One Minute Tip: Ask about Pre-existing conditions

Here is the easiest way to ensure that you are prepared for your client the first time they show up for a treatment.

 

The best way to prepare for a client, is to do as much discovery as you can before they show up for their appointment.
Make sure you ask them if there are any conditions that you should be aware of prior to receiving a massage treatment.

 

This will hopefully give you ample time to research their requirements before you get them on the table, and will make you feel more confident and prepared.

 

Let us know in the comments here, or on Facebook, or send me an email at sally@dynamicbodywork.co.uk and share how you get on.

One Minute Tips: Loyalty Cards

We all struggle from time to time encouraging our clients to schedule another appointment.

Here’s my quick tip on how to provide value to your services, and reward clients for their loyalty.

 

 

We often thing that Loyalty cards are more for Cafes and Coffee shops, but these are a simple, low cost way to encourage your clients to return to your Massage Practice, or Spa.
Create a 5 or 10 spot visit area on a business card, and each time your client receives a treatment that you feel qualifies, sign and date, or stamp the little window on the card.

Once they have filled in all the spots on the card, they can redeem this for a discount, upgrade or free service from you.
Easy Peasy.

Here’s the other great thing about these little loyalty cards, it means that your clients are ALWAYS carrying around your contact details. It makes it so much easier for them to refer you to another potential client when they can hand over your contact information right there and then.

The pregnancy question finally answered

Pregnancy Massage is a treatment that I have always loved to offer, and it’s one of my favourite classes to teach because you really get an amazing view of how the body works, and all the fine detail of changes that take place whilst a baby is developing in the womb.

Sadly this sentiment isn’t always shared, and it became apparent when I was messaged by a Mum who I met during my pregnancy with Moxie, she was also pregnant at that time and we belonged to an online group for women who were due in the same month.

She reached out because she knew I was in the massage industry, and was worried about an upcoming Spa Day she had booked.

Having just found out she was 6 weeks pregnant, she was worried she would lose out on her booking.

I suggested that she contact the place she was due to visit, and let them know her situation so they can advise her on how they would like to continue.

If they have therapists on staff who are trained in Pregnancy Massage and she has no health concerns or contraindications for pregnancy massage, the treatment she was receiving shouldn’t have been an issue.

She called and they made a note of her condition, and she made the journey with her family for her Spa Day.

I got a call from her whilst she was there, and she was inconsolable. Long story short, they refused the massage which they are entitled to if they don’t feel comfortable with performing the treatment or are untrained, but they went on to treat her pretty poorly.

At one point during the facial portion of her package, she was visibly upset and told by the therapist that she “can’t see what the problem is, she’s pregnant after all, surely thats something to be happy about.”

It made me sad.

If this was a first time mum, I can’t image how upsetting this would have been, but it did make me decide that enough was enough.
I wanted answers. I wanted to know why the “No massage in the first trimester/first 13 weeks” rule is still being taught to students, and I wanted to know whether our Massage Associations and Insurers still adhered to this belief or whether they were updating policies as new research and findings are being released.

I started with writing a list of everyone I felt had an authoritative say in this issue, and I contacted each of the following:

Federation of Holistic Therapists (FHT)
Complementary Therapy Association (CThA)
Complementary and Natural Healthcare Council (CNHC)
The Guild of Beauty Therapists
Balens Insurance
Associated Beauty Therapists (ABT)

I also reached out to the Subject Matter Experts, and contacted Elaine Stillerman, author of Prenatal Massage and Carole Osborne, Author of Pre- and Perinatal Massage Therapy. Both books have been extremely invaluable in the development of our own Pregnancy and Post-Natal Massage course.

 

I am still waiting for a response from ABT and Carole Osborne, but understand they may be very busy and don’t expect an immediate response, however I will update whenever I do receive feedback from them.

The question I asked was very simple:

“Can you provide me with details on your organisations stance on Massage during the First Trimester, and (if you are an insurance company) do you provide coverage for therapists with adequate training on the subject?”

