Raising Awareness for Prenatal and Postnatal Care in NYC

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Raising Awareness for Prenatal and Postnatal Care in NYC

 

Miles for Midwives helps raise awareness for prenatal and postnatal care in New York. 

Raising awareness for prenatal and postnatal care in NYC

Every year we are fortunate enough to participate in some great events through some of our amazing friends. This year we ran the Miles for Midwives 2018 5k run in Prospect Park, a fantastic event that is also child friendly. Miles for Midwives is a professional organization that supports midwifery and midwives in New York. Their mission is to help raise awareness to important issues surrounding birth, prenatal and postnatal care. Last year Miles for Midwives raised $35,000 for their organization through their fundraising.

What is a midwife you ask? Midwives are independent practitioners that provide healthcare — maternity, gynecologic, reproductive, contraceptive and primary healthcare — to women from adolescence through post menopause, and to infants up to 28 days of age”.  Midwives can help you make healthy choices for birth and after-care, working with your health care team. 

Why focus on women’s health and Prenatal/Postnatal Care?

The United States has the unfortunate position of being one of the worst countries for infant and mother mortality, especially for minorities, despite the United States being one of the wealthiest countries in the world. If you would like more information on that subject, check out this NPR article that is fully linked to research. 

Female complaints, such as chronic fatigue often often go untreated due to not being taken seriously, and women are often subject to longer wait times than men, therefore medical professions that focus on women’s health are incredibly important. That is not to say women are not getting great care because there are a number of resources women can use throughout their lives to improve their chances of getting what they need when they need it. Midwives are just one of the resources. It is, however, important to always remember that a mother may not be getting great care, and that keeping alert for signs of both mental and physical distress are essential as part of a health care team. 

Our care-team often work with pregnant women and women in their fourth trimester (what is the fourth trimester?)  One of the most important jobs a massage therapist can fill is to spot potential problems and refer people to the right kind of health care. Consequently, we thought we would take some time to provide a little reader information on some of the potential problems and health care concerns that our care-team often intercepts. 

Pre-baby we often focus on pain and stress management in our office but during intake we ask for a full health history. Headaches, swollen limbs, faintness, over-fatigue, and numbness and tingling can all be signs that you need a referral out, and your massage therapist should be happy to give you one. Over the course of my career I have referred a number of patients out for similar reasons, only to learn later that we were able to intervene early in an issue, which avoided a more serious problem later.

Beret Kirkeby Massage TherapistI am currently pregnant, so I understand how confusing some of the symptoms can be! Many of the warning signs are also symptoms of pregnancy!

Additionally, given pregnant woman sometimes have changed their lifestyle, it is extremely important that mothers know there are resource available to them. Letting a mum to be know there is help available to them can be invaluable; they just need to know to look in the right place.

As massage therapists, when we sit down with someone and spend an hour with them facilitating a restful state, we have the luxury of time that medical professionals often don’t have so we can often direct women to resources that they need, such as lactation consultants, doulas, midwifes, and pelvic PT’s. Additionally, we can help a woman understand that it is okay to take an hour a day to seek help with us or another practitioner to help with their stress management.

After the baby is born, it is especially important to continue with self-care. Many women simply do not know help is available for them, mostly because women do not talk about the problems they are having. In fact, after birth 1 in 10 mothers continue to experience pelvic pain after the 3 month mark and after their first vaginal birth, 21% of women may experience incontinence.

Massage therapists who do a quality intake and know the statistics can help steer women to great referrals when they come in for unresolved pain issues or complications. 

What can you do to help? 

Continue the conversation on women’s health and participate in great events like the Midwives for Miles next year!

 

Body Mechanics Orthopedic Massage, Prenatal and Postnatal Care

1 W. 34th St, #204

NY, NY, 10001

646-709-2280

 

 

 

 

 

Do you want run like a Spartan? Try a run at the Spartan Sprint.

