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Massage Regulation: What is the Point?

Seems like almost daily, on one of my networks, someone will post the question of “what good is massage regulation really doing?”

They often throw up points like “prostitution still exists,” and of course it does and it always will.

Other complaints are about how much money the state revenue department, or the licensing board, or the Federation, or the testing company is making.Then we’ve got the complaints about taking CE to satisfy the law, and how that’s just a money-making racket.

As a CE provider, believe me when I say I’m not getting rich off of it, and very few are. But back to the question, what is the point?

The point of licensing in any profession is basically quality assurance for the public, for their own safety and protection. 

To get a license, you’re supposed to have x number of hours of education.

You’re supposed to pass an exam proving entry-level knowledge .

In most places, you’re supposed to get the continuing education in order to keep it. You’re supposed to agree to abide by a code of ethics and uphold standards of professional behavior. You’re supposed to first do no harm. You’re supposed to act in the best interests of the client.

There are now only a couple of states that are the last holdouts with no regulations in the works or already in effect…anyone may call themselves a massage therapist or any other derivative indicating massage, whether they actually know anything or not.

In reality, it’s hard to find out exactly how many members of the public have been harmed by massage therapy. 

The insurance companies and professional associations don’t like to release that information.

Many of the state massage board websites do have license verification online, and some do list disciplinary actions, but in most cases that will only show up if you already know the name of the therapist that has been found guilty of some infraction.

It must be said that not every single person who has been found guilty by a board is really guilty…there were times during my own five years of board service that I did not believe the accused person was guilty, but the majority voted that they were. 

It must be also be said that some therapists who are in fact guilty never ever get reported and thus keep preying on the public. There just aren’t any guarantees, just like with any other walk of life or profession.

There are people in every profession that are dishonest or predatory, and massage therapy is no different.

All things considered, I think licensing has been a valuable thing, and personally, I’d like to see it in every single state.

Yes, there are still people who will practice illegally. There are still prostitutes who will hide behind massage. But I think on the whole, licensing has brought a healthy amount of awareness and credibility to massage therapy.

I’m not resentful of having to get a criminal record check to get a massage license. If we were being singled out I’d be upset, but every other health care provider in our state has to do it.

Photo by: geralt

Photo by: geralt

I’m not resentful of having to take continuing education…I love learning and I actually look forward to taking CE. However, I do think there comes a point in time when that should be optional.

Realistically, should someone who has been practicing for 20 years need to attend an ethics class the same as someone who has only been practicing for a year and may not have even faced any kind of ethical dilemma yet?

I’m not happy with the present state of the CE environment, anyway.

I think a person who is taking science-based classes or classes designed for public protection deserves more credit than people taking fantasy-based classes. With the long list of inappropriate classes that are currently approved, I really don’t see how attending a class in shape-shifting is doing anything to protect the public.

Some state boards are self-supporting. Some are at least partially subsidized by the state. Some try to educate the public. Some don’t. Some pursue illegal massage more than others.

Nothing’s perfect.

The point, to me, is that the majority of us, by paying for that license and jumping through the hoops, are proving that we have at a minimum, the entry-level knowledge to practice massage safely. The majority of us have taken the education, and passed the exam, and meet our CE requirements. The majority of us are practicing ethically. The majority of us are trying to keep massage and sex separated. The majority of us abide by the rules. The majority of us are just here to take care of our clients and do the best we can. There will always be some bad apples, but I think requiring licensing has weeded out a lot that might otherwise be here. Just my opinion.

Does Massage Therapy Need To Rebrand Itself?

 

“Why can’t we just be called Registered Manual Therapists?” – Kelsey Matichuck RMT

“There has never been a better time to rebrand ourselves” – Anita Wilson RMT

Masseuse, Masseur, Full Service, Happy Ending.

We’ve all heard it and gotten pretty annoyed by it.

For reasons that have nothing to do with us, our profession has a little dark side that quite frankly none of us like. In fact we’re all pretty done with it.

Why our profession, why not another one?

Why did other establishments choose massage therapy as the avenue they would use to lure clients in for acts of prostitution.

Its time for a change, time to permanently separate ourselves from these establishments.

Defining Exactly Who Is A Massage Business

With a recent change to our local code of ethics there was some heated discussion at our AGM.

A good friend of mine made the statement:

“The word “massage” in our title sexualizes the treatment environment. We can’t erase the history and connotation of the word “massage” with the sex trade and massage parlours” – Jenny Slauenwhite. 

