Ask The Massage Therapist

Ask The Massage Therapist Is Moving To www.massage-stlouis!

2010-09-29T22:50:00.004-05:00

Dear Readers,

This blog was my first venture into online communication. It was a fun and easy way to venture onto the internet. Thanks to everyone who has given encouragement and support and to the readers who have submitted questions.

Since I began this blog, I started a FaceBook page. I'll be posting there whenever I write a new blog article. I hope you'll become a FaceBook fan of Massage St. Louis.

In April of this year I was finally dragged into the 21st century and got a website. My web master, Jean Probert, did an excellent job and I'm very excited about the new web site. Please check out www.massage-stlouis.com.

Ask The Massage Therapist will be moving to the new website. All the old material from this blog is available at the new location and new material will be posted there from now on. You can still Ask The Massage Therapist your questions about massage therapy.

We look forward to hearing from you. Tell your friends to stop by and visit. And remember, if you have any questions about massage therapy, please feel free to Ask The Massage Therapist. We'll try to answer as best we can.

A Reader Asks About Swelling After A Massage

2010-09-29T22:47:00.001-05:00

A reader asks:

I received a great massage about a week ago but the next day my lower back was swollen. Why would this happen? The massage was perfect pressure and she never hurt me at all. Can you please help me understand this?

Without having been there or being able to ask follow-up questions, I can't give a definitive answer to your question. However, I'll take an educated guess.

It may have seemed that the pressure was perfect but it's possible that your body did not think the pressure was perfect. It may have been too much pressure. That's one possibility.

Another is that your back may have been overtreated. Massage therapists sometimes spend a long period of time in one area, thinking that every single tight fiber and sore spot must be relieved before they move on. It can even feel good to do it at the time but it may not be a good thing to do.

Massage sets a process in motion that continues after the session is over. Too much massage in one area can cause congestion, inflammation, and tightening of the muscles. A therapist should not work more than about ten minutes on one specific area. It is better to work a little, give the area a rest for two days, and then come back to it. It is always better to do too little than too much. Too little will do no harm but too much can cause irritation.

Did she put heat on the area after working on it? Massage will draw blood to the area. Adding heat will draw even more fluid to the area and cause congestion. Heat to warm the area before working on it can be good, but heat after an area has been thoroughly massaged can be too much.

Finally, it's quite possible that the swelling had nothing to do with the massage and was a coincidence. Perhaps something else occurred that you may not have been aware of. These things happen.

I've never had the experience of a client getting swelling after massage, but I did have an experience of too much massage creating congestion. I was in Latvia with my Russian Massage teacher Zhenya Kurashova Wine. We were at a clinic learning how massage was used in a clinic setting and we ourselves received treatment. Since we were foreigners and there for a limited time, we were getting more treatment than would have been normal. My arms were bothering me from overuse so I welcomed the opportunity to have them treated.

By the fourth day they began to feel congested. The therapist did not use a lot of pressure but the massage brought a lot of blood to the muscles. Zhenya always told us that muscles should be massaged like this only every other day, not every day, because it was too much. You bring the blood to the area and then leave it alone for a day to give the body a chance to do its work. When I told Zhenya my arms were feeling a little congested, she instructed me to skip treatment for a day. My arms began to feel better. I learned myself that more is not always better.

Yours is an uncommon response and so I don't know exactly why you had that experience. However, these may be some possible reasons why you had some swelling after your massage. Should this happen again, you might try putting ice on the affected area and ask your therapist to work more gently for less time on the area.

Thanks for your question

What Is The Right Kind Of Massage?

2010-05-12T14:26:00.003-05:00

Massage is an ancient healing art that has been practiced in every culture. Captain Cook once described how his back pain was successfully treated with massage by the native people of Hawaii during his stay in the islands. Massage has evolved and taken many paths and continues to evolve during these modern times. With so many names and philosophies, how does a client know which is the right kind of massage for them? And how does the therapist know what is the right kind of massage for the client?

Sports massage, Swedish massage, Russian massage, accupressure, deep tissue massage . . . there are so many different kinds of massage. I'll discuss some general categories in another article but for now I want to talk specifically about what I mean when I say that the right kind of massage can be very effective, while the wrong kind of massage will, at the very least, be ineffective and, at worst, cause symptoms to worsen.

Let me give an example taken from my own practice. Years ago, when I was first beginning to learn Russian massage, a woman called and booked an hour appointment. Upon arrival, she told me she had Chronic Fatigue Syndrome. She'd had experience with massage before, liked it, and wanted a fairly vigorous one hour massage. I had recently begun to study with the renowned Russian Massage therapist Zhenya Kurashova Wine and knew from Zhenya that a vigorous one hour massage would not be the best choice for her and that, in fact, a gentle 20 - 30 minute treatment would be better. I explained this to the client. She was willing to consider it for a future visit but at that moment, she really had her heart set on a one hour vigorous massage. Against my better judgement, I complied. At the end of the appointment she said that she liked the massage very much and booked another appointment for the following week to try the alternative treatment I'd suggested.

When she came the following week, I asked how she felt after her first massage. She said she'd felt better for the rest of the day and then went home, crashed, and could barely get out of bed the following two days. I proceeded to do the very gentle 30 minute treatment that I do for CFS and fibromyalgia. The client came in the following week and, again, I asked how she felt after the last massage. She reported that she'd gone home, took a 20 minute nap, and then felt really good for the next three days.

Two different massage treatments, two entirely different reactions.

Zhenya would tell us that massage is like medicine. First, you have to have the correct diagnosis. If you don't know exactly what is the problem, you are not going to know what is the correct solution. Then, as with medicine, you have to know what is the right medicine and what is the right dose. How much? How often?

In Russian massage we study the specific effects that each stroke has on the physiological processes of the body. How is the treatment for nerve irritation different from treatment for muscle pain? How is treatment for an acute situation different for a chronic condition? How would one approach a systemic disorder? A client with congestive heart failure? Stroke?

As you can see with my client, the wrong kind of massage felt good at the time but really did not help her. The right kind of massage got much better results.

A good therapist will understand exactly how her touch affects the body at many levels. She will listen carefully to the client's needs and adjust accordingly. By understanding the client's condition at that point in time and understanding how we affect the body, we can deliver just the right kind of massage and achieve greater results.

Benefits of Massage Therapy

2010-05-08T14:52:00.003-05:00

If you've ever had a massage, you know that you can start to feel better within minutes. We are biologically wired to respond to welcome human touch. The massage therapist begins to spread oil over your back. Skilled hands begin to massage tight muscles. Right away, you feel better and begin to slip into a state of relaxation. That alone is worth the price of admission. But there's more!

People come to massage for a variety of reasons. Many come primarily for relaxation and wellness. Experts estimate that at least 80% of doctor office visits are for health problems that are caused or aggravated by stress. Headaches, backaches, and many other of life's most common complaints are aggravated by stress. Anything we can do to counteract and alleviate the effect of stress is going to have a beneficial effect on our health. In The End of Stress As We Know It, author Bruce McEwen describes the effects that chronic exposure to stress hormones have on the body. Among other things, continued elevated levels of these hormones lead to higher cholesterol, a higher incidence of Type II diabetes, and increased accumulation of belly fat.

Sore muscles from overexertion respond quickly to the right kind of massage. Chronic muscle aches can often be alleviated by the right kind of massage. Athletes find that regular massage can help to naturally improve their performance and minimize injuries by eliminating unnecessary tightness in muscles.

The Touch Research Institute at the University of Miami Medical School has conducted over a hundred studies documenting the beneficial effects of massage. TRI has found that massage therapy improves weight gain in premature infants, enhances attentiveness, alleviates depressive symptoms, reduces pain, reduces stress hormones, and improves immune system function. In fact, Dr. Tiffany Field of TRI has said that in every study they've undertaken, massage has been shown to be beneficial. That's amazing.

We don't need to wait for scientists to confirm what we already know from our own experience. Massage feels good and it's good for you.

Massage For Couples Class: 6/12/10 & 7/10/10

2010-05-03T12:42:00.005-05:00

Have you ever wanted to do massage at home with your partner but didn't know where to start? Do you try doing massage but get tired quickly? Are you wondering how to please your partner, who keeps asking for "harder," without hurting yourself? If so, you need to take one of the Massage for Couples classes I'll be teaching at Forest Park Community College on June 12 and July 10.

This one day, 5 1/2 hour class is meant to give nonprofessionals the basic skills to do massage for relaxation at home. While we can't teach you to be a massage therapist in one day, you should leave the class feeling confident that you and your partner can begin to enjoy sharing massage with each other at home. "Couples" can be any two individuals, not just spouses, but you must register for the class in pairs. Friends, roommates, teammates, and family members are welcome to participate.

The class begins with some introductory information on massage theory so that participants can understand the "why" behind what they are doing. Precautions are covered so that it is clearly understood how to work in a manner that does no harm to either the giver or the recipient. Most of the class is "hands-on." Particular attention is paid to making sure the "giver" works in a way that will not strain them. A variety of strokes are taught that allow for maximum flexibility. Participants learn strokes that are light but still effective and also more vigorous strokes that can affect deeper tissues.

