Massage:

The availability of over-the counter NSAIDs (non-steroidal anti-inflammatory drugs), such as aspirin, ibuprofen, and naproxen, have allowed tens of millions of people reduce the pain, swelling, and inflammation associated with mild to moderate athletic injuries.

When orthopedic surgery is required to repair more severe injuries, like a rotator cuff tear, prescription versions of these medications are often used to control inflammation and pain.

Because many massage practitioners work with clients who are taking these medications, and clients will ask our opinion, it’s important to be aware of the potential negative effects of anti-inflammatories.  This in no way implies or suggests that we are qualified to give medical advice, nor to advise a client to disregard a physician’s recommendation/prescription to take these medications.

Over the last 20 years, a significant body of research has shown that NSAIDs interfere with the healing process in bones and also compromise healing at the junction of bone and tendon.  This has broad implications for an active person who has undergone a surgical repair, or who regularly takes an NSAID for minor muscle strains, tendonitis, or other overuse injuries.

A 1986 study conducted at the University of North Carolina School of Medicine examined the effects of NSAIDs on the healing process of strained muscle.  The researchers divided laboratory rats into three groups (one control group, two experimental groups with muscle strain injuries) and administered piroxicam (a prescription NSAID) to one of the injury groups. They found that the piroxicam group showed a delay in the inflammatory reaction to muscle strain, accompanied by delay in the muscle regeneration phase.

The title of a 2006 study sums up the finding: “Indomethacin and celecoxib impair rotator cuff tendon-to-bone healing.”  The important finding to note in this study is that the problem was not just at the site where the tendon attaches to the bone, but in the overall strength of the tendon, even 8 weeks post-surgery.

Collagen is the building block material for tendon and muscle regeneration.  A 1995 study suggests that NSAIDs interfere with the amount and the quality of collagen produced during the healing (proliferative) phase of a repetitive motion injury.  On a positive note, once the healing phase is complete and the tissue is in its maturation and remodeling phase, NSAIDs appear to stimulate protein synthesis, a beneficial effect.

A 2007 study of the healing response of rat patella tendons in the presence of a variety of pain-relieving medications provided some interesting and cautionary results.  Acetaminophen (not an NSAID) and ibuprofen had no detrimental effect on tendon healing.  The healing process for the animals fed the other NSAIDs in the study (naproxen, piroxicam, celecoxib, valdecoxib) all showed decreased tensile strength and reduced collagen content.

Although NSAIDs are still generally considered safe, the cautious consumer may want to consider other methods to control the pain and inflammation often associated with soft-tissue injuries.  One such strategy could be to use acetaminophen for pain-relief and the application of ice to help control both pain and inflammation.

Book Review: Medical Conditions and Massage Therapy, A Decision Tree Approach by Tracy Walton

Tracy Walton is a massage therapist, teacher, and writer best known for her leadership and teaching in oncology massage therapy.

With the release of her excellent new book, she has expanded her work to include many common medical conditions (such as cancer, diabetes, high blood pressure, and osteoporosis) that massage therapy clients may be dealing with.  The central feature of Walton’s book is the Decision Tree, a simple flowchart that helps manage and assess medical information to determine massage contraindications and to decide on the best approach for providing massage therapy for clients with specific medical conditions.

Walton writes simply about complex medical issues, and her wealth of experience as a practitioner and teacher is clearly evident throughout the text.  Her writing is clear and accessible and the organization and layout are extremely user-friendly.  She has managed to write a book that serves all levels of massage students and practitioners, providing the tools and information to grasp the important components of a medical condition and how to work with it safely and effectively.

The book is divided into three parts.  Part One lays the foundation for what follows in Parts Two and Three.

Part One contains a wealth of material useful for every massage therapist, including the process of making a decision tree; a wonderful discussion of the elements of massage (intentionally steering clear of controversial terms like “medical massage”); general principles of massage application and contraindications, as opposed to hard and fast rules; and a clear-headed approach to massage research.

Part Two covers medical conditions organized by body system.  Walton describes fifty-eight sample medical conditions and includes pre-made Decision Trees, interview questions, and massage guidelines.  She summarizes an additional 140 medical conditions in tables at the end of each chapter in Part Two.