We even had a blog post on here a couple of weeks ago telling the story about people targeting Massage Therapists for sexual reasons.

In doing research for this blog (I’m not going to cite the reference because its demeaning to our profession) I came across a blog from a person who worked in a massage parlour, explaining their experiences.

In it they described the services offered and included “Therapeutic Massage” as one of the options in addition to the sexual services offered and then stated “WE ARE A MASSAGE BUSINESS”.

Unfortunately anyone reading this site could associate what we do with what’s going on behind the closed doors of various establishments simply because of the name. Again, we’ve all heard the jokes and are getting pretty sick of it.

As healthcare professionals, what we offer is so drastically different than what is being advertised by parlours. The reality is, we are the massage business, what they are doing is not massage therapy.

Our code of ethics differentiates us from these establishments (in addition to the fact that we would never perform such acts).

We have a duty to our patients (not clients) to set appropriate boundaries and provide not only competent treatment, but also a duty to our profession.

In our code of ethics it is stated:

“sexual misconduct” means:

  1. sexual intercourse or other forms of physical sexual relations between a massage therapist and a patient,
  2. touching, of a sexual nature, of a patient by a massage therapist,
  3. behaviour or remarks of a sexual nature by a massage therapist towards a patient, or
  4. sexualizing the treatment environment,

but does not include touching, behaviour and remarks by a massage therapist to a patient that are of a clinical nature appropriate to the massage therapy service being provided.

  1. Massage therapists must set and maintain appropriate professional boundaries with a patient.
  1. Massage therapists must refrain from taking advantage of a patient for the massage therapist’s own personal, sexual, emotional, social, political, or financial interest or benefit.
  1. Massage therapists must not engage in sexual misconduct with a patient.
  1. A massage therapist must refrain from entering into a close personal relationship with a former patient unless:
  1. a reasonable period of time has elapsed since the therapeutic relationship with the former patient was terminated, and
  2. the massage therapist is reasonably satisfied that the power differential inherent in a therapeutic relationship no longer exists.

While I know this is nothing new for any of us, this information could be new to potential patients as they may have seen (or possibly partaken in) what goes on at “Massage Parlours”.

But how do we get the point across, so we never have to deal with these situations?

How do we educate the general public who may associate our practice with these places?

Massaging A Name Change

I wish I could take credit for it, but the idea never came from me.

I was sitting at work one night supervising in the student clinic when my buddy Kelsey looked at me and said “why can’t we just change our name and be done with all of this”?

I don’t know if he was surprised by the look on my face but i’m sure it was one of shock.

He went on to voice his annoyance with our name and the connotation that sometimes follows it and said “why can’t we just be called manual therapists? “

We are never going to be able to change what everyone else is doing or thinking, so let’s just take some control out of their hands.

Ever since I was in college there has been discussion on how to improve our profession and get it the respect it so vitally deserves.

It’s doubtful this discussion will ever end and we have come a long way over the last several years. I have heard this idea circled around a little bit with the argument that we have done so much to improve, but we can’t turn our back on the past.

There are those who have fought and struggled to gain respect for our profession.

The ones who spent years researching, writing textbooks and truly put their heart and soul into improving massage therapy.  Everyone of them deserves our respect for what they accomplished, and what they did for those of us who are currently therapists.

Even those whose information we used to take as gospel from, but new research has changed our thinking on what they published don’t want the profession to sit idle.

I can promise that none of those early researchers and writers want our profession to just rely on the old laurel’s that got us to this point.

We need to move forward, we need change, we need more control.

Photo by: geralt

Photo by: geralt

Progress As Manual Therapists

In the past five years our profession has seen major change.

There has been constant motion in moving the profession forward and challenging our old beliefs.

I don’t think any of us just do “massage therapy” anymore. We are constantly looking for new information, learning, changing, adapting.

The majority of our treatments are not like the massage therapy sessions of old. We incorporate therapeutic exercise, movement therapy, research, we communicate differently with our patients than we used to. I’m willing to bet for the most part, the actual massage is only a part of the treatment and part of our approach.

Even our continuing education has changed.

We are moving past just having modality classes and reaching deeper to get an understanding of pain science, biopsychosocial models, movement therapies and behavioural understanding.

There are entire conferences dedicated to pain science.

The most recent massage therapy conference I went to was even called aManual Therapy Conference.

