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Pregnancy and Ankle Massage: Is it safe?

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Pregnancy and Ankle Massage: Is it safe?

Why did I want to write this post about pregnacy and ankle massage?

After my two pregnancies and seeing a post on a prominent Facebook parenting group for the Upper East Side of New York, I started thinking about writing this blog.  In the post, the OP had asked the group, “Is it safe to get a pedicure or foot massage while pregnant?”  Apparently, some people had heard it could cause miscarriage.  I am not going to post the link to that discussion, as it is not fair to “out” people for their private views and conversations on another platform, one meant solely for the ears of parents.  I’m sure the post is searchable, and you might find another in any parenting group by searching “massage and pregnancy” or “ankle massage and pregnancy”.  Given that massage therapy is my vocation, I had watched the post grow, in part because it is actually fairly rare that massage gets posted about at all.  What I saw unfold was that a great many people are wildly misinformed about massage, but are perfectly willing to give advice on what is medically appropriate for pregnant women based entirely on hearsay.

Where does the myth of ankle massage causing miscarriage come from?


The advice fell into three categories.  The first was the “I heard massage on the ankles or specialized pressure points can cause a miscarriage”, some posters going so far as claiming it as fact.  So let’s look at that specific misinformation.  It is NOT a fact.  The whole ankle massage myth is based on Eastern medicine pressure points.  Eastern medicine is traditional medicine, which means it is based on philosophy, not on clinical trials and research (although clinical trials and research DO exist for eastern medicine NOW covering a great many areas).  I want to be clear that there is nothing wrong with adding Eastern Medicine to your care.  I am not here to bash Eastern medicine.  Women should be wary of adding fear to the list of things their complementary health care brings to the table as part of that.

 In the Eastern pressure point/acupuncture philosophy, certain points on the body correlate to other body parts and functions. Stimulating them, and meridians, might be part of a holistic care plan, and many people find value in that kind of treatment as a supplementary or management tool. I want to be clear though, that if I am in medical distress, I do not seek out an acupuncturist—I want to see a medical doctor.


In writing this, I tried using Google Scholar to find any existing research on ankle massage and miscarriage, or pressure points and miscarriage, but I could not find anything.  In other words, I found no research to support the theory that ankle massage or pressure points can cause miscarriage in any way.  What I DID find is many articles written by reflexologists and on pregnancy sites such as this on Hellomotherhood:  which have published articles stating that it is dangerous simply because the philosophy says so, without any research to substantiate that claim.  From a medical point of view, there is no real correlation between miscarriage and ankle stimulation. In fact, as a trained massage therapist, if I could stimulate your baby to come by pressing a few spots on your leg, I would probably be able to earn a great deal more than I do now. At week 40 you are rather desperate to get the baby out!

Is the idea of ankle pressure points supported by research? And what should we focus on?

Photo by Conscious Design on Unsplash

What should women be paying attention to in terms of risky activities?  Their focus instead should  be things like Am I a high-risk pregnancy?”  “Have I been cleared by my doctor for this activity?”  “Will there be any substances used in my treatment that may not be appropriate for a pregnant person?”  (see essential oils)  “Is my therapist experienced in prenatal massage?”  These are far more valid concerns.  Traditional medicine can be an important part of care especially in cultures where it connects people, but we need to reject the parts of traditional medicine that cause fear or people and spread misinformation.  If we cannot support an idea with research, it is only an opinion.  But we don’t recommend you simply take our word for it.  Look for articles that are linked with supporting evidence like this one about prenatal massage and ankle massage from “Massage and Fitness Magazine.”

What about first-hand experiences of people who went into labor after a foot massage?