 

The Spartan Sprint run took place at Citi Field on Saturday April 16th 2016.

citi field stadium. New York, New YorkSoooo my friends and I signed up for the Spartan Sprint run at Citi Field. What is a Spartan Sprint you ask? Well…it can be a lot of things but this one is a fantastic 3 mile + obstacle course race through Citi Field stadium.  I am a runner by trade and have been running for years, but I am also scrappy. I spent my early childhood scrabbling up trees so I was totally up for this challenge. And who does not want to break up the running season with something a little different!

A Spartan is an obstacle course race. This one happens to use Citi Field as its tromping ground. To be fair, I have no idea how many obstacles we actually did:), I will go more into that later, but the whole race takes you on a run all over the stadium, through the bleachers, up the stairs, through the parking lots, on the field and in the back tunnels. If you are a sports fan, it is kind of amazing. The views are fantastic and I can truly say, never have I ever seen more of a stadium.

One of the nice things about this race is the location, which is easily accessible by car or by train.  I took a train there and my racing buddy drove, neither one of us had any problems. We simply met up in the parking lot where we picked up our bibs and tags like any other race.Race entry packet, Spartan Sprint New York

This was easy and well organized. We had formed a team, so we were essentially running at the same time with a drawn go-time of 9:30 am. Being a team has it’s benefits and to be truthful this is one of the really nice things about the Spartan culture. While running is usually a solo project, the Spartan races allow you to form teams and do the race as a group which allows for your teammates to help you on challenges that might be just out-of-reach.  If you fail an obsticals, a teammate can help you or share in the penalty (30 burpee’s) to ease the burden.

This race had some great obstacle in it. A short list includes, rope climb, crawling under/over things, spear throwing, bucket carrying (with and without water), general lifting and hauling of things, a  plank skateboard thing, jumping rope and some other odds and ends. The set up is simple…run, then stop and perform a task (while the refs cheer you on). If you fail the task for some reason or cannot complete it due to physical reason then you can opt for 30 burpee’s. Sadly, we did not do a great job of documenting it because we were so busy running! But we managed to capture these shots from the obstacles.

IMG_5794 (1) Spartan Sprint run NY, NY

 

By the time we finished the race it was 10;30 or so…keep in mind we talked to other runners and wandered around snacking on the free goodies provided and comparing race stories. By that time there were a lot more families coming in to race too. They run a children’s Spartan race along side the adult one which is wonderful.

As an entry level, this sprint is a great time. It is challenging if you do all the obstacles and are in reasonable shape, but so long as you are fairly active I think any group that likes a challenge could participate in it. There were loads of people who walked the course rather than ran. The ability to share tasks makes the tasks achievable, but you can always opt out and take the burpee penalty. So as long as you know your skill level, you can keep yourself safe from injury. I say this with a grain of salt because any time you are doing complex activities while you are tired, you could easily hurt yourself…so be carful out there! And injury is relative. I would totally expect to come home with a few of these beauties! Since we were a little beat up we recovered by treating ourselves to Spa Castle for a sauna, which is just a short drive away.

IMG_5805 (1) FullSizeRender (16) (1)

But you will also get an amazing day, some great new skills and this….IMG_5809 (1)

Totally worth it. I really enjoyed the switch up from running, to some more skill oriented tasks. As a woman, I also have to say one of the nice things about races like this is it challenges you to build upper body strength in a really useful, practical way. I really do not know if I will ever have to bench a bunch of weights cold, but you never know; I totally might have to lift my body over a fence while running one day.

Helpful links on Pain and the Body

You’re with your body all day, so it’s pretty important to you.

Let’s look at some places you can get more information on Pain and the Body

I wanted to put together a list of places to look for good information on subjects pertaining to massage, movement, pain, and the body. This is by no means comprehensive, but it is a place to start. Navigating the health care world as your own advocate can be hard. I could have a ticker tape parade with the number of times I have written key search words or links on the back of a napkin.  Without a background in science, it can be hard to tell plausible from implausible.

Soooo… that being said, I’ve compiled, all in one place, some links to some subjects that we end up sending out most. We  think these links are pretty helpful.

Why am I in pain?

Most people coming to see us are in pain. Pain can be scary…but what happens when you have been cleared by your doctor as healthy, and you still have pain? Or chronic pain? Or you have no pain but are diagnosed with a problem?

