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How Massage Therapists Can Treat The Thorax Part 2

In our last post Robert discussed how the assessment and treatment of the thorax was far from acceptable.

He went on to outline the importance of gaining informed consent from patients will help them feel more comfortable with treating this sensitive area. The more you can tune in to the area and ask for information with your palpation, the better we can develop the treatment.

Here is the follow up with Robert’s instructions on how to assess and treat the thorax:

 

In the previous post I had hoped to serve you by discussing my general thoughts and perspective on the Anterior Thorax. This section will be a discussion on some basic assessment techniques and perspectives I regularly utilize for the anterior thorax.

When looking at treatment for the anterior thorax, the manual therapist must have a good knowledge of the anatomy of the exterior and interior thoracic cage. One book I recommend is “The Thorax” by Jean-Pierre Barral. It is a great resource and I refer to it on a regular basis.

From Amazon:

“Barrral begins by describing the thorax as an area of conflict and contrast: it must protect the organs thoraxenclosed within, yet must also allow exchanges with the neck and abdomen. Problems with either of its dual roles of protection and exchange lie at the root of most thoracic disorders. Detailed descriptions and illustrations are provided of tests for dysfunction and treatment of the nonaxial joints, fasciae and viscera of this important area of the body.

Among the special topics contained in this volume are global and local listening of the thorax; utilization of the completed Adson-Wright test; cervical attachments of the pleura; intrasternal tests and treatment; utilization of various access points to the phrenic nerve; and stretching along the orientation of the coronary arteries.”

I couldn’t agree more with this description.

Complaints Massage Therapists Will Hear

There are a number of patient complaints that we see every day; shortness of breath, tight exterior chest and or back, sharp specific and or shooting pain, deep pain, referred pain/tension, the inability to breathe deeply etc… There are also complaints from condition such as asthma, post surgical trauma, post unforeseen trauma such as MVA, strains, sprains, fractures, contusions etc…

As with all patients complaining of dysfunction in the thorax, a detailed thorough history must be done to rule out conditions that are outside our scope of practice and may require immediate emergent care.

I have had a few times in my practice where I’ve caught a Myocardial Infarction and called 911. If this has yet to happen to you, be forewarned, it will. Most of the time though, the complaints are well within our scope.

A future article will deal with information gathering during history taking.

Massage Therapists And Orthopaedic Tests

So, the question is how do we assess and come to a treatment plan for a patient in discomfort? There are a number of assessment tests that are available to utilize. There in lies the problem. There is much research that shows that these tests are unreliable due to user perception, testers reliability and testers education on the application of the tests.

Therapists perform the same tests on the same patients and come to completely different conclusions. This happens more often that we would all like to believe.

So do we throw out all the tests, books written on the tests and our education?

Well… not yet!

My suggestion is to have a few books written on orthopaedic testing in your library. Refer to each of them on a regular basis and compare/contrast the application of the tests.

Once you have become familiar with them, choose 3/body part that you feel you are capable of performing. These should be committed to memory and should be practiced on a regular basis. Make these part of your regular routine diagnostic assessment portion of your treatments.

Your goal is to become very skilled in the investigative art of attempting to understand what possibly is causing your patients complaint.

In my office I created orthopaedic assessment paper that had a list of my commonly used tests and expected positive and negative outcomes for each region of the body. I did this to make it easier to remember the tests and before long, this list was imprinted in my mind through my eyes.

Remember that we don’t just perform tests willy nilly. There has to be an underlying reason.

The patient must have some complaint that leads you to testing. Pain, tension, loss of AROM/PROM, headache, referred pain/tension and so on must be investigated. Initially attempting to investigate the complaint with orthopaedic testing is the logical starting point.

One main problem I find is that there are too few orthopaedic tests for the thoracic cage.

There are Specific AROM tests for vertebralcostal joints, Sternochondral joints, and you can usually feel for a decreased intercostals space and there are tests for extremity’s with neurological/vascular complaints, loss of AROM etc… but what about torsional strain feelings behind the sternum?

What of pain over the heart where the heart has been ruled out?

What of pain within the chest sometimes described as being in between?

What of respiratory challenges?

Sure there are medical tests that can confirm what the patient is complaining of, but why?

In cases such as these and many more, you must rely on your sensing/palpatory abilities and patient observational skills to make the determination of what a possible cause may be.

How Massage Therapists Can Acquire Information

In my previous post “The Thorax Part 1”, I very briefly suggested that you commit yourself to not palpate, but to “sense” for information your patients body is attempting to relay to you. I find these listening skills come into place more and more with concerns of the thorax.

Develop your “allknowingseeingthinkingfeeling” hands.

I utilize a combination of palpatory and sensing techniques together. Try the following:

Standing above your supine patient at their head, placing your full palm onto their sternum. Slowly and firmly load down into the table and inferiorly through the sternum.

sternum-1-300x200What to you feel? Does the tissues take you straight, or is there something that takes you into either a rotational or diagonal direction or a combination of both? Come back out and this time perform the same action with less force of compression. Do this over and over until you get to the point where you can feel the direction of ease of the tissue using the minimalist amount of compression …ounces. You are now on your way to sensing! This is a great technique for any body part.

