Therapeutic Massage: Bringing it all Together

Does the time you make yourself available to give treatments impact your bottom line?  What do you think?  I tend to have very flexible hours treating clients from as early as 5:30 in the morning to starting my last treatment at 10pm.    You may think that this makes for a long day.  I run a clinic where clients can come for massage therapy, Acupuncture, Chiropody, reflexology or Qigong.  This works because we are, by appointment only clinic and this allows each and every therapist to set their own schedule based on the number of hours they want to make themselves available.

I also offer off site treatments at hospitals and people’s homes.  This past Christmas holiday was quite busy for me.  Quite a few home visits right up to Christmas morning starting at 6am.   A majority of the time when I receive a request for a home visit the client has already gone to the hospital and they are in quite a bit of pain.   There is of course a  trade-off, personal time, but this is where you as the therapist can look at the area you are interested in.  You can determine what sort of industry is around you and how can you better serve the population and still have a personal life.

I believe we are in a profession where we want to help others through education and therapeutic treatments.  So, in order to do this I believe we need to make it easier for that client that finishes work late to be able to get treatment without having to take a day off.   Those of us with flexible hours I believe can accommodate that person that finishes after 5pm or the office worker that can only make it into the clinic at 6am.  This early hour would give them enough time to get to the office without having to take extraordinary measures to receive a treatment.

I am not available all day from the hours I mentioned but I try to accommodate some mornings, some evenings and weekends.  This gives people choices and makes it an easy choice when people are looking for a place to go.

I have not found that “perfect balance” yet but I am working towards it.  What hours do you keep?

I was teaching a class on Advanced Lower body treatment techniques and demonstrating a variety of techniques and treatment positions highlighting:

1. access to the Psoas and Iliacus

2. Positioning to reduce anterior rotation of the hips

3. reducing facet joint irritation when a statement followed by a question was voiced… and a great segway.

Do you remember when you were first riding your bike in traffic. More than likely you learned some of the non-verbal communication gestures. Those arm gestures allowed you to communicate with other riders and drivers letting them know your intentions.

Well the same must hold true for communicating during a Temporomandibular Joint Disfunction (TMJD) treatment. In order for the client to feel comfortable about communicating during their treatment, you should use at least 3 hand signals. You may be asking, why three? Take for example you are working intra-orally and you are attempting to get to the Lateral or medial Pterygoid muscle. How is the client going to tell you that you need to pause for a moment or how are they to inform you to “get out now!” without physically pulling your hands from their mouth.

I have not come across a universal set of hand signals that is the “standard” in massage other than thumbs up to mean all is well/ good, ok, continue. What about a signal for “hold it there” or “get out now”. For these two remaining phrases, I use a fist to mean hold it there, and I use an open hand gesture to mean, “get out now!”. What ever gestures you use remember to practice them a few times before starting the treatment.

May you never get your finger bitten or experience the lingering scent as the result of the gag reflex, even after you have cleaned up the mess.  What hand gestures do you use?

Remember years ago when you learned your skeletal and muscular anatomy along with arthrokinematic / Osteokinematic movements, well all of that knowledge is continually being used from the visual assessment of the client to the orthopedic functional assessment right down to the rational for the treatment positions , treatment techniques and modalities you plan to use.

As you enthusiastically look at your list of New year’s resolutions,  may I suggest including some Oblique sit ups as part of the exercise routine you plan on doing.    I find these sit ups not only  helps with mobility and with trunk rotation but also very beneficial for running, golf and just about any activity that you plan on participating in.

How to position yourself to do these:

1. lay on your back in a hooklying position(supine, knees bent with feet flat on the ground)                                                                                                                      2. Arms out to the side, palms up   3. place your right ankle proximal to the knee on the quadricep                                                                                                        4. Place your left palm behind the head to support the head                                    5. From here you are going to bring your left shoulder towards your non-moving right knee.

Try doing about 5 slow controlled movements, exhaling as you lift and rotate towards the knee.  Then change sides.