Do we advocate for those people to get checked again? Absolutely. But we also want them to know that pain is normal. That their body’s number one job is to protect them, and they can do a lot to manage that pain by understanding the basics of it. For that, we usually send them home with this video on pain by Lorimer Moseley. Not only can it be understood by professionals and lay people, it’s also really entertaining.

If you really want to learn and possibly change how your body feels about pain, take a look at this course by the ‘Retrain Pain Foundation’.  Each module takes just 2 or 3 minutes and can really make a difference in your life.

If you enjoyed the last one, and want more detail, we also recommend this handy video on pain. This is put out by the Hunter Integrated Health Service which delivers evidence-based pain care in Australia.

Is it my body posture?What to do about pain

The next question that inevitably comes up is, “Where did the pain come from? Since I don’t have an injury, is it my posture?”.  For various reasons, there is a LOT of misinformation out there on posture.  Posture certainly can affect you. For instance, we have all felt the pain of sitting in one position too long, but for the most part, your posture is probably fine. You could spend your whole life trying to whittle yourself into the perfect posture or way of moving. To help you understand the posture bunk we really like Paul Ingram’s blog pain and posture. It is very user-friendly and a really great place to start a search on a number of physical problems. Take a peek through the topics and you will see he touches a little on everything. A lot of the information he provides is the kind that can keep you from throwing good money after bad. So it is WELL worth reading through some of his work.

 

Do I need to foam roll or self treat?

People ask a LOT about foam rolling. Sometimes it’s in this hushed voice, like a secret, “You know I don’t foam roll…should I be?”. Look, it feels great to massage yourself. It also feels great to do something for yourself. But do you NEED to foam roll? A better question is, do want to?  The easiest thing is to probably do a little reading on what foam rolling actually does and to answer that, we usually provide Tom Hardgroves great blog piece on “How foam rolling worksand let you decide for yourself. His work is decidedly more technical but if you have a keen interest, it’s not out of reach. He also has a phenomenal book on movement you might check out. Sadly, we rarely have it in the office because we keep sending it home with patients.

 

What else can I do?

Well, it turns out you can do a lot. While doctors, physical therapists and massage therapists might help you with some aspects of your health and recovery, there is a lot you can do on your own to manage. Two videos by Dr. Mike Evans cover some of the excellent general things you can do for your physical and mental health to manage pain. Both are short, watchable and entertaining.

The first video talks about the research behind being active with your body and the health benefits that has. It is a great video on the benefits of moderate physical activity.

The other video that pairs nicely covers the topic of stress and your health.  Together, both of these topics are very important for helping you manage pain and function long-term. Do we recommend you see a doctor? Absolutely! But there is a lot you can do on your own too, without falling down the rabbit hole of unattainable results.

 

As more people ask questions we will add to this list. Good luck!

 

 

 

 

Finding Naturalism in Massage

naturalism and massage

Many of us in the massage industry spend a lot of time talking to other therapists about massage therapy. What is holding it back? Is it the non-science based nature that is the issue? Is it the lack of research? Is it the people it attracts? Is it the professionalism? What about the spiritual aspects that some seem to want to connect to?

As most of you know, I am firmly in the science-based camp. My background is  pain management with rehabilitative exercise. This is what I was taught in school and I was exposed to nothing else. Prior to my RMT training, I had taken pre-med courses in college, and before that all the AP science classes offered in high school so the Canadian program fit right in with my science-based ideals. It made sense to me.

The US massage industry frustrates me to no-end. I desperately want it to change because, after working in Canada as part of a heath care continuum, I know how good a massage program can be.

I know there are a lot of us pushing for a shift to a science-based program. However, given the condition of the US system and its irregularity, changing to science-based might be asking too much transitionally.

The US massage industry faces a number of problems. With such a large number of workers currently in the industry, the change would surely need to be gradual. One of the things I constantly think about is, with the current requirement of 500-1000 hours and no competency requirement, are we barking up the wrong tree demanding science? Is science even doable? Of course I learned some science in my education, but I didn’t necessarily learn the act of science in massage school. Often times what we receive is the outline of science, the puppetry of science, the mimicry of science…not actual science, even from the best and brightest who teach and share knowledge.  I am not saying don’t teach the science aspects, I am saying expecting meta data analysis from someone still trying to figure out where the elbow is, is probably unrealistic.  The results may be as poor and dangerous as pseudoscience.  Maybe what we should be asking for is naturalism…and leave the science to the experts.

