking for possible injuries.

This is where you could possibly find a medic alert bracelet or necklace that could tell you they are diabetic. Nowadays some people are also getting them as tattoos, so you may see this as well.

Assuming the person can talk to you, then there is a series of questions to use called the SAMPLE questions. It is just a simple mnemonic which can help you determine what is going on:

  • S – signs and symptoms?
  • A – allergies?
  • M – medications?
  • P – past medical history?
  • L – last meal?
  • E – events leading up to the emergency?

In the case of a diabetic emergency, there are a few questions that can really help you out.

If you didn’t already know it was a diabetic emergency, knowing their medication (insulin), past medical history (diabetes) and their last meal can give you great insight into what is going on.

The person might tell you right away what is wrong and ask for something to help, but just in case they don’t, asking those questions can get you the information you need.

Now that you have determined the emergency, we need to get sugar into their system.

Keeping fruit juice, candy or non-diet soft drinks in your clinic are all great resources to help someone in this condition. After they have some sugar, it will help quickly, actually it’s surprising how quickly it can turn things around.

If the person is unconscious, do not give them anything, you could end up compromising the airway and making things worse.

Just monitor their ABCs until further help arrives.

There is a bit of controversy about determining the difference between hyper and hypoglycemic conditions as there could be a concern about giving someone sugar who already has too much sugar in their system.

While this could cause some more damage, it is not going be as life threatening as it is for someone who has low blood sugar and needs to get sugar in their system.

For our purposes in a clinical setting, we are going to treat the person with sugar because it will be difficult to know which condition is causing a problem.

Since we are not authorized to give medications we don’t inject insulin for people. If this happens before a treatment, you cannot carry on with the massage even if the patient has some sugar and starts to feel better. They need to go eat a proper meal to help balance out blood sugar. It doesn’t mean they need to go to the hospital (unless they don’t start to feel better within five minutes of getting sugar in their system), remember this is something they deal with on a regular basis (if they go unconscious, call 911). Since 9.3% of the population has diabetes and a large population remains undiagnosed, as well as the prevalence of gestational diabetes affecting 9.2% of pregnant women, there is a strong chance you will have to deal with this kind of an emergency in your clinic one day. Knowing the signs, symptoms and ways to deal with it will be the biggest way you can help any one of your patients should this happen. And yes, the Jets came back and I still get to talk to my buddy about it regularly.  

How Not To Rub Your Patients The Wrong Way

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Your client is coming to you in order to feel better. They want an experience that is going to relax them or perhaps even energize them. They’re not coming to you to be rubbed the wrong way.

A good client consultation requires more than just technique in massage and the administration of physical therapies.

Your goal should be to give them a complete therapeutic experience not only for their body but their mind as well.

Here are three ways you can avoid rubbing your client’s body and mind the wrong way.

Ask Questions

One of the things I did as a matter of routine at the beginning of any client session was to ask them what they enjoy most about massage.

This might seem like a redundant question when you’re there to provide therapy, but your clients are looking for a rewarding experience.

Knowing their pain points as well as their pleasure points will make you much more sensitive to their needs and far more likely to result in the satisfying massage experience for your clients.

I have been massaged many times by professionals who never asked me anything beyond how I was feeling. All you have to do to win me over is massage my legs.

You can do that all day long, and I would walk out feeling great.

But if you fail to ask questions and just move on assumptions you’re probably going to spend an hour on my neck, and I’m just going to be irritated.

Sure, my neck may be the presenting problem, but part of remedial therapy is to bring the entire body back into a harmonic state.

And one of the best ways to bring the body back into a harmonic state is to compensate the discomfort with a positive experience.

Be Dedicated to Your Client

Your clients want your attention. They want a commitment from you.

A single-minded passion and focus on your profession and your client can take you a long way in the therapeutic and massage industry.

Robert Granter, a leading educator in soft tissue dysfunction and a trainer at the Melbourne Institute of Massage in Australia, entered the profession as a patient. Robert says he was so impressed by the effectiveness of the treatment that he decided to enter into the field himself.

His dedication, which includes a dedication to the clients themselves, has taken him to several Olympics and Commonwealth Games events as a therapist and opened up many doors for him in his profession.

Commitment means a willingness to not only improve your therapeutic and remedial skills, but it also means being entirely focused on the client right in front of you.