The second kind of so-called proof of danger that was given as a reason to avoid ankle massage during pregnancy came from “experiential proof”.  People often are not objective by nature.  We are wired to find meaning in things.  So a number of women stepped up to say things like “I had a massage and asked to have my ankles massaged at the special points, and then I went into labor.”   While it might not be unreasonable to assume that if you did “A” and then “B” happened, they are connected. “B” might just as easily have happened WITHOUT “A”.  This is an issue of correlation versus causation.  We would have to look at a substantial amount of data to be able to prove that “A” actually caused “B”.  I would cite one of my favorite educational sources on science, The Kahn Institute.  Here is the example they put forth:  

Correlation vs Causation: see the example

“Liam collected data on the sales of ice cream cones and air conditioners in his hometown.  He found that when ice cream sales were low, air conditioner sales tended to be low and that when ice cream sales were high, air conditioner sales tended to be high.

—Liam can conclude that sales of ice cream cones and air conditioners are positively correlated.

—Liam can not conclude that selling more ice cream cones causes more air conditioners to be sold.  It is likely that the increase in the sales of both ice cream cones and air conditioners are caused by a third factor, an increase in temperature.”

The Kahn Institute


The Kahn Institute has an entire post on this subject if you want to learn more about or check out your reasoning skills.  Correlation and causation can be tricky for people because we want things to have meaning and time is linear.  We attribute meaning to things that happen just before or after an event.  A perfect example would be athletes who wear their “lucky” socks or people who tell you to wash your car if you want it to rain.  It is easy to be tricked by this kind of reasoning, so listen closely to what people tell you for evidence of their claims.

What about hearing a story about early labor and ankle massage?

The next kind of comment that I saw was a combination of correlation and causation mistakes plus hearsay.  It is the weakest of all the arguments.  These posts said in effect “I had a friend once who went into early labor after a massage”.  Indeed that could be horrible and scary.  At the heart of it, though, we do not know if those two things were actually interrelated.  AND we don’t know the whole story. What we do know is, if you have a massage late in pregnancy, at some point you will go into labor. The sum is it is hearsay and could have been filtered in any number of ways by that claimant.   

Miscarriages are common and we need to talk about them

The truth is, miscarriages and pregnancy loss are very common, and often not preventable.  There is actually a day designated to encourage advocacy around not keeping these struggles silent.  October 15th is National Pregnancy Loss and Infant Loss Remembrance Day.*  The fact that people often do not talk about their miscarriages can conceal just how common losing a pregnancy actually is.  This can contribute to rumors or concerns that you must have done something to lose the pregnancy.  It contributes to guilt, poor mental health, and poor understanding of the facts. There is no room for blame in health care, especially in issues like a loss.  A woman could carry that “what if” her entire life when it is not reality.

What is the truth about having a foot or ankle massage while pregnant?


Getting an ankle massage or foot massage during pregnancy is a perfectly acceptable way to handle stress and pamper yourself. Rest assured that there is no medical reason not to have one unless you have been told by your doctor for OTHER reasons that you should not.  I enjoyed them successfully during my pregnancies, although markedly less with the second one because I spent so much time chasing my toddler  🙂 Taking care of your health means taking care of yourself.

If you would like to book a prenatal massage with one of our massage therapists check out our booking page or go to our prenatal massage in NYC page to find out more information!

Body Mechanics Orthopedic Massage

1 W 34th St
#204,
New York, NY 10001
Phone: 212-600-4808
Email: info@bodymechanicsnyc.com

Racism is Both a Moral Issue and a Public Health Issue

Black lives matter image

 

Within the span of just the past few weeks, a number of Black Americans have been killed. Many of these people were murdered by police officers over non-violent offenses or no offenses at all. Tony McDade, Breonna Taylor, George Floyd, Ahmaud Arbery, David McAtee, Jamel Floyd, and Sean Reed are just a few of the names we must remember as this list appallingly keeps growing. This is tragically familiar territory in this country and it needs to stop. We here at Body Mechanics extend our deepest condolences to all who have been affected by these grave injustices, both past and present. We stand firmly alongside those who seek justice and systemic reform from a system that so clearly does not value human lives equally.