Naturalism is defined as: A philosophical viewpoint according to which everything arises from natural properties and causes, and supernatural or spiritual explanations are excluded or discounted. 

Massage therapy lends itself  very well to naturalism. At its base even the most complex thing that I have done with a patient through a rehabilitation is simply mimicking how the body would normally behave in a controlled, suggestive state in the hopes that the body realizes it can keep moving and that it does not need whatever protection or feeling it has produced.  I try to remind the body of its normal function by setting the stage with relaxing/safe elements, and then lead it through passive, active and resisted activities.   And follow up by assigning exercises that will re-enforce that. There are only so many things the body can do. We take the body through these activities in order to start a dialogue. A dialogue with words like – rest, slack, stretch,  move, stimulate, sense, resist and strengthen.  I try to build windows of time where there is an altered signal or decreased signal, so the body can get back to doing what it loves to do…homeostasis. I monitor all of it through range of motion and pain scales. It is not rocket science;) Of course it can get more complex when you start building in limitations and conditions, but at its base its fairly simple.

Science can be a complicated system of testable questions and answers. There are entire systems in place to understand how to correctly ask the questions, let alone address  the answers. Rarely is it simple. It takes years to study, explore and even begin to understand even small parts of it. Naturalism however is beautiful in it’s simplicity. With 500-1000 hours of training and little time to test the application let alone question it, perhaps some of the answers lie there.

Starting with a few simple observations, perhaps we could make a safer, simpler, more ethical massage world. Here are some of the simple statements I keep in mind when practice daily.

  • Relaxation has value and potential.
  • The body is fine the way it is. Homeostasis works. For the most part the body will correct itself naturally, unless disease is present.
  • In the end, all change comes from internal function, not external force *other than trauma
  • Setting the stage for rest and digest may help remind the body that things are ok, which may let the person move more or differently, so they can get back to their normal.
  • Form is not necessarily representative of function.

What are the statement you practice under? More and more I see statements like “the science of massage”. Yet that statement is pretty misleading, when I think about what I do, as I am not really doing anything. I am simply setting the stage for what the body does for itself…naturally. Absolutely there is room for more advanced practitioners in advanced practice settings,  but at the core we need to get comfortable with who we are.

*I want to make a small disclosure here, as to the above statements of rehab. Rehab or rehabilitative exercise falls within the scope of an RMT (Canada). In no way do I advertise the practice of that here in NY, the example is based on my past experiences where it would be very normal for me to work with stroke patients, whiplash patients, etc combining manual therapy, movement and rehab exercise on my own. Your scope will depend on where you practice, and you should follow the local law to that effect.

 

Does your Massage Consent Pass the Peanut Butter and Jelly Test?

Consent, Massage &Peanut Butter & Jelly

*Full disclosure, I believe I learned this exercise in grade school creative writing.

Frequently when talking to clients you may think that you are communicating effectively and giving a great consent when you actually are not. This failing actually massage consenthappens with everyone at some time. People are full of funny little quirks. If you ask them if they understand, they may say yes when they mean no, or you yourself may unintentionally overcomplicate the matter in order to show you understand when you don’t understand. To make things even murkier, lurking below our psychology, the actual words we choose may have a totally different meaning to another person based on the context, their past experience, and the desired outcome.So how do you know if you’re really making sense and connecting on any legitimate level?

I would always advocate for clarity and simplicity of speech, but sometimes even when you think you are being clear you are not.

This recently happened between a staff member and a client. As the mediator, I listened to both sides of the event, and both thought they had clearly communicated their thoughts but both walked away completely at odds with the outcome. So what happened?


 

-The client had expressed that her shoulders were tight and her neck needed work

-After a full intake, the therapist confirmed that she agreed and that she also wanted to work on those areas and described “We have 30 minutes. I would like to spend about 15 min on each area. How does that sound?”