Part Three is devoted to special topics, with chapter 20 focused on general information about cancer, its treatment, and the effects of treatment. Chapter 21 explains several common medical procedures and provides decision trees, massage guidelines and possible benefits of massage. In this chapter, Walton also addresses the topic of medications, and includes detailed information on three drug categories: NSAIDS, corticosteroids, and opioid analgesics.  Because so many massage therapists have clients who use these medications on a regular basis, this chapter is a MUST READ.

An additional feature that I really found helpful/enjoyable/poignant is the collection of stories written by massage therapists about clients or their clinical practice that help “make real” the concepts being discussed in the chapter.

I’ve managed to collect quite a few books in my 30 years as a massage therapist.  I didn’t think I really needed this one, but in the weeks since I’ve had it, I’ve referred to it many times.  I’ll be keeping it handy (right next to Ruth Werner’s Guide to Pathology), and I strongly recommend you add it to your collection.

Medical Conditions and Massage Therapy, A Decision Tree Approach
Tracy Walton, LMT, MS
Lippincott Williams & Wilkins
ISBN-13: 978-0-7817-6922-8

Are you thankful?

For most of us, it’s extremely gratifying when a client or colleague refers a friend, family member, or patient to our practice.  A personal recommendation carries much more weight with a potential client than any form of advertising or marketing.  Referred clients already expect to get results before they even pick up the phone to set an appointment.

I think it’s important to truly appreciate how much our “referrers” contribute to our success in building a practice.  When it comes to saying “thank you”, I’m old-fashioned.  I don’t make a “thank you” phone call, or send a “thank you” e-mail or text message.  I prefer to snail-mail a handwritten note expressing my appreciation. 

It’s easy to forget that we are really in the business of building relationships.  According to Florence Isaacs, author of the book, Business Notes, “…a personal note is a powerful tool.  People appreciate it and respond to it in a way they don’t to other means of communication.”  She goes on to quote a business executive she interviewed for her book.  “Building relationships with customers and being thoughtful about their needs is a major part of what business is all about…When you write ‘Thank you for your business,’ you let people know you care about them.  Then what do they do?  They talk about you.  If they see someone who needs your product or service, they say, ‘Go see this guy.’  We’re all very attracted to courtesy because we get so little of it today.”

I know many of you have ways of showing your appreciation to your “referrers”. I hope that a written thank-you is one of them.

Thanks for taking the time to read my post.

Here’s a link to to the Amazon page for: Business Notes

Now is an excellent time to look ahead for marketing and networking opportunities related to National Stress Awareness Month.  The Health Resource Network recently disseminated this press release:

For the 17th consecutive year, April 2009 has been designated “Stress Awareness Month.” During this thirty day period, health care professionals and health promotion experts across the country will join forces to increase public awareness about both the causes and cures for our modern stress epidemic.

Sponsored by The Health Resource Network (HRN), a non-profit health education organization, Stress Awareness Month is a national, cooperative effort to inform people about the dangers of stress, successful coping strategies, and harmful misconceptions about stress that are prevalent in our society.

“Even though we’ve learned a lot about stress in the past twenty years,”says Dr. Morton C. Orman, M.D., Founder and Director of HRN, “we’ve got a long way to go. New information is now available that could help millions of Americans eliminate their suffering.”

Dr. Orman has invited leading health care organizations across the country to develop and disseminate helpful educational materials and other information about stress during the month of April. He is also promoting public forums, discussion groups,and other informative community events.

The Health Resource Network is a non-profit health education organization established in 1982. It consists of health professionals, health promotion experts, and educators committed to developing more effective programs for improving health and preventing disease. In addition to sponsoring Stress Awareness Month, the organization also sponsors National Stress Awareness Day, held every April 16–or the day after income taxes are due!

##

www.stresscure.com/hrn

Now that you know, what will you do to promote your massage practice as an antidote to stress?  I look forward to your creative ideas.

