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Five Things Your New York State Massage Therapist Should be Doing for You

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Five Things Your New York State Massage Therapist Should be Doing for You

We have put together the top 5 things your New York State Massage Therapist, should be doing for you but may not be….

This blog post is specific to New York State Massage Therapy, but in any state that see’s massage therapy as a licensed medical profession, these may apply. We put together this list of important bullet points in order to educate the public about their rights. Massage therapist undergo training in order to become professionals, but the public is often unaware of what that training is or what their rights are. So here it goes, here are our top five things your New York State licensed Massage Therapist should be doing for you.

1. Giving you a full consent before you are treated or assessed

What is consent you ask? It is your agreement to the treatment, assessment, or procedure that is about to be performed. It can be both verbal and written. Consent can cover the type of treatment for massage (for example: trigger point therapy, stretching, or Swedish massage), how it is performed, what products or tools may be used (for example lotions or graston tools), and even as far as what smells you might encounter. The bottom line is, you have full control over what happens to you, even if you have not been made aware of it. What does this mean for you in real time? At the very least you should be looking for a Massage Therapist who gives you a rundown of what they are going to do before they do it, a little snapshot so to speak. This rundown, not only keeps you safe but also ends up in making you happier over all with your massage because you can actually relax.

2. Protecting your right to privacy

In New York state, Massage Therapists are considered Medical Professionals. They are required by law to protect your privacy. If you find your therapist is particularly chatty about their other patients, it may be time to move on.

The New York State Massage law reads as follows:Massage therapists will safeguard the confidentiality of all patient/client information, including patient/client records, unless disclosure is required by law or court order. Any situation which requires the revelation of confidential information should be clearly delineated in records of massage therapists.

3. You have the full right to refuse, modify, or change the treatment at any time. 

Ever have the feeling you have made a terrible mistake, part way through something? It happens, even with massage. It is totally ok to stop once you start. Individual clinics may have policy’s on if you will pay or not based on stopping treatment so you may want to check, but generally if you encounter a medical problem, such as feeling dizzy, we waive all fees at our clinic. Fee aside, you can always simply stop regardless of the situation. If you just think that it is not working out, you can always change the plan too. If your therapists pressure is not right, tell them…or redirect the treatment entirely so it works on what you just figured out you want. A 30 minute back massage can easily become a 25 minute foot massage. Do it, it is your right.

New York State Massage law reads as follows: Massage therapists will respect the patient’s/client’s right to refuse, modify or terminate treatment, regardless of prior consent for such treatment.

4. Referring you out

Is your therapist Mr/Ms fix it? It is fantastic that you found a great therapist. Massage Therapists cannot wear all health care hats however. As a Massage Therapist we cannot diagnose or treat disease, so if you genuinely have a medical issue no one has seen you for, your therapist should refer you out. Vibrant clinical practices are loaded with referrals, we send people out and they send other people to us. We just cannot be all things at all times. It may totally be appropriate for your massage therapist to work alongside another professionals work though, just because they refer you out does not mean you necessarily have to stop going to your therapist.

New York State Massage law reads as follows: Massage therapists may provide services that lead to improved health and muscle function, but they do not diagnose medical diseases or disorders. They evaluate patients/clients in terms of health and disease in order to know what massage technique should be used and when to make referrals to other health care practitioners.

5. Maintaining your personal health records

Records are an essential part of making sure you get a good treatment. If you are seeing one person, they help them remember the details of the last treatment. If you are at a clinic that shares files, they help keep your heath care consistent and make sure your health information travels to the practitioner you are seeing next. Beyond that, your health care records may be needed if you have been in an accident, or are claiming to certain kinds of insurance. Beware of the therapist without files, they may not serve you best long term. New York State Massage Therapists have to maintain records for 6 years.

New York State Massage law reads as follows: therapists must keep a record of client evaluations and treatments for six years or until the client turns 22, whichever is longer.

If you want more information on New York State Massage Therapy, you can find it at the New York State Government website. If you want to verify that your massage therapist is in good standing you can do so here.

Body Mechanics Orthopedic Massage

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

 

 

Hands on Suggestions for Working with Trauma

Working with Trauma and Abuse

Before we go into what this post is, I want to touch quickly on what this post is NOT.hands on suggestions for working with abuse

It is not a substitute for an education course or training in working with victims of abuse/trauma. It is also not a suggestion to go beyond your scope or treat the abuse/trauma through massage therapy. You should follow your local law in reference to reporting abuse as a health care worker as it applies to you, and stay within your scope. I would also like to note that trauma takes many forms, it is not up to us to decide what is traumatic.