As healthcare providers, we recognize that systemic racism is both a moral issue and a public health issue. We recognize that the medical care you have access to, and how you are treated when you receive that care is often determined by the color of your skin. We vow to confront the pernicious racist myths and misinformation that are still highly pervasive across the medical field – because being silent is being complicit.

As New Yorkers, we recognize that our strength lies in the diversity of our community. That none of us are safe until all of us are safe. We promise to listen to our clients, coworkers, friends, family, and partners if or when they are ready to speak. We may not always have answers, but we are committed to hearing from you and supporting you however we can.

The phrase “these uncertain times” has become cliché amid the COVID-19 pandemic, so we want to make absolutely certain where we stand: Black Lives Matter

Further Reading/Resources:

https://www.nejm.org/doi/full/10.1056/NEJMp1609535

https://nymag.com/strategist/article/anti-racist-reading-list.html

https://www.hsph.harvard.edu/race-and-health/

https://www.apha.org/events-and-meetings/webinars/racism-and-health

Additionally, we would like to highlight a personal perspective from Yoga Therapist and author Yuliana Kim-Grant’s personal perspective on family, racism, and the current state of events. Please take a moment to check out her deeply personal blog here. 

To read more about Body Mechanics views on equality, check out our blog on Body Mechanics Orthopedic Massage supports the LGBTQIA+ community

Sports Massage Profile Gerry

Get to know our sports massage therapist Gerry!

We asked our sportsports massage therapist nyc gerrys massage therapist, Gerry, a few questions so you can get to know him a little better. Here is what he had to say!

What is your background in sports, since you are working in sports massage currently?

Gerry: I used to race and I was a bike messenger, back when that was a thing in New York.  I also spent some time snow boarding.

If you could try any sport what would it be?

Gerry: Motorcycle racing!

How did you get into sports massage as a thing?

Gerry: I have a curiosity about the way people move and want to help them.

Are there any athletes your particularly admire? 

Gerry: Peter Sagan, he is a professional road bicycle racer.

Is there anything that sets your massage apart from anyone else?

Gerry: I hope it is my sensitivity

Do you have any specialized training that you are really drawn to?

Gerry: While I love working with athletes, I also work with geriatric paitents and that work is really inspiring. 

Is there any special skills or hobbies you want us to know about, something people would be surprised to know?

Gerry: I am really good at backgammon and swing dancing.

Last but not least, if you could have a super power, what would it be?

Gerry: I would want to fly of course!

 

If you want more information on Gerry you can find it on our therapist profile page.

To book an appointment see our prices page.

Body Mechanics Orthopedic Massage

1 W 34th St
#204,
New York, NY 10001
United States (US)
Phone: 212-600-4808
Email: info@bodymechanicsnyc.com

 

 

 

 

 

Sports Massage Therapy Profile -Laura F.

Get to Know One of Our Sports Massage Therapists, Laura!

We are asking our sports massage therapists for a little extra information so that you can get to know them and their experience in sports massage.

 

So here it goes!

First off Laura, What is your background in Sports?

Laura: I have been working in the field of sports massage for 30 years.  I am not just a massage therapist but I am also a personal trainer, and I train myself.  I have played a number of sports… including boxing, running, and lifting.  If you are coming in for these things, I have a pretty good understanding of what is going on. 

What is your best “uh oh” story in regard to injury?

Laura: When I moved from LA to NYC, I (bleeping) fell on some black ice and I tore my left medial meniscus.  That was awful and it was a long recovery. 

If you could try any sport now, without limitations, what sport would it be? 

Laura: Krav Maga!

How did you get into sports massage?

Laura: When I was at Swedish Institute in NYC, I was bored with the relaxation massage and energy work I was learning.   I had an an instructor who taught sports massage and she was incredible.  That’s when I knew that was what I wanted to do. 

What are your favorite kinds of ‘sport’ people to work on now?

Laura: I love to work with dancers, but I also just love people who are active and want to take care of their bodies. 

Are there any athletes that you particularly admire?

Laura: Manny Pacquiao and Michael Jordan.  They are my favorites!