January 11th marked the second annual “Human Trafficking Awareness Day”.  The scourge of human trafficking affects each and every one of us, whether we’re aware of it or not.  Worldwide, experts estimate that 27 million people, mostly women and children, are suffering some form of slavery, whether it be for the sex trade, domestic servitude, or forced labor in factories, mines, etc.

According to experts, trafficking of humans is the second largest criminal industry in the world (tied with the arms trade and second only to drug trafficking), and is the fastest growing.
Approximately 800,000 people are trafficked across national borders, not including the millions trafficked within their own countries.

In the US alone 14,500 to 17,500 people are trafficked each year. This figure includes domestic trafficking and the movement of victims across national borders.  80% of trafficked people are women and girls and 50% of trafficked people are under 18 years of age.

Why should we as massage therapists be concerned about this? Because many of the trafficked women end up in massage parlors in every city in the USA, and in brothels of every kind throughout the world.   Parlors use the cover of massage to conduct the very profitable business of prostitution.  They sully our profession and perpetuate the cycle of violence and degradation that keeps these unfortunate victims enslaved.

I urge you to become more educated about human trafficking in general, to start paying attention to what is happening in your own community, and to contribute your time, energy, and money to help end this slavery.

Here are some links for more information:

http://www.polarisproject.org

http://www.notforsalecampaign.org/

http://www.humantraffickingawareness.com/

Touching the World Foundation (TTWF) was created by Roger and Shannon Patrizio, owners of the Colorado Institute of Massage Therapy in Colorado Springs, to raise awareness and money to help victims of human trafficking.

In an interview, Roger said “We believe our involvement with victims is unique to massage therapists because victims are often forced to use massage therapy as a cover for prostitution.  Removing victims from this situation is beneficial for both the survivor and the massage community.”  Please consider making a donation to further the work of TTWF:
http://www.ttwonline.org/

Another way to be involved with this issue is to help prevent boys and girls from being trafficked in the first place.  Many of the trafficked children come from and through the Golden Triangle area of Myanmar, Cambodia, Laos, and Thailand.   One of the at-risk groups are the Akha tribe, non-Thai residents who live in villages throughout the mountains of this region.  The Akha children who finish the fifth-grade in local schools can only go on to middle-school if they have the mandatory school uniforms.  Since the families generally do not have the funds to purchase the uniforms, the children, out of school and with nothing to do, are susceptible to being lured by traffickers with the promise of work in the ciy.

I’m the President of New Vue Productions, Inc., a 501-(c)(3) non-profit.  One of our projects is to raise the money to help buy school uniforms for the children graduating from 5th-grade in several of the Akha villages.  Last year, we raised enough to supply uniforms for the sixteen 5th-graders (all girls) who were ready to go on to middle-school.  If oyu would like to contribute to this fund for 2009, please visit our website and click on the “Donate” link.

http://www.newvue.org/

I look forward to reading your comments and suggestions.

In my last post, I commented that, for the most part,  retaining clients is easier and cheaper than obtaining new ones.  In the same vein, it may also be easier and more cost-effective to reactivate clients than to recruit new ones.

Clients stop coming for massage for a variety of reasons.  For some, it’s a financial decision, especially in economic times like these.   People move or change jobs and your location is less geographically desirable.  They take on new responsibilities, and massage appointments fall off their radar. Occasionally, they stop because they’re no longer satisfied with the results they’re getting from your sessions.  I think this last reason is fairly rare, but it does happen.

Practitioners use a variety of methods for converting inactive clients back to active status.  Quarterly newsletters, postcards, and  special discounts are a few of the ways that can have positive results.

Other more personal interactions are also effective.  Sometimes a simple phone call to remind a client they’re overdue is all it takes.  I’ve done this many times over the years and am usually pleasantly surprised when the client thanks me for the call, then goes on to apologize to me (!) for  not coming in, and sets an appointment or two, or three.

Another way to be in touch with inactive clients is by sending them information that may be of special interest to them, from a newspaper, a magazine, or a website.  People appreciate it when you know their interests and care enough to pass on information that’s relevant to them.  You don’t even need to ask for the massage appointment in this kind of a communication, simply attach a note  that let’s them know you’re thinking of them.

