Skin Sensitivity in Clients

As our world changes, auto-immune diseases are more prevalent, allergies are more widespread and the choices that we, as therapists, make in our oils and lubricants are more likely to have an impact on our client. Asking about skin sensitivies and allergies ensures that your clients can confirm compatibility with your lubricant and oil choices. Personally, I have known two massage therapists who have developed contact allergies, one to coconut oil, a common ingredient and the other to a specific brand of lubricant. Presumably these two developed their allergies from repeated long-term exposure.

So take heed, vary what oils you use and make sure that your clients don't have any known reactions to what you are using.

Ahhh, the lowly clavicle

The clavicle is such an underappreciated bone. This small strut serves to link our whole upper extremity to our trunk and is the bony connection from the scapula to the sternum. As such, the clavicle serves a very important job. Without the freedom afforded to our clavicle, much of what we know of upper extremity range of motion would be unavailable to us.

Restrictions along the clavicle will impact the range of motion available to the rest of the upper extremity. In order to externally rotate the humerus in abduction, the clavicle must also rotate along its axis with the humerus. It is my experience that easing restrictions along the clavicle will facilitate ease in the upper trapezius muscles and possibly the rhomboids.

A way to gain appreciation for the support the clavicle is through a pressing motion above the head, such as a military press or downward dog. At full extension, the line of force will be through the arms, the scapulae and the clavicles into the sternum.

This post comes as a result of my own experiences with my clavicle the past several days and those of a few recent clients. I encourage any massage therapist to explore the willing clavicles available to them for further research and discovery.

Chapman's Reflexes and Semiotics

On her blog the Healing Presence, Kate Sciandra posted about the juxtaposition of metaphors in "the healing presence". I totally agree that we have great systems forfooling ourselves into thinking we have more "knowing", more control, than we actually do." Clients come to me for stress reduction, often complaining that their stress is mental. It is only once I start to work with them or probe deeper in questions that they remember where they notice it in relation to the rest of their body. As part of my Practitioner training program, I attended a class with Morel Stackhouse about Chapman's system of reflex points. The most striking part of the class was that she commented though we know where these points are located, we don't really know what they do to the body.

For those not familiar, Frank Chapman was an early-20th century osteopath who described a pattern of points which corresponded to various ailments/disorders. Dr. Charles Owens continued Dr. Chapman's work and subsequently documented some of the patterns into a book, "An Endocrine Interpretation of Chapman's Reflexes" .
As Kate stated in her post, "The map is not the territory" and this seemed to be especially true with my experience with this class. It is my understanding that Luann Overmyer conducted a study working with selected Chapman's points, which was discontinued due to a tremendous and overwhelmingly negative response to the work performed. As told to me, the clients all chose to discontinue treatment of their Chapman's points, since they became ill or at least uncomfortable.

The lesson that I took away from Morel's class was acknowledge the existence of Chapman's points as a system, with no expectation of using it for diagnosis (outside of our scope of practice) or for treatment (We don't really know what the result is of treatment of Chapman's points).
Another example of "the more we know, the less we know".

Alignment and reality in relativity: Scoliosis

After a recent visit by a client with scoliosis, I have been contemplating the notion of alignment. Prior experience with scoliosis reminded me that a small amount of change can be very potent. Instead of being oriented to an external level, a person with scoliosis is aligned to their curves. This is to say that what they are accustomed to is not what measures as “level.”

During the session, I was cautious to provide very little structural work in order to "balance" her structure. Knowing that her reality is not one of symmetry but one of curves and rotations which move both anterior/posterior and bilaterally. During the intake, she remarked that she had strong previous "rejections" of therapy, a reminder again, that a little structural change leads to a significant alteration in perception of "reality" or "alignment." Had I set about to work with her entire spine and balanced it according to what she presented with on the table into symmetry, she would most likely have faced much discomfort and pain.

When faced with a client who has scoliosis, ask them what modalities they have had success with and ascertain their goals. Do they want to be "level" and are they prepared for the journey there. Such a journey may not be easy or comfortable, as they have to leave a form of their body that they are accustomed to, in order to change their structure.

Such a transition may not be possible. One possible cause of a scoliosis is a vertebra that is not “square”, causing a lateral distortion in relation to the superior vertebra. It is important to ask the client what information they know about their curvatures (Direction of curves, degree of curvature), anatomy and history of treatment.