“Co-operate with the tissues, you’ll get more with less!”

Now move to one side of the table. Working cross body, place both of your hands onto the chest wall, one sternum-2-300x200placed on the upper ribs 1-4, and one place on the lower ribs 6-10. If you patient is female, the breast tissue will be in between your hands, but our focus is still the thoracic tissues. Perform this exercise once again. Does the tissue take one hand in a different direction than the other? Does the whole cage move easily down into the table or is there some kind of diagonal/rotational torque. Do the upper tissues move differently than the lower tissues?

Information acquired can change with small movements of the head, neck & arms.

Don’t be afraid to move your patient or have them move. Load into the sternum once again with either of the techniques described above and have the patient rotate their head one direction then the other. Look for subtle changes not only in what you can sense, but also in feedback from the patient.

What are you feeling; Skin, Superficial fascia, muscle, deep fascia, bone, ligament, joint capsule, endothoracic fascia, parietal/visceral pleura, lung, mediastinum, neurovasculature, pericardium, oesophagus, trachea, vertebral rotations, fluid dynamics, tissues of the same side or opposite side?

I find it’s always a good idea to have a Netter Anatomy around when trying to be specific as to what tissues are speaking to me.

Don’t forget to monitor to your patients heart rate and thoracic respiration. These are great systems that let you know when you are close to the source of a patient’s complaint(s).

“The quieter the mind, the stiller the hands, the less movement we make, the more we are able to perceive involuntary movement.”

– James Jealous, DO

Look for health!

Where is the health, where is the restriction?

We all seem to be very focused on finding the restrictions, tension, pain, but how often do you look for the health in the tissue?

How often do you look for what is working pain free?

Look for the health in every patient at some point. It’s quite refreshing to watch the physiology work as a well sounding orchestra! Music not only to your hands, but to your physiology also. Time seems to stop in this place… enjoy it.

Always make sure give extra attention to a patients complaints when it comes to the thorax. Get that detailed history from them so you can rule out anything that may be out of your scope of practice and may require emergency care. In addition, make sure you are comfortable with orthopaedic tests while also relying on your palpation and observation skills. Continue to look for health in your patients and see how you can help them to start working pain free. As always, I hope that I have been able to serve you in some way with this information, be it a completely new perspective into your patients, be it some new thoughts about how to approach a treatment or provide you with a review and acknowledgement that what you are doing, as far as I’m concerned, is having an amazingly positive impact in improving the quality of life for your patients.

 

How Massage Therapists Can Treat The Thorax Part 1

 

 

In this Part 1 section for the Thorax, I hope to serve you by discussing my general thoughts and perspective on the Anterior Thorax. Part 2 will be a discussion on the assessment and treatment of the anterior thorax.

Please remember that ALL structures in our bodies are connected, from the largest organ to the smallest arteriol.Ribs-2-10-general-300x200

Everything is dependent on each other. When a part is removed or becomes dysfunctional, the rest of the system is affected in some form or fashion.

Fascia, skin, vasculature, nerves, lymphatics, interstitial fluid…they all span the complete existence of who we are and we are never apart from them. Even though I have divided these discussions into sections, we, as a whole, are not.

Currently, I feel that the assessment and treatment of the anterior thorax is an area of education and instruction that is far from acceptable. I feel the same for the abdomen & pelvis. I estimate that the majority of manual therapist spend the majority of their careers touching the dorsal thorax and rarely the ventral side. If you are a therapist that treats the anterior thorax on a regular basis, then I commend you.

We are all greatly affected by negative events that occur in our lives. My perspective is that when these negative events occur, our physiology attempts to revert to the foetal position. You can see the postural changes that occur in someone when they are being verbally abused/bullied at work, school, home etc…

Stress accomplishes this perfectly. In today’s society, there is such a prevalence of Essential Hypertension, the anterior thorax is an area that is sorely in need of treatment.

Knowing the detailed anatomy of the thorax is necessary. Your education for this area will consist of study of the vital organs, vasculature, osseoss articulations, fascia, musculature etc… and their interactions with each other. This study takes time, focus, patients and a continued interest.

Gil Hedley’s Dissection DVD series is an AMAZING volume to learn from. I watch them on a regular basis and always see something I missed from the previous time.

The payoffs for focus in the area are the compliments that you will receive from your patients for helping to improve their quality of life, helping them to move from dysfunction to function.

Massage Therapists, Gain Informed Consent

Typically, in my practice, techniques in this area are “clothes on” techniques. I treat through the clothing, educating my patient along the way, describing what I’ve found & what may potentially be contributing to their complaints. Patients must be informed so as to make an informed choice about receiving treatment.

I am always clear and precise.    1st-rib

An informed patient who recognizes that you have an interest in improving their quality of life and who feels that you have the confidence to treat effectively in this area, will give you permission to work here.

Please do not fear the potential of touching anatomy (breasts) that shouldn’t be touched. The breast tissue is quite extensive in some women and in order to gain access to the structures we intend on making changes to, some breast tissue will be touched.

