Review of Walt Fritz Myofascial Release Seminar

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Review of Walt Fritz Myofascial Release Seminar

Posted on by Beret Kirkeby

Walt Fritz’s Myofascial Release Seminar for Neck/Voice/Swallowing disorders

Before I get into the meat of this, there are a few things to note.  This class, ‘Myofascial Release Seminar for neck/voice/swallowing disorders,‘ is named for the conditions that may occur in the area being treated, as well as how the touching is done. While the title is ‘neck/voice/swallowing’  you can use many of the cervical techniques with any patient who has neck discomfort.  To further the point about the course name, it also is named for Myofascial release.  However Walt is not suggesting that this modality is meant to replace whatever intervention you are already using or that you should just go pulling on skin.  We frequently have a description problem when it comes to manual therapy and courses that operate within the realm of scientific reality.  The question becomes, what do you call things when your tag is “this may help some people, some times, in some way, with some things…but it also may not”.  So if you are fine with the spirit of this, keep reading.

Two other staff members (Tommy and Sylvia) and I attended this course in April of 2019.  It is a two day seminar.  This particular one was at the Grabscheid Voice and Swallowing Center of Mount Sinai near Union Square.  The attendees were mostly speech pathologists, with a smattering of other professions, including massage therapy.  I will get back to who is in the course, but one of the reasons I have admired Walt’s classes is that he has taken the time to get his classes approved for New York State Massage Therapy continuing education credits.  In New York State, it is super hard to level up your skill set when the same information is being taught and re-taught by the same professionals, over and over again.

Walt’s class was well attended and well organized.  He utilizes helpers to make sure you get real feedback ,even though you are in a large group.  Snacks and coffee were provided, although we did not need the coffee to keep us awake.

If research is your thing, Walt does provide it with his materials, but

you are not going to go into a deep dive in this class.  He will give you an introduction and you are welcome to proof on your own.  The assumption is that you are a professional and as such, it is your job to review this information.  A small amount of time was spent on this.  In this way the class was pretty neutral in the “how we think this works” department.  It is not likely to radically change anyone’s mind on the function of manual therapy.  That being said, I am not really sure anyone’s mind can be changed unless they want to.  That is another topic entirely.

The same goes for anatomy in this course.  Walt provided some information in the form of his manual, but the goal is not to teach you anatomy.  If you are a little rough on what goes where in the head, face, neck and jaw, I would recommend flipping through your anatomy book before attending.  You will get a lot more out of the course by being able to connect the dots.  Keep in mind that he is not trying to reinvent the wheel, just showing you different ways you can roll it.  If you are struggling to find a touch that feels safe and appropriate due to anatomy, you might be slowed down.

This class follows the fairly typical pattern of  the presenter talking about what you are going to demo, then performing a demonstration on a willing subject, before you split off and practice on each other.

There are three things Walt does that I like:

  1. He utilizes technology to solve the issue of everyone standing around him, blocking the view of those behind them, while he demos.  One of his helpers was present at all times to get a live feed video on the manual actives that he is showing.  That video was then projected onto three screens so that everyone in the conference hall could access it as if they were in the front row.  The space we were in was well set up for that, and other spaces may not be, but I can only assume if he took the time to do it thoughtfully this time, he probably does in most spaces if there is need. (Maybe he will chime in on an answer for us post, post 🙂
  2. Walt gives his interview process with a patient equal weight to the hands on that he is doing.  In most classes, manual or otherwise, teachers often jump to new technique.  The format becomes ‘for this problem use this thing”.  Not so here.  Walt lets you sit in on his client/patient interview.  If you are a massage therapist, who wants to improve quality, booking, professionalism etc, this is 100% the area that you need to work on.  Sitting in on this is gold.  What he is showing is a conversational health care format of “ol’ dr fricara” interview (if you do not know what that is here is a link) and an adapted motivational interview strategy that continues on to the treatment in the form of feedback (remember consent is an ongoing process).
  3. He has a mixed profession class. For many of the speech path professionals manual therapy was new. They got to work with massage therapists. I think they learned a lot from them. For the massage therapists we got to work with speech pathologists….same story. Both sets came away with great referrals and a really good understanding of how we might work together to better care for people. Rather than pair off into our professions, we sought out the other for their expertise. It was a unique opportunity.

As to the things I did not like. To be honest I would have to be super nit-picky about this. It is a great class. I would say if you are really comfortable working cervical spine in multiple ways manually, or intra-oral treatment is in your wheel house already, it might be a little slow for you. Both Sylvia and I spend a fair amount of our days in working with TMD, so much of this was review. Even so, we managed to come away with some good take aways. Even if this is the case, there is HUGE value in watching how someone else problem solves the same problems. This course assisted us in the decision to add ‘dycem’ as a home care tool for our population, as they often struggle to figure out how to self treat at home in a way that feels good.

Walt also provides ongoing support in his facebook groups (invite only) and his YouTube channel for Myofascial Release.

So to wrap it up: If you are a speech pathologist, much of what he teaches will give you a fresh approach and more options, if you are a massage therapist, this is right up your alley, and will be a detailed course getting you comfortable with helping cervical/jaw/neck pain and problems.

Additionally, if you do find that you NEED more and this was basic, Walt also has an advanced MFR for Neck, Voice, Swallowing class you can check out.<—-I just found out about that from his mailing list.

 

Sports Massage Therapy Profile -Laura F.

Posted on by Beret Kirkeby

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

Image of Laura, massage therapists

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.

We Have Moved to a New Location!

Posted on by Beret Kirkeby

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

Hands on Suggestions for Working with Trauma

Posted on by Beret Kirkeby

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.

 

Helpful links on Pain and the Body

Posted on by Beret Kirkeby

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 works” and 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

Posted on by Beret Kirkeby

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?

Posted on by Beret Kirkeby

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

Posted on by Beret Kirkeby

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

Posted on by Beret Kirkeby

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.

Science Based Massage Therapy the Opposite of BS

Posted on by Beret Kirkeby

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?

 

Wiki definition of Bull Shit
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.