There were topics covered that don’t even resemble that massage therapy of old. Things like:

  • The Importance of Modern Psychology to Manual Therapy
  • Understanding and the application of the Placebo Effect in Manual Therapy
  • Pelvic Pain Disorder in Women and Men
  • A Process Approach in Manual Therapy, Beyond the Structural Approach

These are just to name a few, but the point is we have moved past being just a massage therapist. The work we are doing has become more encompassing than just simply providing swedish massage and remembering to go distal to proximal.

As our communication techniques have gotten better with our patients there are some words that we should also stop using. The people who come to see us are not “clients” or “customers”, they are our patients.

Let’s also stop using the word “release” and I know this will be a tough one as there are some continuing ed courses with release in the name and we even loosely use the term to say we have released a muscle.

And it’s not a massage therapy “session” it is a treatment. These words are considered code words in the parlour industry, so let’s just take them out of our vernacular.

Collectively working together with our associations there is consistent improvements to our profession as we try to become regulated nationally. We are seeking out more education, more opportunity for specializations and setting up Professional Practice Groups all in an effort to move our profession forward. While we can’t turn our backs on the past and those who fought to get us where we are now, we do have a responsibility to continually move forward. Granted if we changed our name to Manual Therapists, it will still take time to educate the public and shake off what remains of being associated with “massage parlors”, however for the next generation of therapists it would make a massive difference when this is their profession. Except now I guess I’ll have to change the name of this blog. Although “Manual Therapist Development Centre” does have a nice ring to it.

How Massage Therapists Can Remove Discomfort From Psoas Treatments

 

It can be painful and uncomfortable.

It is one of the more sensitive areas a Massage Therapist can treat.

Getting in and working on the psoas is a skill in itself. It takes practice and some clear communication with your patient.

Over the years I have had some great success with it and even have some people who request specifically to have it treated.

There is also a lot of debate over whether it should be treated manually or not. But if you take care with it, the treatment and learn some different modifications the benefit can outweigh the discomfort.

This post has some great tips on how you can treat this sensitive area and make it more comfortable for your patients.

How Massage Therapists Can Help By Treating Psoas

I want to share a technique that is as useful as it is uncomfortable, this is the way I used to do it.

The psoas has spinal attachments, and is more than just a hip flexor. Some studies think it functions as a stabilizer. Since it attaches to the spine, the only way to release it manually is to go DEEP.

This technique will help:

  • Female runners with SI problems (lack of hip extension causing SI and lumbar                           hypermobility, plus an inhibition of hip abductor/extensors)
  • Older patients with stenosis (lack of hip extension causes lumbar hyperextension,                       further closing the stenosis)
  • Hip capsular patterns – will improve hip external rotation
  • Posteriorly rotated ilium
  • Pt’s with diffuse anteriolateral thigh complaints from compression of femoral nerve
  • Pt’s with spondylolisthesis, may help in conjunction with soft tissue work to the paraspinals
  • And a stabilization program

Have your patient lay supine with knees and hips flexed. Use an even finger grip, both 3rd and 4th fingertips with your elbows flared out so that your fingertips have even contact. Start about 2-3″ laterally to the umbilicus and slowly move from superficial to deep until you can’t move any further.

The abdominal contents will move out of the way. If you move too quickly, you will activate the rectus abdominus and the contraction will push you out.

How do you know you’re on it?

Here are two signs to make sure:

  • It’s not pulsing, if it is, go more lateral as you’re on the descending aorta!
  • Ask the patient to slightly flex their hip; as soon as they do, you should feel it contract under your fingertips

Start with oscillations, and you can progress to functional release movements starting with heelslide (you push proximally as patient slides heel distally), ipsilateral upper extremity elevation, combination upper extremity elevation and heelslide, then anterior pelvic tilts.

The last is the most uncomfortable, and maybe even the first time you can get a patient to posteriorly pelvic tilt correctly, as they want to move away from your hands! Perform for 5-7 minutes or until you feel a change. Reassess function, ROM, special test, or however you came to the conclusion the patient had a restricted psoas to begin with.

Techniques For Massage Therapists To Work Psoas Pain Free

Let’s be clear, you are no where near the psoas when doing a release, but this is the new way I do it.

I am just targeting the area around and above, and am very general to release lower quarter tone anteriorly, that’s about it.