Class size is limited so that participants get plenty of individual attention and so that personal concerns and interests can be addressed. The class is relaxed and friendly. Participants have ranged in age from their early 20s to their 70s and come from many walks of life. It's a lot of fun.

Cost of the class is only $29 per person. To register, go to the website for Forest Park Community College and look for Continuing Education. The class is listed as "Couples Massage" in the catalog and is in the Health section. (HEAL:704) Alternatively, you can register by calling 314-984-7777. Students have often said the online registration is a little frustrating and have a better experience registering over the phone. Participants should bring a bag lunch, since we only have a half hour lunch break and options for eating out are limited. Participants also need to bring a set of sheets and a pillow or bolster. Oil will be provided. Sometimes the room is cold so a blanket is highly recommended. Also highly recommended is a yoga mat or heavy bath towel. Since we have to use hard top regular classroom tables, something to make the surface more comfortable is desirable. Wear comfortable, loose fitting clothing. You should wear a bathing suit or other clothing that allows maximum access to your skin under your street clothes.

This semester, the class will be offered on two Saturdays, June 12 and July 10. If you're interested but can't make it this time, don't despair. The class is offered twice each semester.

If you've got any questions, please don't hesitate to contact me. If you have questions about registration, call the Continuing Education department at Forest Park Community College.

Hope to see you there! And tell your friends!

Remembering Dr. David Simons, Co-Author of The Trigger Point Manual

2010-05-03T10:41:00.001-05:00

It is with great sadness that the massage community received the news that Dr. David Simons recently passed away at the age of 87. Dr. Simons co-authored Myofascial Pain and Dysfunction: The Trigger Point Manual with Dr. Janet Travell, the physician who helped President John F. Kennedy with his back pain.

The contribution that Travell and Simons made to the world of pain management cannot be underestimated. At first met with skepticism, the concept of trigger points and their importance in the treatment of musculoskeletal pain eventually came to be accepted and embraced by practitioners in every area of pain relief and pain management. Massage therapists, physical therapists, medical doctors, and chiropractic physicians all look to The Trigger Point Manual as an important resource for understanding and treating many common pain problems. Until Travell and Simons, muscular pain was not taken seriously by doctors and very little research was done about how to relieve it. Travell and Simons began investigations into the causes and treatment of muscle pain and, in particular, the phenomenon that they came to name "trigger points." They mapped the most common locations of trigger points and their most common referral patterns which eventually led to the practice now commonly known as "trigger point therapy."

I've known a number of massage therapists, chiropractors, and medical doctors who have had contact with Travell and Simons over the years and they all remark at their incredible generosity. They had a genuine interest in relieving pain and were enthusiastic that so many practitioners used their work to great effect.

It is with a deep sense of gratitude for the work of Dr. Simons that I take a few moments to remember the important contribution he made towards relieving pain and suffering. Thank you, Dr. Simons. You will be missed.

Check Out My New Web Site: Massage-StLouis.com!

2010-04-28T20:04:00.008-05:00

Yes, this semi-Luddite has finally been dragged into the 21st century. Check out my new Web site at www.massage-stlouis.com. Make sure you include the dash and skip the period in stlouis or you'll get directed somewhere else.

More and more people are turning to the internet to find goods and services and my clients are no exception. Many new people find me through the internet and it's important to have at least a minimum of Web presence. I finally turned to Jean Probert, illustrator-designer, to help create a Web site for my business.

Jean has been the creative force behind those beautiful business cards, magnets, and postcards that many of you have admired during the last ten years. She is highly skilled, creative, and knows me well enough that the end results are a good reflection of who I am and what I want to convey. She patiently walked me through the steps of creating a Web site, kept me on task, and contributed helpful suggestions along the way. She was not only Web designer but editor and proof reader, too.

I am very pleased with the results. She did a beautiful job and the site functions well. You'll find an introduction on the home page with additional information on inside pages. There are brief descriptions of the types of massage in which I specialize, details about my training and experience, and articles from my blog, as well as contact information, rates, etc.

New blog articles will still show up on my FaceBook page, Massage St. Louis. And in case you are wondering, Massage St. Louis is my Web site and FaceBook page name but I still conduct business under my own name.

I hope you'll take a few minutes to check out the new Web site and let me know what you think. If you run into problems, let me know and we'll do what we can to fix them. If you aren't already a fan of my FaceBook page, I invite you to become one. I promise I won't inundate you with posts and you will be notified of classes, promotions, and anything else that comes up that you might want to know about. In the future, I may post links to helpful sites and products that people often ask about.

Thanks to Jean for her work and her patience guiding me through the process. If you'd like to see more of her work, check it out at jeanprobert.com.

"That Was Awesome!"

2010-04-12T08:56:00.003-05:00

"That was awesome!" This was the comment most frequently heard during the two hours I was doing minimassages on a constant stream of girls ranging in age from 5 years to around 12 years old. A couple of adults and teens snuck unto the line, too.

The event was called Girls In The Know and, in its first year, had 500 little girls and their moms sign up in advance.

I've worked many events over the years: the Working Women's Survival Show, Earth Day, the Muscular Dystrophy Telethon, and numerous health fairs, to name a few. When I walked into this event, though, and saw a sea of little girls, I thought, "Oh my goodness, this is going to be different!" To be honest, I was a little intimidated at first. I'm accustomed to working with adults at these events; what was it going to be like having scores of very young girls line up at my table? Well, I'm always up for an adventure.

What was it like? It was a blast! The first little girl, a young gymnast, was so ticklish I could hardly touch her. However, I have some techniques to overcome ticklishness and she responded well to them. She said her neck was always tight and no one could touch it, but I was able to massage her neck. She really liked it a lot and when she got up off the table, she exclaimed, "That was awesome!" Her best friend, also a gymnast, was next in line. I told them both how I worked with the gymnasts of Cirque du Soleil. They liked that. The second girl told me her mom massages her. I invited her mom to come to the office and I could teach her some specific techniques that would help her work effectively with her daughter.

The rest of the day became an endless series of little girls hopping onto and off of my table. Each one of them was adorable. They all dressed so colorfully and many had had their hair fixed with fancy braids. I loved their glittery little shoes and their smiling, bouncy energy. They were all so darn cute!

One mom took a photo of her daughter getting a massage. I hope she'll send it to me. If she does, I'll post it on my FaceBook page: Massage St. Louis.

By the end of the day, I was exhausted but very happy. The girls all looked like they were having a good time and they all loved the massage. From the first to the last, they all agreed, "That was awesome!"

Musicians: Small Muscle Athletes

2010-04-08T10:05:00.004-05:00

I once read an article about musculoskeletal pain among professional musicians. A survey of several thousand symphony musicians revealed that approximately 80% of them suffered from either chronic or intermittent pain directly related to their profession. The highest incidence was reported among the violinists. This was not surprising since they not only hold their instrument in a position that is challenging to the muscles, but they spend more time playing than any other instrument in an orchestra. Other instruments often get breaks or play only intermittently but in most orchestral pieces, the violins play most of the time.

Musicians are small muscle athletes. Their profession requires endurance, strength, and precision. The right kind of massage can help them play with less pain and more agility.

When muscles are tight, movement is inhibited. When muscles are in pain, they become tense, there is less control, and they fatigue more quickly. Maintaining maximum range of motion and eliminating pain allows a musician to play in comfort and can improve performance.

I've worked with a number of musicians over the years and they fascinate me. Those of us sitting in the audience marvel at their skill, but we seldom think of the endurance required to play for hours without a break. I once worked with a couple of conductors and, until that experience, never thought about what it must be like to stand with your arms raised in the air for a couple of hours. Try it, especially while making short, quick, precise movements. It's not easy.

Each instrument has their own challenges. Horn players can get spasms in the muscles of their cheeks and lips. Violinists suffer from neck and shoulder ache. Guitarists, banjoists, and mandolin players will get pain in their forearms or elbows.

A good massage therapist who understands these problems can go quickly to the source of the pain and begin to dissipate the tension and discomfort. They not only can help to relieve the acute pain, they can help a musician continue to play pain free in the future.

Regular massage therapy should be a part of every professional musician's life. It will improve their performance, help them to play with comfort and ease, and extend the length of their career.

Cirque du Soleil

2010-03-31T00:20:00.007-05:00

No doubt about it, the best job I've ever had has been working with Cirque du Soleil. Four times.

People are often impressed that I have worked with Cirque du Soleil. I tell them don't be impressed that they hired me the first time. After all, the first time they didn't know what they were getting. Be impressed that they hired me the second. And the third. And the fourth time.

What is it like working with Cirque du Soleil? It's definitely different. First of all, the sessions are usually for 20 minutes, not the usual hour in the office. This means that you need to get right to the point quickly. Secondly, these are world class performers who put incredible demands on their bodies and need to stay in top shape to perform. They need massage that is effective and efficient.

The combination of Russian Massage and Neuromuscular Therapy, my primary modalities, coupled with years of experience, works well for them. I love the challenge of trying to meet their needs in such a short time and they really appreciate my expertise.

