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!

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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.

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?

As the costs of health insurance continue to spiral upward, more and more consumers are enrolling in high-deductible insurance plans attached to health savings accounts, or flexible health spending plans through their employers (sometimes called cafeteria plans). These plans allow consumers to spend pre-tax dollars on covered healthcare. In many cases, massage therapy is an allowable expense if recommended or prescribed by a doctor. Most clients are unaware of this benefit and will appreciate it when you discuss it with them. Individual plans may vary, so clients need to check with their plan administrator for details.