-At the end of the massage the client was unhappy and stated, “Although I thought the massage was quite good, I asked for my neck to be done”

-In talking to the therapist, I learned she had performed a 30 minute massage, with 15 minutes on the shoulders and 15 minutes on the neck, but she had performed the majority of the cervical massage prone, rather than supine because she felt the client was very relaxed and did not wish to ruin that therapeutically. As the client was use to the neck treatment having been performed face up, she assumed it had not been done and left unhappy. 


 

Even though both parties sat down to communicate formally, because of the personal histories they brought to the table, they failed to reach clarity. For reasons like this, and many others, I really recommend putting your consent through the peanut butter and jelly test. It goes like this:

Write instructions for making a peanut butter and jelly sandwich to an alien, who does not know anything about this planet. 

While the task seems simple enough, you will soon find you are going to run into problems when you start critically thinking about things such as:

 

  • What is jelly?
  • What is a plate? What does that look like?
  • What is a knife?
  • How do you determine amounts?
  • What are descriptive terms? What do they mean?

Through this practice, you begin to understand there is a LOT we take for granted in our communication, even when relating to other professionals. Words like ‘massage, trigger point, therapeutic, deep, strong, sports, etc’ may have lots of meaning, some meaning, no meaning, or a different meaning, depending on who you are talking to. So if you think you are communicating clearly or if you suspect that you’re not, try running through the peanut butter and jelly test and see what you are taking for granted.

 

 

What I did not learn about fascia work and massage

UNLEARNING

This blog was inspired by the fact that we spend a lot of time trending hard and obsessing over modalities. We debate whether they are ‘right’ or ‘wrong’ and what we as therapists should be doing now.

Recently I talked with a very aggressive young therapist who was willing to alienate many of his current peers and deprive himself from the benefit of their experiences by defending a modality he in fact had no training in, simply because some of his previous peers had deemed it ‘right’. And shortly before that, while training another young man, I told him he might want to do some more research on some of the modalities he was using simply to ensure that they actually did what they said they did. At that point, he became completely confused, afraid to treat, thinking he might be doing something wrong.

It leaves me wondering if, as experienced therapists in the age of easy communication, we are really doing our parts by telling younger therapists what to value and what not to, without letting them see how we got there – because the process is just as important as the result.

With that I give you  ‘What I did not learn about Fascia work 2005’


I did not learn about Rolfing or Tom Myers

I did not learn that it was tearing, stretching or re-modeling

I did not learn to use heavy pressure

I did not learn to go in any one direction or follow a track

I did not learn it as a passive activity

I was not told that it would solve any one problem or kind of pain

I did not learn that it would hurt

 

In fact, what I learned did not have much theory behind it. What we had learned about fascia was imparted to us in anatomy and dissection, where it was labeled ‘the packaging’.

Our instructions and week of practice were demos of our teacher accessing different areas of the body, with different holds, based on the shape of the body, the clients’ complaints, and instructions that our work did not have to look like hers. We were just to find a comfortable way to hold, to move in the direction of ease with the biology, to move slowly and gently, and to ask for feed back.

When the demos were over, we were set free to work on our own. Our instructor went around and helped us with body mechanics for staying in one place for a long time, and showed us how to keep our fingers from digging in and pinching skin.

Some of the work was feather light, as it was around the face. Some of the work was broader, as it was on the leg or arm. None of the work was particularly deep. The methodology she gave us was “see what works for your client, given their comfort, and the shape of the structure or how you can access it.” It was simply another way to ‘get in’ based on the needs of the client.

At the end of the class, when we had worked every part, she added to the list, “Next time you practice, experiment with having the person tense a little under your hand, and then relax. And see what that does….see if that changes things.”

I think that was probably the most important part of the class.

I have been working this way since 2005. I also imagine everyone who was in my graduating class is working that way, and that our instructor learned to work that way from someone before her, and that she had a community of peers that supported her in that work.