What sets your sports massage apart from everyone else’s sports massage?

Laura: (laughs) Honestly, I do not compare myself.  I just studied hard and took advanced courses.   I truly care about helping people in pain, and teaching them how to learn about their bodies.  As a trainer, I can also suggest some ways they might prevent hurting themselves. 

And last but not least, are there any other things we should know about you?

Laura: I am also a certified life coach.

To book with Laura, you can book online at this location, or you can read more about her Massage therapy and Sports massage there.

 

Body Mechanics Orthopedic Massage, 1 W 34th St, #204, , New York, NY 10001, United States (US) - Phone: 212-600-4808 Email: info@bodymechanicsnyc.com URL: https://www.bodymechanicsnyc.com/

 

 

We Have Moved to a New Location!

We Have a Fantastic New Location

Hello all! We just wanted to keep you updated to a few of the changes that have happened this year. The biggest of which of course is WE HAVE MOVED TO A NEW LOCATION!! It was a long time coming but after 5 years at our former location, near Grand Central Station, we have moved to a stunning location just near the Empire States Building! We traded one monument for another! Our new location address is 1 w. 34th Street. NY, NY, 10017. We are right across the street from the Empire States Building and across from Heartland Brewery. Our phone number and web contact information remains the same. We stay devoted to the same kinds of treatment: Sports Massage, Medical Massage, TMJ Massage, Breast Cancer Massage and Runners Massage.

There are a few things you should know about our new location 

  • Space! We have a lot of it! We went from 3 rooms to 4 room…and we have a staff room now with an extra large lobby. No more crowds and being on top of one another.

 

  • We have central air that is HEPA filtered. So this is pretty awesome…especially since our old space ran really hot and the dirty old outside air used to come in…but it also means there is 1 temp for everyone. If you are running hot or cold please let us know, there are fans and table heaters in each room but we can’t control the room temperature any more.

 

  • It is MUCH nicer. I mean really, its is totally an upgrade. We look a little more medical, as we are in a medical building, but we have kept with the same lux and plush stylings. We are just a little more streamlined now. The old space was cute, but the building was old and ill cared for. This building is brand spanking new!

 

  • Speaking of new, we have a few new things that may surprise you. Now on weekends we have to buzz you in. It takes a few seconds, but hey we have a buzzer, because we are fancy now.

 

  • We also have changed our pricing. You can find that information here: Pricing at Body Mechanics . Minimum wage is changing in NYC and we needed to adapt to reflect that. On the upside, yay for sustainable living! You will also find little perks like a new hot and cold water cooler, a better bathroom (no more keys), wifi for you, and a new charging station.  We also have some new therapists. You can check them out here: Massage Therapists 

Here are some pictures of our new space to help you get an idea of what we are doing. Scroll through and take a look!!
Our Space
 

Body Mechanics Orthopedic Massage

1 w. 34th Street #204. NY, NY 10017

212-600-4808

info@bodymechanicsnyc.com

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.

 

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.

 

What if what you thought you knew about Massage was wrong?

FullSizeRender (11)

How do you know you know what you know?

Massage Mythology

 

As therapists, every time we perform our techniques we also engage in a variety of other ritualistic and protocol-oriented tasks. For example; the client comes into the space, they lay down on the table, you dim the lights, you play soft music, you engage in assessment. The client prepares mentally, they expect to be treated, they look forward to the event, they undress carefully because it’s not their room, they are touched in a way they normally not, they become passive and let you move them around. Each one of these actions has a cognitive, proprioceptive, or experiential value. So how do we know which of these actions, in isolation, is responsible for the outcome? Are any of them? Are some of them? Is it you? Is it them? Is it just a perceived outcome?[divider_flat]