Why you should use this

  • it doesn’t hurt
  • it rapidly improves hip and lumbar motion
    • if a patient needs sidegliding in standing for an ipsilateral lower quadrant issue, but is unable to move without discomfort

Patient:

  • supine, in hooklying
  • at least the involved lower extremity needs to be bent at the hip and knee

MT:

  • standing on the involved side
  • use either the pads of digits 3-4 of both hands or even easier, an EDGE Mobility Ball (any ball will do)
  • assess resistance to superficial to deep pressure lateral to the umbilicus on one side versus the other
  • the side with increased resistance is the side you should treat

Technique:

  • lightly apply superficial to deep pressure, it SHOULD NOT cause any pain
  • at the point of resistance that is highest, have the patient complete 3-5 diaphragmatic breaths
  • make sure they exhale fully
  • the exhalation will help reduce tone autonomically

re-test the limited hip and/or lumbar motion

As it is with so many other techniques in Massage Therapy communication and consent is key. Make sure when attempting this treatment that if you feel the pulse, you move off of it quickly as you do not want to compress the descending aorta. Whether you’re helping someone with stenosis, spondylolisthesis or just SI issues treating the psoas can give you and your patients greater success in treatment. Use both videos as a guide to help you with the treatment and see which one works best for your patients.

A Dangerous Client Fantasy

It was roughly midnight and for some reason I was still up.

Sitting at my kitchen bar trying to catch-up on emails and social media that I’d not had time for.

It was TGIW for me.  “Thank Goodness It’s Wednesday”.

I pile 15-17 clients in on Monday through Wednesday and have the rest of the week to work on my online business academy.  Needless to say, I was somewhat blurry-eyed.

My phone buzzed from a text message.  

Ugh, I didn’t have the patience to thwart another “I want you to rub my groin pull” moron.  It wasn’t a creepo.

It was one of my best friends and colleagues, Michelle.  I knew this midnight text had to be an emergency phone call because she’s deaf and totally aware that I go to bed early.

I was about to get crushing news.

In The Shadow Of A Famous ‘Madame’

Up until about two years ago, my fellow Massage Therapist and I would get one or two calls for sexual massage per year in our county of 100K residence.

Then it became an everyday occurrence right after two hush-hush-windows-blacked-out massage places opened up.  Apparently whatever they were doing had put Bowling Green, Kentucky on the map for “massage parlors” once again.

My little area of Kentucky is not only famous as the home of the Corvette, the largest cave on the planet and being the home of Bluegrass and Newgrass music; It is infamous as having been the home of the longest-running house of prostitution in America.

For 30+ years, Miss Pauline’s upscale brothel was a top must-do for businessmen, prominent politicians, military men and college students coming from all up and down what we call the ‘I-65 corridor’.

Not surprising since 80% of the US lives within 300 miles of it.

Due to our downtown’s redevelopment project, the house was torn down and individual bricks were sold off with plaques commemorating the establishment for $2,000 a piece.  Miss Pauline was known for paying her girls high wages, free medical/dental care and helping them get college degrees.  Once she retired, she picked up a different kind of hoe to become the first (non-Amish/Mennonite) organic farmer in Bowling Green.

Please don’t think that I’m trying to glorify Miss Pauline’s selective-exploitation.  I’m not and I don’t believe that the creepos calling today even know this bit of history.

Be that as it may, somehow they now believe sex can be had at any massage establishment in Bowling Green; just like when Miss Pauline would set her milk can out on her front porch to let men know she was “open for business”.  

Back to the midnight text

Did I Just Open A Massage Parlor?

Michelle’s text: I hope you’re sitting down.

Don’t freak just click this link http://www.rubmaps.com/bowling-green-massage-parlors-ky  I’m here if you need to talk.

I clicked the link.

I was suddenly bombarded by an old familiar stomach-churning, black-out rage so intense that I couldn’t breath, scream or cry.

It felt as though every cell in my body turned from its position to flee in a lateral path out of me.  I’m describing the quiet PTSD-bomb that goes off when you’ve been utterly violated by a monstrously exploitive excuse of a human being.

I had just been listed as a “massage parlor” and I had a “review” that identified me as a prostitute.

Screen Shot 2016-04-11 at 6.45.50 PM

You’ll have to go to the link for yourself and click through to read the review from CalebIV on me.  Yes, I pretty much figured out who he was just from doing a little detective work.  Idiot! And just to set the record straight, His little fantasy description at the bottom is pure fiction.  In order to read the other reviews, you have to pay.

So let me explain this new world of evil to you.