It is fantastic that we now know the tensile strength of fascia, but modalities have never been what drives good treatment, they are ONLY an extension of a communication process. I do not know that we are doing young therapists any favors by debating what is right and wrong as far as modalities. In fact it gives the impression that things are black and white, which they are not. There is ONLY what works given the circumstance, and it requires a lot of thinking outside the box often. Young therapists need to be taught to think for themselves about what is plausible, and to listen. I am not so sure that is the impression we are leaving.

 

Plain Jane Consent for Massage

Being Simple For Your Consent For Massage Is A Best Practice That Will Take You Far…

One of the things I believe is really important in health care, for a number of reasons, is that consent not only must be given, but given in a way that clients understand what they are agreeing to. All too often in health care, especially in manual therapy, there is the tendency towards a professional chatter that is trendy , but to the patient really has no meaning. This is one of the places where a patient/client differential might lurk unseen even by someone with the best of intentions.

Frequently in my space we will hear from reception that a client is looking for “fascia work, trigger point or ART”. We have an extensive intake at our location where we actually sit down with patients beforehand, and generally what we find is that MOST people do not actually know what those things are, they are seeking those things based on research, advice, trend or referral.   Typically people do not feel comfortable admitting what they do not know to another person such as in an intake.  Therefore, health care workers must try to provide a safe environment to guide people through letting go of choices that may not fit and making choices that make sense for them.

I always advocate for using medical terms whenever possible when referring to anatomy and professional conduct. However in talking to clients, we have to let go of that vernacular.  Patients are not just there for a massage–they want to understand what is happening to them.   Consent is not consent unless the patient fully understands what they are agreeing to.  When proposing a verbal contract to a client on a path of treatment, we need to speak in plain descriptive language that the person can understand.

With that in mind, I have put together a list of common “modalities and terms” that we use frequently which have virtually no meaning to a client (and sometimes not even to us) along with some suggested substitutions. Remember, I am not trying to describe what is  happening in the body during the modality (some of that is up for grabs anyway), but what the client would anticipate or feel.

Here is a quick example of what I am suggesting.

Rather than saying: ‘So for this treatment, after warm up,  I think we should do about 30 minutes of fascia work and trigger point to the hamstrings’

The practitioner could instead say ‘ What I am suggesting for this treatment is about 10 minutes of warming the tissue, using stroking motions with lotion.   Then what I would like to do is start working the skin by pulling it gently, moving it around and torquing it.  Finally we will progress to some deeper longer holds using firm finger or elbow contact where I am going to focus on the area just above the knee and below the hip

Here are my suggested possible substitutions for industry fluff

Fascia work I am going to preform skin stretching, pulling or traction of surface tissue, torquing of the skin

ART / Pin and Stretch I am going to be holding the muscle and resisting slightly (or pinning it down) while moving it through a range of motion.  Alternatively:  Holding a muscle and pinning it down while you move it thorough a range of motion.

Stretching  I will extend the muscle until you feel tension and hold

PNF stretching / contract relax etc Take you into a position of stretch for the (effected) muscle and then ask you to contract, resist, or pull against me possibly in a sequence

Trigger point I will use sustained pressure into the muscle using fingers, thumbs or elbows.

Lymphatic Drainage Using very gentle pressure, I am going to try to simulate the natural movement of the tissue that would occur with muscle pumping when the body is relaxed.

Deep tissue We can work deep specific. I will listen to your verbal feedback and from what I feel physically, and make adjustments to my pressure as needed.  If there is an area where you feel that you need more pressure, we can specifically target that area.

Distraction- I will gently hold the joint or tissue to create space between the surfaces inside the joint that we cannot see.

And so on, and so forth. If you are a science based practitioner, this  jargon that we use daily  helps keep the waters murky as to what we are actually doing. It’s a best practice to be simple and clear. Plain Jane never had it so good.

 

Forearm Stretches

Forearm stretches are great for people who sit at a desk, have carpal tunnel symptoms and also have physically demanding jobs that require arm usage.

Many symptoms such as feeling tired and heavy in the hands, tingling, numbness and the feeling of cold can be easily relived by following a forearm stretching protocol.

It’s important to check with your doctor to rule out any more serious problems.

Happy Typing!