I know you have a plethora of ideas and methods  for reactivating clients.  Care to share?

Be well,

Bob

In challenging economic times, retaining current clients is easier, and probably more important, than recruiting new ones. It’s easy to become complacent and forget to treat our loyal clients with the same enthusiasm we might have for a new client.

There are many ways to express appreciation to current clients, including, but not limited to, greeting them with positive energy at each visit, remembering what happened in the previous session, keeping your work fresh by not falling into the “same old routine” at each appointment, saving or e-mailing newspaper or magazine articles of interest to them, and many more.

I recently celebrated my 20th year in practice in Colorado Springs (plus seven in CA prior to that), and several of my clients have been with me since I started here. Although I always go the “extra mile” for these select clients, I decided to show my thanks for their loyalty in a non-massage way. I have a friend and client who owns a popular restaurant here. He made me a deal on gift certificates, so I was able to gift each of these 20-year clients with a $50 G.C. They really appreciated the gesture and I thoroughly enjoyed making it.

What do you do to show clients how much you appreciate their continued business?

On June 2nd, the Governor of Colorado signed into law the legislation (SB08-219) that will register massage therapists at the state level, eliminating our current system that licenses city-by-city, if they license at all.

The law takes effect on July 1st and registration is expected to begin in April, 2009.

For several reasons, the bill was changed from “licensing” to “registration”, with almost all of the same provisions:
1. Definition of scope of practice.
2. Title protection.
3. Grandfathering for a period of one year (April 2009-March 2010).
4. A mechanism for consumer complaints

If you’d like to read the full text of the act, here’s a link to the Colorado General Assembly website page that lists all versions of the bill as it passed through the House and Senate. From this page, you can download a pdf file of the Final act.:

http://tinyurl.com/3nxknv

Although some massage practitioners feel there should be no regulation of our field, I personally think that, in the long run, it’s better for us to work collectively, as we did here in CO, to define and regulate ourselves proactively, than to have outside interests define our scope of practice and impose onerous regulation. After reading over several drafts of the bill, I think we got it right. We had the advantage of learning from the mistakes made in other states, we had excellent lobbyists/advisers, and we had coalition members with a wealth of experience to draw upon.

A special thank you to Jean Robinson, ABMP Government Relations and primary author of the bill; Kathryn Stewart, AMTA-Colorado Chapter Government Relations Chair, and Susan Grubb, AMTA-Colorado member, Coordinator of Massage Therapy Legislative Awareness Day, and Manager of the Legislative Alert Network. These three powerful women worked ceaselessly to shepherd us through this process.

Colorado has just passed a regulatory bill (SB-219) for massage therapists that is awaiting the Governor’s signature. Although it started out as a bill for state licensing, it ended up being state registration, with all of the components of licensing, just by a different name. Such is the nature of legislative compromise. Passage of the bill is the result of several years of work by a coalition of AMTA and ABMP. As always when state regulation is on the table, there is a wide variety of opinion about the need or desirability for regulation.

I personally believe that regulation will be good for Colorado. We have many resort towns that have had no regulation at all, and anyone could show up for the ski season and proclaim themselves a “massage therapist”, whether or not they had any training or experience. In my mind, this put vacationing skiers at more risk for receiving substandard, possibly injurious, massage.

I welcome your thoughts on Colorado regulation, or on how things work where you live.

I’ve been thinking a lot lately about the Summer Olympics in Beijing. If you’ve been paying attention at all, you know there has been a lot of press, mostly negative, about China’s record on human rights, especially in connection with Darfur, and the annexation of Tibet.

Many groups are calling for a boycott of the Games this year. Some are suggesting that Heads of State decline to attend the Opening Ceremonies as a way to send a message to China.

I have the pleasure of working with a number of athletes who have been training for years for their shot at the Olympics and I believe we would do every Olympian a disservice if we boycott the Games. Ideally the Olympics is about sport and competition and fair-play and should be outside the realm of politics. In reality, politics has played a role in every Olympics. I think that all of the attention being focused on China will have a positive effect on the behavior of the Chinese government.