I'd had considerable experience with elite athletes and performing artists before Cirque du Soleil, but my first day with them was an adjustment. Most of the performers are gymnasts of one sort or another. They are muscular but small and lean, very different from the generally larger athletes I was accustomed to. In addition, many did not speak English! My first client spoke only a few words of English. Fortunately, I've traveled in a number of foreign countries and have had experience in communicating with people whose language I do not speak. I learned about eight words of Chinese and relied on hand gestures, pantomime, drawings, etc., to determine exactly what each person wanted and needed.

I loved being able to work the way I've been trained to work. Working quickly and working in a very results-oriented manner is something I excel at. It was very satisfying to be able to meet their needs.

Performers for Cirque come from all over the world. They are a fun and interesting population to work with. It's a joy to be able to work so creatively and to be part of such a creative endeavor.

If you've ever seen them, you know that they perform amazing feats and do it with a grace and artistry that's like nothing else you've ever seen. After working so closely with their bodies, I had even more of an appreciation for their strength and skills when I would watch them perform.

I had the privilege of working twice with one show so I was familiar with about half the performers when they returned a year after their first visit to St. Louis. It made me feel good when two African brothers walked in and greeted me in their beautiful West African French accents, "Ah, Alice, we are so glad to see you again! You are the best of them all!" I feel the same way about them, too.

Carpal Tunnel Syndrome during Pregnancy

2010-03-27T08:48:00.004-05:00

I got a phone call from a client whose wife developed Carpal Tunnel Syndrome six months into her pregnancy as a result of swelling from water retention. The condition became so painful she would wake up at night in tears. Her doctor was not helpful. "It will go away after you deliver," was the only suggestion he had to offer. Not wanting his wife to have to endure this for another three months, my client asked if I could help. I'd never dealt with such a situation but I do know how to reduce swelling so I thought it was worth a try. I worked on her arms and asked her to call me the next day to see if it helped. I told her that we might have to try it a few times before we saw any results and that I couldn't guarantee results, that we were engaging in an experiment. Her husband called the next day to say she had her first painless night in several weeks. This was good news. Now the question was how long would this effect last? The next night it started to return but was not as bad as it had been before we started. By the third evening the symptoms were almost back to where they had been originally. I told the husband she probably should be treated every evening before she went to bed. He was willing to do this for his wife so I taught him how to do the treatment, which only took ten minutes, and he treated her every night. She was able to get through the rest of her pregnancy without pain.

Recently I heard about another woman who had CTS during her pregnancy, induced by water retention. I'm wondering how common is this condition? A quick google of the subject turns up a number of references. Suggested treatment was a cortisone shot. I'm wondering how many women could be helped by a simple, natural treatment that can be done at home? I don't know for certain that other women's pain could be relieved. Just because it worked for one does not mean it will work for others. However, it is reasonable to think it might and certainly worth a try. Have you had CTS during your pregnancy or do you know someone who has? Are you a doctor who sees pregnant women with CTS? How can I get the word out? I hate to see these women suffer what may be unnecessary pain when such a simple solution may be available.

Your thoughts and comments are welcome.

Massage For Couples Class 9/26 & 10/10

2009-09-14T14:52:00.004-05:00

Have you ever wanted to do massage at home with your partner but didn't know where to start? Do you try doing massage but get tired quickly? Are you wondering how to please your partner, who keeps asking for "harder," without hurting yourself? If so, you need to take one of the Massage for Couples classes I'll be teaching at Forest Park Community College on Sept. 26 and Oct. 10.

This one day, 5 1/2 hour class is meant to give nonprofessionals the basic skills to do massage for relaxation on each other at home. While we can't teach you to be a massage therapist in one day, you should leave the class feeling confident that you and your partner can begin to enjoy sharing massage with each other at home. "Couples" can be any two individuals, not just spouses, but you must register for the class in pairs. Friends, roommates, teammates, and family members are welcome to participate.

The class begins with some introductory information on massage theory so that participants can understand the "why" behind what they are doing. Precautions are covered so that it is clearly understood how to work in a manner that does no harm to either the giver or the recipient. Most of the class is "hands-on." Particular attention is paid to making sure the "giver" works in a way that will not hurt them. A variety of strokes are taught that allow for maximum flexibility. Participants learn strokes that are light but still effective and also more vigorous strokes that can affect deeper tissues.

Class size is limited so that participants get plenty of individual attention and many personal concerns and interests can be addressed. The class is relaxed and friendly. Participants have ranged in age from their early 20s to their 70s and come from many walks of life. It's a lot of fun.

Cost of the class is very modest - only $29 per person for a 5 1/2 hour class! For more information or to register, call the Continuing Education department at 314-984-7777 or go to the St. Louis Community College website: http://www.stlcc.edu. Find the class schedule for Continuing Education, Fall 2009, and look for the Massage for Couples class at Forest Park.

Participants should bring a bag lunch since we only have a half hour lunch break and there is no fast food easily available. Participants also need to bring a set of sheets and a pillow or bolster. Oil will be provided. Sometimes the room is cool so a blanket is recommended. Also highly recommended is a yoga mat or heavy bath towel. Since we have to use regular classroom tables, something to make the surface a little more comfortable is desirable. Wear comfortable, loose fitting clothing. You should wear a bathing suit or other clothing that allows maximum access to your skin under your street clothes.

This semester, the class will be offered on Sept. 26 and Oct 10. If you're interested but can't make it this time, don't despair. The class is offered twice each semester, including the summer semester. The next classes will be Feb. 20 and Feb. 27, 2010.

If you've got any questions, please don't hesitate to contact me.

Hope to see you there! And tell your friends!

Some Business Questions From A Reader

2009-08-17T17:19:00.006-05:00

A reader asked the following questions:

I am currently in school for massage therapy and I have a few questions regarding starting a business for myself. My questions include:

What business structure did you chose (sole proprietor, partnership, LLC, etc)?

Are you happy with the structure you selected?

Was it easy or complicated to set up?

Were there costs associated with the business type you chose?

What are the advantages and disadvantages to the type of business structure you chose?

If you had to do it all over again, would they still chose the same business structure?

Any feedback is appreciated!! Thank You!!

Jamie

You really are thinking ahead and that's very good!

I'll be honest with you, when I started out I didn't think about how I'd go about making a living, I just wanted to learn how to be a massage therapist. Perhaps it's fortunate because if I'd realized I'd end up being a small business owner I might have talked myself out of it! At the time, the idea of being self-employed scared me.

I have worked in several situations over the years. When I got out of school, I went to work in a chiropractor's office as an independent subcontractor. I worked on a percentage basis. The advantage to me was that I did not have a set overhead to meet every month. I set about trying to build a clientele and also got some clients from the Yellow Pages ad that the office ran in the phone book.

Eventually I struck out on my own. I began working part-time in another chiropractor's office but I rented a room and did not work for the chiropractor. I had built up enough clientele that I was better off having a set overhead rather than paying a large percentage of my gross. I also had more independence regarding setting my schedule, etc.

During this time, I also went to work part-time as an employee at a hospital. The hospital booked the appointments, did laundry, etc. I just showed up and did my appointments. One of the things I particularly liked about that situation was the camaraderie I experienced with the other therapists. The clients were not "mine" and their records belonged to the hospital, so when I left there very few of them came with me.

I am a sole proprietor. Start-up costs were minimal. I needed a table, sheets, oil, a clock, and something to play music. The first office provided me with a room, a stool, and a desk. Over time I've acquired books and a few other things but one does not need a lot to do massage.

In the beginning I consulted with an accountant and she helped me to set up a basic bookkeeping system. A good accountant can discuss the various options and help you to decide what's best for you.

Each situation has it's advantages and disadvantages. I enjoy the independence that my current situation affords me. I now share an office with another practitioner and I love my room and the space that we share. Each different situation has been a step along the way and has been a learning experience. Each provided for different needs that I had and helped me to clarify what I wanted. I don't think there's any one situation that's "best" for everyone and at different periods of our lives and our careers we can have different needs and may make different choices. You have to think about your own temperament and what you want out of your practice. I'm not the best business person and don't like the paperwork I have to do. Sometimes I wonder if I would be better off being an employee for someone else. However, I enjoy the flexibility and autonomy and so accept the advantages and disadvantages of the choice I've made. I also know that if I want to, I can seek employment with an established business. I always have options.

So yes, I'm happy with my situation. If I were to do it over . . . perhaps I'd do a few things slightly differently but overall it's been a good journey.

One thing I've never done, and would not do, would be to sign a "no compete" clause that would restrict where I can practice or who I can see and when. Perhaps I'll address this separately as I have some very firm thoughts about being an ethical employee.

I hope I've answered your questions. If not, feel free to follow up!

Massage Franchises: The Inside Story

2009-07-25T11:23:00.003-05:00

A few years ago, Massage Therapy Journal published an article, "Get Ready For Massage Envy!" The article, based on interviews with the founders of the franchise, painted a glowing picture of a business where happy massage therapists had 401K plans, were paid for empty appointments during their shift, and were well compensated for their work. I couldn't help but feel, though, that there was a slightly ominous warning in the title. How could a franchise offer all this to the therapist and only charge $39 for an hour massage?