The ancient Egyptians believed that the sun was moved across the sky by the god Kephri, who was the great insect god. In their minds, they connected the movement of the sun to that of a dung beetle moving its ball of dung across the sand. So powerful was their belief that the gods moved the sun that they made scarabs (a totem-carved beetle figure to be worn) that were inscribed for both common people and royalty alike. They also believed that the male beetle fashioned his ball of dung as an egg from which he could spontaneously generate a new beetle. With no need for lady beetles, it gave the beetle the power of life. As a result of this strong belief the scarab became the symbol of life in Egypt. (here is some interesting reading about that). In actuality, what was really happening was the female beetle laying its fertilized eggs inside the dung ball. If you asked an ancient Egyptian how they knew these things to be true, they would likely tell you because they can see it. The sun indeed moves across the sky, and the beetle does roll its dung and new beetles spring from it.[divider_flat]

The modern day mythologies we tell ourselves about care are equally as strong. The attachments we have to fascia, triggerpoints, ‘it’s all connected’, and all the various other modalities all carry weight. Therefore we must be careful not to jump to conclusions just because we were taught it, can see it, or feel it. Seeing and feeling does not mean it is true. The problem arises when we seek to fill in the blanks while only holding part of the picture. So ask yourself daily; what is it I actually know about massage and science rather than what I have been taught. Does the sum of the total add up? Or am I creating more mythology to fill in the blanks.[divider_flat]
The body maintains itself reasonably well with contained self management due to some lovely features like homeostasis and feedback loops of various kinds. As therapists, we can work with those concepts, find ways to be a part of them and use treatments that aid them, but it’s unlikely that change is coming from an entirely external source unless that source is a surgeon or internal medicine. For the most part people get better, or they don’t. As manual therapists we could have a great benefit and place in health care as facilitators, but only if we attribute and analyze our outcomes correctly. The dung beetle has an important place in the ecosystem but it certainly does not move the sun or spontaneously create life. I guess my last note is…let’s not be the dung beetle.

Science Based Massage Therapy the Opposite of BS

Massage therapy and Science Based Massage
Science Based massage, the opposite of BS

 

Well after being so serious I just could not take it any more and this happened. At my clinic we are science based, we are all well educated massage professionals who believe in massage therapy as a science rather than as a fantasy of our own making. In some cases its easier to define what something is NOT than what it is….and this is one of them. Before we go on to what Science Based massage means to me (and yes this definition is what I believe, because it is my blog and my rant) lets take a look at what the meaning of B.S. is (Bull Shit).

I am pulling this definition from Wiki, which is not normally where I get my information, but considering the nature of it, I figured, why not?



 

This article is about the expletive. For other uses, see Bullshit (disambiguation).

Bullshit (also bullcrap) is a common English expletive which may be shortened to the euphemism bull or the initialism BS. In British English, “bollocks” is a comparable expletive, although “bullshit” is more common. It is a slang profanity term meaning “nonsense“, especially in a rebuking response to communication or actions viewed as deceiving, misleading, disingenuous, or false. As with many expletives, the term can be used as an interjection or as many other parts of speech, and can carry a wide variety of meanings.

It can be used either as a noun or as a verb as in the question “are you bullshitting me?”. While the word is generally used in a deprecating sense, it may imply a measure of respect for language skills, or frivolity, among various other benign usages. In philosophy, Harry Frankfurt, among others, analyzed the concept of bullshit as related to but distinct from lying.

Outside of the philosophical and discursive studies, the everyday phrase bullshit conveys a measure of dissatisfaction with something or someone, but often does not describe any role oftruth in the matter.



Pretty much all of the above definitions sum up the way I feel when I hear someone just make stuff up about how massage works. It of course is not always their fault, they may have been passed down bad information from someone else. I am also not talking about peoples spiritual views on connecting to someone, I would not consider that massage.

Lets look at some of the words they used in that quote “rebuking response to communications or actions viewed as deceiving, misleading, disingenuous, or false“. Yep that pretty much sums it up. No matter what the cause of the deception, it is dangerous and damaging. If you work in heath care it is your duty to seek out the truth, or as close as you can get to it, without ego, and keep pursuing it. As massage therapists we spend more one on one time with our clients than almost any provider, and so we can cause some serious problems if we are not careful.