With clear intent, knowledge, and confidence in your skills, an informed patient will feel comfortable and confident having you treat in this area.

If you have any doubts or fears for this work, then practice on a family member, wife, girlfriend, someone whom you can make mistakes with, who will provide you the necessary feedback needed.

I always practiced on my female colleagues any time I am learning a new technique that is performed in a sensitive area. Their feedback is invaluable and has allowed me to help my patients. I am truly grateful!

“The quieter the mind, the stiller the hands, the less movement we make, the more we are able to perceive involuntary movement.”
– James Jealous, DO

Why Massage Therapists Shouldn’t Just Palpate, Also Sense

In the beginning, you must be calm and slow your thoughts in order to develop a “perceptual touch.”

This is an alert observational awareness for the functions, dysfunctions and actions that are occurring within the physiology. The thorax is a busy place and you honestly need to “watch the world go by” for a few minutes to have a sense of what’s going on.

This is the beginning of developing “Listening Skills.” Develop your “allknowingseeingthinkingfeeling” hands.

Once, you’ve have an outsiders look in, then you must start to ask questions with your inner voice and your hands. I know it sounds completely unscientific, and it is, but we are not completely made of substances that can always be explained by science. If you do not believe me than I challenge you to join a dissection class and dissect a thought or a memory.

Back to asking questions; the little voice in side your head will answer back through your patients tissues into your hands. This is your patient subconscious. Biodynamic Craniosacral/Osteopaths have an amazing ability to tune into this “conversation.” Listening in this way will change your skill set.

Ask for information with your hands. What pulls you in is what’s needing help, what pushes you away, does so for a number of reasons. It doesn’t require treatment, or something else is in need of treatment first.

Everyone is different with different injuries, conditions and the sequence of what gets treated in what order is different. This sequence not only changes from patient to patient, but from each treatment with the same patient.

The more you can “tune in” to what the specific sequence is for a patient, the faster you can determine a course of treatment, or make decisions as to what will be treated today and what is on the agenda for the next treatment. Of course we need to stay flexible in our planning as inevitably patients complaints/concerns do change.

Remember, we need to be calm and focused enough to listen and understand the information we are receiving to follow the order of treatment, rather than having a predetermined concept of what the tissues need. Forcing tissue will get you nowhere.

Remember:
“Small changes can result in disproportionately large effects!”

One of the most wonderful processes to watch/feel is thoracic respiration. It’s such a simply detailed process that is ignored as a treatment assistant by many. It should be used to our advantage with every technique and treatment.

My Challenge To Massage Therapists

Sit quietly with a willing, informed participant lying supine on your treatment table.

Seated at the head of your treatment table with your patient lying with their clothes on, place one hand gently but firmly on the sternum.sternum-1-300x200

Your fingers are relaxed, close together, the wholeness of your hand/palm is in full contact with the sternum. You may chose to have the other hand placed along the vertebral column directly at the same level as your hand on the sternum, or you may just choose to monitor the sternum hand on it’s own.

Calm your mind & your hands. Become focused on the functions of the physiology and movements that you are in direct contact with. If thoughts about your life come in to your mind, push them out and refocus. The more you practice this preciseness of focus, the less those life thoughts will enter.

Do not make any attempts to “correct” what you find. You are feeling how the physiology needs to function in it’s current state to allow the current quality of life for the patient. Just sit and “window shop!”

As Rolin Becker DO wrote, “ Be a water bug on the surface of the water.”

Sit in this quiet place, almost in a meditative state for 15 -30 minutes. It may seem like a long time to sit there “doing nothing”, but it will go quicker than you anticipate. You are now listening to what your patients body physiology is speaking to you.

The body physiology never lies, it always tells you exactly what is needed, where, when for how long, and to what tissues.

I the next section on the thorax, I hope to provide perspective on assessment and treatment for the thorax.
As always, I hope that I have been able to serve you in some way with this information, be it a completely new perspective into your patients, be it some new thoughts about how to approach a treatment or provide you with a review and acknowledgement that what you are doing, as far as I’m concerned, is having an amazingly positive impact in improving the quality of life for your patients.

 

Pain Science And Massage Therapy (What I Learned In Greg Lehman’s Course)

“Exercise is an analgesic” – Greg Lehman

Coming out of college, I felt like I had a pretty good handle on things.

Although the sciences were not my strong suit, I didn’t think I needed to know everything about it. Lately there has been a strong move toward evidence based practice, advanced research and pain science.

With so much information out there, sometimes it gets confusing.

Watching facebook groups, blog posts, social media and other constant influx of information, how much of the information is fact or just opinion?

Ever read posts on Pain Science and feel like you’re looking at authentic frontier gibberish?

Maybe I’m alone on that but I quite often get confused and lost in what I’m reading. Almost like people are trying to make is confusing.

So I figured I had to do something about it. One of my neurology instructors from college posted on Facebook that he was bringing out Greg Lehman to teach on the subject of pain science. I signed up right away.