Not long afterwards, the first six massage franchises opened in the St. Louis area, with four more soon to follow, each with ten or twelve massage rooms. I was curious about what it was like to work in such a place and eventually had the opportunity to find out from an experienced therapist who took a job in a franchise for about a year.

First, let's get one thing clear: for $39 you get a fifty minute massage, not a one hour massage. Still, it sounds like a good deal, right? But is it really as good a deal as it appears?

Clients who get massages in salons, spas, and massage franchises are expected to tip and the customary tip in such a situation is usually $10. So, that brings the price of a 50 minute massage up to $49, essentially a dollar a minute. It's still less than what most independent massage therapists in my neck of the woods charge, around $70 for a full sixty minute massage. However, it's not that much less and the $39 introductory price is for one time only. After that, the price jumps to $69 for a 50 minute massage. At that point, you are actually paying more than you'd pay an independent therapist.

The franchise will try to convince you to become a "member" for $59/month. This membership entitles you to one massage per month. As a member, you'll also get the $59 rate for any other massages you book. You will be charged whether you get a massage that month or not. At $59 for a 50 minute massage, you are actually paying more, per minute, than you would be paying an independent therapist at $70 for a full 60 minute massage, and that's before you add the tip. If you don't get a massage, you will still be charged $59. You can defer the unused massage so that if you don't get a massage one month, you can use it the next month and have two that month. However, many members end up dropping their memberships when they find they are not using their massages, so they end up paying for massages they never get. It ends up not being nearly as good a deal as it first appears.

Meanwhile, let's look at the therapists. Solicitations I've received from a popular franchise promise competitive compensation, 401K plans, and compensation for unfilled appointments. However, in talking both with a representative for the franchise who called me, looking to hire a therapist, and the observations of my friend, the picture is not so rosy. Therapists earn $15 per massage, less than half of what the business charges their customers. After deducting taxes, the therapist gets closer to $10. Although many patrons tip, many do not. As for 401k plans, few therapists stay long enough to qualify. After six months, my friend was the only therapist in her location who had been there over three months.

The overwhelming majority of therapists staffing massage franchises have just recently graduated from massage school and are willing to work for minimal compensation in order to get some experience. Even so, few of them stay more than three months. While they are theoretically paid $8.50 for unfilled appointments in their schedule, in reality they rarely receive it since any appointments that are booked that week are charged against their idle time. The therapist is still required to be present during their shift and is not allowed to leave, whether they have appointments or not. Even young, inexperienced therapists soon decide they are getting a bad deal and look elsewhere for employment.

How does compensation at the massage franchise compare to working at other places of employment? Hair salons and chiropractors' offices typically pay the massage therapist 70% of what the client is charged. Spas typically give the therapist 50% but since they often charge more, the therapist is kept busy, and the clients tip, the therapist is still compensated fairly for their work. One local day spa charges between $73 - $98 for an hour massage, depending on the type of massage and the level of experience and skill of the therapist. The therapist earns a minimum of $36 for their work. At $15 per massage, the franchise is giving the therapist less than 40% of what the client pays and less than half of what the therapist would be paid elsewhere. At the full price of $69, the therapist is given barely over 20% of what the client pays the franchise owner.

Being a massage therapist is rewarding work but also physically demanding work. There is a limit to the number of massages most therapists can do in a week. Dropout rate in the profession is high and one of the significant factors is the physical demands it places on the therapist, especially those who are doing deep tissue work. It is no wonder that even young, inexperienced therapists quickly leave the franchises when they are compensated so poorly for physically demanding work.

I've had a few clients who have had a massage or two at one of the franchises. A client who is accustomed to massage from an experienced therapist can tell immediately when their therapist is inexperienced. They adjust their expectations accordingly. Still, one told me of an incident that left her shaking her head. Her massage therapist was doing a fair enough job but when she got to the client's feet, the client could tell she was massaging with only one hand, which was not the norm. When this continued, the client, who was face down, lifted her head to see what was going on. The young therapist was massaging her foot with one hand and text messaging with the other. After what I know about working in a massage franchise, I'm not surprised that the therapist lacked attention and dedication to her work.

I suppose there are some advantages to the massage franchises. If you are someone who waits until the last minute to book an appointment, there is probably someone at the franchise sitting around who can take you immediately. They will probably be someone inexperienced, disgruntled, who is just filling in time until they can get a better job elsewhere. You might as well plan ahead a little and patronize an independent therapist who is experienced and dedicated to her work and her clients. You'll get a better massage and you'll feel better knowing your therapist is being compensated fairly.

Massage For Couples Class: July 18, 2009

2009-06-24T00:05:00.003-05:00

I'll be teaching another Massage For Couples class at Forest Park Community College on Saturday, July 18, 2009. If you'd like to learn how to do massage on each other at home, this is the class for you. A "couple" can be any two people, but you must register in pairs. Spouses, family members, teammates, all "couples" are welcome. Please note that if you register online, you will have to register one at a time for the class. Refer to the Continuing Education catalog for what to bring to class.

For more detailed information about the class, see the blog entry for January 22, 2009.

Hope to see you there!

Improved Performance: One Athlete's Story

2009-04-13T10:04:00.003-05:00

Many years ago I worked with a long distance runner whose goal was to qualify for the Olympic trials. He was the most serious athlete with whom I've worked the most consistently over the longest period of time. I saw him at least once a week for 2 1/2 years. After about six months of regular massage therapy, he commented one day that he'd just gone the longest period he'd ever had without a pulled muscle. I asked him to elaborate.

Don (not his real name) was a serious runner who did everything he could to maximize his performance. He stretched religiously and paid careful attention to nutrition. Still, every few months he'd pull a muscle and have to take some time off from running. Now that he was getting weekly sports massage, his muscles were not getting tight and he was not experiencing the pulled muscles that he'd gotten previously. When he first came for massage, he was running 60 to 80 miles a week. He was now running 80 to 100 miles a week and was running with more ease. In addition he'd shaved two minutes off his 10K time. His recovery time after a marathon had decreased dramatically. He was quite pleased with the results of his weekly massages.

During the 2 1/2 years I worked with Don, he got two minor hamstring pulls from which he recovered quickly. He never missed a race because of a problem with his muscles. Because he was constantly measuring himself, Don could easily see the difference that regular massage had made in his performance.

Don moved away but I asked him to call me if he qualified for the Olympic trials. One day I got a phone call from him. Normally he was a person I'd describe as somewhat serious, but he was giggling like a kid. He'd just reached his goal and had qualified for the Olympic trials. I was elated and felt proud to have been part of his "team".

Whether you are a serious runner like Don or more casual about your physical activity, the right kind of sports massage can help keep your muscles functioning at their best. Less tightness means that you are less likely to pull a muscle, that your muscles will have their maximum power and range of motion, that you will fatigue less quickly, and recover more quickly. If you are a competitive athlete, regular sports massage can give you that competitive edge.

Posture, Leg Length Differences, and Chronic Pain

2009-04-08T20:21:00.003-05:00

I'm back! Yes, I've been gone for awhile. Those who know me personally will know that on 1/30/09 there was a fire at my office building. Fortunately, no one was hurt and my office didn't burn, but my room was devastated by smoke and water damage. After a month of scrambling to make do in the wake of the fire, I moved into a new office with a former office mate, Anne Thomasson. Anne, who was also displaced by the fire, practices massage and also teaches a form of therapeutic exercise called Gyrotonics. She now has a large, beautiful studio and I love walking into such a light, open space every day. We're both settling into our new spaces.

We recently attended the Missouri State Chapter meeting of the American Massage Therapy Association at Lake of the Ozarks. This was the 50th Anniversary of our state chapter and 230 massage therapists attended. There were a number of presenters. Anne and I chose the workshops presented by Paul St. John.

Paul St. John has been a leader in the field of massage therapy since at least the mid 80s. He is a dynamic speaker and his approach is very structural and rational. This particular weekend he focussed on mobilizing the sacro-iliac joint, where the base of the spine meets the hip bone, and the cervical spine where it meets the skull. There was considerable discussion about postural distortion and how it can lead to chronic pain. Paul drew a lot of attention to assessing for uneven leg lengths, which he believes is an underdiagnosed and often an unrecognized factor contributing to many people's postural distortion and pain.

Techniques were taught to mobilize the sacro-iliac joint and the cervical spine where it meets the skull. After the four hour car ride home, I was amazed that I did not feel as stiff as I usually do, something I'm convinced was a result of the SI joint work I'd received that morning in class.

I'm looking forward to becoming more adept at the skills that were taught and incorporating them into my work. I had a great time seeing old acquaintances and meeting new people. The AMTA conference was, I believe, a great success all around.

A Reader's Question: Are Massage Therapists Fat Friendly?

2009-01-22T22:35:00.007-06:00

A reader asks:

Are most massage therapists fat-friendly? Is it more difficult to do work on a fat person, and is it as effective for the client?