The first response I received was from The guild, and this is what their stance is:

Our policy stipulates – Treatments on pregnant clients
Our insurance policy wording has a warranty that applies to anyone who holds a specific Pregnancy Massage qualification and this must be adhered to be insured

1 PREGNANCY MASSAGE. the INSURED must
(i) have the client’s General Practitioner or Midwife’s consent prior to treatment
(ii) not massage over the abdomen
(iii) not carry out treatment during the first trimester (12 weeks)
(iv) not massage pressure points on both sides of the ankles nor massage the webbing between thumb and index finger

A little disappointing, strike one for an Insurer who won’t cover a therapist performing massage during this term. I am glad that they listed their policy wording, as it highlights their reasoning, and allows us to research further into the claims made above.

The rest of the responses came in pretty swiftly, and I am pleased to say that they were mostly positive in nature.

The FHT provided us with this brilliant response:

We have recently published some pregnancy guidelines for all our FHT members.

I have attached the link for you.

www.fht.org.uk/FHTguidelines/pregnancy

Which is a nicely comprehensive outlay of their thoughts on Massage in the first Trimester, as well as comments on the “danger zones” often mentioned in pregnancy massage discussions. At the end of the day, they recommend attending an in-depth training course on the subject so that you can learn about the physiological changes during pregnancy, as well as safe handling and treatment of a pregnant client.

Ideal!

The CThA followed with suggestions that the client receive permission from their GP or Midwife, and if that isn’t possible signing a waiver to state that they understand what’s involved with a pregnancy massage. I think this is great, and should definitely be going through this with our clients when they attend their first massage during pregnancy.

It is advised that  medical, GP or Specialist permission is obtained prior to treatment– In circumstances where written medical permission cannot be obtained the client must sign an informed consent stating that the treatment and its effects have been fully explained to them and confirm that they are willing to proceed without permission from their GP or Specialist

 

The CNHC unfortunately don’t have a specific clause relating to Pregnancy Massage and have suggested that Therapists contact their Insurers, or relative Associations for additional information. Having a regulatory body like CNHC is great, lets hope that as they build as an organisation, we will see the Massage group more refined as Pregnancy Massage is an area where standards would be very beneficial.

Balens Insurance also referred us to the guidelines laid out during our training and made no mention of an inability to be covered by your insurance policy.

Thank you for your message.  We recommend that our clients follow the guidelines of their training in relation to the treatment of pregnant patients.

 

So I’m very happy with the results, and hopefully this should highlight the fact that we really need to share this information with our fellow therapists, and show them that times are changing and we are becoming more informed in the benefits or effects of massage therapy, and shouldn’t be frightened by it.

To finish up I wanted to leave you with the wonderful response I received from Elaine Stillerman, detailing the details behind massage during the first trimester, and hope it makes you feel a bit more comfortable working with pregnant clients. However please remember that if Pregnant clients is a population that you are unfamiliar with, get in touch with us regarding our Pregnancy and Post-Natal courses, as we’d love to share theory and techniques with you that will blast away those fears.

When a massage practitioner is trained in the correct protocol for prenatal massage,  it is safe throughout the entire pregnancy. How many times have pregnant women failed to inform their practitioners about their pregnancies, and yet nothing unhealthy resulted?

But let’s look at this from an anatomical point of view to understand why this old wives’ tale still persists. There are two compelling factors at play here. The first is the fear of miscarriage. The false assumption is that since most miscarriages occur during the first few weeks of pregnancy, if you don’t massage, you won’t cause a miscarriage.

Most miscarriages do occur within the first 8 weeks of pregnancy, but they are not caused by anything the woman did or did not do. 50% of examined fetal cells indicated that the embryo was not viable. It could not sustain life (blighted ovum, failed mitosis, genetic anomalies, etc). Massage has absolutely nothing to do with that cause factor.

So let’s examine the remaining 50% of known causes for the loss of the pregnancy: anatomical or structural maternal obstructions; ectopic pregnancy; heightened maternal immunological response; hormonal imbalances; and environmental factors (smoking, drugs, toxicity, chemotherapy, etc.) No where is massage a factor.

Serious trauma to the pelvic cavity is another possible cause, but appropriate massage avoids deep pressure to the pelvic or abdominal cavities.

Furthermore, any client presenting symptoms of a miscarriage would never receive a massage from a trained professional. So we have dispelled that theory.

Secondly is nausea. Any client, woman, man, or child, presenting with nausea or vomiting should not receive a massage. 60- 90% of gravidas experience nausea, usually within the first trimester, although some don’t until later on. Massage is contraindicated when  any client has nausea. 0.3-1.2% suffer from hyperemesis gravidarum ( your own Kate Middleton) and should never receive a massage. But if the distress subsides by mid-day, then it is a safe to massage when the waves have passed. And I teach techniques to relieve the nausea.