Your clients know when you are inattentive. They will sometimes twitch and move in discomfort on the table. Too shy to say anything, they are hoping you will respond by either adjusting your method or asking a question.

If your mind is distracted with the cares of this world and your other responsibilities, that disinterest in your client will filter down into your fingers, and your client will notice it.

They may not say anything but their feet will do the talking and you won’t see them again.

Continue to Develop Your Communication Skills

One of the motivations your clients may have in coming to see you is to unwind through communication. Others want complete silence so that they can let their minds rest.

Your job as a therapist is to know, when, what and how much verbal communication to engage in.

Not only that but when you do speak you want your words to further the therapeutic process, not detract from it.

There are countless therapeutic schools which provide training in the technical aspects of Massage Therapy but nothing else. If you want a thriving practice, one that grows over time, then it is in your best interest to continue your training.

One of the ways that you can do that is to develop your therapeutic communication skills.

I have found the study of things like neuro-linguistic programming (NLP) and other similar therapeutic modalities to greatly enrich my clients experience as well as my effectiveness as a therapist.

Whatever form of remedial massage therapy you are involved in, your goal is to provide the most satisfying experience for your customers and your clients.

Take these tips and find ways to implement them and perhaps even adjust your mode of operation so that both your professional expertise and your business will grow.

Managing A Collapse In Your Massage Therapy Clinic

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Like it or not, it is going to happen one day.

You do your intake with a patient, leave the room and on your return there they are, lying on the floor not breathing.

Your adrenaline rushes because you never thought you’d actually have to deal with this…ever.

But the odds are against you.

According to the heart rhythm society, in the U.S. more than 350,000 deaths occur each year because of sudden cardiac arrest, which is more than breast cancer, lung cancer or AIDS.

Sudden cardiac arrest takes an average of one life every two minutes.

Unfortunately 95% of people who suffer a cardiac arrest lose their life because of delayed treatment.

However the bright side is that you can help. The odds of being able to revive someone greatly increases when you witness the collapse.

Fortunately when we have our patients in the clinic, chances are we are going to witness the collapse in case they experience a cardiac arrest.

Initial CPR

If you ever witness a collapse, or walk back into your massage treatment room and see someone unconscious, the first thing you have to do is assess if the person is breathing.

We do this by using a technique called: “look, listen and feel”.

Firstly, squeeze the persons traps and see if they respond in anyway. Then put your ear overtop the persons mouth, place a hand on their chest and look at the chest for 15 seconds.

See if you can feel a breath on your ear and watch to see if your hand on the chest rises at all to indicate breathing.

If there is no air exchange occurring, tilt the persons head back, check to see if they start breathing. If they don’t start breathing on their own keep the head tilted back and attempt to give the person two breaths.

Watch to see if the chest rises, indicating air going into the lungs.

If the chest rises, it shows that the person has an open airway, so you can begin chest compressions (if the air didn’t go in, it means something is blocking the airway so they could have choked on something).

If they had choked on something, you would start compressions as well, however the intent of the compressions now is to clear whatever the person had choked on.

To start your compressions, landmark at the persons armpit on the side of the body opposite to you. Then bring the palm of your hand up to the sternum and deliver 30 chest compressions.

Continue to deliver 30 compressions and two breaths until more help arrives.

Once you realized the person was not breathing and CPR was necessary it is important to get someone to call 911 for you, and if available get an A.E.D. (automated external defibrillator).

If you’re on your own, grab a phone, bring it back to the person and call 911. Put it on speaker phone and the 911 dispatchers will coach you on what to do.

Using An AED

People often think that an AED works like the paddles the doctors on TV shows like ER use to jumpstart a persons heart.

It doesn’t work like that.

If the heart is completely stopped and flat lined, the AED isn’t going to do anything.

There has to be a “shockable” rhythm, a tachycardia (fast rhythym) or bradycardia (slow rhythym) for the AED to do anything.

There are a few things to take into consideration when using an AED.

If you are in a wet environment (you sports therapists) you have to do a splash test.

If the ground is wet and you slap it, if it makes a splash you have to move the person before you can allow the AED to deliver a shock. If the ground is just wet and there is no splash, it’s fine to deliver the shock.