Thanks, Alice!

That's a good question and I'm glad you asked. I'm going to ask some massage therapists and see what they have to say about it. I can't speak for "most" massage therapists. Strangely, I don't recall it coming up in conversation so I don't know what other massage therapists would say. However, speaking for myself, I welcome anyone and everyone that I'm capable of accommodating. It pains me when I occasionally hear someone say that they'd like to get a massage but they are reluctant because of their weight. I want people to feel that my office is one place where they can feel good about themselves and accepted just at they are.

It can present some challenges for the massage therapist and some of this depends on the type of massage that you are doing. If you are focusing on relaxation, there should not really be a problem since the work is more general rather than specific. However, if you are trying to work with a specific pain problem, can be more difficult for the therapist to palpate bony landmarks and to directly affect the muscles below. If the therapist knows their anatomy well, they can compensate for this diminished ability to feel the tissues by their understanding of anatomy. Further, since the nerves that serve the muscles also serve the skin directly over the muscles, we can have an effect on deeper tissues even if we cannot touch them directly. My personal experience is that if I focus, I can sometimes eventually palpate more than than I initially realized. So yes, can be more challenging but it is certainly possible.

As for the effectiveness, this is going to vary with the individual client and is hard to predict. My suggestion would be for a person to try it and see if they find it effective.

As long as my table can safely support a person, they are always welcome in my office. If my table could not support an interested client, I would find a therapist whose table could support them. I would hope that other therapists would feel the same. If they do not, then perhaps they should seek another profession.

Massage For Couples Class at Forest Park

2009-01-22T11:44:00.005-06:00

Have you ever wanted to do massage at home with your partner but didn't know where to start? Do you try doing massage but get tired quickly? Are you wondering how to please your partner, who keeps asking for "harder," without hurting yourself? If so, you need to take the Massage for Couples class I'll be teaching at Forest Park Community College on Feb. 21 and Feb. 28.

This one day, 5 1/2 hour class is meant to give nonprofessionals the basic skills to do massage for relaxation on each other at home. While we can't teach you to be a massage therapist in one day, you should leave the class feeling confident that you and your partner can begin to enjoy sharing massage with each other at home. "Couples" can be any two individuals, not just spouses, but you must register for the class in pairs. Friends, roommates, teammates, and family members are welcome to participate.

The class begins with some introductory information on massage theory so that participants can understand the "why" behind what they are doing. Precautions are covered so that it is clearly understood how to work in a manner that does no harm to either the giver or the recipient. Most of the class is "hands-on." Particular attention is paid to making sure the "giver" works in a way that will not hurt them. A variety of strokes are taught that allow for maximum flexibility. Participants learn strokes that are light but still effective and also more vigorous strokes that can affect deeper tissues.

Class size is limited so that participants get plenty of individual attention and many personal concerns and interests can be addressed. The class is relaxed and friendly. Participants have ranged in age from their early 20s to their 70s and come from many walks of life. It's a lot of fun.

Cost of the class is very modest. To register, go to the website for Forest Park Community College and look for Continuing Education. The class is listed as "Massage for Couples" in the catalog and is in the Health section. Participants should bring a bag lunch, since we only have a half hour lunch break and there is no fast food easily available. Participants also need to bring a set of sheets and a pillow or bolster. Oil will be provided. Sometimes the room is cold so a blanket is highly recommended. Also highly recommended is a yoga mat or heavy bath towel. Since we have to use hard top regular classroom tables, something to make the surface a little more comfortable is desirable. Wear comfortable, loose fitting clothing. You should wear a bathing suit or other clothing that allows maximum access to your skin under your street clothes.

This semester, the class will be offered on Feb. 21 and Feb. 28. If you're interested but can't make it this time, don't despair. The class is offered twice each semester, including the summer semester.

If you've got any questions, please don't hesitate to contact me. If you have questions about registration, call the Continuing Education department at Forest Park Community College.

Hope to see you there! And tell your friends!

Unexpected Results

2009-01-15T14:55:00.001-06:00

After a bit of a holiday break, we're back on the blog. Hope everyone is getting off to a good new year.

Life often brings the unexpected and a reader writes about some unexpected results from her massage therapy session.

"Two years ago, I began experiencing considerable, constant pain in my right hip. I was going to be at an event across the country that a friend who is an advanced massage therapist was also going to be at. I scheduled an appointment with him, knowing it was likely to bring me temporary relief and, wow, did I want and need some relief by then!

As it turned out, the single massage gave me a lot more than temporary relief. While he was working, the massage therapist told me what he was noticing in the tightness of my hip and leg muscles suggested that I was probably turning my right foot inward while walking. I'd never noticed myself doing that, but, sure enough, he was right.

Not only did the massage leave me walking pain-free for the first time in more than a month, ever since, whenever I'm walking along and feeling a twinge in my hip, I make a point of pointing my foot out slightly outward...well, making sure it's straight, actually, but it feels like I'm pointing it outward.

Doing that always makes the hip pain go away within moments and the constant pain I was feeling for at least 4-6 weeks before that massage has not returned in the two years since I received it.

I believe it's rare for a single massage to make such a difference, but that one certainly did. It was all thanks to what the massage therapist knew, observed, and mentioned to me as being a possible source of the problem."

I'm always pleased when someone finds relief through massage therapy, but what particularly caught my attention from this reader's story is the unexpected results. We can usually expect to feel relaxed and to get at least temporary relief from sore, tight muscles. However, massage can be a catalyst for other, less expected results.

In this particular reader's case, the therapist was knowledgeable and experienced enough to understand what might be triggering the client's hip pain in the first place. Besides offering some immediate, short-term relief, he was looking at ways to solve an ongoing problem. By making a suggestion as to possible corrective actions, the client herself was able to remedy the source of the pain and prevent future problems.

An experienced and knowledgeable therapist will look for ways to educate the client so that the client can continue to get well and stay well outside of the massage room. By carefully listening to and observing the client, the therapist can help the client discover aggravating factors that may not have been obvious.

Have you had an unexpected result from massage therapy? If so, we'd like to hear about it.

Reader Question: A Broken Foot

2008-11-09T13:58:00.006-06:00

A reader asks:

"I broke several bones in my foot a number of years ago. Most of the time it's just fine. However, once in a while, it aches, is stiff or causes mild pain when I walk.

Can massage therapy help?"

It very well might and is certainly worth a try. Since it's your foot, a place you can easily reach, you can probably do this on yourself.

Besides the bones in your foot having been broken, no doubt the trauma that caused it also strained the ligaments, tendons, and muscles in your foot, too.

Here's where knowing exactly the right stroke to use can really make a difference. While gliding strokes may feel good, they won't be very effective. What will probably work best in this case is lots of friction (rubbing strokes).

The foot is very bony. There are lots of ligaments holding the bones together and lots of tendons going to the toes and around the ankle. The muscles in the foot are small and a little hard to access. They are between the five long bones that lead to the toes and on the underside of the foot beneath the thick skin of the sole and the thick tendonous structure known as the plantar fascia.

I'll describe how you can treat the entire foot. If the ache or stiffness is confined to a particular area you can concentrate on that area.

Friction is a rubbing stroke whereby you rub the skin over the tissue underneath. You can do it with or without oil but if you use oil, use only a little so that you still get some friction. Take the pads of your fingers and rub back and forth. Say you are starting at the ankle. You would rub the area thoroughly. The pads of your fingers will glide over the skin just a little as your are gradually moving around from place to place, but your fingers are not gliding a lot over the skin. It is as if you are reaching through the skin and "scrubbing" the joints, ligaments, whatever, underneath. Do this thoroughly, work around all those bony nooks & crannies. It should create a little warmth. This is very good for the joints, tendons, and ligaments. Do this all over the foot or concentrate around the area of discomfort.

Getting at the muscles between the long bones is a little challenging, but you can take your fingertip and friction between the long bones of the foot located between the ankle and the toes. As I said before, imagine that you are trying to scrub between those bones.

The underside of the foot is also a little challenging because the structures we want to affect are beneath some very thick tissue. If you make a loose fist and use it to rub the area, you can penetrate the thick sole of the foot. Using your thumbs to press into this area and stroke the arch longitudinally is good, too.

Gently mobilizing the many joints of the foot can be helpful, too. Firmly grasp your foot in both your hands and gently move the foot so that the various joints are moved as much as is comfortable. This should not cause any pain.

This can be done regularly or occasionally when the foot is feeling fine as a preventive measure. If the foot is feeling achy, it can be done to try to relieve discomfort. If you know you are going to be in a situation that may cause discomfort, it can be done beforehand, during the stressful activity, and afterwards.

By the way, this treatment is also good for dancers, runners, and anyone who stands on their feet a lot.

I hope this helps!

A Reader's Question: Pre or Post Dance Masssage?

2008-10-30T21:24:00.006-05:00

A reader asks:

"Hi Alice, is it best to get a massage the week before a dance weekend or the week after?

Love the blog!

Thanks Alice.

Pam"

Well, shoot! How about both?