Last weekend a number of us attended “Reconciling Biomechanics With Pain Science For Healthcare Professionals” and it is one of the more rewarding continuing ed courses I’ve taken.

So here is a few of the things I learned in the course. 

How Massage Therapists Can Recognize Pain As An Alarm

Greg used a great analogy that resonated with me (although I’m sure he didn’t know it).

He compared pain to a fire alarm. Do you actually need a fire to make the alarm go off? Does it tell you the severity of the fire?

The answer is no, and I know this firsthand.

When I work as a fire dispatcher, or when I’m responding to an alarm bells call on the truck, 99 times out of a hundred it’s a false alarm. Or the alarm has gone off because someone burnt something on the stove and it’s not actually a fire.

Turns out pain works the same way.

Pain is an alarm in the brain that warns us of the threat of damage, not necessarily that there is damage (although it recognizes that as well). The brain is listening to signals throughout the body, evaluates them and then signals action to protect it. Once the brain recognizes there is a problem it produces pain as a protection mechanism to help you.

However much like that fire alarm it doesn’t always recognize the severity of what’s going on. It is not a great damage indicator.

A year and a half ago I separated my A/C joint. When it initially happened there was a significant amount of pain and it caused a step deformity (brain recognized there was a threat of damage).

I went to the hospital and they determined that putting the shoulder in a sling for a week and no surgery was the only intervention needed. Within a few days the pain diminished and now I just have a funny looking shoulder. It still functions well even though there is torn ligaments and I can hear a grinding noise in my golf swing.

My shoulder is no different now than it was the night I injured it but the brain realizes there is no longer a real or perceived threat, so I’m not experiencing pain. Even with a significant amount of damage there is no pain to indicate a problem.

https://flic.kr/p/66Zman

Photo by: Morgan

 Pain And Sensitivity For Massage Therapists

I had always thought that when a patient came in who was experiencing pain it was because something was damaged.

I would give them explanations of what I thought was happening and why their shoulder or low back was experiencing pain. Ie: the muscle is damaged and is creating or making that pain.

Like so many other times in life, I was wrong.

Pain can persist past healing because for some reason the brain still thinks it has to protect something. Pain has more to do with sensitivity, not so much about damage. This means that you hurt but are not harming yourself.

How many times have you treated someone who was concerned about continuing to harm an injury if they kept up with a certain activity? As pain persists after healing we just become more sensitive to the pain. Our pain threshold is lowered so people start to experience pain sooner with less stress placed on the tissue.

It doesn’t even mean that anything has been damaged, we are just becoming more sensitive to the pain.

When we are providing therapy to our patient we are trying to change their thoughts from being fragile and weak to thoughts of strength so the brain no longer thinks the body requires protection.

This is where communication with your patients becomes invaluable. While we would never want to bluntly say “the pain is all in your head”, a good explanation of why the brain is registering pain can go a long way to improving their condition. We are basically just trying to decrease that sensitivity.

Massage Therapists And Smudging

In addition to everything else in the course I got to learn a new word.

Smudging.

Smudging is basically when brain cells become activated easily or become dis-inhibited which spreads pain or makes it move around. Pain is changing the map of the body within the brain making parts of the body poorly defined within the brain.

Smudging can cause a decrease in sense of balance, decrease in proprioception, change in muscle strength and timing.

This is where we come in. Massage Therapy gives feedback to the brain that it needs to help improve those maps in the brain.

Greg showed us a great example of how just altering someone’s position can change the way they are moving and experiencing pain. He showed a video of a therapist treating someone who was experiencing low back pain and couldn’t bend forward. The therapist got the person onto the Massage table and put them into table top position, then had them rock back and forth hinging at the hips.

Once the person saw that they were able to move, it helped re-work that map in the brain and the person was able to move easier getting off the table.

I used that exact same method at the start of a treatment later that week. A new patient came in who had chronic back pain for years.

They were experiencing a flare up and had never tried Massage Therapy. They were having difficulty walking and couldn’t bend forward at the start. I used the same technique prior to the Massage portion and included it again at the end and recommended it for home care.

They came in four days later for a follow up treatment with no pain and increased range of motion. Getting them moving in a different way helped tremendously in restoring function.

I had a boss years ago who introduced me to the K.I.S.S. rule (keep it simple stupid (well at least that’s how he explained it to me)), and as far as pain science goes, that’s exactly what Greg’s course has done for me.

Understanding that pain involves multiple systems of the body including muscular, immune, nervous and emotional changes has given me a greater understanding of what’s going on with the patients that come and see me. Realizing that pain doesn’t necessarily mean damage but that it is just an alarm the brain is using as a protection mechanism will change the way I communicate and treat my patients. Now, with an understanding of what “smudging” is, I am incorporating more movement therapy, especially with patients who come in dealing with acute pain.

There is so much more that I could blog about in regards to this course but I wouldn’t do it justice. I think it’s better for you to just take Greg’s course when you get the chance. If you don’t get the opportunity, at least download his pain fundamentals workbook to give yourself a better understanding and for better outcomes with your patients.