If the person has a really hairy chest, then you have to shave the chest before putting the pads on. The pads have to be in direct contact with the skin to work properly (fortunately AED kits come with a razor in them).

Also if there is any metal (ie: underwire bra, jewelery etc.) in the path of the pads, it should be removed or it will leave burn marks. Same for any kind of nicotine or medical patches, they should come off.

Then just turn the machine on and follow the directions, don’t try and jump ahead, just do what it tells you.

Make sure when the machine says “everyone stand clear”, no one is touching the patient. If someone was still doing compressions, the machine would read that as the rhythm of the heart instead of it’s actual rhythm.

Also, the second time it advises to make sure “everyone stand clear”, is when it’s about to deliver a shock. Make sure no one is touching the patient or they will get shocked as well.

If the AED detects a “shockable” rhythm it will deliver a shock and you will see the body rise up a bit.

If there is not a “shockable”rhythm it will say: “no shock advised, continue doing two minutes of CPR”.

If you have a second person with you, have them take over doing CPR, so you get a break. Then alternate with the other person every two minutes so that one person doesn’t get tired out.

It should look something like this:


This can be a pretty scary situation to have to deal with. I honestly hope you never have to. However if this ever happens and the outcome isn’t what you had hoped for, please reach out and talk to someone about it. As healthcare professionals we are constantly telling patients to do proper home care, or are referring people to get more help should they need it. This is one of those cases where we really have to take care of ourselves after an incident like this. Chances are if this happens in your clinic, you already have a therapeutic relationship (and possibly a long standing one) with your patient. Going through a shocking scenario (no pun intended) such as this can bring up some very strong and sometimes scary emotions from the person who has to perform CPR. So please reach out and get some counselling or talk to some sort of mental health professional should you ever go through this. Remember how important your own self care is.

 

 

Improved Listening Skills For Massage Therapists

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I took this amazing course on communication a few years back and I have never forgotten the first thing the gentleman said… you don’t really listen now, you never have and you probably never will.

Wow what a harsh way to start a communication course, but in a sense and for the most part it’s true.

But when I learned all the things that were preventing me from really listening, I actually started to hear more clearly what the people in my life were trying to say and sometimes I really noticed the things that were missing in the conversation.

It’s been said, and I believe it to be true, that most of communication is in the listening.

Now in order to really understand this statement we need to include not only the words being said but also the tone of voice, the pitch and rhythm and although it may be controversial in some circles I believe real listening requires visual cues like body language, posture and the physical response to questions especially when you are looking at communication from the therapist – patient relationship.

To really understand what our patients are trying to communicate we first need to understand how (in the context of communication) the majority of the message is relayed by the patient.

Remember that different experts break down things in different ways so the exact numbers may be slightly different but the idea is very similar.

We can break it down like this

– Only 7% of the total message is found in the words

– Up to 38% of is in the paralanguage (this is the pitch, tone and rhythm of the voice)

– The remaining 55% of the message is found in the body language (mostly facial expressions)

Now this does not mean we should ignore the words, it just means, to get the full picture we must be present and pay attention to a number of different cues while our patients are talking.

Blocks To Listening

Are you really listening to the other person when you already have an opinion about the person?

It’s kind of like looking at life through rose colored glasses.

We have so many opinions and preconceived notions about how things are and how people are that it completely invades our listening and hence how we relate to other people.

Some of the blocks to listening:

  • Mind reading: assumptions do not help us hear what the other person is actually saying, they are self-confirming beliefs.
  • Judging: Do I agree, do I disagree with what this person is saying are they right or wrong… these thoughts pull you away from listening they don’t help you hear what the person is saying.
  • Identifying: This is when you relate the speaker’s story to something similar in your life. This is a block to listening because you are not actually listening to their story so you may miss important details that are not in your story.
  • Filtering: This is only listening to the parts of the story that resonate with you and skipping over the parts that don’t.
  • Placating: Bypassing the tough parts of the conversation or saying things like “at least they passed at home or they are no longer in pain”… this is what we sometime do, not for the speaker but for ourselves to avoid our discomfort.
  • Advising: Thinking about advice we can give to help the person while they are talking is noble, but it can take us away from listening to what is actually being said.

These are just a few of the blocks to listening, there are many more.

But if you look honestly, you may see yourself in a few of these examples.