Lots of people like to opt for massage after intense physical activity. It feels particularly good at that time and can help speed recovery. Soreness and fatigue will pass more quickly. Post activity massage will help your muscles to recover more thoroughly so that the tightness will not linger. However, those in the know realize that massage before intense physical activity is a great way to prepare your muscles. They'll be loosened up, the tight spots will be minimized, and you'll be able to dance (or do whatever else you're doing) with more ease. You'll be able to dance longer without getting tired, sore, and stiff. You'll be less likely to get cramps and have less post exercise soreness. You'll have more stamina and energy. You'll recover more quickly afterwards.

In a nutshell: post-activity massage will feel good and speed recovery, but pre-activity massage will not only speed your recovery, it can improve your performance, prevent muscle problems from occurring, and leave you with less to recover from! And it still feels good!

If you can have only one, I'd go for the pre-activity massage. But really, why not have the best of both worlds and do both before and after? Your muscles will be glad you did!

By the way, be sure and check back again. I'm planning on writing about the Care and Feeding of Dancers' Feet!

Thanks for your kind words and be sure and tell your dancer friends to pay a visit to Ask The Massage Therapist!

A Reader's Question: Stiff Neck

2008-10-30T19:26:00.003-05:00

A reader asks:

"I am not sure where to post my question. I am attending a massage school and have a student therapist. I generally have stiffness around my neck from sitting at a computer all week. What should I ask my student therapist to do to release the tension from my neck and shoulder area?"

Thanks for asking your question! And yes, you posted it in exactly the right place.

I'll do my best to answer specifically what your student therapist can do to help your neck. I'll also include some suggestions of things you can do to help minimize the strain on your neck outside of the massage room.

First, you have to understand that a student is a beginner and is not going to have the skills that a more experienced therapist may have. Their palpatory skills are not going to be as well developed yet. In addition, there are advanced techniques that should only be taught to experienced therapists. However, there are still things a student therapist can do to help a person with a stiff neck.

A word of caution: all massage on the neck described here is to be done on the muscles on the back of the neck. The sides and the front of the neck should be avoided unless the therapist is experienced and has been specifically trained to work in these areas.

With the client face up on the table, the therapist should begin with some gentle effleurrage (gliding stokes.) The neck may be gently tractioned (stretched) during the up stroke from the shoulders to the head. The effleurage in this case may be done in one direction (from the shoulder to the head) or alternating both up and down.

After some effleurage, the therapist can begin circular friction with the pads of the fingers on the muscles on either side of the back of the neck. Both sides can be done at the same time, with the fingers on either side of the neck, and can be done both up and down the neck. Depending on the size of the client's neck and the therapist's fingers, there may be room for only one or two fingers. Remember, when doing friction the pads of the fingers are rubbing the skin over the muscles underneath; the fingers are not gliding over the skin. One of my clients liked to call this "scrubbing the ickiness out." Friction should be done firmly but gently. Done correctly, this should cause no pain to the client.

Finish with a few more gliding strokes and then turn the head gently to the left. Use some gliding strokes down the right side of the neck (remember, you're concentrating on the back of the neck) and then begin to thoroughly friction the posterior muscles on the right side of the neck with the pads of the fingers. The client should be feeling the muscles relaxing. They may feel as if they are warming. Finish with a few strokes of effleurage and then repeat for the left side.

When both sides of the neck have been thoroughly massaged, return the neck to the center. Use the pads of the fingers to circular friction the suboccipital muscles along the base of the skull. You can start with both sides at once, using both hands, and then concentrate first on one side, then the other.

Finish with a few more strokes of effleurage and then have the client turn onto their stomach to massage the shoulders.

Standing on the client's left side, facing the body, reach across the body and use continuous effleurage off the right shoulder. Beginning with the hands at the midline, one on the upper trapezius and one hand positioned just medial to the shoulder blade, push one hand off the shoulder, then the other, back and forth with each hand following the other in continuous gliding strokes. After a bit, begin using circular friction with the heel of the hand. Your left hand will be frictioning the upper trap, your right hand will be frictioning over the shoulder blade. When the tissue begins to warm, begin to use the pads of the fingers to friction in more detail along the edge of the shoulder blade, the attachments along the spine, all of the muscles of the area. In areas that are particularly tight or sore, give them a little extra attention. However, don't overdo it.

You can return to some more general circular heel of the hand friction, finish off with some gliding strokes, and end with some vibration. Rest the hand on the shoulder and gently shake back and forth for a few seconds. Repeat the entire treatment for the left shoulder.

Remember: pressure should always be within the client's comfort zone. This treatment should feel good to the client and should not cause any pain. Do not overtreat. This entire treatment should not take more than 15 minutes: no more than 5 minutes on the neck and on each of the shoulders. Overtreating will cause the muscles to tighten back up and create too much congestion in the area.

After treatment, the muscles should not be treated again for at least 48 hours. The ideal would be to repeat this treatment every other day for 10-15 treatments. If you can do it two or three times a week for a couple of weeks, you will get the most progress and will probably start seeing longer lasting results within a week. Short, frequent treatments are more effective than longer, infrequent treatments. You are trying to retrain the muscles so that they will not go back to the way they were. When the desired results are achieved, then you can taper off the treatments. Periodic "tune-ups," perhaps once a month, would be a good idea if needed. After all, since you are probably going to continue to sit at the computer, you'll need an ongoing plan of maintaining your muscles so you don't end up back in the same situation.

Outside of the massage room there are steps you can take to help maintain the health of your neck. If you must be at a computer for long periods, get up and walk around and stretch every 20 minutes. Set a timer so you won't forget. Avoid leaning your head forward for extended periods or turned to one side for extended periods. Rearrange your computer desk for better body mechanics if you need to. Make sure you have low back support when sitting. When we sit, the curve in our low back flattens out and forces our head forward, straining the neck muscles. A low back support that helps maintain the lumbar curve will help to sit more vertically, lessening the strain on the neck.

Let me know how this works for you!

P.S. If you found this helpful, will you do me a favor? Tell your other massage student friends and ask them to visit this site. Help me get the word out so this site can be a resource for others, too! Thanks!

How To Contact Us

2008-10-29T13:54:00.007-05:00

If you have a comment or a question about massage therapy in general or about a point raised in a particular article, please leave your question or comment in the "Comments" section of that article or in the section "Ask Your Questions Here!"

However, if you need to contact me personally, send an email to:

askthemassagetherapist [at] gmail.com

Of course, I've spelled out the "at" symbol in an effort to foil the bots that roam the internet harvesting email addresses so they can spam them. Be sure to use the appropriate symbols for "at."

I look forward to hearing from you!

Thanks,

Alice

Back Pain: Part II Muscle Strain

2008-10-29T10:11:00.004-05:00

Perhaps the easiest type of back pain to resolve is simple muscle strain from overuse. Most of us have experienced this at some point in our life. We may have spent too much time working in the yard on a nice day when we haven't been accustomed to the activity. Perhaps we've been sitting too long at the computer, in meetings, or on a long car ride. Fatigue and overuse take their toll and we find ourselves feeling stiff with a dull, nagging ache.

Such a simple strain can respond well to rest and perhaps modest use of non-prescription pain relievers. It often will resolve itself in a day or two, although the symptoms may linger for longer periods. If this common back ache will pass with time and rest, why use massage therapy?

There are two very good reasons to use massage therapy at a time like this. First, massage therapy can speed recovery. Second, recovery can be more thorough with massage therapy.

Let's look at the advantage of faster recovery: Life keeps coming at us and back pain can interfere in our ability to live fully. It may keep us from doing the things we want or need to do. Even when we are functional, feeling sore and stiff can distract us and drain our energy. Let's face it: being in pain and feeling stiff is no fun. It makes us feel tired, old, and cranky. Why spend any more time in that state than we need to? Life is difficult enough without adding unnecessary strain.

Massage therapy can hasten recovery and return us to being fully functional more quickly. When we are unburdened with unnecessary tension and pain, we move with ease and regain our natural energy. Who wouldn't want that?

In addition, massage therapy can promote a more thorough recovery. Muscles are like elephants: they never forget. Even after the obvious signs of strain pass, there is often tension that lingers in the muscles that is not obvious to us. Although this low-grade tension is tolerable, it erodes our ability to move freely and saps our energy. That chronic low-grade tension is actually work! Your muscles are wasting energy staying tense while they aren't accomplishing anything but adding to your feeling of stiffness and vague fatigue. This state can persist for years. We don't know it, but it's there, making us feel tired, stiff, and distorting our posture. In some cases, the muscles finally give out and go into spasm, leaving us wondering why a simple task such as taking out the trash caused our back to "go out."

Massage therapy can help "erase" the memory of that muscle strain and assist muscles to return to a more normal, fully functional state. By relaxing the muscles and restoring them to their natural state, chronic tension is eliminated. The low-grade stiffness and fatigue that could have plagued us for years is replaced by a natural ease and energy that should be our normal state. The likelihood of a simple task, such as taking out the trash, becoming a major incident is reduced.

