Make the Most of Massage

Category: Accelerate Massage Business (30K – 60K+)

  • Tension Headaches: A Muscle Overlooked

    Tension Headaches: A Muscle Overlooked

    Not one of my clients would ever pass up on suboccipital work for a tension headache.  But as good as suboccipital work can be for relieving headache symptoms, there’s evidence to suggest that jaw muscles could also be contributing to tension headaches. And one in particular—the masseter—is easy to overlook.

    Why Jaw Muscles?

    Jaw muscles may be involved in tension headaches via trigger points. In general, a trigger point can be looked at as a tender, soft or tight area within a muscle that can produce pain elsewhere.

    Why would jaw muscles have trigger points? Science writer, Paul Ingraham speculates that dysfunction could be one reason.

    Partial Antagonist

    The suboccipitals along with other neck muscles help balance the head on the spine. Interestingly, the jaw muscles act as partial antagonists to the suboccipitals.

    Really? But they’re not connected to the spine so how can they act against the suboccipitals to balance the head?

    According to Ingraham, it doesn’t matter if they are connected: “…muscle studies have shown that the jaw muscles behave much like they would in a more normal push-pull relationship with the suboccipitals. They function together and dysfunction together.” (Quote taken from PainScience.Com)

    Dysfunction stresses muscles, and it’s reasonable to assume that trigger points could develop as a result of the added stress to the muscles.

    It’s also worth noting that the masseter is a muscle used for grinding and chewing. The combination of dysfunction and muscle overuse could ramp up muscle tension even more.

    jaw-muscles

    Spread the Rub

    Even knowing this (thank you Paul Ingraham), I sometimes still forget to work the masseter—mainly because it’s not right next to the headache area.

    Meanwhile, muscles that are close to or are part of the area where the headache is occurring, like the temporalis, get lots of my rubbing. That’s why I have to constantly remind myself to spread the rub. Sorry.

    My Approach

    I don’t believe there’s one pain-relief massage formula for tension headaches. Here’s one that works for me:

    Step 1: Go to the headache pain.

    I always go to the headache pain area first for two reasons. One, I want the client to know that I’ve heard her by addressing her actual headache area. When I do this, I’m building  therapeutic rapport.

    Two, if I can desensitize (reduce the pain in) the headache area, my client will start to reap the benefits of a calmer central nervous system.

    By the way, to understand if I’m effectively reducing a client’s pain,  I use a pain scale. Here’s the video for the pain scale approach: Pain Relief Massage: How to Find the Right Pressure Video.

    Step 2: Work any area the client associates with the headache.

    If the person has pain somewhere else (neck or jaw) before or at the same time the headache actually occurred, I work that area using the pain scale system.

    By doing so, I further connect with my client because I again show her that I’m listening to her. Secondly, I can start to desensitize a secondary pain area and continue to evoke a parasympathetic response.

    Step 3: Get that masseter before you forget!

    Finally, I cover the other neck and jaw muscles that weren’t covered in steps 1 and 2–like the masseter!

    Here are my “at the bare minimum have to get muscles” on my tension headache hit list:

    Temporalis

    Masseter

    Suboccipitals

    Jamaar’s Headache

    Here’s what it looks like in action. Jamaar came into my office complaining of headache in the front and sides of his head. As we continued to talk, he grabbed the base of his skull and said that he thought it started there.

    When I got him on the table, the first thing I did was to reduce the pain in his temporalis and frontalis muscles (the headache pain). Next, I reduced the pain in his suboccipitals (the area he grabbed and associated with his headache pain).

    Lastly, I worked the remaining muscles that could be contributing to his headache pain, like the masseter.

    Once all the work was done, I finished up with a scalp massage. Hmm…that sounds pretty good. Sign me up!

    Quick Glance

    Tension headaches are in our pain-reduction wheelhouse. I’ve found these keys to be helpful when treating clients with tension headaches:

    1. Communicate with the client to gauge if you’re helping her. I use a pain scale system: Pain Relief Massage: How to Find the Right Pressure Video.
    2. Go to the headache pain.
    3. Work any pain area the client associates with the headache.
    4. If you haven’t already gotten them, go for the temporalis, masseter, and suboccipitals.