And hopefully pain science won’t sound like this to me anymore:

“I wash born here, an I wash raished here, and dad gum it, I am gonna die here, an no sidewindin’ bushwackin’, hornswagglin’ cracker croaker is gonna rouin me bishen cutter”

– Gabby Johnson, authentic frontier gibberish

7 Ways A Website Can Improve Your Massage Therapy Business

When I graduated college, I wanted to work with professional athletes.

I had a background in sports + a keen interest in movement. 

To be honest, it also sounded good to say “I worked with professional athletes.”

The day after I got my registration certificate, I started working at a busy chiropractic clinic that treated a lot of athletes and in my mind would be the best place to start. I took continuing ed courses about sports massage, learned as much as I could, worked hard and figured it would just be a matter of time before my practice was full of athletes. 

And I waited.

In the meantime, I started treating a lot of patients who had been in car accidents and people who just happened to go to the clinic where I was working. Before I knew it, they ended up being the majority of my clientele instead and I didn’t get to treat many athletes

You’d think I was happy to be busy but I wasn’t – I was burnt out from working too many hours, doing work that I didn’t love and wasn’t nearly as fulfilled as I’d hoped. 

I knew I needed a change.

I moved to Vancouver and started over – with a little more intentionality. I started taking some business courses and really honed in on how I wanted to work and who I wanted to work with. It turns out I didn’t actually want to work with high performance athletes, I wanted to work with the people I call “everyday athletes.”

They’re the ones who are active for the pure joy of it, they run marathons, do yoga, climb mountains and take dance classes. 

They were people I could go for coffee with. 

They’re creative entrepreneurs with a passion project on the side. They’re dog people. They love adventure, a good book and have a sarcastic sense of humour. 

They’re my people.

Knowing who I wanted to work with provided major clarity around the business I wanted to build.

When I was clear on that, I needed a way to connect with the right people, so I started building a website.

It changed everything.

If You Want To Start Marketing + Growing Your Massage Practice, YOU NEED A WEBSITE

A website is crucial because it’s like owning your own little piece of cyber real estate – it’s a home for you online. You can invite people to drop by and visit so they can get to know you a little better and it makes you accessible. 

Building my website was a catalyst to growing the business I wanted. 

Here are just a few things that have made my site so valuable to my practice that you can implement too.

A Website Makes It Easy For Clients To Find You, No Matter Where You’re Practicing Massage

How can people find your information if it isn’t easily accessible? 

This may not be a big deal if you only work out of one space during your entire career, but almost every therapist I know has relocated at least once. Having a website makes it a cinch for clients to find where you work.

It also provides a simple place to refer their friends. 

The beauty of having a website, is that clients just need to know your name. If you have good search engine optimization, they don’t even need your full name. 

On more than one occasion, clients have typed my name in google and voila! All the ways you can contact me just materialize in front of their eyes. And no, I have never paid someone who randomly called offering to “get me to the first page of Google.” 

Please don’t fall for that.

A Website Gives People A Chance To Learn About You Before They Book A Massage

This happens because of the information you share, the word choices you make, and the way you present yourself online. 

Within a few minutes of hanging out on my site or social media, people can tell that I’m a dog person, sarcastic, a mom, a coffee drinker, interested in business…the list goes on.

Your website and social media also allow you to share blog posts, articles and pictures that are interesting and of value to your clients. When they book a treatment, they have a general idea of your area of expertise and treatment style. 

If you want to work with pregnant women, you’ll share very different information than you would if you want to work with middle-aged men who run ultra marathons. 

My website has played a huge role in helping attract clients I work really well with. The way I write and things I share online resonate with a certain type of person and because that information is accessible, these people are more likely to book with me. 

Having A Website Can Make Your Massage Treatments More Effective

True story – because it connects you with the right people. 

I have had appointments where my style of treatment did not work for the client. She just couldn’t relax, conversation was awkward, we were both a little uncomfortable.

And this is a good thing. 

Because on the other hand, I have people who come in and say:

“I booked an appointment with you because I read your website and it mentioned you do deep, relaxing work. It also said that you treat active people. That’s great because I’m a runner and a yoga teacher. Lately, I’ve been having some trouble with my right hip. I really need to feel better because I have a triathalon in a couple of weeks. So if you have any stretches or exercises I can do on my own, that would be great. By the way, your dog is adorable. I have a dog too!”  

If you read the about me  section on my website, that type of interaction makes a lot of sense.

These appointments usually go really, really well. The client has a great treatment, feels better and will tell other like-minded people she knows about that experience.

When you have an effective online presence, you don’t have to chase the clients you want – they find you.

A Website Lets You Keep Your Massage Schedule Up-To-Date

Since moving my practice to Vancouver my schedule has been constantly shifting, depending on life, business and the season. I keep my days and hours updated on my website, so my clients can check there to see when I’m working.

“But can’t they just call the clinic or check the clinic’s website?”

Totally! 

But it is easier to keep your own stuff up-to-date than expecting that the clinic will get website updates done immediately. Some places are really great about it; others aren’t. 