It is much easier to stay well than to get well. By using massage therapy to get well quickly, we will stay well more easily.

Your Testimonials Can Make A Difference!

2008-10-28T16:12:00.004-05:00

Have you experienced a particular benefit from massage therapy, either at my hands or at the hands of another therapist? Would you be willing to share your story? By sharing your experience, you could make a difference in someone else's life.

If you have found relief from pain, either chronic or acute, please tell us. It might help someone else find their own way out of pain.

If you are an athlete who has improved your performance, recovered more efficiently from an injury or a competition, or found massage therapy an important part of your training, sharing your experience might help another athlete achieve their goals. If you are a performing artist who has appreciated what skilled hands can do for you, let others know about it.

If you have found relief from the stress of everyday life and the sense of well-being that massage therapy can bring, let others know so they can experience it for themselves. If you are someone who just enjoys feeling good and likes getting a good massage, let us know about that, too. Feeling good is reason enough.

How do you post your testimonial? It's easy! At the end of this article you will find some small gray print. You'll see the word "comments" or "post your comment." Click on that and it will take you to a box that says, "Leave your comment." Write your comments there and click "post." Your comment should show up after the article pretty quickly.

I really do believe that helping to alleviate pain and creating a sense of well-being in people is one small way to make the world a kinder, gentler place. Help me to help others by telling your story. I appreciate the encouragement and support I've received over these many years from each and every one of my clients and others who have shared their experiences with me along the way. Thank you to all of you.

Massage Therapy and Back Pain: Part I

2008-10-28T00:43:00.005-05:00

Mark asks, "Can you explain how massage helps each of the different types of back injuries: spinal (disc), nerve, and muscle (or tendon)?

Are there injuries where rest or exercise is the better treatment?"

That's an excellent question and a complex one. I'll try to answer as concisely yet thoroughly as I can, but the short answer is this: back pain can be a complicated problem and there is no short and easy answer to the question. However, in most cases I've encountered, massage therapy can be a helpful addition to other treatments, such as rest or exercise, and promote faster and more thorough recovery.

First, let me emphasize that a massage therapist is not qualified to diagnose any condition. Only a qualified physician can diagnose whether your back pain is due to a herniated disc, muscle strain, nerve irritation, or a combination of factors. When in doubt, always consult your primary health care practitioner. Especially when there is numbness, loss of function such as foot drop, or pain when there has been no history of pain and no obvious cause, medical attention should be sought promptly to determine the cause of pain. Sometimes back pain can be caused by very serious conditions that need immediate attention.

Back pain can take many forms and have many causes. It can range from mild discomfort from overexertion to serious, debilitating pain that interferes with any movement at all. The causes may be sore and tight muscles, trigger points, nerve irritation or entrapment, disc degeneration or herniation, or other factors. There can be a combination of factors.

Each situation is unique and treatment needs to address the particular problems involved. Often treatment will involve more than one modality. Rest, ice, heat, traction, chiropractic adjustments, acupuncture, and massage may all be utilized, either alone or in appropriate combinations. Medications for relief of pain and/or anti-inflammatories may be recommended, either prescription or non-prescription drugs. Again, recommendations for medications should always come from the physician.

In most of the cases of back pain that I've encountered, massage can be a helpful addition to other therapies provided the therapist has the skills to handle the situation appropriately. If the therapist is unsure of their skills or what the nature of the condition is, it would be best to do nothing. The first rule is always to do no harm. For the massage therapist, it is always better to err on the side of caution. Too little may be ineffective but it will not hurt the client. Too much might make the client worse. When in doubt, don't.

I would not massage a person whose pain was strong, of sudden onset, with no history of pain or no obvious reason for it until they had been evaluated by a physician. I would not touch a person who was experiencing loss of sensation or control, such as foot drop, until they had been evaluated by a physician. I would not treat any person whose physician or physical therapist had recommended they not receive massage therapy.

Outside of those circumstances, skilled massage can often be a helpful addition to other treatment recommended by the primary health care practitioner. The choice doesn't need to be massage or rest or exercise. Massage, in addition to the rest or exercise, can help speed the healing process and can help recovery to be more complete.

Many chronic pain problems began as an acute injury that was not properly or thoroughly treated. Tightness from the initial trauma can remain in the muscles for years. The client may be aware of its presence through a persistent tightness or ache. Or it may be so low grade that the client is not aware of this continuing tension in the muscles, but it is still there waiting for the next opportunity to flare up. "All I did was bend over to pick up the trash and wham! - my back went out!" How often have you heard that? It isn't the trash. It's usually low-grade tension that keeps building until finally one movement becomes the straw that breaks the camel's back and sends the muscle into an acute spasm.

In the next few entries, I'll talk about some of the specific conditions that can cause back pain and exactly how massage therapy can help.

How Do I Ask A Question?

2008-10-27T17:08:00.006-05:00

Jean asks, "How do I ask a question?" It's very easy.

I've created a section specifically for your questions titled "Ask Your Questions Here!" You can find that section easily by clicking on the label "Ask A Question" at the top right side of the screen. You'll be led to an entry inviting your questions and at the end of that entry you'll find some small print that starts with the words, "Posted by Alice Sanvito." It will give the time it was posted and, following that, it will say, "comments." If you click on that word "comments," it will take you to a page with a box where you can leave your question or comment. After you've written your question, you can select "publish your comment" or "preview." When you are satisfied with what you have written, select "publish." Your question will be forwarded to me and I'll respond as soon as I am able. Your response may come as its own article or entry, such as this one, or if it is a short response it may be posted in the comment section after your own comment.

Questions and comments about other articles may be posted in the comments following those articles. Every new entry is followed by a place where comments can be made. If your question or comment is specific to a particular entry, you can post your comment at the end of that entry. If you have more general questions or a topic you'd like to see covered, post it in the "Ask Your Questions Here!" section.

It's very easy. Thanks for asking!

Ask Your Questions Here!

2008-10-27T12:41:00.003-05:00

Do you have a question about massage therapy?

If you have you never tried it but are curious and would like to know more, this is your opportunity to ask questions. Don't worry, your questions are not silly! If you are thinking of them, someone else is probably wondering the same thing, too. Do both of you a favor and go ahead and ask!

Are you an existing massage client who has questions? Please ask! I'd love to try to answer them.

Are you a beginning massage therapist who would like some input from an experienced therapist? We all start out with a lot of questions, from how to handle specific conditions to client/therapist relationships to getting those pesky oil stains out of the sheets. I've been practicing for seventeen years and would love to share the benefit of my training and experience with you.

Are you an experienced therapist who has some specific questions and would like another therapist's input? We never quit having questions and it's wonderful to have other experienced therapists to talk to. Get another experienced therapist's point of view.

Whoever you are, you are invited to submit any questions you may have. I'll do my best to answer them and be honest when I can't.

I look forward to hearing from you.

Russian Massage Protocol for Fibromyalgia

2008-10-27T09:51:00.000-05:00

Russian Massage is unique in that it is a system of massage entirely based on physiology. Developed in the former Soviet Union as a medical massage, sports massage, and part of their physical therapy, it is supported by over 150 years of serious scientific research. What this means is that they have investigated the various strokes and examined exactly what physiological changes each of these strokes, when done in various ways, produces in the body.

In Russian Massage, the approach taken towards fibromyalgia is to calm the central nervous system (CNS). The idea is that when the central nervous system is normalized, everything in the body functions better. This systemic approach is also used for chronic fatigue syndrome; I have also used it successfully on a client with sarcoidosis.

Russian researchers have found that the central nervous system responds best to shorter and more frequent treatments. Too long of a treatment can backfire and too infrequent is ineffective. The more severe the symptoms of fibromylagia, the shorter and more frequent the treatments should be. They have also found that the CNS responds best to regularity and so, ideally, the treatments are best given at evenly spaced intervals, preferably at the same time of the day.

Since the goal is to soothe the CNS, Russian Massage for fibromyalgia uses only very soothing strokes. Continuous effleurage and vibration on the back and the back of the legs is done for twenty to thirty minutes. This gentle, rhythmic treatment is very relaxing and causes absolutely no pain to the client. The client enters a deep state of relaxation and, since the treatment is relatively short, rises relaxed but regains alertness quickly.

Treatment sessions are usually 20 to 30 minutes each, twice a week. If the client is particularly flared up, treatments are shortened to no more than 20 minutes and increased to three times a week. Treatments are repeated for 12 to 15 sessions and then interrupted for two weeks. This repetition followed by an interruption in treatment allows the body to become accustomed to being more relaxed but not dependent on the treatments. It also prevents the body from becoming so accustomed to the treatments that it no longer responds to them.

In many cases, if the client is taking sufficient care of themselves outside of the treatments, they will start to experience a reduction in the severity of their symptoms within four or five treatments. Significant reductions in symptoms are often experienced by the end of the 12 - 15 treatments. If further progress is desired, another cycle of treatments may resume after the two week break. This cycle of 12 to 15 treatments with a two week break may be repeated as often as necessary until the desired results are achieved. As symptoms are reduced and the client begins to feel better, treatments should be tapered off. Intervals between treatments may be increased. Eventually, treatments can be reduced to once a month to help maintain improvement. At the first sign of flare-up, the client should resume more frequent treatments. If this is done before symptoms have seriously increased, return to a more normal state is often achieved more quickly.