This website, as you can explore, is for the express purpose of training American men in the art of mongering”.

It was originally called rubhub.com and based out of Sri Lanka for the US market.  Men sign up for this site and learn a particular game called ‘mongering’,  that will hopefully get them a variety of sexual acts performed by you, the Massage Therapist.

They have a lexicon, training classes and a forum hosted by “Mongo”.

Each individual man decides how long he will stalk a specific Massage Therapist and the tactics he will use.  He then reports each session back to the forum and receives encouragement and advice on how to proceed for successfully procuring the desired sex act.

Some of these guys will play for up to 12 months to conquer one Massage Therapist.

Once they succeed, they’re done with you and move on to the next challenge (therapist).  If a Massage Therapist is difficult to lead down the proverbial primrose path, that therapist then becomes a hot-ticket challenge for other misogynistic chest-beaters to go after.

Lucky me!  My business, has gotten “mongered’ seven times.

Make no mistake, these men seem super legit.

They are seasoned clients who spend big money getting regular massage for their pursuits.  Back when I discovered this, you could read the forum feed and the stories these men would tell as they came back from the battlefield.  

They don’t use coupons and they book regularly. They even talk about their legit Massage Therapists back home whom they, oddly enough, treat with great respect and don’t monger.  One guy said something about “not s****** where you eat?

…ahhhhh such valor

They decide on the number of massage’s they will get prior to their first attempt to coerce you.

Some of these guys will wait months before propositioning you.  Their most popular way is to get you to feel sorry for them due to some life or relationship tragedy they’ve had and it really helps if they know you’ve had a similar one.  They will loan you books or get you tickets to concerts, etc.

They become your big brother or fun friend.  

They might even send you flowers on your birthday.  Their complements are profuse as they slowly gain a sense of your moral compass.  These men are truly skilled predators; no better or worse than men with lolly-pops and puppies at a park.

The Milk Can Is Back On The Porch

After enjoying nearly half a century without Miss Pauline’s entrepreneurial perfume clinging to my town, it had become painfully obvious that the milk can was back on the porch.

Given the two new massage parlors and being targeted by mongers, I decided to do something about it.

I formed a group of Massage Therapists.  We all shared our strikingly similar stories and decided to do a little detective work to see if we could rid our town of the massage parlors.

Our hope was if they left, so would the creeps.

We gathered enough evidence to present to our chief-of-police and he then convinced our county prosecutor to do a sting operation on them.  Unfortunately, just like in Miss Pauline’s day when the cops showed up, all the girls were just sitting around knitting.

Well, in this case, just nowhere to be seen and the sign that had read, “Ask us about Tantric Massage” was gone.  They had protection, just like Miss Pauline and it didn’t take but about six months of them being in town. So sad.

We’ve accepted that there is not much we can do about the sex trade in our town.  We now are focusing our efforts on self protection and better client screening skills.  One of our members is talking to our state legislators in hopes of changing how we post our licenses.

Currently we don’t have to do that.  She is hoping to get them to force us to have to post our licenses with a current photo.  Then there would need to be public education to make consumers aware that if they didn’t see this upon entrance, to steer clear.

That helps protect the public but what about us?  

Recently, I’ve seen a lot of buzz on social media as to whether or not Massage Therapists should have protection such as pepper spray, body alarms and firearms.

I totally respect everyone’s choices in self protection.  I would say most therapists in my town are protected in one way or another.  However, I’ve determined that never letting the creeps in your front door in the first place (creepo abstinence) works best.

In most places total client confidentiality is non-negotiable but if they’ve never been a client and have just let their lascivious intentions be known in a phone call, they are fair game for exposure.  The therapists in our group have a communication chain where we share the details of any sexual massage requests from non-clients with each other.  We find that if they call one of us, they call all of us.  It’s awesome when we talk and find out that they got rejected over and over.  These guys will often change their name but the phone number is the same.  If they block their number, we just don’t answer, forcing them to leave a message if they dare.  Occasionally they are bold enough to give their names, phone numbers and specific sexual request and ask us for a price…gotta love these guys.  In these cases, I promptly call our local police force and give them the detail.  After all, solicitation for prostitution is a crime.  

Massage CEC’s, Manual, PD Or Conferences?

Every year it’s the same dilemma. Which CEC to take?

How many hours do I need?

How many PD, and how many practical?

Where are courses being offered? Are they any good? Do they actually interest me?