I’m a huge advocate for keeping the business side of your practice under your control and a huge key to that is having your own website.

Your Website And Social Media Make It Easy To Book A Massage

Can’t afford a 24/7 receptionist? Neither can I. 

Luckily, my website takes care of that for me because it directs clients to where they can book. One of the most positive pieces of feedback I hear, is how much people love the convenience of online booking.

I also share on social media when I have last-minute appointment opportunities and those appointments usually end up booking right away. Fewer gaps in my schedule = a good thing. 

Everytime.

WARNING: make sure “available appointments” aren’t the ONLY thing you’re posting from social media. That can come across as spammy.

If you don’t have online booking yet, the clinic I work at uses Click4Time. I have also heard great reviews about JaneApp and ClinicWise.

https://flic.kr/p/d41HES

Photo by: Jason Howie

When Clients Want To Book A Massage, Keep The Information On Your Site Accurate

If I come home from an awesome workshop on fascial release, I can add that information to my bio or write a blog post about it. 

If I’ve read a book that has changed my perspective about an area of treatment, I can share that information.

The more you refine your message, the more you’ll connect with the right people.

I can change my hours and availability. 

I can update the photo in my bio. 

I can choose the colours, fonts and words I use because those play a huge role in influencing the way people perceive me.

A Website Can Give You Insane Clarity About Your Work And Make You A Better Massage Therapist

The best thing about building my website is, the work I put into expressing myself transformed my massage practice in the best way possible. 

As I did the work, I learned so much about the things that set me apart as a therapist and how I can use those skills to help people.

Learning how to communicate your strengths and the way your treatment philosophies influence the work you do, will be invaluable to the way you run your business and the impact you have in the lives of your patients.

You have a specific set of skills and knowledge that will help some people more than others. If you aren’t sharing the things that set you apart and truly represent who you are, those people won’t be able to find you and know you’re the right therapist to see. To portray the most accurate picture of who you are and how you work, you need to be in control of your online presence. Doing the work to get clarity around your practice will connect you with the people you can help most and having a website gives those people a way to find you.

I’d love to hear from you. Let me know in the comments if you have a website, I want to check it out!  

If you don’t have a website, share what’s holding you back. 

How Imposter Syndrome Could Affect Massage Therapists

“I have written eleven books, but each time I think, ‘uh oh, they’re going to find out now. I’ve run a game on everybody, and they’re going to find me out.’ “ – Maya Angelou

“There are an awful lot of people out there who think I’m an expert.  How do these people believe all this about me?  I’m so much aware of all the things I don’t know.” Dr. Chan, Chief of the World Health Organization

 

Sometimes I feel like I don’t know what the hell I’m doing.

And it doesn’t just apply to one aspect of life, with each activity I’m involved in, I question myself.

When I first started supervising at the college, students would sit down and rattle off orthopaedic tests they were doing and while I know I had heard learned those tests, I hadn’t done many of them since I was in college. I sat there and nodded, hoping I’d look like I knew what I was doing.

The first couple times I had to rush to help one of our players get off the ice after a big hit, all I could think was “there’s 1200 people, the team and three students watching, don’t mess this up”.

I’m guilty of comparing how busy I am at the Massage clinic to the other practitioners and wonder why some weeks, I’m just not as busy even though it fills up by the end of the week.

I’ve jumped on a firetruck and responded to hundreds of calls over the years, but there’s always questions in the back of my head coupled with a little bit of fear as we roll down the road, sirens blazing and wondering what we’re going to see when we get there.

Little did I realize that I’m not alone. In fact someone who is well respected (and who I respect) in the physical therapy community posted on Facebook a couple weeks ago that sometimes he feels like a pretender.

I was shocked.

Turns out this whole thing has a name.

“Imposter Syndrome”

Imposter Syndrome Defined

The Cal Tech Counselling Centre defines Imposter Syndrome as:

“A collection of feelings of inadequacy that persist even in face of information that indicates that the opposite is true. It is experienced internally as chronic self-doubt, and feelings of intellectual fraudulence.”

The worst part of this is when people are experiencing Imposter Syndrome, they don’t believe they deserve the success they are achieving. Accomplishments and accolades are often dismissed as luck or good timing. 

But here’s the thing, people dealing with this are achieving success, they are just downplaying the difficulty, time and effort that went into achieving it.

I know that I’m not alone in feeling like this sometimes, in fact over 70% of people have experienced this at some point in their lives.

Even the likes of Albert Einstein, Kate Winslet and Tina Fey have experienced this.

But luckily there are ways to overcome and have confidence in your worth.

Ways For Massage Therapists To Overcome Imposter Syndrome

It’s time to let go of the voices in your head (especially if they’re answering), or at least acknowledge and realize they are there.

It’s a common tendency that if we feel passionate about something, then we think it must be true. Limiting questions will come up in practice and in life, but what can you do to reframe those questions? When these types of feelings come up, try to switch and reframe those thoughts.

“Why aren’t I busier this week in clinic?” = “What can I do to get busier this week in clinic?”