You might ask, “ok so how does massage work then?”. Well, thats the thing, we are not sure exactly, science changes every day. And that is an honest answer. Every time we see a layer deeper into the information we discover new things, so there is a lot still open to explore. We think we know how some of it works, but what we do know for sure is how it DOES NOT work. We could get really specific about the nitty gritty, mico levels, but here I am talking about basic broad high school science concepts like diffusion, osmosis, physics, chemical reactions, electrical conduction etc….The basic rules of high school science apply to the body. Just because it is inside the body does not mean that those rules do not apply. Lets look at more things that it does not do.

It does not magically suck things, move things, push things through the body. Those ‘things’ are governed by the natural biological processes. See ‘osmosis, diffusion, active transport for more information’

It does not instantaneously ‘fix’ things

It cannot cure disease, no matter how much oregano oil you put on

It does not rid you of toxins aka save you from a horrible death by poison because someone who went to school for 500 hrs interviened and gave you a massage…finally

It cannot move bones that have been fused since child hood, like the bones of your head

It cannot make your blood flow rapidly like the river of the Grand Canyon

It is not going to re-align your x, y, z, put your disc back in, correct the spinal curve you have had since child hood

It is not going to make you run faster or clear your body of lactic acid

It does not unravel knots of any kind in the body

There is ALOT massage does not do (that list might get longer as more things come to mind) but the list of what it can potentially help you do is even longer. Your body and brain are in cahoots and they pretty much run the show on what you touch, see, feel, do and experience. Anytime you interact with someone you have the ability to facilitate change via your nervous system, and that is what happens every time you participate in activities like having a massage, going for a run, or even taking a nap. Each activity has a particular response that internally lets the body do what it does…and potentially do it better (or not).  And that is enough for me. I don’t need any huge claims behind it. What being science based is for me is being honest about what I am doing, and pursuing that honesty with my patients daily.

Massage Therapy and Pain (Continued)

FullSizeRender (1)Massage Therapy and Pain

Working with Clients in the Pain Zone

This is a continuation of the last pain blog which offered some history on pain science and also some really general guidelines on massage therapy and pain.

If your client has no red flags in assessment and you have decided it is safe to touch, working with clients experiencing chronic pain not associated with an injury has its own challenges. For many people, pain has the distinct effect of stopping us from moving, regardless of its cause, and so getting your client back to a place where they feel that they can move can be considered a success. To work safely as a massage therapist with an understanding of this, you are going to want to switch from the treatment model where massage is passively received by a client into one where the client has full control of the experience, both physically and mentally.

First lets look at the physical aspects of a client having control

This can be challenging, especially considering that most massage therapy programs teach massage as a passive activity that is ‘done’ to the client. In this role the massage therapist acts more as a facilitator to touch. Consider that touch is not a one way experience and that every time you gently “rub” a muscle, you also have the ability to instead have that muscle and skin move gently under/against you. If someone is in pain, you have the option of saying “I am going to gently put my hand here on your back, why don’t you try breathing up into that feeling”, or “I will never press harder, why don’t you try pressing gently into me?”, or “I am going to hold your arm gently, why don’t you just tense the muscle a little and then relax or wiggle your fingers?”. There should be a direct relationship to the amount of pain present and the amount of control the client has. The more pain present, the more the patient should be in control of what is happening.

This does 3 things in my opinion:

1. Lowers the anxiety associated with treatment, and the anticipation of pain, and possibly dropping their pain level.
2. Facilitates change in the body by signaling normal function and behavior as the patient moves.
3.Protects you the therapist from stepping over a boundary. If the client has control, they only go as far as they want, and no further. 