Bottom line, it is a safe to massage during the first trimester when the practitioner is appropriately trained.

No Pain, More Gain

When I’m working on a client for the first time, there are two reactions that seem to top any other that I get.
The first is, when asking how the pressure feels, through gritted teeth they will say “No Pain No Gain, I can take it”. The second is normally some reflection on a past experience where the massage treatment was a painful ordeal, some may even describe it as horrific, and it then leads to years of them avoiding receiving another treatment.

As massage therapists though, our role is supposed to follow the belief of “do no harm” after all, the work we do is supposed to offer some type of benefit to the client. At the end of the day, regardless of treatment type or therapist, we want our clients to feel good. So why are so many of us still under the impression that a massage has to be painful to be beneficial?

If you haven’t seen a video demonstrating Non-newtonian fluid, check this video out:

What does this have to do with massage?
What we see when demonstrating the Corn Flour suspension similar to that in the video above, we see that applying force or pressure to the suspension is greeted with resistance. If we were to place our hand onto a corn flour suspension, and just rest it there lightly, the suspension would give way and our hand would slowly sink into the mixture.

This is the key to achieving great results when we massage, especially if we are hoping to work muscles that lay deep within the body.

When massaging, we tend to work generally, then specific, then generally again to finish up. If we were to go straight into a treatment working hard and deep with no warming of the tissue, or work with the client the client will most likely tense up. Contract the muscles in the area we are working, and probably end up feeling a bit weary of us.
How are we going to get results if our client is on edge and can’t relax?
If the superior muscles of the body are contracted, we’ll never be able to reach those underneath.

You can’t tickle a feather when it’s laying under a rock.

The Telegraph published an article in August titled “The Sheer Hell of Sports Massage.”

The title is just the first thing that I have issues with, as well as the term “Sports Massage”, Oh and the mention of Toxins Arghhhhhh but that’s a blog article for another time.
Just reading the title shows that this belief is something many people far and wide truly buy into.

But lets talk about pain for a second, because the problem with identifying pain is that it is very subjective. It’s what we personally perceive. What may feel pleasant to one person, may be absolute agony to another. This is why we use pain scales. A scale of 1-5 can be quite limiting, so I like to extend it to a scale of 1-10.

It gives us several ways to interpret the pain that our clients are experiencing.
First we have the number on the scale, I always ask where they feel they are on the pain scale “at rest” this is just sitting around relaxing, no physical exertion or strange positioning.
I then ask them to compare this to when they are in pain from their illness or injury, and identify where it would be on the scale.

Personally, I never want to cause any more pain than what they are currently experiencing. There may be a few rare exceptions where this may happen. But my goal is to reduce pain, and help my clients feel BETTER, not have them leaving in worse condition than they arrived.

So we’ve communicated verbally pain thresholds and current pain levels. That’s the easy part.
Now this is where we really have to work hard as a therapist, we now have to listen with not only our ears but also our hands and fingers.
We are listening for a change in our clients breathing pattern, particularly for signs that they may be holding their breath. We are then feeling through our sense of touch for muscles contracting, limbs jerking, for a sensation that the client is pulling away from you.

These are all signs that they are uncomfortable or are in pain, so we need to take a step back.

The key to getting deep into underlying muscles is to work slowly.
Trust, Warmth, and slow application of pressure are the keys to a good deep massage.
If you are stretching with a client, if they are contracting, tensing, you aren’t going to get a feel for the true end point of the stretch. You’re going to be stopped well before you can stretch the client to their true extent.

This is where we, as therapists, need to through our ego out the door. Inflicting pain on our clients shouldn’t be a badge of honour. We shouldn’t be trying to make the massage more painful than the last therapist.
Our goal is to make it more effective. We need to understand our clients need through proper assessment. Be focused and fully present during the session listening with our ears and with our hands. We also must ask our clients how they are feeling, and don’t take fine for an answer.
We all know, especially coming from women, sorry ladies, but “fine” very rarely ever means that they are fine. If that is the answer you get from a client, it’s time to change the question.
Try “would you like more pressure? or maybe a little less?” Even just a simple question that just needs a Yes/No response would be good. The more you work with a client, the less you will need to ask, but in those early days COMMUNICATION IS KEY.