And let’s be honest, we’re usually scrambling around at the last minute trying to find one. Then we end up just finding one that’s close to home in order to fill hours and be in compliance.

Why does this have to be such a pain in the butt EVERY year? And why do I have to sometimes apply for the course I want to be accepted. Then it’s accepted one year, but not the next.

Why can’t it just be easier?

Manual Vs. Professional Development

I spent the early part of my career avoiding any PD courses, they just didn’t make sense to me.

I’ve always been a practical learner. All through college I did better in the practical courses and practical exams than I did on any theory or science exams.

When it came to deciding what courses to take, I always assumed I’d get the most bang for my buck out of a practical course. I had to learn a new technique or some sort of assessment to make it worthwhile. Maybe one of these practical courses would change the way I treat? Maybe it would open new ideas and completely change my approach?

While the majority have been great courses and have changed my approach on certain things, taught me some cool new moves and even some things I didn’t know I was allowed to do (joint mobs of ribs and spine) they didn’t really change my understanding.

A while ago I started to see things in my facebook feed about the San Diego Pain Summit. The idea of it was intimidating. I wasn’t good at the sciences in college and the whole thing was centered around “Pain Science”. Most of the facebook groups that I was involved in that talked about this stuff always seemed like more of an argument than an explanation to me. So the thought of a full conference on this sounded like something I just wanted to avoid.

Then a couple of courses came my way that changed that opinion.

I registered for Greg Lehman’s course on “Reconciling Biomechanics With Pain Science”. It took a lot of the intimidation away (and it doesn’t hurt that Greg and I have the same type sense of humor so he was easy to relate to). Then about a month ago I took another “Pain Science” course with Eric Purves.

In both instances these “PD” courses changed the way I communicate and treat my patients. And I mean changed things significantly! They also managed to simplify a lot of the things I was reading in those facebook groups that I found so intimidating.

Now when I look at a course and think where am I going to get the most bang for my buck, I’ve come to realize I can get just as much out of a PD course as I can out of a manual course.

It just took actually trying them out to realize it.

Networking At Massage Therapy Courses

They say you’re only as strong as your network.

No matter what course you take, there is an opportunity for you to network. With each course I have taken, I walked away with a new friend, business contact or someone who asked me about First Aid courses.

While it’s not easy being an introvert (and I probably look like a snob sitting by myself, reality is, it scares me to death walking up and introducing myself to people) trying to network at courses, the benefits are huge.

In a conversation with a physio last week, she told me that some opportunities she has gotten in sport have come from contacts made at the annual general meetings for the CSMTA. Then advised me that being in attendance would help build that contact list to start opening up more opportunities.

I’m going to have to attend their next AGM because she is pretty much working my dream job with Hockey Canada and if that opportunity came around I’d fall off my chair.

While it’s not easy, networking can make a major difference in your practice. Knowing various therapists in your area and building a referral network with those who are focusing their practice in certain areas is beyond valuable.

Imagine becoming the therapist who has a network of people not only to refer to and from, but also to ask advice from on topics you’re not as comfortable with. The stronger the connections you have in your network, the more successful you will be.

As important as work ethic is in expanding and growing your practice, making connections and networking is just as important. In fact it’s more important than qualifications. You can have several letters after your name and be a great therapist but if no one knows about you it’s pointless.

I’m sure we all have different practitioners who refer patients to us. The only way this happens is by building a trusting relationship with that practitioner. It’s because at some point you both took the opportunity to get to know each other and build that trust.

Take the time to network and build connections at any course you take.

Photo by: Pal-Kristian Hamre

Photo by: Pal-Kristian Hamre

Massage Therapy Conferences

More and more I’m seeing new Massage Therapy or Manual Therapy conferences starting up.

I’ve never been one that does well with sitting through massive lectures (and trust me I’ve done my fair share).

However when the San Diego Pain Summit was happening this year, I was getting messages from friends telling me I had to go with them next year. Getting those messages started to get me thinking that maybe it’s time to try a conference out. I mean if I can go get my CEC’s and hang out with some friends while I’m at it, it should add to the experience right?

So when I look at the Manual Therapy Conference that the RMTBC is putting on this year, I have to say I’m pretty intrigued. The title alone is enough to pique my interest.

“Manual Therapy Conference – An Interdisciplinary Approach to the Science and Practice”

Yes! An interdisciplinary approach! I’m not all on my own.