Outside of the massage treatments, it is imperative that the client do everything they can to support their physical and mental health. A relatively healthy diet is a must. Alcohol, cigarettes, and caffeine should be kept to a minimum. Clients must maintain regular sleep habits and get adequate sleep. Unnecessary stress needs to be reduced or eliminated. Exercise is important. It is often recommended that patients with fibromyalgia exercise three times a week. However, one doctor has found that his patients who exercise every day get the best results and if they miss even one day, they feel worse for the next two or three days. It is not necessary to exercise the painful muscles to benefit. The effects seem to come from the overall hormonal effects of the exercise.

Over the years, almost every one of my clients with fibromyalgia who has followed this protocol has reported good to excellent improvement. The exceptions have had complications from other conditions.

As with any medical condition, massage therapy is not a substitute for proper medical attention. Massage therapy, however, can support other therapies and be a powerful adjunct.

One client, whose symptoms had gotten severe enough that she did not think she could continue working, told me after two months of treatment, "This has allowed me to stay in my job."

I firmly believe, based on my own experience and validated by investigations at the Touch Research Institute at the University of Miami Medical School, that the right kind of massage therapy could provide safe, natural relief to many who suffer from fibromyalgia. It is certainly worth giving it a try.

Natural Relief for Fibromyalgia

2008-10-26T15:30:00.001-05:00

Fibromyalgia (FM) is a poorly understood chronic pain condition that primarily afflicts women. Patients with fibromyalgia complain that they feel fatigued and ache all over as if they have the flu. They are generally otherwise healthy women and there seems no obvious reason for their pain. Many were very productive before they became afflicted. Symptoms can range from mild to severe but will persist for years. There is no known cause and there is no known cure. I once asked a pain management specialist what treatment conventional medicine had to offer fibromyalgia patients and his response was, "Not much." More recently, a new drug has been introduced that may offer relief to patients with fibromyalgia.

When I first began to practice massage seventeen years ago, it was difficult to find information about fibromyalgia. What information was available was often vague, confusing, and conflicting. At least half of all rheumatologists did not recognize fibromyalgia as a diagnosis and many sufferers went years before being diagnosed. Women often told me they hesitated to see a doctor because, as one put it, "I don't want them to tell me it's all in my head." When they were finally diagnosed, they were often told there was nothing to be done about it. What was a person with fibromyalgia to do? What was a massage therapist with fibromyalgia clients to do?

In my experience, the pendulum seems to have swung in the opposite direction. In recent years, a woman in pain is often told she has fibromyalgia whether she fits the profile for a diagnosis of fibromyalgia or not. I even had one healthy young woman, who had no pain, fatigue, or other symptoms, report that she was told by a doctor (who had never seen her before and was a sub for her regular doctor) that she had fibromyalgia. Two other female clients, who were later diagnosed with and treated successfully for frozen shoulder, were initially told that they had fibromyalgia. What's going on here?

Unfortunately, musculoskeletal pain is not well understood by many doctors. Overworked physicians who are under pressure to see too many patients in a day often do not feel they have the time to thoroughly investigate their patient's pains, pains which may be vague, not easily diagnosed, and do not seem life threatening. It's easy to dismiss them with a diagnosis of fibromyalgia. When these clients come to my office, I do what I can to relieve their muscular pain and help them to determine what perpetuating factors may exist in their daily lives. When it is clear that they need additional help, I direct them towards doctors, chiropractors, and physical therapists who I know will take the time to help them resolve their pain.

But what about the clients who truly have symptoms of fibromyalgia? Can massage therapy help? And, more importantly, what kind of massage therapy?

Fortunately, I met a Russian Massage teacher, the well known Zhenya Kurashova Wine. Russian massage, developed in the former Soviet Union, is supported by over 150 years of serious scientific research into the physiological effects of massage on the body. They can tell you, with evidence to support it, exactly how a particular stroke done in a particular manner will affect the physiology of the body.

I'd been taught to use deep tissue massage on clients with muscle pain but I quickly noticed this made clients with FM only worse. I'd started to lighten up but was afraid I wouldn't be effective. When I began to study with Zhenya, she taught me very specifically how to work with clients with fibromyalgia. As soon as I began to take her advice, I began to get much better results. And when my clients with fibromyalgia followed the suggested protocol, they reported a significant decrease in the severity of their symptoms and the frequency and intensity of flare-ups.

Tomorrow I'll describe the Russian Massage protocol for fibromyalgia and also mention some other conditions for which it has worked well.

Free Chair Massage at Kaldi's Kirkwood

2008-10-25T17:30:00.006-05:00

If you were hoping to get a free chair massage - sorry, the event is over! However, Anne Thomassaon, Maureen Hoock, and I spent three hours giving free massages to the patrons of Kaldi's Coffee Company in Kirkwood. The occasion was Massage Therapy Awareness Week, sponsored by the American Massage Therapy Association. The purpose was to increase awareness of what massage therapy can do for you.

Anne is a member of Kaldi's bicycle team and more than one bicyclist took advantage of the opportunity for a free massage. Other customers included students, a police officer, new parents, and a roller derby queen! We massaged people of all sizes, shapes, and ages, those with aches and pains and old injuries and those without. Many of them had never had a massage before! Every single one of them said they enjoyed the experience and they felt good after only a ten or fifteen minute massage.

Thanks to Anne for organizing the event and to Kaldi's for offering us a place to have it. Kaldi's took great care of us and we are grateful for this opportunity to bring massage to people who might not otherwise experience it.

Living Without Pain

2008-10-25T12:55:00.001-05:00

So many people live with unnecessary pain. Are you one of them? I'm astounded and dismayed at the number of people who believe that they have to live with their aches and pains, pains that could be alleviated, often quickly and easily. They seem to believe that there's nothing to be done. They say, "I guess I'm just getting old." Are you one of them?

Is that really true? Is pain an inevitable part of life at 40? 50? 60? If you feel that badly now, what will you feel like ten years from now? Do you really want to spend the rest of your life in pain when it isn't necessary? What kind of life is that?

How do I know that you can feel better now? Quickly, easily, and naturally? Because I've seen it happen hundreds of times and I've experienced it myself.

I am not going to tell you that all your aches and pains will vanish in an hour massage. It simply isn't true. However, what I can tell you is that the vast majority of clients get up from my table feeling significantly better than they did when they first lay down. In almost every case where pain relief is the goal, they experience at least some immediate reduction in pain.

There is no magic bullet for chronic pain. But if there were a magic bullet, massage would be pretty darn close to being it. I'll estimate that at least 90% of my clients say they "feel a lot better" when they get up from my table. Massage can work wonders. And I'm not talking about any massage. I'm talking about the right kind of massage.

"What?!" you say. The "right kind" of massage? What do you mean by that? Are you talking about "sports massage," "Swedish," "deep tissue"? Not exactly. What I'm talking about is this: does the massage therapist know exactly what to do, specifically what combination of strokes, will be most effective at relieving your specific problem? Do they know the difference between using massage for today's muscle strain and a chronic condition that has existed for years? Or do they do the same massage on everyone that walks in the door? You see, the right kind of massage can be very effective quickly. The wrong kind of massage at best will be ineffective and at worse may make you feel worse.

I'll be coming back to this topic of specifically what kind of massage will best help you and how it can make a difference. I'll be returning to this idea of living without pain. And I'll be reminding you again that you don't need to live in pain, that you can feel better naturally. But you must be willing to do what it takes.

I'm not going to tell you that I have the only answer to your pain. Chronic pain can have multiple sources and perpetuating factors. Finding them and addressing them can require persistence and a willingness to be investigative. Chiropractors, doctors, physical therapists, changes in habits may all be a part of the long-term answer. Part of my job is educating you, the client, how to take care of yourself outside of my office so that you can live a life that you love, free of unnecessary pain and stress.

Yes, pain and stress are an inevitable part of life and in some cases there are conditions that just aren't going to go away. Even in those cases, the severity of symptoms can often be reduced. Usually the condition can be managed in a way that at least some relief can be achieved. For most of us, though, the aches and pains that plague us can be reduced and often eliminated.

The choice is yours. Will you make the choice to live without pain? Or will you keep plodding along, burdened by life's stresses and strains? Which will you choose?

Welcome to Ask The Massage Therapist!

2008-10-24T21:36:00.001-05:00

Hello! And welcome to Ask The Massage Therapist! I'm Alice Sanvito and I'm excited to be here to answer your questions about massage therapy. I'll be sharing some of my experiences as a massage therapist over the last seventeen years and perhaps a few other things that I hope will be of interest. Your questions and comments are welcome; I'll respond as best I can. I'll be sharing with you my own unique approach to massage therapy that's developed over these many years of experience. I love helping my clients learn how to feel better and perform better and have a strong preference for evidence-based therapies. Check back frequently to see what's new and let me know what you think!