 

But what about clients?
There is a vulnerability about being on a massage table, at the hands of a therapist, and some find it difficult to speak up if they are feeling pain or discomfort.
Please be re-assured that we want your feedback. We NEED it. If a therapist ignores your feedback, and works to their own routine or own plan, they aren’t the therapist for you. We are there to meet your needs, provide you with a service and this is where you get to call the shots.
If you don’t like an area being massaged, PLEASE let us know.
If the massage feels pokey, or scratchy we need to know.
If you are in pain PLEASE don’t suffer in silence, we need to know so that we can provide you with the best treatment possible.

We are here to facilitate the bodies natural ability to heal itself, that does not include causing any further discomfort or damage.

Let’s work on changing public perception.
Deeper doesn’t always mean more painful.
Painful doesn’t always mean better.
Bruises after a massage are not something to be proud of.

We can change these beliefs, one massage at a time.

Fighting for our goals

I’ve often tried to condense what I want from life into the simplest form, so that it is much easier to focus and stay determined to achieve those goals.

You’ll hear many affirmations that include the words above:
Happy, Healthy, Wealthy and Wise.

Taking these words at face value can sometimes be confusing for people, or may feel unobtainable but I wanted to share with you what they mean to me, and why I use them as my target in life.

Happy:
Everyone wants to be Happy. However being “forever happy” is quite simply an impossibility. If you are dealing with a rough time in your life it can be even more difficult to feel happy, or to find something to be happy about. When I am in this mindset, I don’t aim for Happy, I aim for satisfied. It removes all the ideas of having to put on a brave face, to fake a smile, and be ridiculously bubbly and upbeat, especially if your world is crumbling around you. Instead I aim for satisfied.
I ask myself “Am I satisfied with what I did today?”, or “Am I satisfied with how I used my time today?”
That way if the answer is no, I still have an opportunity to find something that will allow me to change that answer. Even if it means I have to finally tackle the laundry that I am forever pretending doesn’t exist.

Healthy:
Being in the Massage Industry, our own health is so very important, but there are times that we push through minor niggles or pains because there are so many other things going on in life that feel more important. Then I think about how important it is that I am around for my family. You can never be too cautious with your health. That’s not to say I lead the healthiest life that I can, sitting here at the coffee shop drinking a large caramel smothered brew. But I do take the time to pay attention to my body and investigate anything that I feel isn’t right. If I can, I try to do at leas 30 minutes of some type of movement a day that raises my heart rate, and finally the one our clients are tired of hearing from us, I try to drink as much water as I can stomach. Which isn’t a lot to be honest as I’m not a great fan of plain water, but if I can drink a nice glass of water before going to bed tonight, I will be satisfied (theres that word from before) that I’ve done something healthy for myself today.

Wealthy:
Wealth, this is where you probably envision me as Scrooge McDuck, dreaming of diving off a High Dive into piles of glorious money. wouldn’t that be nice? Not really. Wealth to me doesn’t necessarily mean financial wealth. I simply take it to mean “to have”. I consider myself wealthy because I have many friends and family around me who love me. I have my beautiful daughter, I have my health and a home that keeps me safe and warm at night. My family and I don’t always get along, and boy does Moxie drive me up the wall sometimes. My house is just a simple private let, and I use blankets to help stay warm as energy prices continue to rocket. But I am lucky to have these things, as many people aren’t so fortunate. So there is where I see wealthy on my plans. Wealth and Fortune to means to have and be fortunate and I definitely consider myself to fall into that category. That doesn’t stop me looking up ridiculously expensive “Grand Design” Style homes in the area that I can only dream of ever owning, we all have our guilty pleasures and House hunting is mine.

Wise:
Being Wise is something I think we all strive for. It’s not something we would ever say about ourselves I don’t think, but something someone may say about us. I try not to dwell on how people perceive me, but I do try to better myself every day and become more educated. Even if it is reading up on the news and maybe doing a few minutes extra googling, or searching through wikipedia to learn just a little bit more about the article I just read. My late brother in law used to always say “Every day is a school day” and he was absolutely right. If we aren’t learning something new every day, it’s been a bit of a wasted day. So this is how I strive to be wise.