What this post is about is providing some useful suggestions to practicing therapists  for the physical part of the treatment when the subject comes up with existing patients or someone with a history of abuse/trauma who wants to be part of a massage program.  At some point in a career it is likely that either an existing client or a new client will  disclose to you during intake that they have been the victim of abuse/trauma. If you are unprepared for how to appropriately handle that disclosure, managing it could be challenging. I suggest you take some time to think about it, but here is what works for me. Keep in mind, I follow generally the Canadian standard of practice and use a full medical consent.

My first steps are to determine in a professional way -is it safe and appropriate to continue. While you do not want to make anyone’s situation worse, it is very important that both parties (patient and therapist) understand their roles to be able to continue. Within the consent process this is usually a pause for me. A time to acknowledge a statement, by saying “I am sorry to hear that. Are you getting help if you need it?”. If the answer is no, I can open a conversation about referral and talk about the role of massage, making sure the patient understands our respective roles and the limits of what I can do for them. If the answer is yes, then we can move forward to discussing why they are here today and stay focused on that. Either way, an open dialogue is the way to go.  Keep focused on your role, and be careful not to ask questions that are out of your scope.

You may also be asked some questions about what massage can and cannot do, or about your role. Do not be surprised if, as a lay person, a patient does not necessarily know the boundaries of your treatment and wants something you cannot provide. There are many misunderstandings out there as well as hocus pocus treatments. It is perfectly acceptable to say “I am sorry but that is beyond my training”  or  “You know, that’s totally out of my wheel house” if you are asked to comment, give advice on, or suggest something you’re not qualified to discuss. I tend to say “I just don’t know enough about that” a lot. Training levels are something easily understood by most people, and while it might be scary to say ‘I do not know’ at first, people readily accept it.

A good consent process is essential in all treatments. I usually expand my consent to include a few extra things for this topic to discuss treatment as a whole,  as providing a safe, comfortable, relaxing place that they can control, where all information is private is essential. This is really just a re-wording of my usual consent speech which is that you have the right to stop and modify, and control your treatment. I also expand the consent to have a discussion on triggers. This may not be an issue, but you need to address it before it is. It is important for a patient to know they can stop but what happens then? If for some reason your patient should experience distress in the treatment you should have already asked the appropriate questions about your behavior: Do you A. take your hands off right away? B. Stop moving but stay in place and let the patient try to relax? C.Exit the room so they have privacy? or  D. would they prefer that you check in with them without stopping? Everyone will have a different definition of what will make them feel safe so it is important to discuss this before it happens. If everyone is on board and you have had a frank discussion about how you’re going to proceed with the treatment and what the goals are, you can continue.

Many of the hands-on components that I will use will be the same ones I use every day, just packaged a little differently.

So here are my suggestions, some of them are obvious, and some might not be so obvious, but all of them I have used more than once for one reason or another in this scenario.

 prepared to work clothed

-Be prepared to work through sheets

-Be prepared with a heavy blanket or extra blankets; being covered by weight can feel comforting.

-Some people love heat. Be prepared to work hot if that works for them.

-Perfect your draping to an art form of tight origami

-Think about sleep shapes rather than how someone normally lies on the table- aka let them hold something if they feel like it or lay side-lying.

-Be prepared to try outside-of-the-box activities to give the patient control:

    1.Use body weight rather than press down onto the person- if you know some positional release techniques they may be appropriate. I find this particularly useful in the cervical region.

    2.Let them move under you rather than you move over them

    3.Consider rhythmic activities.

    4.Demonstrate the technique first, let the person try it on themselves and then you perform it with them- The verbiage on this  would be “So I am going to show you a technique, then I am going to let you try it, then we are going to do it together.”

-Let the person choose their own music/sound environment

-Work in non-traditional time lengths if necessary.

-Create patterns within the treatment: creating a pattern creates predictability. If someone is nervous this can go a long way to soothing them. Examples would be:

    1. Always anchoring the drape of the fabric in the same way before you move it to signal change.

    2. Opening and closing all sections of the body in the same way.

    3. Before moving a body part, giving a gentle squeeze (explain it of course by saying , ‘Just before I stretch you I will always let you know we are going to move by….”Creating a system of patterns can be helpful in creating a predictable environment.

-If home care is in your scope, working backwards from a home care first perspective might be helpful too. In this scenario, we would do home care together, and you would facilitate the process in office. As trust and comfort is gained you would add in more participation and possibly hands on. I use balls and body weight and do the exercises with them at first, then expand by adding hands on adjustments and then finally more hands on work.

 

These are just a few of the things that have worked for me in the past. It is important to remember that there is no one single way to treat and that clear communication is essential. I also want to take a moment as some of you might be asking ‘why would someone who has difficulty being touched seek out massage as a treatment and how did it get to this point?’. This is a little like asking ‘why did the chicken cross the road’. What it comes down to, is it does not matter how they got there, but it is your job to get them across the road safely.

 

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.

 

 

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.