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  • -ITIS vs. -OSIS: Why You Need to Know the Difference

    -ITIS vs. -OSIS: Why You Need to Know the Difference

    Research has shown that most people diagnosed with conditions like plantar fasciitis actually don’t have inflammation (-itis) anymore. Instead they have a condition (-osis), like tissue degeneration.

    The medical treatments for tissue inflammation and degeneration are different and may negatively impact treatment outcomes if misapplied. By understanding the difference between the two diagnoses, you can not only fine-tune your massage, but you can also help your client get the correct diagnosis and find the best medical treatment.

    The Past

    It’s a common misconception that inflammation is always associated with tendon/fascia problems. But when researchers examined the tissue of people with conditions diagnosed as plantar fascittis (research study), they didn’t find a lot of inflammation. Instead they primarily found collagen degeneration.

    [bctt tweet=”Most plantar fasciitis cases are degenerative not inflammatory. This changes treatment.” username=”Mark LiskeyMarkLiskey”]

    So What?

    This is big. For one, if a tendon/fascia condition is not an inflammatory condition, then “corticosteroid injections and nonsteroidal antiinflammatory medications (NSAIDS) may not be the most effective options”.

    This could mean that your client who has persistent plantar fasciitis may never have had the appropriate treatment plan.

    What May Help?

    Preliminary research (plantar fasciitis study, hamstring tendinopathy study) suggests that eccentric strengthening exercises may be helpful with -osis conditions (which is what most people have).

    But since many doctors still bundle the terms tendinitis and tendinosis together, they may not appreciate what this can mean for the person in terms of treatment and treatment outcome.

    What’s It Mean for Us?

    Knowing the difference between –isis and –osis changes how I work with a client before, during and after the massage.

    Pre-Massage

    For example, let’s say Sabrina is a runner and she comes to my office with a diagnosis of tibialis posterior tendinitis. First, I’m going to check for visual evidence of inflammation. Is there swelling in the tendon/attachment areas and are they warm?

    During the intake, I will find out if her condition has been persistent (staying the same or getting worse over a course of many weeks). What treatments has she had? Did she have injections that gave her temporary relief? Typically, the positive effects from injections are short lived when it’s a tendinosis condition (Treatment of Tendinopathy: What Works, What Doesn’t and What’s on the Horizon).

    If there are no visible signs of inflammation and Sabrina has had the condition for a while, I’m going to treat her condition as an –osis.

    During the Massage

    This means that I’m going to massage the tendon and foot attachments, rather than avoid them. However, using a 1 – 10 pain scale, I will only work within a 3 – 4 to reduce the pain in these areas. In the surrounding area and the body of the tibialis posterior, I will work in a 4 – 5.

    For a quick tutorial on the pain scale system I use, check out this Pain Relief Massage: How to Find the Right Pressure video.

    Post-Massage Recommendations

    Here comes the tricky part. If you suspect that your client is misdiagnosed and she should get rechecked, you’re going to want to put that bug in her ear. Here’s how I do it.

    First, I lay the groundwork during the intake. After I look for inflammation and consider my client’s injury history, I explain my treatment plan. This is the perfect time to mention the research around “-itis” versus “-osis”.

    Next, since I use a pain scale approach when working tendon/fascia conditions, I’m regularly interacting with the client throughout the massage. This would be another opportunity to talk about “-isis” versus “-osis”.

    I’ve found that during this time the client will often circle back to the pre-massage conversation of finding a solution for her condition. At this point, I go deeper into the topic of “-isis” versus “-osis”.

    After the massage, I do a wrap up. In the wrap up, I tell the client what I did and what I think might be helpful going forward, like getting rechecked to make sure she has the correct diagnosis. It’s not uncommon for me to start by saying, “If it were me…” or “If it were my (fill in the body part)…”.

    Follow-Up

    Finally, I follow up 2 to 3 days after the massage. In this conversation, I don’t press the client about going back to make sure the diagnosis is accurate, but I will give her my opinion if she asks for it.

    Ultimately, my goal is to provide my client with the most current information so that she can make an informed decision about her tendon/fascia condition.