Regardless of the activity we do, we are usually moving our arm and legs in opposition so why not strengthen this movement to help with everyday activities.  I do this exercise and suggest this and other exercises to many of the clients with low back issues, range of motion, repetitive strain from one sided activities…  I will be going into the benefits, muscle groups effected, reasoning and rehabilitation effects of this simple exercise in my next article.  I will try to add pictures as one person suggested to make it easier to visualize.    Remember only 5 sit ups on each side…good luck!

I have had quite a few inquires into the type of Health History form that I use, so I have uploaded to my site a health history form that you can download at no cost.   It is currently available in English, Japanese and before to long: Spanish, French, German and Chinese.   There are also additional forms such as Ongoing treatment forms and Orthopedic assessment forms that I use to track assessment results from the Cervical, TOS  right down to the Ankle.   As therapist we are taught to gather information about our client/patient in order to get an understanding of the individuals past and current health status.   This information along with an assessment and a discussion on what brings the client into your clinic should help to give some additional insight as to the cause of the client symptoms.    These forms have help to support an evidence based practice; the clinical reasoning and rational for the techniques, positions and modalities I have utilized.   That being said, create an account at www.paullewis.ca and then go to services to download the assessment forms.

For those of you that have inquired about my assessment form for Post Surgical treatment of Mastectomy/Implants, I am currently updating that and will post it once it is ready.

How often do you wish you had more time to throughly research the symptoms your various clients presented with; review your notes from the courses you took at school; go to workshops, conferences; read a book other than pathology; take a vacation or even without pressure see a movie.  I commend the people that are able to find true balance in their lives. Being able to balance work, personal life, personal growth along with growing together with their family and loved ones.  That goal has moved to the top ten on my list of 100 things I want to do.

I really enjoy what I do and I believe like so many other therapist the challenges come from the desire to do well.  Is it me or have you also found yourself in today’s society of instant messaging, books on demand, movie on demand, still trying to catch up.   I find myself and the end of the day asking, where did the day go? So you try to stay up later and later each night until the days start to blend into nights and you find yourself sending emails at 3am- wide awake because your internal clock has been skewed.   Balancing is an art and I am just starting to put the brush on the canvas.  It has take me many years to finally realize that balance is the spice of life, but trying to incorporate balance into one’s life can be a challenge.

Starting off with the simple things I believe will help with the process.  During our activity packed days, finding time to eat should not be an exhausting task but rather an enjoyable life sustaining activity that should be shared with others if time permits.   This past weekend I was invited to dinner with a group of 10 while in Minnesota.   I went and ate, listened, spoke, laughed, embraced and was embraced.  Do you give yourself time to do find balance or are you working your way down your long list until you get to the number that says, time to breath?

Do you give yourself time?

What would you do next?

The other day I participated in a therapist group discussion where we talk about issues related to Massage and therapy.  One discussion I would like to share with you because i would like to find out what you would do in this situation.   The discussion was based on a client that came in for a treatment and we had varying opinions and approaches.   The opinions divided us into three equal groups of two.   The question that started it was, what would you do next to help this client?

Remember when you were in school you had the inter-student exchanges, clinics, in class exchanges to practice specific techniques and the sporting events or speciality clinics that you attended.   During the school year, how often did you actually get a full body treatment?  Now that you are out in the work force, do you find you have more control over your personal time? Therefore, giving you greater opportunity to receive the much needed self pampering? Or are you too busy to receive or exchange with other therapists because you don’t want to take a break.   If many of the therapists are too busy to seek treatment, what are you doing to relax and relieve tight muscles?

What ever your situation, I think it is important to be the client once in a while.   Similar to how you care for what you love and protect, you need to care, love ! and protect your body, your livelihood.   Just like the client that comes for their once-per-month preventative and maintenance massage, don’t you think you too should be treating yourself to massages?

I have attached a link to an article that describes a self care exercise that has helped clients with range of motion, muscle stiffness, stress levels and circulation.   Lewis Circles: Self-Care for Health Care I believe that if the exercise can help the client, why not the therapist.   Who takes care of you?