Then when I look at some of the topics being covered as well as the presenters it’s looking like a who’s who of the Manual Therapy world. Ravensara Travillian, Walt Fritz, Christopher Moyer, Sandy Hilton and Eyal Lederman just to name a few are all leaders and educators in their respective fields.

Looking at the topics that will be presented, I think I can apply most of them immediately not only in my practice, but also in different aspects of my personal life as well (except the complex pelvic pain disorders in women, I’m referring out for that).

One of the better things about the conference is that it’s not just PD courses, there is a full day of manual courses as well. So when I sit down and think “where can I get the most bang for my buck” it’s looking more and more like it will be the “Manual Therapy Conference”.

While it will always be important to take the smaller manual and PD courses practitioners put on, the development of these conferences is giving us a great option to save time and money (depending on the travel expenses of course). They are giving therapists the opportunity to get the majority of the CEC hours they need all in one spot, they’re also giving us the opportunity to network with other therapists we may have not had the chance to meet otherwise. Each conference is not only giving us a chance to learn new things, it’s also a way to use them to our benefit and grow our practice by increasing our network and building connections. Hopefully I’ll get a chance to meet you at one of them. If I’m sitting by myself, I’m not being a snob, I’m just working up the courage to start networking. Damn introversion!

4 Steps To Building A Successful Therapeutic Relationship With Your Patients

There was something different about the way she said goodbye.

The lack of communication was strange as her typical six or seven text messages were never sent.

I pulled in the driveway and wondered why she hadn’t gotten home from work yet?

I walked to the top of the stairs and there it was stuck to the fridge, almost glowing because it stood out from everything around it.

That letter told me about the pain she was feeling that I wasn’t able to fix, but really just didn’t know how to. It wasn’t that I didn’t want to, I just didn’t have the ability or maybe the proper tools to.

The last few months had been tough and I guess something I had said, done, or possibly not done was the last straw.

To be honest, I really didn’t know how to deal with our issues and sometimes chose to ignore things because well…it was just easier.

The strong woman that she was had long before decided to move on, since I couldn’t be the man she needed. She put her interests first.

I walked through the house alone.

The relationship we had taken so much time to build up was now gone because I didn’t know how to deal with it.

Why Therapeutic Relationships Are More Important For Massage Therapists

Our careers are built on relationships. 

Patients can go to a Chiropractor, Physiotherapist or even their Doctor and sometimes get a total of 15min with them. When a patient comes to you they get you for anywhere from 30min – two hours, of direct contact.

That time is your opportunity, especially when it’s a first time patient. You could be the best therapist in the world but if you don’t take the time to cultivate a relationship with that person, your efforts will be in vain.

So what can we do to build a solid relationship with our patients?

  1. Make a damn good first impression
  2. Read your patient
  3. Build a good foundation through assessment
  4. Build trust

1. Make A Damn Good First Impression

Remember the old saying “you never get a second chance to make a first impression”?

It is quite frankly the start to any good relationship. Even the girl I spoke about at the beginning must have been impressed the first time we met, it turns out I just couldn’t sustain it.

Greet everyone with a big heartfelt smile, they can tell if you’re faking it. This can set the tone for the rest of the treatment.

It’s important to remember that when your patients come in, it’s all about them. They’re paying you and it is their time.

So, no matter what is going on in your life, it’s kind of irrelevant. 

The more we can do to set them at ease before the treatment even starts, the better. Your patients have a ton of things going on in their lives stressing them out, including whatever injury they’re coming in for. This is not a time for you to come across in any kind of a frustrated way because you’re not having the best day, remember they’re paying you to help.

I used to work with a guy who was constantly stressed out about home life. He would fly off the handle about anything and could only communicate if he was yelling. Everyone was scared to deal with him. But, if he smoked a joint (yes this was happening in an industrial mill) he was way more approachable and easier to deal with.

The only way you could tell?

You could see him grinning ear to ear from across the mill.

Now in no way am I suggesting that you should smoke a joint at the start of your day in the clinic. But, the only way we could tell if he was going to be easy to deal with (which set us at ease) was when we saw that big grin.

Your patients will read you the same way. Most of the time they are coming in to relieve some stress and deal with a variety of other issues.

Do your best to set them at ease right away. 

2. Read Your Patient

This starts to happen as soon as you greet your patient.

Are they in a good mood and happily walking into your room?

Are they slumped forward and feeling down?

Read their body language.