It is not bad and wrong to do these things, it’s just not an effective way of listening to other people.

Pseudo Listening

Pseudo listening is basically pretending to listen but not really listening to what the other person is trying to say.

The intention is NOT to listen, but to have some other needs met.

I know I am guilty of this from to time in my personal life and it has even entered my professional life occasionally.

This is something to be aware of, because only when we are consciously aware of something we have the opportunity to shift.

Some of the reasons we may be pseudo listening:

  • Sometimes we just want to be liked, so we try to give the appearance of listening intently.
  • In social situations we may be checking for signs of rejection.
  • With a spouse or an adversary we could be hunting for a specific piece of information.
  • Sometimes we are buying time  or rehearsing our response.
  • From time it is  Quid Pro Quo I am listening to you, so you will be listened to.
  • During arguments we may be listening for weak points; gathering ammunition.
  • Trying to be or look  good or nice.
  • Sometimes it’s as simple as not knowing how to leave without offending.

Think about the times you are doing this, were you really listening to the other person or were you so distracted by your own thoughts and motives that you completely missed what the other person was trying to say?

Real Listening

So what, you may ask, is real listening?

The Messages Workbook (a text we used to use in PD100), says that being quiet when someone talks does not constitute REAL LISTENING.

REAL LISTENING is based on the intention to do one of the four following things:

  • Understand someone.
  • To enjoy someone.
  • To learn something.
  • To give help or solace.

Intention has a big role to play in real listening, when you get out of the way, listen and watch the person in front of you listening will come easy.

Active Listening

In order to not only hear what the person is saying but also let them know you heard and understood what they said. You can use a three step process called active listening.

1 Paraphrasing

Paraphrasing is simply repeating what you heard back to your patient, but in your words.

In other words ….

So basically how you felt was…

Did you mean…?

Paraphrasing should be used any time your patients say something of importance about their pain, accident, injury etc.

2 Clarifying

We use clarifying to make sure we have understood not only what the person said but also the context.

When we take the time to clarify we show our patients that we want to fully understand the communication, we understand the impact of the situation and we are willing to put in the work to fully know and understand the person and the impact the condition is having on them.

3 Feedback

When we understand what has been said and we have clarified that we understand the context we can now give feedback.

This can be in the form of a treatment plan, a referral to another healthcare professional when the issue is out of our scope, or it may be reminding someone that compliance to home care is vital to the treatment plan.

Listening With Openness

Have you ever heard the phrase “ looking at the world through rose colored glasses”?

I have always believed that this points to the fact that we all have some idea of the way things should be.

This is right and that is wrong, this is good and that is bad.

All of these strong beliefs, thoughts and opinions change the way we listen to others. In fact, when we come from this place we are not really listening to the other person, we are just listing to our own opinion of what the other person is saying.

To really listen to other people we need to stop “shoulding” on ourselves and others, let go of our personal opinions and really objectively listen to what the other person is saying.

Photo by: Unsplash

Photo by: Unsplash

Listening With Empathy

When I teach this type of listening at VCMT I usually feel like I am preaching to the choir.

I really believe that the vast majority of people who have entered the massage therapy profession have done so as an expression of the empathy and compassion they already have.

Listening with empathy comes from an understanding that people, for the most part, are just doing their best to survive and all the crazy things they do are an expression of this.

I remember a few years back when a patient came into my office in severe pain, very short and almost angry.

He kept saying get me on the table we don’t have to do all this other stuff. I realized this man was just in pain and he really did not mean to be rude or short. I calmly explained that the interview and special testing was necessary to determine the approach I would be taking with the treatment and that the better I understood exactly what was causing the pain the more effective I could be in treating him.

To make a long story short, the treatment went quite wall and the man could not shake my hand enough at the end of the treatment.

Remember, no matter what the patient is expressing, its not personal.

People in pain can sometimes say things they don’t mean. Always come from a place of understanding, a place of empathy. Try to put yourself in their shoes, how would you feel if you were on the other side of the room? How would you want to be listened to and treated? I always tell my students that true success is not just about being the best technical Massage Therapist. True success is becoming a well rounded therapist with excellent communication, listening, knowledge and technical skills. I believe that a present compassionate therapist will achieve measurably better outcomes with all their patients.

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