    Getting it Done In 3 Steps

    If you think your client has an “-osis” condition instead of an “-isis”, help her this way:

    1. Tailor your massage to reduce her pain by using a pain scale system and appropriate pressure.
    2. Make her aware of the symptom and treatment differences between “-osis” and “-isis”.
    3. Follow up and answer her questions.

    At times, you may feel like an outsider because you’re operating with the most current information which, in this case, challenges conventional thinking. But your client will thank you for your effort—especially if you can help her get out of pain.

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  • How to Crush “Getting More Clients”

    How to Crush “Getting More Clients”

    If you’re waiting to feel like a pro before you open your massage practice, you’re wasting precious time. Instead of waiting, think about doing the opposite: put yourself out there.

    Putting yourself out there means that no matter how uncomfortable you feel and/or how low your confidence is, you are in front of the people who can refer clients to you.

    But I’m Weak

    This may seem counter-intuitive— showing the world your massage talent when your confidence is shaky—until you view confidence as a moving target.

    When a client sings your praises you feel pretty good, right?  But a couple of days in a row with no work and you doubt if you can even spread cream.

    The truth is that everyone waxes and wanes with confidence. When you’re waning, here’s a technique to help you along: How to Stop Feeling Like an Impostor.

    Holes In My Massage

    But what if your lack of confidence is partially due to the fact that you have holes in your massage? Great! If you’re putting yourself out there, you’ll now have an immediate need to plug the holes.

    Early on in my career, I wanted to be a pro with pain and muscular conditions. However, my anatomy was weak. One day a chiropractor called and asked me to fill in for a sick MT. That quickly lead to a full-time job and suddenly body parts were flying at me. I needed to get up to speed on anatomy fast!

    So before my shift, I’d call the chiropractor to get my client list (and their conditions) for the day. Then I’d  study the anatomy that pertained to each case before I went in. It worked.

    The reality is that most holes that need to be plugged are a lot smaller than we think.  To quickly patch holes when doing relaxation and pain relief massage, check out my posts New Therapists Can Be Good Therapists and Competing with Bob for Clients.

    Putting Yourself Out There

    There are a lot of ways to put yourself out there and get in front of referral sources. I like this 4 step process. It reduces the scariness by easing me into the process.

    Step #1:  Ask Your Current Clients

    Approach your regular clients for referrals, but instead of simply asking them for referrals, give them an incentive to refer to you, like a free massage for each referral. If you have an email list, you can announce your referral program to everyone all at once. Check out How to Email in More Clients for help.

    Step #2:  Email/Call Other Health Professionals

    Next, do a Google search for local businesses with referral potential. Look for businesses that do NOT have massage as part of their business. My list includes: chiropractors, pain management doctors, personal trainers, individual physical therapists, yoga and Pilates studios, country clubs (tennis and golf), cycling shops and running stores.

    Once you have your list, it’s time to call or email to introduce yourself and make a special offer. As a special offer, free demo massages have worked spectacularly for me.  Here’s a demo-massage email [download id=”688″] that I sent to personal training studios. You’ll need to modify it, but it shows you the main points to get across.

    In the email you’ll notice that I offer the demo massages to the business owner, her employees and her clients. In fact, I give the business owner and her employees each 60 minutes of free massage and her customers/clients 15 to 20 minutes.

    My first goal is to win over the business owner and her employees. If I do, they will champion my service to their customers/clients.

    Step #3: Special Intro Offer

    After the demo-massage customer gets off my table, I tell him about our special intro rate. (Our special intro rate is $45.) If the person liked the demo massage, the special intro rate is hard to pass up. Keep your schedule nearby in case someone wants to make an appointment right then. Seriously.

    Step #4: Ask the New Clients from the Demo Massages

    The people from the demo massages who are now your clients are potential referral sources, too. If you have a referral program, let them know about it. If a demo massage client works at or owns a business that’s a good fit with massage, offer to do demo massages there.

    Putting Yourself Out There Is Currency

    It’s not an overstatement to say: “Putting yourself out there” is currency that you spend to build a practice.

    And you don’t need to be an extrovert to put yourself out there. Most of us aren’t. You just need to follow a plan:

    1. Give your current clients a referral incentive.
    2. Email/call businesses and offer to do demo massages.
    3. Tell the demo-massage customers about your special intro rate.
    4. Offer demo massages to new clients who work for or own a business that’s a good fit with massage.