That’s it. Four little words that I try to live by on a daily basis, to make me a better person, and to keep me focused and on on target. The last thing I’ll leave you with is this: When faced with a decision in life, and you don’t know what to do ask yourself if the decision you make will fall into one of the above categories. Will it make you Happy, Healthy, Wealthy or Wise, and if the answer is no maybe it’s not the right decision for you at that time.

Why you should never go foot to face


Why you never go Foot to Face

You may be wondering why on earth you would want to go Foot to Face in your massage session, and to be honest you should avoid it if you can.

However the massage session is all about your client, and there are a few occasions when a client may ask for you to finish the session with a face massage.

Whether this is because they just find that this relaxes them more, or they feel it helps reduce the dreaded cradle face from laying prone on the couch. Whatever the reason, our biggest concern is going to be on the cleanliness of the feet and how we would avoid transferring ANYTHING at all from the foot to our clients face.

Let’s face it, feet are icky.

Many of us don’t work in a facility that allows us to offer clients a shower before their session, and most clients are stopping in for their treatment between other tasks throughout the day. Having freshly cleaned feet, isn’t always the first thing on their mind, especially if they’ve just finished their 7 mile training session for their half marathon, or they’ve popped in for a treatment after 8 hours in the office.

For therapists though, our main concern should be the transfer of any potential bacteria or fungus from the clients feet to the other areas of the body.

What type of ickys are we taking about here?

Cellulitis:
Cellulitis is a common, potentially serious bacterial skin infection. Cellulitis appears as a swollen, red area of skin that feels hot and tender, and it may spread rapidly.

Tinea Pedis (Athletes Foot):

Athlete’s foot (tinea pedis) is a fungal infection that usually begins between the toes. It occurs most commonly in people whose feet have become very sweaty while confined within tight-fitting shoes.

Signs and symptoms of athlete’s foot include a scaly rash that usually causes itching, stinging and burning. Athlete’s foot is contagious and can be spread via contaminated floors, towels or clothing.

Plantar Warts:

Plantar warts are hard, grainy growths that usually appear on the heels or balls of your feet, areas that feel the most pressure. This pressure also may cause plantar warts to grow inward beneath a hard, thick layer of skin (callus).

Plantar warts are caused by the human papillomavirus (HPV). The virus enters your body through tiny cuts, breaks or other weak spots on the bottom of your feet.

You’ve got to admit, those aren’t the nicest things you want to have rubbed and massaged into your beautiful face now is it? Although most of these conditions would be considered a (local) contra-indication, the bacteria and virus that causes them may not always present with the symptoms that you can see above. That, and the smell, oh goodness, the smell of feet. Blurgh.

So how do you get around this issue when a client wants foot work, but also wants work on the face?

Ideally you have a small sink in your treatment room, with hot and cold running water as this would allow you to wash your hands quickly after working on the feet. But if, like myself you aren’t lucky enough to have a sink in your treatment room, never fear, there are some other tricks to the trade that will make this a more pleasant experience.

1 Hand Sanitiser

Even if you don’t necessary need it for the transition from Feet to elsewhere on the body, it’s always good to have Hand Sanitiser laying around your treatment room because you never know what you may get on your hands when working. Or maybe you will want it to clean your hands of product before working with a client who has sensitivies. Either way, your treatment room should never be without it.

2 Hot Towel Cabinet

If you don’t currently offer treatments that include the use of Hot Towels, this may be a great way to slowly introduce them. The Hot towels are normally “steamed” so that they are ready for use, and sit in a small steamer.

You can use the hot towels as a foot wrap before you begin working on the feet (and as a sneaky way to give the feet a little clean) or you can use them for washing your hands after the foot treatment.

You can find them online: Here is one that we use listed on Amazon

3 Pre-session Foot Soak

Another option (in addition to hand washing of course) would be to offer your clients a complementary foot soak prior to their treatment. This can often be used as a way to get them into that relaxed mindset prior to their massage treatment. Foot soaks can be simply warm water with a little essential oil, or epsom salts.

What tricks do you use to get your hands “nice and clean” during a massage treatment?

Obviously washing your hands when necessary will always be your number one rule in staying clean and sanitary, but it’s important to know you have options if you need them.

Just remember, that without a handy method of getting your hands nice and clean afterwards, you should NEVER go Foot to Face!