Carpal Tunnel Syndrome during Pregnancy

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

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

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

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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

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!