In closing, when a client with scoliosis comes to your table, be cautious. Their body may not respond favorably to “level” since it is not what is “normal” to their body. If you undertake structural work with them, ensure that they are prepared for emotional and physical changes.

Why is body awareness important?

Have you ever wondered how you, as a client, can get more from your massage session? Have you ever wondered why your clients keep coming back for the same ailments? One of the causes could be a lack of body awareness.

Our medical society is relied upon to tell us what is wrong with our bodies, rather than allowing our inner senses to tell us when something is wrong. The maxim, "If it hurts, don't do it" is simply not an option. To whit, the athletes that compete and win in events such as Ironman Triathlon, Iditarod, and the Tour de France just to name a few. These individuals push their bodies to the extreme. In order to do this, a person must be well versed in the use and care of their body.

By reflecting on the aches and pains that nag us, we are able to stave off further injury down the road. By asking a client to make a before and after assessment of their body, I am opening the door for them to find words for their sensations. If they are able to make the connections about what changes have happened on the table, then they will have greater access to the changes off the table.

Whenever a client presents to me with a specific problem, I ask for a great deal of feedback. I want to know how their body is responding to the work and I want them to follow the internal changes that are occurring over the course of the session. While the changes may seem more profound if they get to explore only at the end of the session, the client loses out on the process of change. This process allows them to connect their issue to their life (That reminds me of when I ...) and their experience beyond that of the table.

Your clients may just surprise you if you offer them these chances on your table.

The Quest for "Just Right"

In his blog, Ben Crabtree recently discussed 10 modalities or techniques that are commonly available to massage consumers.

I would like to second his statements about Deep Tissue Massage:

"While some massage therapy practitioners use a heavier, sometimes uncomfortable pressure in Deep Tissue Massage it should be noted that a more moderate pressure can reach deep tissues and achieve great results with little discomfort."

While clients continue to request deeper massage, when the depth is sufficient to create guarding or tensing of muscle in a protective reflex, the results are temporary, at best.

My own experience is that this amount of pressure is variable from place to place on each individual person. One aspect of pressure that I have noticed is that sometimes, the skinniest client is the one who is requesting the deepest pressure, while a thicker client may ask for only very light pressure. This is in no way a direct correlation or an absolute. Certain clients in my own practice and that of the massage school where I work have given me pause to think about what shapes these differences. Why can a slight client tolerate heavy-handed pressure which another client of larger build cannot not?

One of the amazing preconceptions that I have encountered as a massage therapist is how effective a light touch can be. This was first brought to my attention during massage school when we were studying a style of lymphatic massage that relies upon feather strokes with infinitesimal pressure in a rapid, repetitious manner. The contact was hardly a fingertip at a time, yet several clients in my student clinic were describing excellent physiological responses to the technique. I have used those same principles in a clinical physical therapy setting with post-operative ACL patients to great benefit.

After starting to study Ortho-Bionomy, I was amazed at how the results which were desired by the client (and in some cases, the physical therapist whom I was working for), without a great deal of exertion or labor. As I have progressed, I have come to appreciate that different clients have different needs and consequently differing pressures.

As a client, it is your responsibility to communicate the pressure desired and if what is being applied is too little or too much. If you don't say anything, the therapist has no knowledge that you would like something other than what they are doing. Similarly, it is the therapist's responsibility to ask during the course of the session if the client would like the pressure modified or the same.

Whether a client or therapist, deep-tissue fan or swedish massage therapist, the amount of pressure applied during the session is always changing and is vital to creating a trusting, relaxing and therapeutic environment.

For more information, you can contact me via email at jonathanwaltonbodyworker (AT) yahoo.com or in Madison, Wisconsin 608-239-6612.

Is there anything I should do in advance to prepare for a massage?

In his post, Terence offers several good points to consider about to prepare for a massage. I would add that scheduling your time after your massage is important, so that you don't have to rush back to work or stress following your session. By allowing yourself time after the massage, you allow the experience to last longer and to transfer into the rest of your world, instead of ending as you get off the table.

I would second that taking an internal inventory of your aches and pains so as to ascertain changes from before to afterwards. By establishing how you feel before and then comparing to afterwards, you get a good sense of what changes were made during the session.