I want to be clear that if you are using this kind of treatment with someone who is in pain, you never want to cause pain. Their may be pain associated with the treatment, but it should not be from a new stimulus you are providing, such as pressure or forced movement. The pain associated with treatments of this nature should be caused by a patient moving through their own pain signal. What does that mean? It means that if someone has had long standing neck pain, and they are completely cleared for treatments, with no red flags, you should never aggressively treat with traditional deep massage. Instead I should gently guide the person to the edge of their painful experience and create a safe, controlled, comfortable setting in which they can explore going further-if they choose to do so. If the feeling of pain does not abate, you should, discontinue and refer out, but often reducing the anticipation of pain and giving the client control is the first step in the pain management in Massage Therapy.



How do you do it?

It all sounds pretty simple-give the client the control and they might get past their pain, but its actually a bit more complicated than that, because you don’t want to be randomly trying techniques. I divide my techniques up into graded categories to help me organize the treatments.

  • Low pain– resisted eccentric/concentric contractions and dynamic stabilization, and holding the tissues muscle while the muscle moves beneath
  • Medium pain– gentle active resisted techniques, holding the skin while the muscle moves underneath, simple isolated muscle movements
  • Higher intensity pain– tense and relax exercises for muscles or groups of muscles, breathing exercises that activate accessory breathing muscles

You will notice the different categories of pain could also be explained as acute, sub acute, chronic, or you could use a pain scale to divide them up. The important thing is that you know where you with the person you are treating. I use LP, MP and HP for short hand charting proposes. Lets look again at that client with the neck pain so we can get a better idea of the application of these techniques for the different pain categories.



Lets look at some examples to make things clearer

Client with HP  neck –  This client is afraid to move and has pain on movement of any aspect of cervical spine or upper thoracic, with a history of whiplash. Does not go about normal activities.

Treatment– Is a gentle skin deep gliding massage. The goal is just to get used to the client getting used to touch. Once the client is relaxed we are going to begin graded breathing exercises to see if we can get them to reduce the bracing in the accessory breathing muscles. I isolate a muscle by gently touching it and say “can you make this expand and contract by moving air?” We go though each and every muscle that would be effected by breathing. Then we switch to tense relax and do the same. Isolate the muscle, or muscle group by gently touching it, ask the client to control it by tensing up and then relaxing. I finish by going back to very gentle surface treatment of gliding massage.

Client with MP neck -Client has some movement but feels very limited by their pain. Range of motion is reduced to about half, and some of the ranges are less quality than others. Goes about normal activities but has stopped participating in any sports or anything unnecessary to their day.

Treatment– General massage with light to medium pressure. Once the client is comfortable I begin holding isolated areas skin in areas of pain and asking the client to gently pull away from me. If the client experiences pain we go back to the above treatment. We reverse the technique and this time I isolate muscles and have the client push into me (essentially bowing the muscle) If the clients pain level keeps dropping we then move to full simple isolated muscle movements. I hold the muscle and they run though a full rang of motion. (Video example of type of activity)I often do this by saying “ok now try to squish my fingers with your neck”. I correct any movement where they are recruiting another unnecessary muscle to complete the movement or avoid moving through the whole range. At the end of the treatment we return to gentle massage.

Client with LP neck-This client has pretty much full range of motion, but experiences pain at the end range. In their words “I just feel I can’t get past the final stage of the injury”. They are going about their daily lives, and participating in sports with occasional flairs. (this is the client you should most often be treating and seeing unless you are an advanced practitioner)

Treatment–  A general massage with light to medium pressure. You can use any of the above mentioned techniques to warm the tissues. As the treatment progresses, I move to holding the muscles firmly while they go through a range of motion. If no pain is present I ask the client to gently resist the movement for the selected muscle. (Video example of activity)If still no pain is present, I ask the client to resist with movement and move on to eccentric concentric moments. All of these activities are still gentle (the client need only meet you with enough force to activate the muscle)We end the treatment with the same general massage. If at any point the pain or the tone of the muscle rises, we go back to a previous treatment plan.

Wait!!!

But we have gotten ahead of ourselves…before you can do any of this cool stuff, you have to talk to your client about exactly what you will be doing with them and why you think it is the best choice!!!! And that’s exactly what we will go over next time.