This makes a huge difference in your treatment. If they’re feeling down and in a bad mood, they may not be as happy with your treatment as when they come in with a better frame of mind.

The results of the treatment may reflect that.

Other than getting this massage and relieving some stress, what can be done to elevate their mood?

Change your music to something more upbeat. It doesn’t always have to be new age spa music (in fact if I played that all day in my treatment room, I’d have to jump out the window), throw some 80’s music or something else they like on and elevate the mood a bit.

Try telling them a story or a good (albeit clean) joke to bring their mood up. Recite your favourite part of a a Seinfeld episode to them.

Get them to tell you a story about something great happening in their lives right now. Get them to talk about their kids, another loved one, or some accomplishment they have had in the last while. People love to talk about themselves, so ask them to.

I’ve heard it said that “the only thing we should be talking to our patients about is their healthcare”.

If that was the only thing you ever talked to, or allowed your patient to talk about, I doubt you’d get too many repeat patients. While the conversation should always be kept professional, patients aren’t coming in to be treated by a robot.

Your personality is part of what keeps them coming back. 

3. Build A Good Foundation Through Assessment

I didn’t completely understand what my teachers were harping on me so much about when I was in college.

They would get after me about “make sure you do three different assessments with each patient”. Then I became one of those teachers harping on the students.

Assessment is your foundation. 

A good assessment isn’t just to give you an idea of what’s going on with your patient, to tell you what areas to treat.

It’s your proof.

It is your opportunity to prove that you know what you’re doing and that you did a good job, that you made a difference. When you can perform the same orthopaedic tests after their treatment and demonstrate the greater range of motion, decrease in pain or freedom of movement, it instills faith in you and what you do.

Even if you’re a little stumped on what assessment to do, make something up, figure something out. Then look up what test you could do while they are getting on the table. You can always do more tests during the treatment.

In fact, get them moving on the table, so that you both get feedback about how the treatment is going.

It’s amazing the difference it makes when part way through a treatment someone can only move a certain amount and it continues to get better as the treatment progresses because you continually assess.

Photo by: Roger Mommaerts

Photo by: Roger Mommaerts

4. Build Trust

This is one of those areas where we are pretty privileged.

There is an assumed trust before our patients event get there. They know coming in that they are going to be naked on a table. That’s a pretty huge thing for anyone to give to us. Think about it, even before meeting us, they have enough faith to take their clothes off and just lay there, assuming we will be professional and bring no harm to them.

It’s our job to in still that trust immediately.

For me as a male therapist this is huge. Not everyone is comfortable coming in to see me, and some do it reluctantly. There are times I have to put people at ease before even starting an assessment (although I think I have an advantage from dealing with people in emergency settings) and let them voice how they’re not overly comfortable being treated by a guy, but they just need treatment.

Fair enough.

Let them talk. This is a big opportunity to build trust. After the treatment, when they realize nothing bad happened or was going to happen, they’re usually happy to book in again. 

In a conversation with someone a couple of weeks ago, they told me that their spouse had asked:

“What is so wrong with you, that you have to go for a massage once a week?”

The response:

“It’s more than just a massage, It’s my therapy. I get to unload about life, I get a good belly laugh and I get to de-stress”

Sometimes people need a non-judgemental ear. Allowing them to unload about the stress of life can me more valuable than the actual treatment (while of course keeping our professional boundaries in check without offering advice or counselling).

When people know that what they say in the room stays in the room, (think of your room like Vegas, okay maybe not all of Vegas, but you get what I mean), it builds their trust in coming back to see you again. Especially when different family members come in and talk about home life. We definitely don’t want to cross a line and say something to another family member that was said to you in confidence.

If someone comes in with a condition or injury you’re not sure how to deal with, refer them to someone who can. It’s okay to admit you’re not sure how to deal with something, just get them to someone who does. Trust me they’ll respect you for it.

Use these four steps to build a therapeutic relationship with your patients. Although some of these suggestions may seem like common sense, sometimes it’s easy to become complacent in practice. Even though I named the fourth one building trust, using the first three steps are a good way to set up the foundation to build trust. Communicate effectively with your patients when they describe their pain to you, figure out how to deal with it. Refer out and collaborate if necessary. A patient can pick any Massage Therapist in their community to use for their healthcare, being engaged and building relationships with the people who come to see you is what will keep them coming back. Be the therapist they need so that you never get a “goodbye letter” from your patient. Now if someone could just tell me how to get the TV and the Netflix account back that would be awesome.