“I don’t belong here” = “I do belong here, look what I’m doing”

There is a drastic difference between feelings and reality. Just because you feel strongly about something doesn’t make it real. Your feelings can trick you about reality.  Shift your focus to what you have done and what you have accomplished.

I remember sitting in College and thinking that if I’d known school was that hard I wouldn’t have taken the course. But, I passed.

Then came board exams.

I  stared at the clinical science exam, completely frustrated about half way through and shaking my head, saying out loud “I’m gonna f&*#ing fail this”. The girl beside me probably thought I’d lost it. But I passed those too.

Take the time to make a list of your accomplishments and successes, then keep adding to it as you continue to progress.

When was the last time you paused to celebrate and appreciate all you have done? After you make that list,  celebrate and enjoy it. Take a day off, go for a hike, go for a nice dinner, enjoy a good scotch, do something to recognize all you’ve done. 

Too often nowadays we accomplish something and immediately look for the next problem we need to defeat, rather than focusing on what we have done to be successful.  

Focus on what you HAVE done versus what you haven’t done.

You Don’t Have To Know Every Aspect Of Massage Therapy

Be confident in what you are doing.

Humility is a great thing, and has its purpose. But it can also help to reinforce imposter feelings.

When we avoid showing confidence in our abilities, we can persuade ourselves that we don’t deserve a positive outcome or success.

As I read through Facebook threads in Massage Therapy groups, the one thing that always gets me feeling negative is all of the topics on science. I’m not an overly scientific guy and struggled with some of the Anatomy and Physiology classes in college. Some of the other MT’s seem like they have it all together and talk fluently about their knowledge.

Sometimes I just stare at the screen and think “why can’t I be more scientific”? (Honestly I say sciencey, but I don’t think that’s a word).

But here’s the thing, science is just one aspect of Massage Therapy. So is experience, techniques, first aid (yeah I snuck it in there), education and so many other things. Just like you learn new techniques as your career grows, you can also learn more about these other aspects.

The pounding drive to improve can wear you down. The need to make things happen feeds the sense that you are faking it. Develop the awareness that you can get things done without pushing, forcing and going harder.

You are living evidence of your success.

You don’t have to overcompensate so that others believe you. You are the only one that needs convincing.

There will always be things that you do not know, there are things that you will never know and there are things that you can decide to learn.

When I see those Facebook threads, I’m essentially comparing myself to those MT’s who have spent so much more time researching and putting effort into learning a science based practice.

If you find that you’re comparing yourself to others, don’t compare forwards, compare backwards. If you must compare at all, look at the people behind you, or look at where you were one, two, three years ago. How much more do you know now? Think about all the expertise you have gained through life, practice and your experiences.

Look at those behind you as those you can teach, your peers as your peers and those ahead of you as mentors. You can learn from each group.

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Photo by: Sylvia Duckworth

Your Failures And Mistakes Make You A Better Massage Therapist

We all make mistakes in life and in our Massage practice.

The difference is what we do with it. Rather than being hard on yourself about it, work with them.  Use it as a lesson and research in the name of personal and professional growth.

Get support from others. Talking with a more experienced Massage Therapist might help you understand that you are not alone and can give you the reality check you need. Just because you might need some help doesn’t mean you are inferior or unintelligent. In fact, knowing when to ask for help is one of the smartest things you can do.

The reality is, we will all have ups and downs within our career. While we all need to continue improving, taking CEC’s and expanding our education, you don’t have to do it all. Reaching out for help when needed, having confidence in our abilities and embracing our success are all steps we can take to overcome imposter syndrome. You do not have to attain perfection to make a difference in your practice or to be worthy of success. Question any negative thoughts that come into your head and reshape them to shift your thoughts into a positive state. It’s not about lowering the bar, it’s about resetting it to a realistic level that doesn’t leave you forever striving and feeling inadequate.

What Massage Therapists Need To Know About Cerebral Palsy

 

“See the person, not the disorder” – Meaghan Mounce RMT

I stood holding a client health history file, suddenly nervous with my mind racing.

I had never massaged someone with this condition before.

It was my first week at a new massage therapy clinic. I had just moved to the city and stepped into a busy clinic where my first week was booked solid. The second day of work I was reviewing the files of the clients I was going to see that day.

My last client of the day was a young lady in her mid twenties. I read through her file and health history form and immediately felt the butterflies I used to get when I was a student!

My client had cerebral palsy (CP), was nonverbal, used a motorized wheelchair to get around and had a care aid with her at all times. No other RMT’s on shift at the clinic worked with this girl before and I so I had no one to ask advice!

A million questions flooded my brain at once. In my four years of massage therapy practice I had not worked with anyone with a severe disability.

How would I communicate with her?

How would I know if I was hurting her?

Is she able to move around on the table?

Do I have to help with lifting and transferring her to the massage table?

Dealing With Spastic, Ataxic And Athetoid Cerebral Palsy

Luckily, I had just taught the section on cerebral palsy in the Pathology course at the massage therapy college in Victoria, BC so I had some recent information on the condition. However, as we all know, dealing with a real life patient is far different than reading about it in a text book!  