    Free Course to Jumpstart Your Massage Business

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  • Don’t “Wear a Fancy, Red Tie” When Treating Sciatica

    Don’t “Wear a Fancy, Red Tie” When Treating Sciatica

    When I was a kid, Dr. Grant made me feel better as soon as he walked into the examining room. He always had a smile on his face and I liked his fancy, red tie. Later in life I was shocked when I learned that his fancy, red tie could actually have been harmful to patients. A study showed that neckties worn by surgical technicians carried a lot more disease-causing pathogens on them than neckties of other hospital workers.

    In massage, we have our own “fancy, red tie” oversight. The way you position a sciatica client on a massage table may seem unimportant. However, if positioned incorrectly, it may actually make the condition a whole lot worse.

    Lower-Back Nastiness

    Sciatica is irritation of a lower-back spinal nerve, and a sufferer may experience pain, numbness and/or muscular weakness in the buttock and legs. Pain can be intermittent or constant and depending on where the nerve compression or irritation is occurring (L4, L5, S1, S2 and S3), the symptoms can manifest in different places.  For example, John, a sciatica client of mine, had pain that bent him over and traveled all the way down into his foot.

    Body Position is Key

    Since sciatica symptoms vary depending on where the spinal nerve is being compressed, no single body position will relieve symptoms for everyone. Some sciatica sufferers can’t find a comfortable sleeping position and constantly wake up at night. Others have less trouble sleeping but more pain when they’re sitting or standing.  John had no problem standing, but ask him to sit and, during the acute phase, the pain was unbearable. On the table, the importance of body position is no different.

    Beware of Prone

    I’ve found that having a sciatica client in the prone position, especially for a long period of time, can aggravate the condition. In addition, a prone client leaves the door open for the MT to ratchet up the pressure. More pressure in the lower back/sacrum area could further tick off already angry nerves. Lastly, if you kick up the pressure, a sciatica client may not notice anything while on the table, but she’ll probably feel more pain once she’s up. Though John never said that lying facedown bothered his back, I limited the time he was facedown just to be safe.

    Think Sleeping Position

    If we limit facedown time during a massage, then we have to add in supine and/or side time. To determine which position is the best for the client, ask her: “Which position do you sleep in now?” Most will tell you either on their right or left side. The best sleeping position is your go-to position when working on the sciatica client. John’s sleeping position was his left side, and that’s the position I had him in when I did the majority of my work. Regarding supine, I can’t remember a sciatica client preferring face-up sleeping. But if so, it’s not impossible to work with your hands under the back while your client lies face-up.

    Double-Check

    Sometimes a client is not in tune with his sciatica pain and could be inadvertently giving you bad information. If you suspect this, do more digging. First, make sure he’s providing you with his best “after my sciatica acted up” sleeping position. Also, is he loading up on pain medication at night which is “allowing” him to be in a bad sleeping position? John knew exactly which sleeping position worked best for him—and so do most clients. But, if in doubt, opt for side-lying, and then pick a side. Check to see if the pain is increasing. If so, switch to the other side.

    Change Positions

    Working on a sciatica client in one position for the entire massage can irritate a back nerve. If facedown hurts the person from the get-go, choose best side-lying position for 60% to 70% of the time and then throw in the opposite side-lying position the rest of the time. If prone is okay, you can mix that in also. Here’s what body positioning on the table looked like with John:  50% left side (his  “after my sciatica acted up” sleeping position), 25% right side, 25% face down.

    Body Position Checklist

    Body positioning is a simple and overlooked strategy to lessen the likelihood that you’re going to make a sciatica condition worse. Here’s a quick checklist that will help you to effectively manage body positions when working with sciatica clients.  (1) Ask: Does lying facedown bother your back? (2) Ask: What is your most comfortable “after my sciatica acted up” sleeping position? (3) Double-check to make sure that the sleeping position information is accurate. If pain killers were used before bed and/or if you were given “when my sciatica is not acting up” sleeping positions, you have unreliable information. (4) Throughout the course of the massage have the client change body positions on the table. Give it a shot and please let me know if your sciatica treatment outcomes improve!

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