Cerebral palsy is a non-progressive neurological disorder caused by abnormal development of or damage to the brain. This damage usually occurs in utero and can be caused by exposure to radiation, infections or lack of oxygen to the brain. Less commonly, CP can be caused from trauma during birth or serious infections during infancy.

There are three main types of cerebral palsy, as well as mixed CP which presents as a combination of the other three. There seems to be a wide spectrum of how the symptoms can present, from mild to severe.

Spastic CP is the most common type and causes symptoms of an upper motor neuron lesion of the brain, such as hypertonia of affected limbs .

Ataxic CP shows symptoms of damage to the cerebellum. Patients with ataxic CP often have difficulty with balance, walking and fine motor skills such as writing or typing.

The final type of CP is Athetoid and has symptoms associated with damage to the basal ganglia and to the neurological structures that affect involuntary movements. These patients will present with a mixture of hypertonia and hypotonia and will experience involuntary movements.

Learning about the Condition Beyond a Textbook

From my knowledge of the subject, I decided my lovely client had athetoid type cerebral palsy. It was not stated which specific type of CP she had on her health history form.

She was bound to a wheelchair, had hypotonia (no muscle contractions) in her lower limbs. Her legs and feet had no voluntary movement, were very thin and cold to the touch. Her upper limbs were spastic. Her fingers were curled around the thumb in flexion. While she had some voluntary control of her arms, the movements were very jerky and she often had flailing limbs that were out of her control.

She could not speak, but had an amazing computer that she could press a button and it would say a few programmed sentences for her.

On the day I was to massage her, I waited patiently, nervous but also excited for a new challenge.

Get To Know Your Client And See Beyond Types Of Cerebral Palsy

She rolled into the clinic on her motorized wheelchair, controlling it herself with her head. Her care aid walked behind her encouraging her in a relaxed manner to drive the wheelchair forward.

The first thing I saw was a huge smile on the client’s face. After I said ‘Hello’, she quickly pressed a button on her computer and an electronic voice replied, “Nice to meet you!”.

I quickly had a huge smile on my face too and some tightness in my throat from emotion.

The care aid placed my client on the massage table on her side with a pillow between her thin legs, another under her head and one for the client to hug.

I was told that she usually feels good, but often suffers from constipation. She had a feeding tube directly inserted into her abdomen, so I was shown where that was.

After the quick run down we were left alone for an hour to get acquainted. My nerves went away quickly and were replaced with admiration.

I was able to communicate easily with this client through yes or no questions. A ‘no’ response was given with a lowering of her eyes and chin towards her chest. A ‘yes’ response was shown through raising her eyes and chin. An excited ‘yes’ was accentuated with a cry of ‘yeaaaahhhhh’, which made me laugh every time!

I quickly found out about how many siblings and pets she had and that she really loved when she got to ski at the local skill hill the month before!

Massage Treatment For Cerebral Palsy

I massaged her in her side lying position the entire treatment. She confirmed she was comfortable the entire time.

I did a full body massage to all the areas I had access too. Through her lower and upper back I performed mostly general swedish massage with some gentle muscle stripping through the erector spinae and upper trapezius muscles.

On her lower limbs, I did mostly circulatory work. I started distally and used small, but broad strokes to help encourage blood flow. I massaged her feet, which were very cold, and moved her ankles through passive range of motion.

I also did some abdominal massage to help with her constipation issues, while avoiding the feeding tube.

Her arms were the trickiest to massage. With any quick movements her arms would jerk into a flexor pattern (internal rotation of the shoulder and flexion of the elbow, wrist and fingers). I used slow strokes moving from proximal to distal to relax the muscles of the upper limb.

She watched thoughtfully as I slowly opened up her palm to allow some kneading to her hands.

The client seemed to relax easily and I noticed her eyes drooping a few times into almost sleep.

Once the hour treatment was up, her care aid dressed her and situated her back into her wheelchair. She steered herself out of the treatment room and pressed a button on her computer that said, “Thank you! See you in a month”.

I was thankful she was my final client of the day because I was fairly emotional after the treatment.

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Photo by: Incase

Using Conditions Like Cerebral Palsy To Find A Learning Experience Anywhere

I felt extremely grateful that I got to be a small part of her health care plan. I learned how to communicate with someone who doesn’t speak the same way you and I do. I got to experience outside of school what hypertonia, spasticity and hypotonia really feel like.

Most of all I got to see what an amazing personality she had.

I was lucky enough to work with her a few more times before I moved away. Even though she no longer is my client, I will never forget her.

Working with her was one of the best experiences of my life.  

From this experience, I learned to not shy away but embrace situations that may be challenging. You can communicate easily with someone even if they cannot verbally tell you their thoughts. You can use vision to see someone relax and feel tension ease. I always figured I would learn more once I was out of school and working with people. I thought I would gain this knowledge from continuing education or from the opinions of other health care practitioners. What I didn’t know is how much I would learn about each client’s view of their own condition, disease, injury or how they see themselves in the world; knowledge that you cannot find in school or a textbook. Embrace every client and experience you can! You never know what you will learn!